Rubbing cream into your skin to calm an itchy rash may seem harmless, but not all topical anti-itch formulas are created equal.
"People don't understand the potential dangers of prescription-strength steroid creams," said Dr. Lawrence Green, clinical professor of dermatology at George Washington University in Washington, D.C.
Hydrocortisone -- a topical steroid often used to treat a rash or allergic reaction -- is not approved by the U.S. Food and Drug Administration for over-the-counter use in a potency greater than 1 percent. But in some stores it is easy to obtain without a prescription, a new study warns.
The researchers found illegal corticosteroid creams at dozens of stores nationwide that specialize in foreign imports.
For the study, the investigators visited 80 stores in 13 cities in nine states. Posing as customers, they asked for cream to treat an "itchy rash." Three dozen stores sold prescription-strength creams over-the-counter without a prescription.
The creams were made in 12 countries, including China, Mexico, Kenya, Korea and Switzerland, the study authors said.
All stores visited in Chicago and San Francisco sold illegal steroid creams, as did 80 percent of those visited in Minneapolis, 60 percent of those in Washington, D.C., and 36 percent in New York City. Even smaller cities -- including Durham, N.C. and Madison, Wisc. -- had stores selling illegal creams, the findings showed.
The report was published in the February issue of the Journal of the American Academy of Dermatology.
The results came as little surprise to study co-author Dr. Sara Hylwa, a dermatologist at Hennepin Healthcare in Minneapolis.
Hylwa works in a clinic that treats many immigrants. Occasionally, patients acknowledge using prescription-strength corticosteroid creams for rashes and even as skin-lightening formulas, she said.
In many other countries, the creams are available legally over-the-counter, she said, so it wouldn't be unusual for a newcomer to expect to purchase them without a prescription. But misuse can bring serious side effects.
Hylwa recalled one patient whose use of a skin cream containing a potent steroid resulted in severe skin thinning -- a common side effect often seen in sensitive areas, such as the face and around the eyes.
Other side effects include stretch marks; easy bruising; and glaucoma, cataracts or even blindness when applied to the eye area, according to the American Academy of Dermatology.
Green said he sees patients who have misused skin creams almost every day.
"Unfortunately, they're getting inaccurate advice from the internet, friends, or just trying to help themselves with a previous prescription cream they have in their house -- one that was prescribed for something else unrelated -- until they go to the doctor, or trying to avoid going to the doctor altogether," he said.
While consumers may think liberal use of topical medications is less harmful than medicines that are swallowed, that's a misconception, Green said.
"When you put something on a large enough surface of your skin, it can be absorbed into your bloodstream," he warned. "You then can have all the potential permanent damage not only of putting cream too often on the same place on your skin, but also the potentially dangerous side effects of taking a pill form of the cream."
So, what's the safest approach to take for a skin rash that doesn't resolve in a few days with nonprescription-strength creams?
Make an appointment with a doctor, suggested Dr. Erin Warshaw, a professor of dermatology at the University of Minnesota, who was also involved in the study.
Warshaw urged patients to take any skin creams they may be using with them to their appointment, to show the doctor. These creams may very well yield valuable clues about what's causing a skin irritation or preventing it from healing.
Learn more about proper skin care from the American Academy of Dermatology.
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WASHINGTON — Amid growing international concern over coronavirus, a World Health Organization panel on Thursday declined to declare the new outbreak a global emergency, saying it was largely confined to China, where strong steps toward its containment were already underway.
“This is an emergency in China, but it is not yet a global health emergency,” said WHO Director-General Tedros Adhanom Ghebreyesus at a news conference, describing the conclusions of the organization's emergency panel, which had a near 50-50 split vote on the decision. "It may yet become one."
WHO reported 584 confirmed cases of coronavirus — also known as 2019-nCoV — and 17 deaths since the outbreak began Dec. 31. Local news outlets in China reported slightly higher totals: 644 confirmed cases and 18 deaths.
The virus, a newly discovered member of the coronavirus family that includes past outbreak diseases SARS and MERS, was first reported from a patient who had visited a seafood and meat market in Wuhan. The coronavirus causes pneumonia-like symptoms, including coughing, fever, headaches, difficulty breathing, and fatigue.
As of Thursday, Singapore, Japan, South Korea, Taiwan, Thailand, Vietnam, and the US had reported cases in which coronavirus patients had traveled from China. And Texas A&M University confirmed Thursday afternoon that one of its students who had traveled from Wuhan is under investigation as a possible second US coronavirus case.
But all the deaths, and 575 of the 584 reported illnesses, took place in China, Tedros said, arguing that the outbreak was not yet of global concern. The cases of person-to-person transmission of the virus also appear to be confined to China, largely among family members and health care workers, rather than infections from everyday activity. Deaths are taking place among elderly patients, or ones with underlying health conditions that may worsen their pneumonia.
In addition, the WHO panel concluded that China had taken appropriately aggressive measures so far to contain the outbreak. Early on Thursday, China widened a travel ban from Wuhan, the city of 11 million people at the center of the outbreak, extending the quarantine to include more than 20 million people in nearby cities in Hubei province.
Tedros declined to set a date for another meeting of the emergency panel but said he would not hesitate to do so if the conditions of the outbreak changed.
In response to a US patient first reported on Tuesday, the CDC has been screening air travelers from Wuhan at major airports in Atlanta, Chicago, Los Angeles, New York, and San Francisco, redirecting flights to those cities.
In their last comments on the outbreak, federal health officials last week rated the risk to people in the US from the outbreak as low. "For a family sitting around the dinner table tonight, this is not something that they generally need to worry about," said Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases.
“There is still a lot we don’t know about this coronavirus,” chiefly just how infectious and how deadly the virus is, Stanley Perlman, a coronavirus expert at the University of Iowa, told BuzzFeed News. "It will take time and a larger number of cases to calculate that for this virus."
Quarantines proved to be effective in the SARS coronavirus outbreak of 2003, he noted, because the virus was largely contagious only when it reached the late stages of illness, usually transmitted via coughing. SARS ended up killing 774 people across 29 countries, with the majority of deaths in China and Taiwan.
If the new coronavirus is similar, becoming infectious only late in a case, then quarantines will likely prove to be effective, he said. The flu, a different kind of virus, is partly more infectious because it lodges in the nose and throat, leading to sneezing early in a case and triggering more infections from casual contact.
But if the new coronavirus mutates and lodges in the nose and throat like the flu, Perlman added, "then all bets are off."
The unknowns led some experts to criticize the WHO's decision, arguing the outbreak met the criteria for issuing an emergency declaration.
“WHO should have declared a Public Health Emergency of International Concern. All the legal criteria have been met, including a novel virus, rising cases, and international spread," said Lawrence Gostin, a professor at Georgetown, in a statement. "There are already major impacts on travel and trade. I expect the crisis to escalate, as cases will mount in China, Asia, and globally."
Coronaviruses typically spread first from animals to people, as in the MERS outbreak of 2012, which originated in camels and has killed 858 people to date. Which animal in the Wuhan seafood and meat market was the host for the new coronavirus is another unknown, Tedros noted. Some studies have pointed to snakes as the point of origin, while others have suggested that the outbreak was sparked by bats sold as food in the market in Wuhan.
"Probably all coronaviruses are bat viruses. The question is just whether the bat virus went through some intermediary animal before infecting people," said Perlman.
Spread of the new coronavirus that originated in China has not yet reached a level that would deem it a global public health emergency, the World Health Organization said on Thursday. The virus has sickened more than 600 people, and 25 have died.
"Now is not the time. It's too early to consider that this event is a public health emergency of international concern," Didier Houssin, chair of the WHO emergency committee, said during a news conference from Geneva.
Houssin said the decision is based on the limited number of cases worldwide, as well as efforts in China to try to contain the disease.
"Make no mistake, this is an emergency in China," said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. "But it is not yet a global health emergency."
Most of the patients have ties to the epicenter of the outbreak: Wuhan, China, though several cases have been reported in other Asian countries. One patient has been diagnosed in the U.S.: a resident of Washington state who had traveled to Wuhan and is now recovering in a hospital.
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Three cities in central China were put on lockdown in an effort to stop the spread of the respiratory illness. It's an extraordinary measure, particularly this week, as hundreds of millions of Chinese residents were expected to travel in advance of the Lunar New Year, a major holiday, on Saturday.
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Tedros said he hopes the travel restrictions will be "both effective and short in duration."
The WHO committee plans to come up with an official name for the illness caused by the new virus, now known as 2019-nCoV. That means it's a novel, or new, coronavirus that was discovered in 2019.
"For the time being, this name is OK. We can work with it, and it's understood by everyone on the planet," Dr. Sylvie Briand, director of the WHO's pandemic and epidemic diseases department, said during the press briefing, adding the committee members hadn't had time to discuss the name.
Naming an illness can be difficult and contentious. Public health officials generally avoid linking a virus to any particular region, especially one that can cause severe illness or death.
The WHO's official declaration of a "public health emergency of international concern" is reserved for unusual and serious public health events that have the potential to spread disease worldwide.
The designation has been used sparingly in recent years, including during the 2009 H1N1 (swine flu) pandemic; the 2014 Ebola outbreak in West Africa; and the Zika virus epidemic in 2015-16.
The hope is that such a formal declaration from the WHO would improve and streamline information gathering and sharing about the new illness about which little is known, as well as potentially increase funding for the response.Related
Earlier this month, Chinese researchers shared the full genomic sequence of the new virus to public databases, making it possible for health officials worldwide to study it and test for it.
Preliminary analyses suggest the new virus may share some genetic similarities with SARS, or severe acute respiratory syndrome. SARS also originated in China, and spread quickly to more than two dozen countries. More than 8,000 people became ill during the 2003 outbreak, and nearly 800 people died.
The new coronavirus is a different strain, and it's unknown whether it will be as severe or as contagious as SARS.
In a letter published Thursday in the Journal of the American Medical Association, researchers from National Institute of Allergy and Infectious Diseases wrote that "so far, it appears that the fatality rate of 2019-nCoV is lower than that of SARS-CoV."
But the outbreak is still evolving, and much of it remains unknown. There is no specific treatment for the new virus, though several antivirals and potential vaccines are under preliminary investigation.
"We have to be very, very careful in the beginning of an epidemic in making any pronouncements about the true severity," Dr. Michael Ryan, executive director of the WHO's health emergencies program, said at the news conference.
"It’s extremely important that we stick to the facts," Ryan said. "The facts are that 17 people have died. Their families grieve them this evening."
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