What are the recommended ointments for common skin conditions?

Common Ointments and Their Indications

Emollients and moisturizers are the foundation of topical therapy for most skin conditions, with specific medicated ointments indicated for various dermatological disorders based on their severity and characteristics. 1

Emollients and Moisturizers

• Water-in-oil emollients should be applied three to eight times daily for dry skin conditions, with 200-400g needed weekly for adequate coverage 1
• Recommended emollient types:
  • Lotions: Eucerin intensive (10% urea), E45 Lotion, Aveeno lotion - best for weeping skin 1
  • Creams/gels: Diprobase cream, Epaderm cream, Doublebase gel - good for daily use 1
  • Ointments: White soft paraffin, yellow soft paraffin, emulsifying ointment - most occlusive, best for very dry skin 1
• Soap substitutes: Aqueous cream, Doublebase emollient shower gel, Oilatum bath/shower products 1

Topical Corticosteroids

• Used for inflammatory skin conditions with different potencies based on severity 1
• Categories and examples:
  • Mild: Hydrocortisone 1% (0.1-2.5%), Daktacort (hydrocortisone 1% + miconazole 2%) 1
  • Moderate: Eumovate (clobetasone butyrate 0.05%), Trimovate (combination with antibiotics) 1
  • Potent: Betnovate (betamethasone valerate 0.1%), Elocon (mometasone 0.1%) 1
  • Very potent: Dermovate (clobetasol propionate 0.05%) - reserved for severe cases 1
• Application technique: Apply thinly once or twice daily to affected areas; use ointment formulations for dry skin and creams for weeping areas 1, 2
• Caution: Risk of skin atrophy and systemic absorption with prolonged use, especially with potent preparations 1

Topical Antibiotics

• Indicated for superficial skin infections or prevention of infection in minor wounds 3, 4
• Common preparations:
  • Triple antibiotic ointment (bacitracin, neomycin, polymyxin B) - effective for preventing infections in minor skin trauma 5, 4
  • Fusidic acid 2% - often combined with steroids (e.g., Fucidin H) for infected eczema 1
  • Clindamycin 2% or erythromycin 1% - useful for acneiform rashes 1
• Application: Apply 2-3 times daily to affected areas until healing occurs 3, 4

Antifungal Preparations

• Used for fungal skin infections including tinea and candidiasis 1, 6
• Common preparations:
  • Clotrimazole 1-2% - effective for most superficial fungal infections 6
  • Miconazole 2% - often combined with hydrocortisone (Daktacort) for inflamed fungal infections 1
  • Ketoconazole - useful for seborrheic dermatitis and fungal infections of the scalp 1
• Application: Apply 2-3 times daily for 2-4 weeks, continuing for 1-2 weeks after clinical resolution 6

Specialized Ointments for Specific Conditions

For Burns and Wounds

• Silver sulfadiazine 1% cream - for prevention of infection in second and third-degree burns 7
  • Apply once to twice daily to a thickness of approximately 1/16 inch
  • Reapply after hydrotherapy or when removed by patient activity 7

For Acne and Acneiform Rashes

• Benzoyl peroxide (2.5-10%) - first-line treatment for mild to moderate acne 1
• Topical retinoids - for comedonal acne and maintenance therapy 1
• Clascoterone - newer topical treatment for acne 1
• For EGFR inhibitor-induced rash:
  • Grade 1: Topical antibiotics (clindamycin 2% or erythromycin 1%) 1
  • Grade 2-3: Combination of topical antibiotics, steroids, and oral tetracyclines 1

For Atopic Dermatitis and Eczema

• "Soak and smear" technique - 20-minute plain water soak followed by application of mid to high-potency corticosteroid ointment to wet skin 8
• For severe cases: Tacrolimus 0.03% or 0.1% ointment or pimecrolimus 1% cream as steroid-sparing agents 1, 2
• CBD-enriched ointment has shown promise for inflammatory skin conditions including psoriasis and atopic dermatitis 9

For Warts

• Salicylic acid (15-40%) for plantar warts; lower concentrations (2-10%) for plane warts 1
• Formaldehyde gel or glutaraldehyde 10% solution for resistant cases 1

Application Guidelines

• For most conditions, clean the affected area before applying ointments 1
• Apply emollients in a downward direction to avoid folliculitis 1
• For inflammatory conditions, apply corticosteroids thinly once or twice daily 1, 2
• For severe mucosal involvement (e.g., Stevens-Johnson syndrome):
  • Apply white soft paraffin ointment every 2-4 hours to lips and affected mucosae 1
  • Consider potent topical corticosteroid ointment once daily for involved surfaces 1

Common Pitfalls to Avoid

• Underuse of emollients - most patients apply insufficient quantities (should use 200-400g weekly for adequate coverage) 1
• Overuse of potent steroids - can lead to skin atrophy and systemic effects 1
• Using creams when ointments would be more effective for very dry skin conditions 1
• Discontinuing treatment too early - many conditions require continued maintenance therapy 1
• Using topical antibiotics as monotherapy - increases risk of resistance 1