Pharmaceutical sciences
Cosmetics
Medicated Cosmetics
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Development Team Principal Investigator
Dr. Vijaya KhaderFormer Dean, Acharya N G Ranga Agricultural University
Prof. Farhan J Ahmad Jamia Hamdard, New Delhi
Paper Coordinator Dr. Javed Ali Jamia Hamdard, New Delhi
Content Writer Sana Khan Jamia Hamdard, New Delhi
Content Reviewer Dr. Javed Ali Jamia Hamdard, New Delhi
Medicated Cosmetics 2017
Pharmaceutical sciences
Cosmetics
Medicated Cosmetics
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CONTENT
1. Background
2. Medicated Cosmetics : Introduction
3. Medicated Herbal Cosmetics
4. Medicated Skin Care Products
i. Antibacterial creams
ii. Anti-acne creams
iii. Anti-aging creams
5. Medicated Hair care products
i. Anti-Dandruff Shampoos
ii. Shampoos for Colored hair
iii. Gluten-free or wheat-free Shampoos
iv. All-natural Shampoos
v. Baby Shampoos
vi. Veterinary Shampoos
vii. Solid Shampoos
viii. Jelly and gel Shampoos
ix. Paste and cream shampoos
x. Antibacterial shampoos
6. Cosmetic Dentistry
i. Medicated tooth paste
ii. Medicated Mouthwash
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1. Background
Traditionally, American drug stores have carried beauty, personal care and hygiene products
along with pharmaceutical products. Ingredients like dried herbs, fragrant essential oils and
extracts were used in the preparation of medicines. Thus, perfumes were among one of the first
few products to be available in American pharmacies. Eventually as the industry expanded
personal care products and cosmetic products like make-up, razors, hair dyes and deodorants also
found a place on the shelves of many drugists’.
The inclusion of beauty products in pharmacies highlights the age old belief about health,
hygiene and physical beauty being interconnected. The manufacturers of beauty products these
days claim that apart from making our body parts beautiful their products also help improve their
health. These claims have become so common that we don’t even notice them anymore. Sample
this: make-up that claims to purify and cleanse our skin, hair dye that claims to give our hair a
‘natural’ shine, flower scented feminine hygiene products, mouthwashes and toothpastes that
claim to give us better breath and scented soaps. The marketing of beauty products that claim to
make us “healthier” rather than just making us attractive make the distinction between medicine
and cosmetics difficult.
Passing of the Food, Drug and Cosmetics Act in 1938 by the Congress further reinforced the
interrelation between cosmetics, drugs and medicine. The act also acted in providing an
oversight to the Food and Drug Administration of the cosmetics industry. The Personal Care
Products Safety Act is in consideration in the Congress today which is amendment to the 1938
act and will also strengthen it further.
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2. Introduction
Medicated oils, creams, shampoos, soaps, moisturizers, gels are some of the examples of
medicated personal care product. Little or no distinction is made between medicated cosmetics
(including natural cosmetics) and personal hygiene items. The list of personal care products
listed above is mostly used for maintaining personal hygiene and also to enhance beauty. The
medicated cosmetics are uniquely used for beautification purposes. However, there is no
distinction between the personal hygiene products and the medicated cosmetics in a store aisle.
Another reason for there being no distinction between the two is that both these products are
used for both beautifying purposes and also for personal hygiene. Henna hair dye, neem cream,
antibacterial soaps, anti-wrinkle creams, herbal body massage oils are some of the frequently
used medicated personal care products.
Figure 1. Medicated Cosmetic products
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There are about 750 companies with annual combined revenue of $40 billion that make up the
medicated personal care product industry. Apart from the major exporters there are also many
small scale exporters and traders who engage in the business of wholesale medicated cosmetics.
3. Medicated Herbal Cosmetics
Herbal extracts such as, mints, basil, bay leaves, rose petals, fennel seeds, chervil leaves etc are
utilized in the preparation of several personal hygiene and herbal cosmetic products. These
herbal extracts are considered to be one of the best skin care products. Moreover, each of these
products has a number of other uses. For example, a product that contains cooling and soothing
agents can also be used curing pain and aches. Manufacturers also sell many innovative natural
or herbal cosmetics in the global wholesale market. Products belonging to the medicinal product
categories that are also sold at the wholesale market include neem soap, herbal face pack, aloe
vera body lotions, aloe vera soap, herbal face cream, herbal shampoo, herbal skin toner and
fairness creams etc.
Figure 2. Essential aroma oil containing mint intended for therapeutic use
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The increasing demand of these herbal products is mostly led on by consumer concerns about the
harmful effects and toxicity of the ingredients used in cosmetics and other such products. People
are increasingly moving from medicated cosmetics to herbal products; suggest recent findings, as
herbal products are perceived as causing fewer side effects to the skin. Products like garlic and
Echinacea are said to have antibiotic properties but cause fewer side effects when compared to
conventional anti-infective agents like ceftazidime, pencillion, ceftiofur or ceftoxitin. One of the
most traditionally used forms of medicines include herbal remedies from flowers, leaves and
other parts of a plant, the popularity of which is still on the rise. Using natural or herbal products
as cosmetics is not a new concept but has been in existence since the past 3000 years, Egyptians
were known to use rose and fenugreek to prevent wrinkles. The growth of herbal cosmetics
worldwide has been phenomenal in the past few years with around US $ 83 billion earned in
sales. Countries like Canada, Germany, France, Japan, United States, United Kingdom and
Brazil are the leaders in supply of herbal based cosmetics. The industry is growing multifold
with almost a large number of Americans are now spending US $4.2 billion on buying herbs and
botanical plants. The market share of herbal lotions, creams, soaps, perfumes, mouthwashes, face
packs are a real hit in the market.
4. Medicated Skin Care products
Skin care personal hygiene products are used for moisturizing, toning, cleaning and nourishing
the skin. Skin care toiletries are known to have healing and anti-inflammatory properties. Anti-
aging cream, anti-cavity toothpastes, dental floss, mouth washes, antiseptic lotions, conditioners,
medicated socaps, anti-bacterial lotions, gels, facial scrubs, anti-acne cream, face washes, body
washes, cleansers, medicated creams, body talc and many other products are examples of natural
skin care products that are available in as wholesale medicated or herbal cosmetic. Thus a
medicinal skin care product can be found in a variety of different wholesale medicated
cosmetics.
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The skin care product industry is currently worth US $250 billion and is expected to grow at 6%
annual average rate. The major suppliers of the skin care products in the industry are Proctor and
Gamble, Beiersdorf, Johnson and Johnson.
One of the signs of a healthy human being is his/her skin; wrinkles, acne, pimples, scars are all
considered as unhealthy and thus personal skin care has become an integral part of the global
health and beauty industry. People are now turning to mainstream skin care products to avoid the
above mentioned disorders. A good skin is reminiscent to a beautiful body. There are a plethora
of products to choose from for a healthy and beautiful skin including lotions, shampoos,
conditioners, oils, gels, creams, moisturizers, cleansers etc.
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i. Antibacterial Soaps
Anti-bacterial soaps are a sort of cleaning products that often include chemicals like triclosan,
triclocarban and chloroxylenol. These chemical products help in killing off the bacteria on the
skin.
Though the ability of anti-bacterial soaps to kill bacteria and viruses found on the skin has been
under the scanner many times. Studies have found that the chemicals found in antibacterial soaps
do not have the desired effect anymore, i.e., these chemicals do not kill the bacteria and viruses
than any other detergent of soap. Reports by the US Food and Drug Administrative (FDA) have
also claimed that triclosan is not effective in reducing the transmission of respiratory or
gastrointestinal infections. The FDA even banned the use of nineteen chemicals in September
2016 used frequently in antibacterial products due ot lack of information about their long-term
effects.
Ingredient
As mentioned earlier, Triclosan and Triclocarbon are the most commonly used compounds in
antibacterial soaps, though there are other compounds that are used as well.
Although there have been studies examining the purported use of antibacterial soaps, no
consensus can be found over the results. Studies also claim that washing off with plain soap is
enough to make the bacteria ineffective. Whereas there also have been studies that found that
antibacterial soaps are more successful in killing bacteria and deactivating viruses present on the
skin. A study conducted by Dr. Elaine Larson of the School of Nursing of Columbia University
stated that no distinguishable effects over a period of 48-weeks could be found over the use of
antibacterial soaps. Reports published by the US Food and Drug Administration questioned the
usage of antibacterial soaps and hand sanitizers claiming that no medical studies were found
showing a connection between the decline in infection rates and a specific consumer antibacterial
product.
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Figure 3. Gel Soaps with antibacterial activity
These studies were also cited by Stuart Levy, a microbiologist at the Tufts University in an effort
to compare the antibacterial action with the antibiotic resistance - "Dousing everything we touch
with antibacterial soaps and taking antibiotic medications at the first sign of a cold can upset the
natural balance of microorganisms in and around us, leaving behind only the 'superbugs'." It has
also been proven that methods used by Levy were not effective while predicting bacterial
resistance for biocides like triclosan. Not only that, there are a minimum of seven studies
including a study coauthored by Levy himself that demonstrate the ineffectiveness of triclosan
while dealing with skin bacteria over a short term.
A latest research study from the Levy’s lab stated that the study does not “implicate the use of
antibacterial cleaning and hygiene products as an influential factor in carriage of antimicrobial
drug-resistant bacteria on the hands of household members”. Even so, a recent review of
literature by Levy states – “the lack of an additional health benefit associated with the use of
triclosan-containing consumer soaps over regular soap, coupled with laboratory data
demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by
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governmental regulators regarding antibacterial product claims and advertising”. The authors of
the paper has requested for continued research in the area.
Back in September 2016, the US Food and Drug Administration administered a ban on 19
chemicals that were commonly used in antibacterial products. The FDA claimed that there has
neither been any proven record of these chemicals having antibacterial properties nor any
findings proving them to be better than standard soaps and detergents. The Food and Drug
Administrative agency also declared that it did not receive any satisfactory data from the
manufacturers of antibacterial products about the long term effects of these chemicals. The ban
did not apply to hand sanitizers.
ii. Anti-aging creams
Anti-aging creams are primarily cosmeceutical skin care products that claim to make the user
look younger than his/her age by reducing, masking or preventing signs of aging. The common
signs of aging include poor skin texture, sagging skin (laxity), wrinkles (rhytids) and photoaging.
Photoaging usually includes redness of the skin (erythema), brown discolorations
(dyspigmentation), yellowing of skin (solar elastosis) and abnormal growths (keratoses).
Regardless of the increasing demand of anti-aging products, most of them have not been proven
to have the long lasting effects they claim to have. A study found that the best perfoming anti -
wrinkle creams reduce wrinkles by 10% in 12-weeks which is hardly noticeable to the human
eye. Another study stated that moisturizers that cost less were equally effective as high-priced
products. A study done at Manchester University in 2009 claimed that certain ingredients can
have the desired effect.
Anti-aging creams have been traditionally aimed at women consumers but a rise in products
marketed at men can be seen in the recent years.
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Figure 4. A woman applying anti-aging cream
Ingredients
Anti-aging creams primarily contain conventional moisturizing ingredients but also use
certain anti-aging ingredients like Retinol, mostly in the form of retinyl palmitate. The
chemical has been scientifically proven to reduce fine lines and pores.
Epidermal growth factor is used to stimulate collagen production in the skin and also for
cell renewal. It also helps in strengthening elasticity and structure. Stenley Cohen and
Rita Levi-Montalcini won a Nobel Prize in Physiology and Medicine in 1986 for the
discovery of epidermal growth factor. Studies have shown that epidermal growth factor is
known to reduce sagging, fine lines and wrinkles. It also has healing (wounds and burns)
and anti-inflammatory properties.
Alpha Hydroxy Acids (AHAs) and Beta Hydroxy Acids or other chemical peels, that
facilitate the dissolving of intracellular “glue”. This glue is responsible for holding
together the dead cells on the skin. Regular use of this product is known to gradually
enhance the exfoliation of epidermis which exposes the new skin cells and helps in
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improved appearance. AHAs are also known to irritate some skin types thus causing
redness and flaking.
Peptides, such as Matryxil and copper peptides.
Coenzyme Q10
Argireline (also known as acetyl hexapeptide-3), which is responsible for relaxing facial
muscles thus preventing wrinkles and fine lines. Anti-oxidants help in protecting the cells
from damage caused by free radicals. The studies in the area of anti-oxidants are not
known to prove anything. Although there is a lack of evidence against antioxidants
having an impact on diseases.
Sunscreens are known to protect the skin from effects of the UVA radiation, including
wrinkles.
Vitamin C is known to be an efficient ingredient in wrinkle creams which is also though
to help the healing process.
iii. Anti-acne creams
A long term skin disease, also known as acne vulgaris, acne is characterized by blackheads or
whiteheads, pimples and scarring in some cases. Clogging of hair follicles with dead skin cells
and oil from the skin is the cause of acne. Acne affects areas of the skin which have relatively
high number of oil glands, which includes the face, upper part of chest and back. As a result,
acne could lead to low self-esteem and anxiety, and depression and suicide in extreme cases.
In almost 80% of the cases the primary cause of acne is said to be genetics. Although, widely
believed that smoking and diet of a person plays a role in acne, studies have not been able to
prove anything. No concrete proof about the role of exposure to sunlight and cleanliness in
causing acne has been found. Acne is most commonly found in both the sexes during puberty
years because of an increase in hormones. Another possible cause for causing of acne is
excessive growth of bacterium Propionibacterium acnes, which is most commonly found on the
skin.
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Acne is treatable and options like medications, lifestyle changes and other medical procedures
are suggested to people suffering from it. Eating fewer carbohydrates such as sugar helps in
preventing acne. Moreover, treatments that include application of formulations such as azelaic
acid, benzoyl peroxide and salicylic acid containing topical formulations on the affected skin are
also known to help.
Benzoyl peroxide
A first line-treatment drug for the treatment of mild acne, Benzoyl Peroxide (BPO) is known for
its effectiveness and mild side effects (mainly skin irritation). BPO is said to kill P. acnes in the
skin follicles. This is done by the formation of oxygen free radicals and benzoic acid in the skin
follicles. These free radicals affect the bacteria’s metabolism and the ability to create proteins.
The chemical can also be occasionally paired with topical antibiotic or retinoid such as benzoyl
peroxide/clindamycin and benzoyl peroxide/adapalene as well. Benzoyl Peroxide is also known
to have properties that can break down comedones and also inhibits inflammation.
Photosensitivity, dryness, redness and occasional peeling are among the side effects caused by
benzoyl peroxide. Thus, use of sunscreen is advised during treatment with benzoyl peroxide to
prevent sunburn. Benzoyl peroxide is not known to generate bacterial antibiotic resistance and
lower concentrations of BPO are considered to be as effective as higher concentrations in
treating acne.
Retinoids
Structurally similar to vitamin A, Retinoids are known to reduce inflammation, normalize the
follicle cell life cycle and also reduce sebum production. Retinoids alter the cell life cycle in the
follicle lining that further prevents the accumulation of skin cells within the hair follicle that can
cause a blockage. Retinoids are known as first-line acne treatments and is known to help in the
faster improvement of postinflammatory hyperpigmentation. Retinoids are known to be most
effective for darker skin.
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Adapalene, isotretinoin, retinol, tazarotene, and tretinoin are the most commonly used topical
retinoids. These chemicals are known to cause a flare-up of acne and also facial flushing which
can further cause skin irritation. Retinoids work by increasing the skin’s sensitivity to sunlight
and are thus advised to use at night. Tretinoin, the cheapest retinoid is known to cause most skin
irritation while Adapalene, the costliest of retinoid causes least skin irritation. Retinol, that is a
form of Vitamin A has milder effects and is commonly used in over-the-counter moisturizers and
other topical products. On the other hand, Tazarotene, the most effective of all Retinoids costs
the most.
Azelaic acid
Azelaic acid is known to an effective anti-acne chemical when treating mild to moderate acne
and applied topically at a concentration of 20%. It is advisable to continue the treatment with
azelaic acid for atleast 6 months, proving to be as effective as benzoyl peroxide 5%, isotretinion
0.05% and erythromycin 2%. Another reason why Azelaic acid is said to be effective is due to its
ability to decrease skin accumulation in the skin follicle and also due to it s antibacterial and
anti-inflammatory properties. Azelaic acid also has skin lightening properties which are a result
of its ability to inhibit melanin synthesis. As a result, azelaic acid is used for treatment of
postinflammatory hyperpigmentation. It may cause skin irritation but is considered safe. Azalaic
acid is known to be less effective but is more expensive than retinoids.
Salicylic acid
Salicylic acid, a topically applied beta-hydroxy acid, is known to have keratolytic properties and
also stops bacteria from reproducing. It helps in opening of obstructed skin cells and thus
promotes in shelling of epithelial cells. Known to be less effective than retinoid, its topical
application is known to cause dry skin. Darkening of skin is another side effect seen in
individuals with darker skin.
Other medications
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Alternative medications of acne include topical and oral preparations of nicotinamide, which is
the amide form of Vitamin B3. Nicotinamide is said to heal acne as it has the ability to produce
sebum and promote wound healing. Its anti-inflammatory properties can prove to be useful while
healing acne. Other alternative medications include oral and topical preparations of zinc because
of its capacity to reduce inflammation and sebum production and also inhibit P. acnes, though
there is not much evidence to support the claim. Antihistamines can also help improve symptoms
of acne among those already taking isotretinoin.
5. Medicated Hair Cosmetic
i. Anti-Dandruff Shampoos
The shedding of dead skin cells from the scalp is commonly known as dandruff. One of the most
common and biggest skin problems, caused mainly during winters, dandruff causes itching and
discomfort. Studies have not been able to point out to a single factor causing dandruff, dry skin
on scalp, oily skin on scalp, not combing enough or mental stress, anything can cause dandruff.
Cosmetic companies have come up with shampoos with dandruff prone scalps. These shampoos
generally consists of fungicides for example zinc pyrithione andketoconazole, that helps in
reducing loose dander by killing Malassezia furfur. Other elements used in anti-dandruff
shampoos are coal tar and salicylate derivates. Nizoral anti-dandruff shampoo, Head &
Shoulders, Neutrogena T/Gel Therapeutic shampoo and DHS Shampoo are among some of the
commonly known anti-dandruff shampoo.
Though anti-dandruff and medicated shampoos are a huge hit with consumers, there are other
alternatives for people who do not like to use chemicals. Organic and natural shampoos that used
tea tree oil and extracts are a feasible option.
ii. Shampoos for Colored hair
Companies have also come up with shampoos for protecting coloured hair. These shampoos
claim to have gentle cleaners so as to cause less harm to colored hair.
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iii. Gluten-free or wheat-free Shampoos
Wheat and gluten free shampoos are also offered by cosmetic companies these days. There are
people who suffer from eczema on their palms and head. This is caused due to wheat or gluten (a
protein found in many foods including protein) allergy. Most people with wheat or gluten allergy
are sensitive to foods containing these proteins, for example, celiac disease wheat allergy.
Shampoos have the tendency to make contact with the mouth while washing hair, thus people
with gluten allergy prefer gluten free shampoo. The manufacturers have tried to tap into this
section of the market as well and thus there are more and more options available for gluten and
wheat free products.
Wheat derivatives and other gluten grains are used as binders and emollients in many shampoos.
Although most of the below mentioned ingredients do not technically contain any wheat
proteins, but there may be leftover wheat proteins due to incomplete processing and
contamination:
Wheat, oats,barleyand rye, including any oil, protein, hydrosylate, or other extract from
any part of the plant.
Vitamin E(tocopherol), which is derived from wheat
Hydrolyzed vegetable protein
Cyclodextrin, which is produced from starch
Maltodextrin, dextrin, dextrin palmitate, or (hydrolyzed) malt extract
Phytosphingosine extract
Amino peptide complex
Disodium wheat Germamido PEG-2-Sulfosuccinat
Fermented grain extract
AMP-Isostearoyl
PG-Propyl Silanetriol
PVP crosspolymer
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Yeast extract
iv. All-natural Shampoos
Some companies also claim to use “all-natural”, “botanical”, “organic” or “plant-derived”
ingredients. These mostly include extracts or oils. These natural ingredients are used in addition
with one or more ingredients. The use of the term ‘natural’ is often used to mislead or ‘green-
wash’ the consumers. Green-wash is a common term used to trick the consumers into buying
shampoos that are harsher without their knowledge. Companies also retort to changing the names
of a surfactant to an acceptable form.
Figure 5. Shampoos with herbal ingredients
v. Baby Shampoos
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Baby shampoos meant for infants and young children are built around the idea that they are less
irritating and do not produce stinging or burning sensation in the eyes. Johnson baby’s shampoo
that is marketed under the tagline of “No More Tears” is the biggest example. Less irritating or
shampoos that do not cause burning or stinging are accomplished by the following methods:
Dilution – the product is diluted in case the shampoo runs off the top of the head and
comes in contact with the kid’s eyes.
Adjusting pH- the pH level of shampoos is adjusted to be around 7, which is considered
neutral and do not cause tears;
Use of surfactants which are less irritating than those otherwise used in shampoos.
Non-ionic surfactants that counteract eye sting are also used in such shampoos.These
surfactants usually include polyethoxulated synthetic glycolipids and polyethoxylated
synthetic monoglycerides.
The use of non-ionic surfactants mentioned above does not overcome the controversy
surrounding the use of shampoo ingredients reduce the eye sting that is produced by other
ingredients. As a result, there is at times much greater quantity of surfactants used in baby
shampoos as compared to other shampoos which affect the foaming of these products. The
monoanionic sulfonated surfactants and viscosity enhancers that are a common ingredient in
other shampoos are less frequent in the baby shampoos.
vi. Veterinary Shampoos
Shampoos intended for the use by animals contain insecticides or other medications that are
useful for the treatment of infestations or skin conditions unique to animals. These shampoos
must not be used on human skins. Human haircare products that contain ingredients like zinc are
fatal when ingested by animals and thus human shampoos should never be used on animals. Cats
are the most easily affected animals by human haircare products as they are used to grooming
their fur by licking thus increasing the chances of ingestation. Shampoos intended for pets serve
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more than one purpose. These shampoos are not only meant for cleaning the pet’s skin or coat
but are also made to treat skin conditions in animals or fight fleas or other allergies. The primary
ingredients in animal shampoos can be broadly grouped under antimicrobial,
insecticidals,emollients, emulsifiers and humectants. While many of these ingredients are
believed to be efficient in dealing with skin conditions in animals it is always better to take the
veterinian’s recommendations into consideration before using these products on animals.
Figure 6. Shampoos for animal hair care
Traditionally, insecticidal pet shampoos consist of pyrethrin, pyrethroids and carbaryl. These
ingredients are meant to fight against parasitic infections in pets. Pets with yeast or ringworm
infections require the use of antifungal shampoos.
Similarly, antibacterial shampoos are used for combating bacterial infections in pets.
Theingredients used in these antibacterial shampoos include benzoyl peroxide, povidone iodine,
or chlorhexidine.
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For relief from itching conditions like atopy and other allergies Antipuritic shampoos containing
ingredients as oatmeal, hydrocortisone,menthol, and diphenhydramine are usedto reduce
inflammation, cure the condition and also provide comfort to the pet.
Anti-seborrheic shampoos are meant for animals with scales or excessively oily coat. The
chemicals mentioned earlier are helpful in treating or the prevention of seborrhea oleosa, a
condition caused by excess of oils in an animal’s coat.
Emollient shampoos that mostly contain oils such as corn, almond, olive, coconut, safflower,
Persia, peanut, lanolin, sesame, mineral or paraffin are a god remedy for treating dry and itchy
skin in animals. These shampoos are generally used with emulsifiers. Stearyl alcohol, carboxylic
acid, lactic acid, cetyl alcohol, or polyvinylpyrrolidone are some of the common ingredients in
emollient shampoos.
The pet shampoos available in the market can be both highly effective and less effective. Though
there are natural pet shampoos available in the nature they are said to cause irritation to the
animal. Eucalyptus, lemon extracts, orange extracts or tea tree oil can cause allergies in animals.
Moreover, oatmeal is among the most commonly used skin friendly ingredient found in animal
shampoos. It is important for most animal shampoos to be animal safe as most pets will lick their
coats. Shampoos containing fragrances, deodorants or colours are harmful for the skin of the
animal causing inflammation or irritation. Hypoallergenic shampoos, that is, shampoos which do
not contain any unnatural additives are increasingly becoming popular.
vii. Solid Shampoos
Solid shampoos, also known as shampoo bars are spill-proof. These shampoos use surfactants
that are formulated as solids and are easy to apply. The bar shampoo can be simply rub over wet
hair and lather can be then worked into.
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viii. Jelly and gel Shampoos
Shampoos in the form of jelly and gels can be obtained by increasing the shampoo’s viscosity.
ix. Paste and cream shampoos
These types of shampoos apply faster than solids and also dissolve quickly, and are mostly
marketed in jars or tubes.
x. Antimicrobial shampoos
These kinds of shampoos are widely used as medicines in animals for various purposes, as well
before surgeries in humans.
Table1. Ingredients of Medicated OTC Shampoos (Reference: Jeannette Y. Wick, RPh, MBA, FASCP.
Medicated Shampoos: Washing Away Childhood Complaints. Pharmacy Times.2013)
Ingredients Clinical application
Coal tar Antipuritic
Ketoconazole Antifungal
Menthol Provides a secondary neurological stimulus to create antipuritic
sensation
Povidone-iodine complex Topical antiseptic
Salicylic acid Keratolytic
Selenium sulfide Able to reduce epidermal cell turnover, also has local irritant, anti-
bacterial and mild antifungal activity
Sulfur Antibacterial/antifungal and keratolytic
Zinc pyrithione Antibacterial/ antifungal
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6. Cosmetics dentistry
Dental work that is aimed at improving the appearance (not necessarily the functionality) of teeth
gums and/or bite is known as Cosmetic Dentistry. Cosmetic Dentistry typically focuses on
improving the color, position, shape, size, alignment or just the overall appearances of a set of
dentures. Many dentists these days refer to themselves as cosmetic dentists irrespective of their
training or experience in the field. This could be seen as an unethical practice as its dentists use
this to market themselves to patients. Interestingly, cosmetic dentistry is not recognized as a
formal specialty by the American Dental Association.
Cosmetic dentistry mainly involves:
Addition of dental material to teeth or gums – examples: bonding, porcelain veneers
(laminates), crowns (caps), gum grafts
Removal of tooth structure or gums – examples: enameloplasty, gingivectomy
Neither adding nor removing dental materials, tooth structure, or gums – examples: teeth
whitening (bleaching), laser whitening, gum depigmentation
Straightening of teeth accompanied by improvement in appearance of face – orthodontics
The most commonly practiced dental cosmetic procedure is whitening, also known as ‘tooth
bleaching’. Although, many whitening products are also available in the market these days,
dentists still prefer the recommended dentist supervised procedures for lightening of discolored
teeth.
Teeth reshaping or sculpting and bonding is one of the most common dental cosmetic procedure
that can be completed in one visit.
There are also teeth whitening using laser. The procedure includes gums being covered with
rubber while a bleaching chemical is applied on teeth. It is followed by projecting of a beam of
argon laser onto the teeth which is supposed to fasten the bleaching process. The laser works by
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activating the bleaching chemical and in turn lightening the teeth color. This procedure is
considered to be six times more effective than other teeth whitening procedures.
Tooth reshaping that is also a common cosmetic dental procedure is aimed that removing part of
the enamel to improve the appearance of the tooth. This procedure can be used to correct a minor
chip or even help in alteration of length, shape or position of teeth. Tooth reshaping is also used
to correct Tooth Size Discrepancy. The enamel that is removed cannot be replaced and can lead
to exposure of dentin. This is also known as enameloplasty, odontoplasty, contouring,
recontouring, slenderizing, stripping. The procedure is known to produce quick results and can
also be used as a substitute for braces at times.
The process in which an enamel like dental composite substance is applied and then sculpted into
a tooth’s surface and is then hardened and polished is called Bonding.
Devices used in replacing one or more missing teeth are called dental bridges. The process
includes the preparation of the teeth on both sides of the missing teeth for the bridge. The bridge
consists of abutments (the teeth that are prepped up) and pontics (the false teeth). This is a
common procedure used to replace one or more missing teeth. Bridges consists of more than
three teeth in general and the feasibility of a bridge is calculated using the Ante’s law and the
position of the teeth in the mouth. The bridges are usually fixed and cannot be taken out in the
same way that partial dentures can. Cantilever bridges are used in areas of the mouth that are
under less stress, for example the front teeth. Also known as Maryland bridges, these are used for
replacing missing front teeth. Although minimally invasive the chances of failure are high in
cantilever bridges. Dental bridges require strict dental hygiene and usually have a lifespan of
nearly ten years.
Veneers, that are ultra thin porcelain laminates, are used to close gaps, enhance shape or change
the color of the teeth that are otherwise non-responsive to whitening procedures. In most of the
above mentioned procedures, some amount of tooth reduction is a necessity.
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Dental implants are the equivalent to prosthetic limbs, i.e., they are used as replacement to
missing teeth. International Congress of Oral Implatologists or ICOI recognize three parts of an
implant: the implant device which is commonly made of titanium and is interred unto the bone,
he abutment and a dental crown which is connected to the implant with the help of the abutment.
Gum Lift is another cosmetic dental procedure that raises or sculpts the gum line. The procedure
of gum lift usually consists of giving new shape to the tissue and/or underlying bones so as to
produce more symmetrical looking teeth.
An alternative to traditional metal braces is the invisalign treatment which is mainly used for
treatment for spacing between teeth, crowding of teeth or overlapping teeth, also clear aligners
are easy to clean and comfortable. The invisalign treatment has been around for more than a
decade and is used to create a smile that the patients desire.
People who have altered vertical dimensions of teeth due to grinding or acid reflux can opt for
Bite Reclamation. This process gives the patient a closed or shorter look to their face and smile.
A qualified professional can correct the vertical dimension of a set of teeth by opening up the
patient’s bite.
Decayed and cracked teeth are repaired using inlays and onlays. When a filling is too small to
correct a damaged teeth and a crown would be excessive, this process is then used for correction
of teeth
Materials for cosmetic dentistry
Earlier, dental fillings and other tooth restorations were mostly made of gold, amalgam and other
metals. Some of these were also coated with porcelain. Nowadays, most dental work is made up
of porcelain or materials that are closer to the appearance of a natural tooth. These materials are
then joined to the tooth structure with the help of resin adhesives. Cosmetic Dentistry is an ever
growing branch that is constantly evolving and introducing new procedures.
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i. Medicated Toothpaste
Medicated toothpastes are one of the preferred remedies for teeth and gum related issues like
tooth decay, cavities, sensitive teeth etc. To deal with these dental problems, dentists have come
up with toothpastes that contain active ingredients like Potassium Nitrate, Triclosan, Fluoride&
Tannic Acid.
Figure 7. Potassium nitrate toothpaste for Cavities, Sensitivity, Gingivitis, Bad Breath, Plaque
and Cleaning.
(Source:https://www.alibaba.com/product-detail/medicated-toothpaste_148890425.html)
Potassium Nitrate is a proven and suggested medication for tooth sensitivity. These toothpastes
also carry a number of other ingredients including herbal extracts. Use of herbal ingredients like
roots, barks, and flowers facilitate the tightening of loosened gums and also benefit the teeth and
gum in many other ways. The fact that these natural products have no harsh abrasives and
artificial ingredients, they leave the mouth with a pleasant and fresh sensation.`
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ii. Medicated Mouthwashes
The major classification of medicated mouthwashes includes mainly two types: cosmetic and
therapeutic.
Therapeutic mouthwashes are easily available in the market in pharmacies or by prescription of
dentists, depending on the formula of ingredients in the toothpaste. These toothpastes further
help in reduction or control of plaque, gingivitis, tooth decay and bad breath, though these
mouthwashes are not recommended for children under the age of 6 until recommended by the
dentist as children swallow it in large quantities.
The use of mouthwash, also known as mouthrinse is a necessary addition to maintaining daily
oral hygiene. This is no replacement for daily brushing and flossing though. One of the biggest
benefits of mouthwash is the ability to reach into areas of the dental cavity that is not easily
accessible by a toothbrush. The choice of using the mouthwash before or after brushing is on the
user but different mouthwash may have different ways to maximize results. For instance,
mouthwash containing ingredients like calcium hydroxide or aluminiumhyrdroxide can form a
complex compound when it comes in contact with fluoride ions thus reducing the mouthwash’s
end results. Thus, rinsing with water or before brushing the teeth may be recommended for such
mouthwash.As mentioned earlier, mouthwash is not advisable for use by children under 6 years
of age. This is due to the under developed swallowing reflexes in young children.It is advisable
to verify the product label for specific precautions and age recommendations.
Types of Mouthwash
Cosmetic mouthwash is mainly used to control bad breath, though they have no otter chemical or
biological effect. A product that is unable to kill bacteria related to bad breath will inadvertently
fall under cosmetic mouthwash. On the other hand, therapeutic mouthwash intends to help or
control the bacteria or help rectifying conditions such as bad breath, plaque, tooth decay and
gingivitis.
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Table1. List of Ingredients of therapeutic mouthwashes with their uses
S.No Active Ingredient Use in therapeutic mouthwash
1. Cetylpyridinium chloride fight bad breath
2. Essential oils control plaque and gingivitis
3. Chlorhexidine control plaque and gingivitis
4. Peroxide Whitening
5. Fluoride prevent decay
Availability of therapeutic mouthwash depends on the formulation of the mouthwash, like
mouthwash containing essential oils can be easily found in a pharmacy while a mouthwash
containing chlorhexidine is only available by prescription.
Clinical Considerations
Mouthwashes are designed to combat the following conditions:
Bad Breath
The major factor responsible for bad breath or halitosis are thevolatile sulphur compounds
(VSCs), that are caused due to a number of factors such as dental plaque and bacteria allied with
oral disease. Cosmetic mouthwash is used for temporarily dealing with bad breath, these
mouthwashes are provide a pleasing flavor but do not fight the bacteria that is responsible for
bad breath. Whereas, therapeutic mouthwash that contain ingredients like antimicrobials have
long term effects while dealing with bad breath. Zinc salts, ketone, terpene and ionone are some
of the compounds used in mouthwash to counter the odor causing compounds.The combination
of ingredients like chlorhexidine, cetylpyridinium chloride plus zinc lactate is known to reduce
bad breath but it is also known to contribute to tooth staining.
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Plaque and Gingivitis
Antimicrobial ingredients such asessential oils, cetylpyridinium and chlorhexidine are helpful in
mitigating plaque and gingivitis when used in mouthwashes. Some studies found that
chlorhexidine gave better results to control plaque, no considerable difference has been found
with mouthwash containing essential oils. Cetylpyridinium and chlorhexidine are also founds to
be associated with staining of teeth and tongue.
Tooth Decay
Certain mouthwashes also promote remineralization which is facilitated by the presence of
fluoride ions in a mouthwash. Regular use of fluoride mouthwash is found to have reduces tooth
decay in children, said a Chochrane systematic review, even when the children were exposed to
other sources of fluoride.
Topical Pain Relief
Mouthwashes are also used to relieve the pain.Lidocaine, benzocaine hydrochloride, dyclonine
hydrochloride, or phenol constitutes the ingredients of these mouthwashes. Pain relief is
provided by components such as sodium hyaluronate, and glycyrrhetinic acid.
Whitening
Carbamide peroxide or hydrogen peroxide facilitate stain reduction when present as active
ingredients in a mouthwash. Around 1.5 to 2 percent hydrogen peroxide may be available in
mouthwashes that claim to whiten the teeth. A study found that usage of mouth wash containing
hydrogen peroxide for 12 weeks produced similar results as using mouthwash that contained 10
percent carbamide peroxide for 2 weeks.
Xerostomia
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Xerostomia is defined as the lowering in the quantity of saliva bathing the oral mucous
membranes. The lack of saliva may further facilitate the increase in the risk of caries. Thus a
mouthwash containing fluoride is used to deal with the problem. These mouthwashes commonly
contain alcohol as well and as alcohol can lead to dryness a non-alcoholic mouthwash can be
recommended.
Oral Cancer
Consumption of alcohol as well as tobacco are known causes of oral cancer. Thus, it raises the
question of whether the use of alcohol in mouthwash facilitates the risk of cancer. A recent study
although has failed to find a connection between the use alcohol in mouthwash and oral cancer.
Patient Information
It is important to use the mouthwash/rinse as per the prescription. For example, if a dose is
skipped the rinse should be used instantly as daubing the dose will not have increased effect. One
must also keep in mind the ADA Seal of Acceptance while buying mouthwash from a pharmacy.
The seal is proof that the product is tested and safe. Mouthwash cannot replace regular brushing
and flossing, they are used for additional benefits such as mouth refresher, and reducing cavities,
gum disease.
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