Anesthetic agents are used in the skin to decrease pain when injections, laser, cryotherapy, electrolysis, excisions, or other procedures are performed. These include lidocaine hydrochloride 3% cream (LidaMantle), 30% to 40% lidocaine compounded in Velvachol or Acid Mantle cream, EMLA cream or disc (2.5% lidocaine and 2.5% prilocaine), and ethyl chloride spray. Anesthetic agents for mucous membranes are used to temporarily ameliorate discomfort from mucous membrane diseases. They include viscous solution of lidocaine (2%) and Hurricaine liquid or gel spray (20% benzocaine); for ophthalmic use, Alcaine solution (0.5% proparacaine) and Pontocaine (0.5% tetracaine) are used.

Antipruritic agents relieve itching in various ways. Commonly used chemicals include menthol (0.25%), phenol (0.5%), camphor (2%), pramoxine hydrochloride (1%), sulfur (2% to 5%), and coal tar solution (liquor carbonis detergens [LCD]) (2% to 10%). These chemicals are added to various bases for the desired effect. Numerous safe and unsafe proprietary preparations for relief of itching are also available. The unsafe preparations are those that contain sensitizing antihistamines, benzocaine, and related—caine derivatives. Itch-X gel and spray is over the counter (OTC) and contains 1% pramoxine hydrochloride and 10% benzyl peroxide (Itch-X lotion is OTC, 1% hydrocortisone).

Keratoplastic agents tend to increase the thickness of the horny layer. Salicylic acid (1% to 2%) is an example of a keratoplastic agent that will thicken the horny layer.

Keratolytics remove or soften the horny layer. Commonly used agents of this type include salicylic acid (4% [Salex lotion and cream] to 10%), resorcinol (2% to 4%), urea (20% to 50%), and sulfur (4% to 10%). A strong destructive agent is trichloroacetic acid. Urea in 5% to 10% concentration (Eucerin Plus lotion and Carmol) is moisturizing, whereas in 20% to 50% (Vanamide, Keralac, Carmol) concentration, it is keratolytic. Urea is also available in a nail stick applicator, Kerastick (50%), for onychoschizia and in a Redi-Cloth (Kerol [42%]). α-Hydroxy acids (lactic acid [Lac-Hydrin 5% or 12% cream and lotion or AmLactin and AmLactin XL 12% cream or lotion]), which are sold over the counter, and glycolic acid (Aqua Glycol is sold OTC in various concentrations and is available as facial cleanser, toner, face cream, shampoo, body cleanser, hand lotion, and body lotion) in 5% to 12% concentrations are moisturizers, whereas in higher concentrations up to 80%, are keratolytic and can be used in the office for facial peeling, with caution. Some moisturizers combine ureas and α-hydroxy acids such as U-Kera E (40% urea, 2% glycolic acid) and Eucerin Plus. Kerol Topical Suspension (50% urea with lactic acid and salicylic acid) is keratolytic and can be massaged into callosities for 60 seconds after bath or shower.

Antieczematous agents remove oozing and vesicular excretions by various actions. Soaks for 10 minutes twice a day or clean towels soaked in a solution for 10 minutes twice a day are very effective. The commonest agents include water soaks or compresses (lukewarm to cool), Domeboro solution
packets or dissolvable tablets that are nonprescription, coal tar solution (2% to 5%), hydrocortisone 0.5% to 2% (0.5% and 1% are available without a prescription), and more potent corticosteroid derivatives incorporated in solutions, foams, and creams.

Antiparasitic agents destroy or inhibit living infestations. Examples include permethrin (Elimite or Acticin) cream for scabies, γ-benzene hexachloride (Kwell) cream and lotion for scabies and pediculosis, crotamiton (Eurax) for scabies, and permethrin (Nix) for pediculosis. For scabies and lice, 10% sulfur can be mixed in petrolatum and is effective and very safe, even in infants and pregnant women, but is malodorous and stains.

Antiseptics destroy or inhibit bacteria, fungi, and viruses. Alcohol hand sanitizers are effective on hands and cloroxcontaining cleansers are very effective on inanimate fomites such as counters, floors, exam tables, and so on.

Antibacterial topical medications include gentamicin (Garamycin), retapamulin ointment (Altabax), mupirocin (Bactroban), bacitracin (recently found to cause a significant number of cases of contact dermatitis), Polysporin, and neomycin (Neosporin), which causes an appreciable (at least 1%) incidence of allergic contact sensitivity. Soaps, such as Lever 2000 and Cetaphil antibacterial soap, can have extra antibacterial additives.

Antifungal and anticandidal topical agents include miconazole (Micatin, Monistat-Derm), clotrimazole (Lotrimin, Mycelex), ciclopirox (Loprox), econazole (Spectazole), oxiconazole (Oxistat), naftifine (Naftin), ketoconazole (Nizoral), butenafine hydrochloride (Mentax, Lotrimin Ultra), and terbinafine (Lamisil). Sulfur (3% to 10%) is an older but effective antifungal and anticandida agent. Nystatin is anticandida but not antifungal.

Antiviral topical agents are acyclovir (Zovirax) ointment or cream and penciclovir (Denavir).

Emollients soften and moisturize the skin surface. Nivea oil, mineral oil, and white petrolatum are good examples. Newer emollients are more cosmetically elegant and effective.

Ointments moisturize the skin. Examples include Vaseline Petroleum Jelly, Lanolin, Aquaphor, Cetaphil, and Eucerin.

Creams dry the skin but are more cosmetically acceptable than ointments because they do not feel greasy and do not leave oil marks on paper products. Examples are Dermovan and Acid Mantle cream. Newer moisturizers attempt to restore the normal skin barrier for protection and to increase penetration of other topicals applied on top of these agents. Three examples are Mimyx, Atopiclair, and CeraVe.