Generic Name

Witch Hazel

Mechanism

• Tannins & Polyphenols: These compounds precipitate proteins on the skin surface, forming a protective film that tightens tissues and reduces capillary permeability.
• Vasoconstriction: The astringent effect leads to transient narrowing of superficial vessels, which decreases erythema and swelling.
• Anti‑oxidant activity: Scavenging of free radicals mitigates oxidative stress from inflammation and injury.
• Moisturizing effect: While acting as an astringent, the extract can be formulated with humectants (e.g., glycerin) to prevent desiccation of the skin.

Pharmacokinetics

Indications

• Dermatologic
• Mild eczema, psoriasis flare‑ups, and seborrheic dermatitis
• Acne – reducing post‑acne inflammation and redness
• Minor burns, insect bites, and superficial abrasions
• Post‑procedure skin prep for minor surgeries
• Gastro‑enterology
• Hemorrhoidal symptom relief (external application)
• Relief of anal itching due to hemorrhoids or fissures
• Reproductive Health
• Treatment of vaginal itching and irritation (when compounded as a hydrating cream)
• Cosmetics
• Toner for facial skin to tighten pores and reduce shine

Contraindications

• Hypersensitivity to *Hamamelis* species or tannin‑containing products.
• Open or compromised skin—avoid use on deep wounds or infected lesions to prevent additional irritation.
• Children under 6 years—limited data on safety; use with caution.
• Pregnancy & Lactation—considered low‑risk but data are sparse; use only per clinician’s guidance.
• Avoid ophthalmic contact—may cause burning or itching.

Dosing

• Topical Cream / Lotion (5–10% extract, alcohol‑free):
• Apply a thin coat to affected area 2–3 times daily or as needed.
• Tapered Alcoholic Toner (10–20% extract):
• Use a cotton pad to dab on skin twice daily; leave to dry.
• Hemorrhoid Application:
• 1–2 drops applied externally once daily; may increase to 2‑3 times daily if no irritation develops.
• Preparation Guidelines
• Store in a cool, dry place away from direct sunlight.
• Ensure product is free from added fragrances or alcohol if used on sensitive skin.

Adverse Effects

• Common
• Mild skin dryness or flaking (especially with alcohol‑based formulas).
• Local irritation, burning, or itching.
• Contact dermatitis (rare).
• Serious
• Severe hypersensitivity reactions: rash, swelling, anaphylaxis (exceptionally rare).
• Phototoxicity if combined with certain sunscreens; advise sun protection.

Monitoring

• Clinical Observation:
• Inspect application site for signs of irritation, erythema, or delayed healing.
• If Used for Hemorrhoids:
• Monitor for worsening pain, bleeding, or bleeding episodes.
• Long‑Term Use:
• Assess skin barrier integrity; adjust hydration regimen if dry skin persists.

Clinical Pearls

• Formulation Matters: Alcohol‑free extracts preserve skin integrity and reduce irritation; choose alcohol‑based toners only when astringency is paramount.
• Potency Check: Higher concentration (10–20%) works best for vascular congestion (e.g., hemorrhoids) but may provoke dryness on sensitive areas.
• Combine With Humectants: When formulating for eczema or psoriasis, pair witch hazel with glycerin or aloe vera gel to balance astringency with moisturization.
• Avoid Eye Contact: Even mild irritation can cause discomfort; always apply around the ocular region with caution or avoid entirely.
• Sun Protection: Witch hazel does not function as a sunscreen; advise patients to wear sunscreen after application, particularly if the product is alcohol‑based.
• Age‑Appropriate Use: For infants and toddlers, consider a 2–5% solution and apply sparingly; infants over 6 months may tolerate lower‑strength products under supervision.

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• *Prepared by: Precision Pharmacology Assistant*