What pharmacists need to know about DermaGen

Article by Ann Winkle MPS for Australian Pharmacist

To provide relief from minor eczema,dermatitis, cold sores and acne,manage topical steroid withdrawal symptoms and support minor wound healing, pharmacists can offer DermaGen skincare for a completely natural remedy that is soothing and safe at any age.

What is DermaGen skincare and what is it for?

DermaGen products by Botanical Chemist contain manuka oil, propolis and essential oils. They nourish the skin with natural oils and waxes to form a barrier that minimises water loss to keep skin hydrated; supporting healing and regeneration. Unlike topical steroids they don’t thin the skin.

The products are non-toxic and can be used on everyone, including children and infants.1 DermaGen skincare may be beneficial on broken, inflamed skin where topical steroids are not recommended. Broken skin is at risk of moisture loss and bacterial infection, delaying healing. DermaGen ingredients are used in traditional medicine for antimicrobial and anti-inflammatory effects, although clinical trials are needed. 2-6

Overuse of topical steroids resulting in withdrawal symptoms is known as ‘topical steroid withdrawal syndrome’ (TSWS). The dilemma for clinicians is knowing when to stop steroids to allow the skin to heal. There is a role for DermaGen skincare in supporting healing without relying on topical steroids.

The DermaGen brand aims to change the way symptoms of eczema, psoriasis and dermatitis are managed.1 DermaGen by Botanical Chemist is owned and manufactured in Western Australia, with botanical ingredients sourced organically.1

Therapeutic Goods Administration (TGA) listings

Manuka Oil Cream, Manuka Oil Balm and Propolis Balm are TGA-listed for symptomatic relief of minor eczema and dermatitis, cold sores, pimple and acne breakouts, and supporting skin healing of minor wounds and grazes.7
Labelling must state: If symptoms persist, talk to your health professional.7
DermaGen balms are preservative-free. The aqueous cream requires a warning on the pack stating that benzoates are included.7

Active ingredients

Manuka oil from the manuka tree is used for wound management in traditional medicine. Evidence shows it suppresses ultraviolet (UV)-B-induced skin inflammation and photoaging, inhibits herpes simplex virus (HSV) in animal studies, and has in-vitro antifungal and antibacterial activity. Data confirms manuka oil’s potential for antimicrobial, anti-HSV and inflammatory benefits in pharmaceutical products.2-4
Propolis is a mix of wax, bee saliva and collected natural resins produced by bees. Its chemical composition includes over 300 flavonoids, terpenes and phenolic acids, which (mainly flavonoids) have anti-inflammatory, antibacterial, anti- viral, antioxidant and regenerative properties. Propolis is widely used in traditional medicine.5

Propolis is considered beneficial in healing wounds, including burns where evidence suggests it can be used as an alternative to silver sulfadiazine cream.6
Propolis is well tolerated with no toxicity reported. Allergies are rare, but propolis should be avoided in people with pollen or bee product allergies.5

What is topical steroid withdrawal syndrome (TSWS)?

Patients using higher potency topical corticosteroids are at risk of TSWS, especially on the face or genital area and for long periods. TSWS incidence and prevalence is unknown, but atopic patients are most at risk.8Features include red skin, burning pain or stinging, itch, skin peeling, oozing oedematous areas. Hives and excessive sweating are signs of recovery.8

Redness on the face may present as a headlight sign, where the nose and perioral area are spared from redness seen on the rest of the face. A ‘red sleeve’ to the extremities and ‘elephant wrinkles’ on the knees are also described.8

General practitioners (GPs) are encouraged to consider this syndrome and support patients at risk. Patients need informed discussions with trusted GPs and pharmacists when seeking answers.It is essential that concern about TSWS does not prevent adequate and appropriate treatment for eczema.Australian guidelines recommend topical steroids once or twice daily to all inflamed skin until eczema is cleared.8

Counselling tips

Karen Cheah, Proprietor of Priceline Pharmacy Margaret River, researched and formulated the DermaGen range in her compounding pharmacy.
When she sees multiple topical steroids prescribed, she doesn’t go against GP advice but does explain TSWS, with referral to information sources (e.g. www.ITSAN.org).
She asks: ‘How often do you use topical steroids and for how long?
Where are they applied?
Do you need a stronger steroid to manage symptoms?
Do symptoms get worse when steroids are stopped?
’If a patient experiences TSWS symptoms (a burning, stinging, red rash) she asks them to consider DermaGen skincare to relieve symptoms safely and naturally, without dependence on steroids.
Other pharmacological interventions and non-pharmacological interventions should also be recommended for the more severe TSWS symptoms.8 After a week of using a DermaGen product, Ms Cheah follows up and refers them to the GP if symptoms don’t improve. Resolution can take a long time, with flare-ups possible.
Patients may need to add dressings, wet compresses and other symptom relievers.
Ms Cheah told Australian Pharmacist: ‘We’ve formulated these natural products so patients, especially young children, can have an alternative. Hopefully by using natural products for minor conditions, we can prevent the over-dependence and over-use of topical steroids in the long run, as TSWS is a very debilitating condition, hard to manage as a healthcare professional, and difficult to go through for both carer and person living with these symptoms.

’Jarred Smith, pharmacist at West Busselton Pharmacy in Western Australia told AP the DermaGen range is popular in his pharmacy.
‘We recommend Propolis Balm for mild eczema, dermatitis and burns. Long-term sufferers are amazed at the results, often when nothing else works. It has become our go-to product and staff are confident in recommending it for a number of skin complaints knowing it is natural, it works, is steroid-free and is suitable for all ages.’

References

1.    DermaGen. Botanical Chemist. At: https://dermagen.net.au
2.    Kwon OS, Jung SH, Yang BS. Topical administration of manuka oil prevents UV-B irradiation-induced cutaneous photoaging in mice. Evid Based Complement Alternat Med 2013(6):930857.
3.    Chen CC, Yan SH, Yen MY, et al. Investigations of kanuka and manuka essential oils for in vitro treatment of disease and cellular inflammation caused by infectious microorganisms.  J Microbiol, Immunol Infect 2016;49(1):104–11.
4.    Reichling J, Koch C, Stahl-Biskup E, et al. Virucidal activity of a beta-triketone-rich essential oil of leptospermum scoparium (manuka oil) against HSV-1 and HSV-2 in cell culture. Planta Med 2005;71(12):1123–7.
5.    Martinotti S, Ranzato E. Propolis: a new frontier for wound healing? Burns Trauma 2015; 3:9.
6.    Han M, Durmus A, Karabulut E, et al. Effects of Turkish propolis and silver sulfadiazine on burn wound healing in rats. Revue Méd Vét 2005;156(12):624–
7.    Australian Government Department of Health: Therapeutic Goods Administration. ARTG summaries. Manuka oil balm, manuka oil cream, propolis balm. 2021. At: www.tga.gov.au/ australian-register-therapeutic-goods
8.    Sheary B. Topical corticosteroid addiction and withdrawal – an overview for GPs. Aust Fam Physician 2016;45(6):386–88.