The American Skin Association estimated that 50 million Americans are exposed to urushiol yearly, the most common contact allergen in the US.
Summer is in full swing, and therefore our patients have an increased risk of exposure to many outside elements that cause the skin to itch. Move over sunburns, because plants, sweat, medications, sun sensitivity, bugs, and other culprits are in full force for many patients in the US. According to the American Skin Association, an estimated 50 million Americans are exposed to urushiol yearly, the most common contact allergen in the US.1
Typically, most patients reach for over-the-counter (OTC) options to calm the itch before seeking medical attention. If not controlled, patients go to urgent care, desperately try to get into the dermatology office for treatment or, worse, develop infections from scratching too much. Approximately "240 million Americans use over-the-counter (OTC) drugs annually. OTC drugs are available to consumers without a prescription and can be safely and effectively used without the supervision of a health care provider."2
OTC anti-itch options are abundant on the market today. The list below summarizes what is available to tackle the pain, inflammation, and itch from summer rashes. The question is how well they work, the potential side effects, and what they intend to do. Most importantly, it is essential whether patients are applying them correctly, especially children. Many of these have been used for over 100 years. Remember that the OTC Drug Review Monograph for safety and effectiveness was not developed until 1972 and updated in March 2020 with the "CARES Act" to modernize how OTC drugs are regulated.3
Calamine Lotion: With active ingredients such as zinc oxide and iron oxide (the reason it is pink), this product has been around for 1000s of years and can soothe mild itch, pain, and discomfort, but because of its drying effects, it can irritate the skin.5
Menthol: This counterirritant was isolated in 1771 by Gambius, but evidence shows that it has been used in Japan for 2000 years. It works as an analgesic/anesthetic on the skin and is often combined with other topicals, such as camphor or hydrocortisone, to distract from any pain while calming the itch. It is a synthetically made organic compound or derived from peppermint or mint oils.6,7
Capsaicin: Capsaicin is a chemical compound first isolated from chili peppers in crystalline form in 1878 and synthesized in 1930 and is used for neuropathic pain and has been reported to help with chronic itch in hypersensitivity states. It can calm itch and irritation when combined with other ingredients.8-10
Camphor: Camphor was first synthesized by Gustaf Komppa in 1903 and is currently synthetically produced from turpentine oil.11 It is known for its anti-fungal, anti-bacterial, and anti-inflammatory properties and can also help alleviate skin irritation and itch. Typically, this is also combined with other topical formulations.
Pramoxine: Developed in the 1950s, this has been used as a topical anesthetic and has had anti-pruritic effects on the skin since; however, it can cause skin redness, irritation, burning sensation, or pain. Often it is combined with hydrocortisone for pruritic skin conditions.12,13
Hydrocortisone: Topical corticosteroids have been around for over 50 years and are the most popular topical therapy used in dermatology. With OTC approval around 1982, these have been the center of controversy regarding the safety of public use, specifically in children.14 Though the concern about percutaneous absorption with Hydrocortisone 1% is lower, factors such as age, location, vehicle, amount, and frequency are worth considering.15 It takes care of the itch and inflammation but may slow down healing.
Strontium: The newest ingredient on the anti-itch, anti-inflammatory scene is a novel formulation containing strontium, ceramides, hyaluronic acid, and antioxidants. Strontium is naturally found in crystalline form (Strontium sulfate) and a salt form as chloride or nitrate. “About 99% of the strontium in the human body is concentrated in the bones."16 It is used in a proprietary formulation to target itch and inflammation. It can last hours after application. It also has skin-healing properties.
There are many formulations for today's consumer to target the itch of the plethora of summer rashes one can be exposed to. Due to the many options available today, finding a suitable formulation may overwhelm patients, therefore the dermatology professional should assist with providing the correct guidance for the safety, efficacy, and prevention of worsening summertime dermatitis.
Renata Block, MMS, PA-C, is a board-certified physician assistant at Advanced Dermatology & Aesthetic Medicine in Chicago, Illinois.
1. Poison ivy, sumac, and oak. American Skin Association. Accessed July 10, 2023. https://www.americanskin.org/resource/poisonivy.php
2. Blaiss M. Don’t let allergic rashes spoil summertime fun. US News & World Report. July 15, 2019. Accessed July 10, 2023. https://health.usnews.com/health-care/for-better/articles/allergic-rashes-in-the-summer
3. Michele T. An exciting new chapter in OTC drug history: OTC monograph reform in the CARES act. Updated August 2020. Accessed July 10, 2023. https://www.fda.gov/news-events/fda-voices/exciting-new-chapter-otc-drug-history-otc-monograph-reform-cares-act
4. Ravis SM,Eaglstein WH. Topical Hydrocortisone From Prescription to Over-the-Counter Sale:A Past Controversy: A Cautionary Tale.Arch Dermatol.2007;143(3):413–415. doi:10.1001/archderm.143.3.413
5. Calamine lotion. Cleveland Clinic. Updated June 2022. Accessed July 10, 2023. https://my.clevelandclinic.org/health/drugs/23338-calamine-lotion
6. Menthol. National Center for Biotechnology Information. Accessed July 9, 2023. https://pubchem.ncbi.nlm.nih.gov/compound/Menthol
7. Menthol: history and occurrence. Wikipedia. Updated. March 22, 2023. Accessed July 10, 2023. https://en.wikipedia.org/wiki/Menthol
8. Schumacher M, Pasvankas G. Topical capsaicin formulations in the management of neuropathic pain. Prog Drug Res. 2014;68:105-128. doi:10.1007/978-3-0348-0828-6_4
10. Anand P. Capsaicin and menthol in the treatment of itch and pain: recently cloned receptors provide the key. Gut. 2003;52(9):1233-1235. doi:10.1136/gut.52.9.1233
11. Camphor. New World Encyclopedia. Updated January 2017. Accessed July 20, 2023. https://www.newworldencyclopedia.org/entry/Camphor
12. Pramoxine HCL foam – uses, side effects, and more. WebMD. Accessed July 10, 2023. https://www.webmd.com/drugs/2/drug-6057/pramoxine-topical/details
13. Agarwal A, Das A, Hassanandani T, Podder I, Panda M. Topical Pramoxine in Chronic Pruritus: Where do We Stand?. Indian J Dermatol. 2021;66(5):576. doi:10.4103/ijd.ijd_1_21
14. Ravis SM, Eaglstein WH. Topical hydrocortisone from prescription to over-the-counter sale: a past controversy: a cautionary tale. Arch Dermatol. 2007;143(3):413-415. doi:10.1001/archderm.143.3.413
15. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids. Indian J Dermatol. 2014;59(5):460-464. doi:10.4103/0019-5154.139874
16. Strontium – uses, side effects, and more. WebMD. Accessed July 10, 2023. https://www.webmd.com/vitamins/ai/ingredientmono-1077/strontium#:~:text=Strontium%20is%20a%20silvery%20metal,strontium%20found%20in%20dietary%20supplements.