Francesca Fusco, MD
Francesca Fusco, MD, dermatologist, Wexler Dermatology, New York City. She is a leading expert in state-of-the-art cosmetic surgical procedures, and has appeared on CNN, The Today Show and other television news programs.
Each day, we bombard our bodies with a variety of chemical-containing topical products — this includes most shampoos, bath soaps, moisturizing lotions, shaving gels, makeup products and colognes.
In addition, many of us compound the situation by applying a variety of medicated creams, lotions and gels to our bodies.
Problem: Even though our skin provides a barrier against most irritants, it naturally thins as we age — allowing for easier absorption of dangerous chemicals found in seemingly harmless over-the-counter (OTC) products.
For people with eczema, the risk is even greater — this skin condition causes microscopic cracks in the skin that allow chemicals to penetrate more easily and enter the bloodstream. Even the tiny cracks that occur in everyone with dry winter skin can provide entry points for chemicals. What you need to know to safely use…
Methyl salicylate, also known as wintergreen oil, is the active pain-killing ingredient in most OTC muscle creams, including Ben-Gay and Icy Hot. Used properly, these products can help relieve sore muscles, but too much can be dangerous — or even deadly.
Frightening incident: A New York City high school track star died in 2007 after applying excessive amounts of methyl salicylate–containing ointment to her sore muscles.
The New York Medical Examiner’s Office concluded that the methyl salicylate had accumulated due to repeated use. Some doctors speculated that the methyl salicylate had possibly interacted with unidentified aspirin-based medications that she may have been using, leading to cardiac arrest.
For safe use: Apply a small amount (not to exceed the size of a quarter) onto the painful joint or muscle no more than three or four times a day.
Good rule of thumb: If you use more than a four-ounce tube within a week, that’s probably too much.
Caution: The FDA warns that methyl salicylate–containing products should not be used for more than seven days and should not be applied to wounds or under a tight bandage. Also, watch your aspirin intake (do not exceed the daily dose on the label) and be aware that these creams may compound the effects of blood-thinning drugs, such as clopidogrel (Plavix) or warfarin (Coumadin), and supplements with blood-thinning effects, including vitamin E, ginkgo biloba and fish oil.
We apply OTC neomycin and bacitracin to minor cuts, scrapes and burns to kill germs, but few people realize that up to 10% of users are actually allergic to such products.
The allergies are easily missed because the redness or rash that results may be mistaken for a worsening of the original problem. This often prompts the user to apply even more ointment.
For safe use: If your skin looks like it’s getting worse or develops a rash, stop using the product and call your physician for treatment advice. If you have a cut, scrape or burn, you may be better off trying an ointment that contains vitamins A and D or products such as Vaseline or Aquaphor Healing Ointment — all of which keep the wound moist without irritating it.
Numbing creams and patches are used as topical anesthetics for medical procedures (such as removing a mole) or cosmetic procedures (such as laser hair removal). Most OTC varieties contain small amounts (less than 5%) of the active ingredient — such as lidocaine, benzocaine or tetracaine.
When used according to package instructions, these products are safe, but if your skin becomes too numb, you’re at risk for injury due to lack of sensation to trauma or heat. That’s why you should let your doctor or aesthetician know if you lose all feeling in the affected area during such a procedure.
Numbing creams also may cause an allergic reaction and can be absorbed systemically, leading to a toxic reaction, such as a slowed heart rate, a drop in blood pressure, confusion, tremors or convulsions.
For safe use: Apply numbing creams sparingly.
An OTC product, such as minoxidil (Rogaine), can help men and women regrow hair, but a small percentage of patients may experience hair growth in places other than the scalp. This is because the active ingredients, once rubbed into the skin on the head, can trigger hair growth in other areas.
After two to four months of regular use, some women may notice soft, downy hair on their faces, and men may see extra tufts near their temples. In some cases, the minoxidil also may rub off on a person’s pillowcase, and the ingredients can be transferred to unwanted areas.
For safe use: Apply a few drops less of the medicine if you see unwanted hair growth, and change your pillowcase daily to avoid transferring the medicine from your scalp to your face.
OTC age-spot fading creams promise to lighten age spots, but such products that contain hydroquinone actually may have the opposite effect in some people — especially those with dark skin — causing ochronosis (darkening of the skin).
For safe use: If you use a topical product that contains hydroquinone, do so only under a doctor’s supervision.
Used as a topical product, hydrocortisone has an anti-inflammatory effect that helps relieve itching caused by chronic skin conditions (such as eczema), poison ivy, contact dermatitis, insect bites and hemorrhoids. OTC topical steroids typically contain just 1% hydrocortisone, which is usually safe.
However, these products can penetrate more deeply in such areas as the eyelids, armpits and groin, where skin is thinner and more folds exist, causing irritation and other local adverse effects, such as increased hair growth, acne or changes in pigmentation. If applied frequently and in excessive amounts, hydrocortisone can be absorbed into the bloodstream.
For safe use: If you notice any of the adverse effects described above in the areas to which you have applied hydrocortisone, stop using the product and see your doctor for treatment advice.
