Choosing Between Creams and Ointments for Skin Conditions
Ointments should be used for dry, thick, or scaly skin conditions requiring deep penetration, while creams are better for less dry skin, areas with friction, and when cosmetic acceptability is important. 1
General Principles of Vehicle Selection
- Ointments are more occlusive, have higher oil content, and provide better barrier protection, making them ideal for very dry or thick skin conditions like psoriasis and chronic eczema 1
- Creams have a higher water content, are less greasy, and are more cosmetically acceptable for daytime use and in areas where friction occurs 1
- Vehicle selection significantly impacts medication penetration and efficacy, with ointments generally providing better drug delivery than creams for the same active ingredient 1
When to Use Ointments
- For thick, scaly plaques of psoriasis where deep penetration is needed 1
- For very dry, cracked skin conditions requiring intensive moisturization 2
- For nighttime application when greasiness is less concerning 1
- For wound healing and protection of damaged skin barriers 3
- For areas that need occlusion to enhance medication penetration 1
- For chronic conditions requiring sustained release of medication 4
When to Use Creams
- For intertriginous areas (skin folds) where occlusion could promote maceration 5
- For facial applications where cosmetic acceptability is important 1
- For hairy areas where ointments would be difficult to apply 1
- For acute or subacute inflammatory conditions with some moisture 1
- For daytime use when patients need to avoid greasy residue 1
- For areas with friction (like under breasts or between thighs) 5
Special Considerations
- For intertriginous areas like under-breast intertrigo, creams or lotions are preferred as ointments may trap moisture and worsen the condition 5
- For facial and genital skin, which is thinner, lower potency preparations in cream formulations are generally safer 1
- For scalp conditions, solutions, foams, or gels are typically preferred over both creams and ointments 1
- For children with atopic dermatitis, ointments may provide better barrier repair but creams may have better adherence due to comfort 1
Practical Application Tips
- The "fingertip unit" method can help determine appropriate quantity for application (one fingertip unit covers approximately 2% of body surface area) 1
- For optimal moisturization, apply products immediately after bathing while skin is still damp 1
- Patient preference significantly impacts adherence; matching vehicle to patient lifestyle and preferences improves treatment success 4
- Consider using creams during the day and ointments at night for conditions requiring intensive treatment 1
Common Pitfalls to Avoid
- Applying ointments to weeping or infected areas can trap moisture and worsen maceration 5
- Using high-potency topical steroids in ointment form on thin skin areas (face, genitals) increases risk of skin atrophy 1
- Neglecting patient preferences regarding vehicle formulation, which is a major factor in treatment adherence 4
- Using occlusive ointments in skin folds where they can trap moisture and promote fungal infections 5
By selecting the appropriate vehicle based on the location, skin condition, and patient preferences, you can optimize treatment efficacy while promoting adherence to the prescribed regimen.