Witch hazel, Hamamelis virginiana, is a botanical astringent agent commonly found in dermatological preparations and anorectal preparations. Astringent agents are commonly used to cosmetically freshen the skin, to cleanse an irritated area, and for personal hygiene. Witch hazel has long been an adjunct to perineal care following rectal or vaginal surgery or childbirth to help provide topical relief to inflamed tissues, including hemorrhoids. Pads or wipes containing witch hazel are also sometimes used for cleansing during diaper changes. Products containing the agent are available without a prescription (OTC) in the U.S.
Historically, the use of witch hazel in North America has been documented in Native American history. Native Americans boiled the stems or bark of Hamamelis virginiana and used the distillate as a remedy for sore muscles, cuts, insect bites, and inflammatory skin problems. European settlers learned of its use, and commercial products were first introduced in America around the time of the Civil War. The true medicinal efficacy of the substance has remained in question for decades. The FDA downgraded witch hazel from a Category I substance, which can make claims for efficacy and safety, to a Category III substance, which is unable to claim therapeutic efficacy, in 1980. However, the FDA later reversed its decision after further review, and witch hazel retained claims for use as an astringent agent.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Topical Administration
-For external use only.
-Follow application directions for specific product.
-Prior to application, when practical, cleanse the area to be treated with mild soap and water; rinse and gently pat dry.
-For cosmetic use; moisten a cotton ball or pad with the solution and gently apply to face and allow to dry. Or, use a pre-moistened commercial towelette.
-During application to the rectal area, do not put this product into the rectum by using fingers or any mechanical device or applicator.
-After topical application, discard cotton or pad.
-Many pads and wipes are safe for septic and sewer system disposal; check specific product label.
Most patients do not report any side effects from use of witch hazel; it is well tolerated topically. Witch hazel may rarely cause stinging on application (due to alcohol content of selected product) or skin irritation (e.g., drying of the skin or xerosis). Allergic reactions are rare, but patients should report any unusual skin rash (unspecified), worsening of the treated condition, or other unusual symptoms.
Instruct patients to discontinue witch hazel use and consult a health care professional if condition does not improve after 7 days or if the condition worsens. Patients should discontinue pad use and seek a health care professional for advice if rectal bleeding occurs. Witch hazel pads should not be put directly in rectum by using fingers or any mechanical device.
Self-use of witch hazel products has not been specifically established in children < 12 years; consult a doctor prior to use in any child under 12 years of age. Safety and efficacy have not been established for infants or neonates.
A specific FDA pregnancy risk category has not been assigned to witch hazel products for topical use; the products are non-prescription and carry no warnings in regard to pregnancy. Topical wipes soaked with witch hazel are commonly used during pregnancy; decades of anecdotal experience have not uncovered any suspected maternal or fetal risks with topical use.
Topical use of witch hazel has not been reported to have adverse effects in post-partum use and use is generally considered to be compatible with breast-feeding. Some products are non-prescription and contain no warnings with regard to breast-feeding. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
For the temporary relief of external itching (pruritus), burning, and irritation associated with hemorrhoids or for use to cleanse or for hygienic care to provide soothing relief of topical irritation in the perineal area:
Topical dosage (pads, towelettes, and wipes):
Adults, Adolescents, and Children 12 years or older: Gently apply the affected area by patting. May be used as a wipe instead of toilet tissue or other wipes to cleanse or soothe affected area. To use as a moist compress, fold and place in contact with irritated tissue; leave in place for 5 to 15 minutes. Discard after use. Repeat as needed. May be especially comforting following childbirth or vaginal or rectal surgery. Can be used up to 6 times per day or after each bowel movement; more frequent use should be under the advice of a health care professional.
For use as an astringent for the face and body and for relief of minor skin irritations due to insect bites or stings and minor skin abrasion (i.e., cuts or scrapes):
Topical dosage:
Adults, Adolescents, and Children 12 years and older: Apply to the affected area as often as needed.
Maximum Dosage Limits:
-Adults
6 applications/day for nonprescription use.
-Geriatric
6 applications/day for nonprescription use.
-Adolescents
6 applications/day for nonprescription use.
-Children
>= 12 years: 6 applications/day for nonprescription use.
< 12 years: Safety and efficacy have not been established.
-Infants
Safety and efficacy have not been established.
-Neonates
Safety and efficacy have not been established.
Patients with Hepatic Impairment Dosing
No dosage adjustments are needed.
Patients with Renal Impairment Dosing
No dosage adjustments are needed.
*non-FDA-approved indication
There are no drug interactions associated with Witch Hazel products.
Witch hazel, a commercial name for aqueous extract products distilled from a North American shrub, Hamamelis virginiana, is a botanical astringent that provides a local, limited astringent effect. Studies have suggested that the tannin released in the distillate has anti-inflammatory and astringent properties. Astringents contribute to topical drying of skin cells by decreasing secretions such as mucus. The drying effect and removal of debris helps relieve local burning, itching and irritation.
Witch hazel is applied topically. Systemic absorption is unknown, but thought to be minimal with topical application.