What ointment should I use for skin conditions?

Selection of Ointments for Various Skin Conditions

For most common skin conditions, moisturizing ointments such as white petrolatum or water-in-oil emollients are recommended as first-line treatment, with specific medicated ointments added based on the particular skin condition. 1

General Principles for Ointment Selection

For Dry Skin (Xerosis)

• First-line: Moisturizing ointments applied 3-8 times daily 1
  • White petrolatum (Vaseline) is highly effective and economical
  • Water-in-oil emollients are good alternatives when sweating is a concern
• Application technique: Use clean hands or latex-free gloves; consider single-use packets to avoid contamination 1
• Frequency: Apply after bathing to lock in moisture 1

For Inflammatory Skin Conditions (Eczema/Dermatitis)

1. Mild cases:

   • Start with moisturizers/emollients 1
   • Add low-potency topical corticosteroids (e.g., hydrocortisone 2.5%) for flares 1

2. Moderate cases:

   • Medium-potency topical corticosteroids 1
   • Consider maintenance therapy with steroids 2 times/week to prevent flares 1
   • Topical calcineurin inhibitors (tacrolimus 0.03% or 0.1% ointment, pimecrolimus 1% cream) 1

3. Severe cases:

   • Higher-potency topical steroids for short courses 1
   • Consider systemic treatments if topicals fail

For Infected Skin Conditions

• Localized impetigo: Mupirocin 2% ointment applied three times daily for 5-7 days 2, 3
• Widespread infection: Consider oral antibiotics rather than topical treatment 2

Specific Recommendations by Condition

Atopic Dermatitis/Eczema

1. Base treatment: Moisturizers (strong recommendation, moderate evidence) 1
2. Anti-inflammatory options:
   • Tacrolimus 0.03% or 0.1% ointment (strong recommendation, high evidence) 1
   • Pimecrolimus 1% cream for mild-moderate disease (strong recommendation, high evidence) 1
   • Topical corticosteroids (strong recommendation, high evidence) 1
   • Crisaborole ointment for mild-moderate disease (strong recommendation, high evidence) 1
   • Ruxolitinib cream for mild-moderate disease (strong recommendation, moderate evidence) 1

EGFR Inhibitor-Related Skin Reactions

1. Xerosis/dry skin:

   • Oil-in-water creams or ointments (avoid alcohol-containing products) 1
   • For pruritus: Add urea- or polidocanol-containing lotions 1

2. Acneiform rash:

   • Grade 1-2: Topical antibiotics (clindamycin 2%, erythromycin 1%, metronidazole 0.75%) 1
   • Grade 2-3: Add topical steroids and oral antibiotics (doxycycline, minocycline) 1

Onychomycosis (Fungal Nail Infections)

• Amorolfine 5% nail lacquer 1
• Ciclopirox 8% lacquer 1
• For severe cases: Consider oral antifungals rather than topical treatments 1

Minor Wounds and Bug Bites

• Simple wounds: Petrolatum-based ointment is as effective as antibiotic ointments with fewer risks 4, 5
• Infected bug bites: Mupirocin 2% ointment for localized infections 2, 3

Important Cautions

1. Avoid in neonates/infants:

   • Active substances like urea, salicylic acid, or silver sulfadiazine due to risk of percutaneous absorption 1

2. Antibiotic ointments:

   • Use only for clearly infected wounds 2
   • Unnecessary use contributes to antibiotic resistance 6, 4
   • Can cause allergic contact dermatitis 4

3. Topical steroids:

   • Risk of skin atrophy and systemic absorption with prolonged use 1
   • Use lowest effective potency, especially on face and intertriginous areas

4. Calcineurin inhibitors:

   • Monitor for systemic absorption, especially with tacrolimus ointment 1
   • Use only for short-term management of flares on limited areas 1

Evidence-Based Recommendations

Research demonstrates that for many minor skin wounds, simple petrolatum-based ointments (like Aquaphor) provide equivalent or superior healing compared to antibiotic-containing ointments 4, 5. This approach reduces risks of contact dermatitis and antibiotic resistance while maintaining excellent outcomes for wound healing.

For specific infections like impetigo, topical mupirocin has proven efficacy and should be used as directed for the full treatment course 2, 3.