Sometimes approaching the skin care section in your local pharmacy can be confusing. Most treatment options leave the buyer with the decision of cream or ointment, with not much information to make an informed decision. The issue is that topical products come in many forms, from creams, ointments and lotions, to gels, oils and sprays. How do we choose which is best? Is it all about convenience or is there a science to the madness? This article will try to help explain when to use one over the other, and hopefully turn the issue of choosing between them into the blessing of choice.
To start, the most common form is simply the cream. It is thick and generally made from a moist water-washable type base. A cream is used on areas of skin that may be dry, such as a rash from eczema or other forms of dermatitis. The primary role is to rehydrate the skin with its moisturizing cream base while being rapidly absorbed into the surface to provide relief through various medications. The most common over the counter (OTC) example is hydrocortisone cream or any other kind of non-medicated moisturizing cream that would be used on dry skin.
Another very common type of topical product is the ointment. While many believe that ointments and creams are interchangeable, this is only partly true. In order to fully optimize treatment of certain skin conditions, ointments are vital. There are many types of ointments. They can be water soluble such as in products containing polyethylene glycol (PEG), emulsifiable (water can be added to create an emulsion, but the main base does not contain water) such as hydrophillic petrolatum found in Aquaphor, or cold cream found in Eucerin, and finally there are ointments that do not mix with water at all, such as white petrolatum (Vaseline®). The less water absorbable, the more of a barrier it will create for protection. The more water absorbable, the more moisturizing it will be.
The main function of ointments is to provide an occlusive barrier to the treatment area, so that it may heal free from the environment to avoid further damage or infection. Ointments are commonly used for open wound care in which an antibiotic ointment is applied followed by a bandage or dressing (such as cutting a finger or scraping a knee). The main downside to using an ointment is that they are generally greasy and do not get absorbed into the skin as quickly as a cream, so for simple moisturizing, a cream would be preferred. Due to its greasy nature, many people find that applying an ointment before bedtime followed by a bandage is best in order to avoid being uncomfortable (particularly with cuts on the feet, to avoid putting a sock over it). Another common use for a non-water absorbable ointment is for diaper rash to prevent chafing between body creases. A moisturizing cream should be applied and allowed to absorb before using a barrier ointment to prevent drying.
It is important to note that occlusive ointments should not be used when there is any weeping of the area or wound. The weeping is a natural defense mechanism and should be allowed to occur in most cases.
Typically used for large areas of skin, lotions are a great option for many people. They are made similarly to a cream, with a higher amount of water in order to be less dense and viscous. The most common uses are for large areas of acne treatment, as well as simply protecting yourself from the sun with a bottle of sunscreen.
Typically made from carbomers or cellulose ether, gels are excellent for fast absorption and cosmetic acceptability. They are water-soluble and tend to liquefy quickly upon contact with the skin. This leaves behind the dissolved medication, which can then be absorbed into the skin through a thin layer. A common use of a gel is in arthritis pain relief due to its deep penetration and quick action, such as diclofenac emulgel (Voltaren®). However, because of its liquefaction upon skin contact, gels tend to be drying and are likely not the best choice for treating conditions that require moisturization.
Generally not used for large areas of skin contact, oils are reserved for their ability to hold an aroma such as in massaging oils or essential oils in aromatherapy. However, there are some more immediate medical treatments that come in liquid oil form, such as applying medicated oils to combat fungal nail infections.
Used for their ease of application, sprays can come in water-based or oil based lotions, aerosolized powders, among other forms. The most common uses are in anti-fungal sprays, and spray on sunscreen or deodorant.
Choosing the right base for the condition can dramatically improve healing.
Please do not hesitate to contact our Canadian Compounding Pharmacy team for more information on this topic at (416) 239-3566 or leave a comment below.
- Sc. (c), Pharm. D (c)