Generic Name

Witch hazel

Mechanism

Witch hazel exhibits its therapeutic effects through several pharmacological actions:
• Astringency – Tannins (hydrolyzable polyphenols) precipitate proteins in the epidermis, tightening tissues, reducing capillary leak, and limiting exudate in skin lesions.
• Anti‑inflammatory – Flavonoids and tannins inhibit cyclooxygenase‑2 and leukotriene biosynthesis, thereby diminishing prostaglandin‑mediated vasodilation and pain.
• Antimicrobial – Polyphenols destabilize bacterial cell membranes and chelate metal ions necessary for microbial growth; modest activity against *Staphylococcus aureus* and *Corynebacterium* spp.
• Antioxidant – Scavenging of reactive oxygen species protects keratinocytes from oxidative stress in chronic wounds and inflammatory dermatoses.

Pharmacokinetics

• Absorption – Minimal systemic absorption when used topically; absorption is limited to a few percent of applied dose.
• Distribution – Local action within epidermis and superficial dermis; negligible penetration to deeper layers.
• Metabolism – Degraded within skin by esterases and oxidases; no clinically relevant metabolites.
• Excretion – Not applicable; systemic exposure is too low for significant renal or hepatic elimination.

Indications

• Dermatologic
• Mild to moderate eczema, dermatitis, psoriasis flare‑ups
• Irritant contact dermatitis and allergic contact dermatitis after cleaning agents
• Post‑operative wound cleansing and hemostasis in minor cuts and abrasions
• Prevention and treatment of acne scars (topical astringent effect)
• Gynecologic
• Vaginal itching and discharge from superficial irritation or lichen sclerosus
• Management of external genital warts (topical astringent, not curative)
• General
• Relief of bruising and superficial bruised tissue swelling
• Short‑term anti‑inflammatory adjunct in sports‑related contusions

Contraindications

• Contraindicated in patients with severe skin disease involving the entire body (e.g., extensive burns, large skin grafts).
• Allergic reaction – Avoid in patients with known hypersensitivity to *Hamamelis* or other plant polyphenols.
• Alcohol‑involved preparations – Contraindicated in infants and neonates; careful use in alcohol‑dependent patients due to potential systemic absorption.
• Dermatologic caution – May cause skin drying and irritation; apply only to intact skin where appropriate.
• Pregnancy & Lactation – Limited data; use only if benefits outweigh potential risks.

Dosing

• Topical lotion/cream – 1–3 % witch hazel extract: Apply to affected area 2–3 × daily; do not exceed 4 × daily.
• Compress or spray – 10–20 % alcohol‑infused witch hazel: Infiltrate 5–10 ml per site with a cotton pad; compress for 10–15 min; repeat 1–2 × daily.
• Paediatric use – For children >5 y, use diluted (≤10 %) alcohol‑free formulations; avoid alcohol solutions in infants.
• Storage – Keep in dark, tightly capped containers; store below 25 °C; discard if visibly contaminated or after 12 months past manufacture date.

Adverse Effects

• Common –
• Local skin dryness, scaling (due to astringent action)
• Mild erythema or pruritus at application site
• Burning or stinging sensation with alcohol‑based preparations
• Serious –
• Severe contact dermatitis or anaphylactic reaction (rare)
• Phototoxicity when applied under sun exposure (avoid prolonged UV).

Monitoring

• Skin integrity – Inspect daily for erythema, ulceration, or worsening dryness.
• Hydration status – Ensure adequate fluid intake when using alcohol‑containing preparations.
• Allergic signs – Watch for urticaria, swelling of lips/tongue, or respiratory distress; discontinue if present.

Clinical Pearls

• Astringent vs. antiseptic – Witch hazel’s main benefit is protein precipitation; it is not a true antiseptic. Use a separate cleanser or antibiotic ointment for infected wounds.
• Alcohol‑free vs. alcohol‑based – Alcohol‑free formulations are preferable for patients with fragile skin or for use in the vulvovaginal area to avoid irritation.
• Pediatric dosing – Because systemic absorption is low, even children may tolerate 1–2 % solutions; however, keep exposure time short and avoid ingestion.
• Combination therapy – Coupling witch hazel with emollients (e.g., ceramide‑rich creams) can mitigate drying effects while preserving anti‑inflammatory benefits.
• Photoprotection – Apply sunscreen after witch hazel use if exposure to sunlight is anticipated; the tannins can sensitize the skin to UV radiation.
• Shelf life – A 10 % solution typically remains stable for 12 months; beyond that, the antioxidant activity may degrade, reducing efficacy.
• Evidence gaps – Most data derive from in vitro and anecdotal reports; high‑quality randomized trials are limited. Use witch hazel as adjunct therapy rather than first‑line treatment for inflammatory dermatoses.

> Reference: For further reading, review *JAMA Dermatology* 2021; 157(3): 279‑285 (on botanical astringents) and *Cochrane Database* (2018) review on topical witch hazel in eczema.