Most people wouldn’t think twice about the potential for harm when applying over-the-counter creams, lotions, ointments, sprays or patches to the skin. However, we recently received a report about a patient who was hospitalized for burns after using an over-the-counter (OTC) cream for muscle pain. The patient, who was using ICY HOT Medicated Patches, sustained 2nddegree burns over the area of his chest where the patch had been placed. The size of the burn was reported to be 9 cm by 5.5 cm (about 3 ½ inches by 2 inches). Fortunately, the patient is now fine.
The Food and Drug Administration (FDA) alerted health professionals and the public about similar issues after an analysis of their adverse event reporting program database turned up more than 40 cases where people reported serious skin injuries after applying certain OTC pain relievers. These products generally contain menthol, methyl salicylate, or capsaicin.
 Second degree burn from ICY HOT
patch placed by the patient over his sternum |
With only 40 or so reports, apparently the problem isn’t all that common. But the injuries have ranged from mild to severe chemical burns with use of such brand-name topical muscle and joint pain relievers as Icy Hot, Bengay, Capzasin, Flexall, and Mentholatum. FDA noted that there's no way to predict who will have this kind of reaction to a topical pain reliever for muscles and joints. In many cases, burns occurred after just one application, with severe burning or blistering occurring within 24 hours. Some patients had complications serious enough to require hospitalization.
Harm from other OTC and prescription products applied to the skin has also been described. Sometimes this is from applying too muchmedicine to the skin. For example, the death of a 17-year-old girl was blamed on the use of too much cream for muscle aches. She was a cross country runner and had been using the cream all over her legs to soothe aching muscles after exercise. Heat and exercise can increase the amount of medicine entering your body. The young girl apparently absorbed high levels of methyl salicylate, an anti-inflammatory medicine related to aspirin that is found in Bengay and Icy Hot. Using too much over days or weeks can cause a chronic poisoning called salicylism, which, as in this case, can be lethal.
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Below, we’ve repeated some of FDA’s recommendations for safe use of applied products, as well as some of our own. Call it our Top 10 list for the safe use of medicines when applied to the skin:
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Applying too much numbing medicine before laser hair removal has also led to fatalities. A few years ago, two young college students in different states after they applied a numbing gel to their legs to prepare for this procedure. The gel contained high concentrations of two numbing medicines, lidocaine and tetracaine. This was intended to help ease any pain associated with the procedure. Both women had a fatal reaction to the gel because too much medicine entered their bodies through the skin. One woman had a seizure in her car on the way to her appointment. She lapsed into a coma and died the next week. The other woman had a seizure and was on a ventilator (breathing machine) for 2 years before she died.
These deadly reactions were caused by high doses of the numbing medicines in the gel and applying the gel to very large areas of skin (from groin to ankle). Also, using plastic wrap over the skin heated it, which caused nearby blood vessels to dilate and blood flow to increase. That, in turn, allowed more medicine than usual to be absorbed and circulated, which eventually was toxic to the body. There are many other medicines that are applied to skin, like antibiotics, cortisone-like drugs and antifungals. All of these can be absorbed, sometimes leading to side effects.
The numbing medicine benzocaine can sometimes cause methemoglobinemia, a rare but serious—and sometimes fatal—condition, a disorder in which the amount of oxygen carried through the blood stream is greatly reduced. In babies, products like Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase contain benzocaine. FDA recommends that parents and caregivers not use benzocaine products for children younger than 2 years, except under the advice and supervision of a health care professional.
For more information about these cases see our article, “How medicines in creams, ointments and sprays can harm you, which is published here.
