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Calamine lotion

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Calamine lotion is a shake lotion composed of calamine (zinc oxide/carbonate and ferric oxide), zinc oxide, bentonite, glycerine, sodium citrate, and liquified phenol. It is used widely in dermatology as a soothing agent. It is a preferred topical therapeutic agent for children including infants and is considered safe in pregnancy and lactation.
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Calamine lotion
Nirma Joy
Department of Dermatology, MKCG Medical College, Berhampur, Odisha, India.
INTRODUCTION
Calamine lotion comes under the category of shake lotions and contains calamine and zinc oxide
as active ingredients.[1] In addition, it also contains bentonite, glycerine, sodium citrate, and
liquied phenol.[2]
is article focuses on calamine lotion and preparations that contain calamine lotion. e topical
preparations that contain zinc oxide or calamine alone (instead of calamine lotion as a whole) are
not discussed here.
Simple suspensions or solutions of medication in water, alcohol, or other liquids are called
lotions.[3] When le on the skin, the lotion will leave a lm of medication on skin surface, as the
liquid portion evaporates.[3]
Shake lotion is an aqueous suspension of powders. Hence, such lotions require shaking before
each application.[3] e United States of America Food and Drug Administration (US FDA) has
approved calamine lotion as an over-the-counter medication that can serve as a skin protectant.[1]
Calamine lotion is included as an anti-inammatory and antipruritic medicine in the World
Health Organizations list of essential medicines, under the category of dermatological medicines
(topical).[4]
It is recommended that all shake lotions should be dispensed in wide neck bottles so that a small
paint or varnish brush (with which the lotion is applied to the skin) can be directly inserted into
the bottle.[2]
ere are some dierences in the ingredients of calamine lotion as mentioned in British
Pharmacopoeia (BP) and the United States Pharmacopoeia (USP).[2]
e dierence starts from the constituents of calamine itself. As per BP, calamine is basic zinc
carbonate colored with ferric oxide. Calamine according to the USP is zinc oxide colored with
ferric oxide.[2]
*Corresponding author:
Nirma Joy,
Department of Dermatology,
MKCG Medical College,
Berhampur, Odisha, India.
nirmajoy@gmail.com
Received: 06November 2021
Accepted: 17December 2021
EPub Ahead of Print: 13 January 2022
Published:
DOI
10.25259/JSSTD_77_2021
Quick Response Code:
ABSTRACT
Calamine lotion is a shake lotion composed of calamine (zinc oxide/carbonate and ferric oxide), zinc oxide,
bentonite, glycerine, sodium citrate, and liquied phenol. It is used widely in dermatology as a soothing agent.
It is a preferred topical therapeutic agent for children including infants and is considered safe in pregnancy and
lactation.
Keywords: Calamine lotion, Shake lotion, Zinc oxide
www.jsstd.org
Journal of Skin and Sexually
Transmitted Diseases Article in Press
Joy: Calamine lotion
Journal of Skin and Sexually Transmitted Diseases • Article in Press | 2 Journal of Skin and Sexually Transmitted Diseases • Article in Press | 3
e dierences in the composition of calamine lotion by BP
and USP are shown in Table1.[2]
A comparison of BP and USP concerning calamine lotion
shows that the powder proportion is slightly higher in BP.
According to the BP, bentonite is added to the powders
before the addition of water. Calamine lotion, as per BP, has
sodium citrate as an ingredient while USP formulation does
not include sodium citrate. e BP-directed preparation of
calamine lotion is simpler than the same by the USP. e USP
necessitates the preparation of bentonite magma. BP allows
the preparation of a thixotropic suspension (a suspension that
is a gel at rest and becomes liquid on stirring). Moreover, the
USP distinguishes between a bland and a phenolic calamine
lotion. Liquied phenol is a constituent of calamine lotion as
per BP. Due to the presence of phenol, the BP formulation
of calamine lotion cannot be considered as a bland vehicle.
Calamine lotion of the USP formulation does not contain
liquied phenol and qualies as bland calamine lotion. e
USP also mentions the preparation of a phenolic calamine
lotion which is constituted by the addition of 1ml liquied
phenol to 99ml of calamine lotion.[2]
Oily calamine lotion as formulated by BP (calamine 5, oleic
acid 0.5, wool fat 1, arachis oil 50, and calcium hydroxide
solution add to 100) causes less drying.[2]
PHARMACOLOGICAL ACTION OF INDIVIDUAL
INGREDIENT OF CALAMINE LOTION
1. Calamine: It may be either zinc carbonate or zinc oxide
(98%), colored pale pink with ferric oxide (2%), and has
bland, soothing, and antipruritic properties.[2]
Zinc oxide: It is an inorganic powder with cooling
and slightly astringent properties. It has soothing and
protective properties. It can block broad-spectrum
sunlight (ultraviolet B and A and visible light).
Hence, it is preferred as an inexpensive physical
sunscreen. Ann et al. reported that zinc oxide exhibited
bactericidal action on Staphylococcus aureus and
Pseudomonas aeruginosa. e antibacterial property was
attributed to the structural morphology of zinc oxide
that induced toxicity and a killing eect on bacteria.[2,5-7]
2. Bentonite: Bentonite is colloidal hydrated aluminium
silicate. Bentonite serves as a stabilizer in shake lotions.[2,6]
3. Glycerine: Glycerine is a humectant, emollient, and
stabilizer.[8]
4. Sodium citrate: Sodium citrate controls the pH of the
lotion.[9]
5. Liquied phenol: It acts as a preservative, alleviates
itching (through its anesthetic eect), and acts as an
antiseptic.[6,8]
ADVANTAGES OF CALAMINE LOTION
When applied to the skin, the aqueous component
of calamine lotion evaporates. e heat required for
evaporation is taken from the body which gives a cooling
eect at the site of application. is provides the lotion
its soothing and antipruritic eect.[5,8]
e powder added to the lotion increases the surface
area of evaporation. As a result, the lotion eectively
dries and cools wet and weeping skin.[8]
It is suitable for application to large surface areas due to
its ability to spread easily and uniformly.[5]
Calamine lotion allows passage of some amount of
secretion and exudation.[5]
It is considered safe in pregnancy and lactation since it
has been in use for centuries and has not been reported
to cause any adverse outcomes in pregnancy or lactation.
However, there is a lack of data from studies.[5,8]
However, phenol containing preparation is to be avoided
in pregnant women.[10]
It is oen the favorite preparation in treating children
and considered safe in infants.[5,8] However, phenol
containing preparation is to be avoided in infants.[10]
By the addition of specic ingredients, the lotion can
be made more eective in the management of dierent
dermatoses.[5]
DISADVANTAGES
A drying eect on skin.[5,8]
Some patients and some body areas (calamine lotion
becomes gritty in moist, intertriginous areas) do not
tolerate the lotion.[5]
e powder component may clump together and
become abrasive aer evaporation of water, and hence,
patients should be instructed to remove the residual
particles before reapplication.[8]
e pink color may be cosmetically unacceptable for
daytime use, especially on exposed skin.
Calamine lotion produces only a supercial eect since
it does not penetrate to deeper layers of skin, which
makes it less eective as a treatment modality.[5]
Calamine lotion is considered safe in pregnancy and
lactation. However, the safety of the modied preparations
Table 1: Ingredients of calamine lotion according to the British
Pharmacopoeia and the United States Pharmacopoeia.
British Pharmacopoeia United States Pharmacopoeia
Calamine 15 g
Zinc oxide 5 g
Bentonite 3 g
Sodium citrate 0.5 g
Liquied phenol 0.5 ml
Glycerine 5 ml
Water add to 100 ml
Calamine 8 g
Zinc oxide 8 g
Glycerin 2 ml
Bentonite magma 25 ml
Calcium hydroxide solution add to 100
ml
Joy: Calamine lotion
Journal of Skin and Sexually Transmitted Diseases • Article in Press | 2 Journal of Skin and Sexually Transmitted Diseases • Article in Press | 3
in pregnancy, lactation, infants, and children has to be
reassessed based on the added ingredients.[5,8] In infants,
resorcinol-containing preparations should not be applied
to more than one-fourth of the body surface.[5] Menthol,
when combined with camphor in a topical preparation,
is pregnancy category C (US FDA).[10] As already
mentioned, phenol-containing preparation is to be
avoided in pregnant women and infants (US FDA).[10]
A shake lotion has less chance of getting absorbed
systemically; but care must be taken when calamine lotion
with added ingredients such as resorcinol, tars, anthralin,
phenolic substances, or benzocaine is applied to large areas of
the body or perioricial regions or when used in children.[5]
Like all other shake lotions, calamine lotion also develops
sediment that cakes at the bottom of the container. Aer
some time, it becomes impossible to disperse the sediment
by shaking the container. A properly prepared shake
lotion lasts longer than its poorly made counterpart.[2]
Suen et al. had reported a case where the calamine
lotion applied by the patient mimicked intramammary
calcications on the mammogram.[11]
CALAMINE LOTION WITH ADDED
INGREDIENTS
Menthol or camphor or diphenhydramine, when added to
calamine lotion, can potentiate the antipruritic action of the
lotion.[5,8] Menthol is a cyclic terpene alcohol that induces a
cooling sensation and relieves pruritus.[1,5,8] Menthol reduces
itching, through its action on cold receptors and/or nerve
bers.[8] Diphenhydramine is an H1 (histamine receptor 1)
antagonist with a localized anesthetic eect by blockage of
sodium channels.[8]
Table2 shows preparations of calamine lotion with added
ingredients.[5]
USES IN DERMATOLOGY
Calamine lotion is found useful in many conditions due to
its soothing and antipruritic actions. e addition of specic
ingredients can render it antiparasitic, antifungal, and
keratolytic eects [Tab l e 2].[5,12] e following are dermatoses
in which calamine lotion is found useful:
1. Acute or subacute, less edematous, and less inamed
dermatoses or eczema [Tab l e 2].
2. Dermatitis or eczema complicated by fungi (calamine
lotion containing resorcinol).
3. Eruptions of herpes zoster and drug eruptions (calamine
lotion acts as a soothing agent).
4. Crusted and excoriated stage of dermatitis herpetiformis
[Table2].
5. Lichen planus: Calamine lotion or its modications with
antipruritic action [Tab l e 2] are useful to relieve pruritus
associated with lichen planus.
6. Pityriasis rosea: Calamine lotion or a simple modication
of the same containing menthol and phenol may
alleviate the pruritus of pityriasis rosea [Tabl e 2]. e
addition of 3–5% of solution of coal tar may improve the
antipruritic eect and 1–3% of resorcinol may accelerate
the desquamation of the rash.[5]
7. Sunburn.
8. Miliaria, urticaria, insect bites, and stings (calamine
lotion provides antipruritic and soothing eects).[12]
9. Acne vulgaris and other acneiform dermatoses [Tab l e 2].
10. Physical sunscreen (calamine lotion can act as a
sunscreen since it contains zinc oxide).[12]
Table2: Modied preparations of calamine lotion.
Composition Use
1. Menthol 1
Calamine lotion add to 100
Antipruritic action
2. Menthol 0.3–0.6
Solution of coal tar(liquor carbonis
detergens) 3.6–6
Chloral hydrate 3.5
Calamine lotion USP add to 120
Antipruritic action
3. Menthol 0.3–0.6
Phenol 0.3–0.6
Liquor carbonis detergens 6–12
*Benzocaine 6–12
Calamine lotion USP add to 120
(Resorcinol/salicylic acid 1–2% or
camphor 2–4% may be added)
Antipruritic action
4. Menthol 0.15–0.6
Phenol 0.15–0.3
Resorcinol 1.2–3.6
Liquor carbonis detergens 2.4–6
Calamine lotion USP add to 120
Mildly parasiticidal,
soothing and drying,
anti-eczematous
preparation
5. Menthol 0.3–0.6
Phenol 0.3
Resorcinol 2.4–7.2
Calamine lotion USP add to 120
Intertrigo due to fungus
6. Benzyl benzoate emulsion 50
Calamine lotion 50
Anti-scabietic with
reduced potential to
cause skin irritation in
comparison to benzyl
benzoate emulsion
7. Menthol 0.15–1.2
Phenol 0.15–0.6
Liquor carbonis detergens 3.6–12
Camphor 2.4
Calamine lotion USP add to 120
Crusted and excoriated
stage of dermatitis
herpetiformis
*Benzocaine may cause sensitization; USP: United States Pharmacopoeia
Joy: Calamine lotion
Journal of Skin and Sexually Transmitted Diseases • Article in Press | 4 Journal of Skin and Sexually Transmitted Diseases • Article in Press | PB
CONCLUSION
FDA considers calamine lotion as a skin protectant. e
addition of specic ingredients can potentiate its antipruritic
action or can impart it keratolytic or antiparasitic or
antifungal properties.
Declaration of patient consent
Not required as there are no patients in this article.
Financial support and sponsorship
Nil.
Conicts of interest
ere are no conicts of interest.
REFERENCES
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How to cite this article: Joy N. Calamine lotion. J Skin Sex Transm Dis,
doi: 10.25259/JSSTD_77_2021
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Conference Paper
Full-text available
In this study, we report the structural morphology of a zinc oxide (ZnO) sample and antibacterial application of the ZnO structures in calamine lotion. Antibacterial activities of the calamine lotion towards Staphylococcus aureus and Pseudomonas aeruginosa were investigated. The structural morphology of ZnO sample was studied using a transmission electron microscope (TEM) and a field-emission scanning electron microscope (FESEM). The morphologies of the ZnO structure consisted of many rod and spherical structures. The particle sizes of the sample ranged from 40 nm to 150 nm. A calamine lotion was prepared through mixing the ZnO structures with other constituents in suitable proportion. The energy-dispersive x-ray spectroscopy (EDS) revealed the presence of large amount of ZnO structures whiles the X-ray diffraction (XRD) results showed a good crystalline property of ZnO in the calamine lotion mixture. The morphological structures of ZnO were found to remain unchanged in the calamine lotion mixture through FESEM imaging. In the antibacterial test, prepared calamine lotion exhibited a remarkable bacterial inhibition on Staphylococcus aureus and Pseudomonas aeruginosa after 24 h of treatment. The bactericidal capability of calamine lotion was largely due to the presence of ZnO structures which induce high toxicity and killing effect on the bacteria.
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Miliaria crystallina is a transient, superficial obstruction of eccrine sweat ducts resulting in rapidly evolving noninflammatory vesicles. The disease is observed frequently in hot, humid, tropical climates and in the neonatal period, most likely due to lack of maturation of the sweat duct during the first few days following birth. It is rarely present at delivery and remains a diagnostic dilemma for the neonatologists. We report a rare case of “Congenital miliaria crystallina” that was present at birth.
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Detection of microcalcifications is important in detecting early breast cancer. We present a case of screening mammogram in which calamine lotion mimics intramammary calcifications.
  • M K Polano
  • P J August
Polano MK, August PJ. Topical Skin erapeutics. Edinburgh: Churchill Livingstone; 1984.
Rook's Textbook of Dermatology
  • J B Jones
  • C E Griffiths
  • J Barker
  • T Bleiker
  • R Chalmers
  • D Creamer
Jones JB. Principles of topical therapy. In: Griffiths CE, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook's Textbook of Dermatology. 9 th ed. Oxford: Wiley Blackwell; 2016. p. 18.1-39.
Dermatology diagnosis and treatment. 2 nd edition
  • M B Sulzberger
  • J Wolf
  • V H Witten
  • A W Kopf
Sulzberger MB, Wolf J, Witten VH, Kopf AW. Dermatology diagnosis and treatment. 2 nd edition. New York: e Year Book Publishers Inc.; 1961.
Fitzpatrick's Dermatology in General Medicine
  • A D Souza
  • B E Strober
  • L A Goldsmith
  • S I Katz
  • B A Gilchrest
  • A S Paller
  • D J Leffell
  • K Wolff
Souza AD, Strober BE. Principles of topical therapy. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8 th ed., Vol. 214. New York: McGraw Hill; 2012. p. 2643-51.
Fitzpatrick's Dermatology in General Medicine
  • C N Burkhart
  • K A Katz
  • L A Goldsmith
  • S I Katz
  • B A Gilchrest
  • A S Paller
  • D J Leffell
  • K Wolff
Burkhart CN, Katz KA. Other topical medications. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick's Dermatology in General Medicine. 8 th ed., Vol. 222. New York: McGraw Hill; 2012. p. 2697-707.