OTC Case Studies: Skin Care

CASE 1: Sunscreen

TS is a 24-year-old woman with no significant medical history. She reports that her face is red and itchy after using sunscreen. She says she has not spent time outdoors, so it is not sunburn. The sunscreen TS brought to the pharmacy has oxybenzone as the primary ingredient, and she would like to try another sunscreen. However, she has heard that some sunscreens are not environmentally friendly.

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Q: What recommendations should the pharmacist provide to TS regarding daily sun protection?

A: Based on her symptoms, TS may be having a reaction to the sunscreen. TS can try to switch to a physical sunscreen containing zinc oxide or titanium oxide and avoid chemical sunscreens containing oxybenzone, avobenzone, octisalate, octocrylene, homosalate, or octinoxate because she may have an allergy to ingredients in chemical sunscreens.^1-3 In addition, chemical sunscreens and nanoparticles can harm marine life.³ The pharmacist should instruct TS to try a broadspectrum sunscreen with sun protection factor (SPF) 15 or higher. TS should be counseled to apply sunscreen approximately 15 minutes before going outdoors to all skin not covered by clothing and reapply it every 2 hours or immediately after swimming or sweating.¹

CASE 2: Waterproof Sunscreen

JK is a 24-year-old man with no significant medical history. He enrolled in a surf camp for beginners and will have his first surfing lesson next weekend. His coach reminded him to apply waterproof sunscreen before the class. However, there are many different products available on the market and each of them is marked with an SPF number, which he does not understand.

Q: What recommendation should the pharmacist give to JK regarding sun protection for surfing?

A: SPF stands for sun protection factor, which is a measure of how much UV radiation is required to produce sunburn on protected skin relative to the amount of solar energy required to produce sunburn on unprotected skin. Sunscreens with higher SPF values (up to SPF 50) provide greater sunburn protection.¹ If he plans on being in the water frequently, JK should purchase a water-resistant product. JK should reapply water-resistant sunblock every 40 to 80 minutes and non–water-resistant sunscreen every 2 hours. He can buy any broad-spectrum sunscreen with SPF 15 or higher and apply at least 1 ounce of sunscreen to the entire body 30 minutes before entering the water.⁴ He should also be educated that sun rays are most dangerous between 10 am and 4 pm, during which time he can use long-sleeved sun-protective clothing.¹

CASE 3: Skin Care

BK is a 38-year-old woman with no significant medical history. She recently noticed some new dark spots on her cheeks and more wrinkles on her forehead. Her friends use all kinds of antiaging products, but she is confused about which ingredients would be helpful. BK says she would like to try some cosmetic products to slow the aging of her skin.

Q: What antiaging products should the pharmacist recommend to BK?

A: Vitamin C and retinol are both scientifically proven antiaging ingredients. Vitamin C helps brighten and soften the skin and reduce wrinkles and fine lines by stimulating collagen production and having an antioxidant effect. Retinol minimizes wrinkles and fine lines by slowing the breakdown of collagen and stimulating exfoliation. BK should have a daily routine of washing her face and moisturizing. In addition, she can apply vitamin C serum every morning and retinol every evening to help slow down aging. BK should be counseled on applying sunscreen every day as recommended and avoiding pregnancy while using retinol.⁵

CASE 4: Dry Skin

TK is a 75-year-old man with hypertension. He complains about itchiness on his arms and legs and has some cracks in the skin on his right heel. He wonders if any OTC products could help him with the itchiness and the cracks. The pharmacist takes a quick look at TK’s extremities and finds his skin is very dry without other significant abnormalities.

Q: What recommendation should the pharmacist provide to TK on skin care?

A: Itchy skin is very common in older adults because skin tends to become drier with age. The pharmacist should advise TK to apply a fragrance-free moisturizing ointment or cream, rather than a lotion, generously over the skin at least twice a day because ointments and creams are more effective and less irritating than lotions. To trap enough moisture, TK needs to apply the moisturizer immediately after washing while his skin is still damp. The moisturizer should contain ingredients such as jojoba oil, dimethicone, glycerin, hyaluronic acid, lactic acid, lanolin, mineral oil, petrolatum, or shea butter.⁶ The pharmacist should also recommend that TK use a heavier, oil-based cream or petroleum jelly for his cracked heel and wear pair of thin cotton socks at bedtime to help the moisturizer work.⁷