Here in the United States or in other developed countries with adequate sanitary conditions, diarrhea is often viewed as a minor discomfort. The manifestation of diarrhea could be a symptom of serious illness and should not always be viewed as something minor that requires over -the -counter, self-care intervention. Diarrhea is often classified as either acute or chronic.

Treatment of acute diarrhea is within the realm of self-care in some cases.

Chronic diarrhea on other hand should always be referred to a physician.

Acute or chronic diarrhea may be caused by such etiologies as diet, medication or infections. Chronic diarrhea can also be due to several medical conditions such as Crohn’s disease, ulcerative colitis, diabetes, irritable bowel syndrome, endocrine disorders, malabsorption, irritable bowel syndrome and celiac disease.

Consultation with a qualified health care professional over self –treatment of diarrhea is very important for patients considering over the counter options. According to FDA 2003 ruling on antidiarrheals there are two ingredients proven to be safe and effective for diarrhea in patients who have not seen a physician. The two ingredients are Bismuth subsalicylate (brand names: Pepto-Bismol, Kaopectate) and loperamide (brand name: Imodium A-D).

The choice of which antidiarrheal to use between Imodium and Pepto-Bismol becomes less daunting by focusing on the age of patients, contraindications, precautions and drug interaction if co- administered with other medications. Before using Imodium A-D or Pepto-Bismol, patient must consider the exclusionary criteria for self-treatment options such as when there is a bloody or black stool, mucus in stool, fever and if symptom persists for longer than two days, counting from the first loose stool. Patients with diarrhea should drink lots of water or clear fluids to help prevent dehydration resulting from severe fluid and electrolyte loss which often leads to health complications. Electrolyte products such as Pedialyte, Infalyte do not treat diarrhea. They only help to prevent dehydration. No over the counter medication is proven safe for diarrhea if patient is pregnant or breast- feeding.

Keywords: Acute Diarrhea – Chronic Diarrhea

It becomes a lot easier to choose between the two featured over-the-counter topical antipruritics also known as topical anti-itch medications by presenting brief differences between both. A quick glance at the basic differences helps to guide an over-the counter (OTC) shopper against confusing label claims thereby leading to uninformed decisions for the appropriate over-the counter topical use and remedy for mild to moderate itch.

Topical hydrocortisone (steroid) helps to provide relief of itch due to skin inflammation and is not recommended to be used to treat a generalized itch. Due to potential side effects, topical hydrocortisone is not intended for long term use and may be used where the itch is limited to a small area.

Caladryl (non steroid), on the other hand, has active ingredients with combined anti-itch properties. The three (3) main active ingredients in Caladryl are Calamine, Pramoxin HCL, and Camphor which provide anti-itch properties but in different ways. Calamine acts as a skin protectant, Pramoxine HCL as an anesthetic and Camphor, a counterirritant, acts as a cooling agent which helps to mask the itch sensation.

So, which OTC anti-itch medication should you use, topical hydrocortisone or caladryl? The choice of which product to use is related to and is dependent on the cause of itch which could be due to skin damage, inflammation or dryness. Topical hydrocortisone is suited for itch related to or caused by skin inflammation. Caladryl, on the other hand, is suited for itch due to skin dryness. Other available over-the-counter (OTC) treatments of mild to moderate itch are topical antihistamines, Capsaicin, cooling agents, emollients and low pH cleansers and moisturizers.

Cortisone

• Therapeutic Classification: Dermatological disorders (Topical steroids)
• Pharmacologic Classification: Anti-inflammatory / Antipruritic
• Generic Description: Hydrocortisone 0.5%, 1%
• Indications: Topical inflammation and pruritus
• Adults and Children Apply thin film 2-4 times daily.
• Contraindications: Untreated bacterial or viral infections, Hypersensitivity to glucocorticoid or components of vehicles (ointment or cream base, preservative, alcohol).
• Precautions: Hepatic dysfunction, Diabetes, Cataracts, Glaucoma or tuberculosis, Preexisting skin atrophy, Pregnancy, Lactation or Children.
• Side Effects: Allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reaction, hypertrichosis, hypo pigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae, adrenal suppression (may be due to use of occlusive dressings, long term therapy).
• How Supplied: Cream and ointment —0.5%, 1%.

Caladryl

• Therapeutic Classification: Dermatological disorders (Topical non steroids)
• Pharmacologic Classification: Anesthetics / Antipruritic
• Generic Description: Calamine 3%, Camphor 0.3% / Pramoxine HCL 1%
• Indications: Pruritus and topical anesthetics.
• Adults and Children: Not recommended in children under 2 years. Over 2 years apply up to 4 times daily.
• Contraindications: Hypersensitivity to drug/class/components
• Precautions: Avoid eyes
• Side Effects: Skin lesions, anaphylactoid, skin sloughing.
• How supplied: Lotion, Cream