What ointment is used for skin conditions?

Topical Ointments for Skin Conditions

For general skin conditions, white petrolatum (petroleum jelly) and emollient ointments are the primary topical treatments, applied 3-8 times daily for dry skin, while specific conditions require targeted therapies such as topical corticosteroids for inflammatory conditions or antiseptics for infected wounds. 1, 2

General Emollient Ointments

White soft paraffin (petrolatum) is the most commonly used sterile occlusive ointment for basic skin barrier protection and hydration. 1 This serves as the foundation for managing most dry skin conditions and provides a protective barrier.

Application Guidelines for Emollients

• Apply water-in-oil emollients 3-8 times daily, requiring 200-400g weekly for adequate coverage 2
• Clean affected areas before application 2
• Apply in a downward direction to prevent folliculitis 2
• Use ointment formulations rather than creams for very dry skin, as ointments spread more evenly and maintain consistent dosing across the treated area 3

A critical pitfall: creams and solutions evaporate rapidly, leading to uneven distribution with lower doses at the periphery of application, making ointments superior for consistent drug delivery. 3

Corticosteroid Ointments for Inflammatory Conditions

For inflammatory skin conditions like eczema, psoriasis, and dermatitis, topical corticosteroid ointments are the mainstay of treatment 1, 4:

Potency-Based Selection

• Mild potency: Hydrocortisone 1% for mild inflammation, safe for facial and genital areas 2, 4
• Moderate potency: Eumovate, Trimovate for moderate inflammatory conditions 2
• Potent: Betnovate, Elocon for severe inflammation on body surfaces 2
• Very potent: Clobetasol propionate 0.05% for resistant conditions like lichen sclerosus (once daily for 1 month, then alternate days for 1 month, then twice weekly for 1 month) 1

Application Technique

• Apply thinly once or twice daily to affected areas 2, 5
• Use ointment formulations for dry skin; reserve creams only for weeping/exudative areas 2
• Avoid prolonged use of potent steroids due to risk of skin atrophy and systemic absorption 1

Important caveat: The basic principle is using the least potent preparation required to control the condition, with periodic treatment breaks when possible. 1

Specialized Ointments for Specific Conditions

Tacrolimus Ointment (Calcineurin Inhibitor)

For areas where steroid-induced atrophy is a concern (face, genitals), tacrolimus 0.1% ointment applied twice daily until clearance is an effective alternative. 6, 7

• Available as 0.03% for children 2-15 years and 0.1% for adults 6
• Particularly useful for facial eczema and perineal conditions 6, 7
• Minimal systemic absorption when applied to intact skin 6
• FDA black box warning exists, though clinical evidence shows no causal link to cancer 6

Antiseptic Ointments for Infected/At-Risk Wounds

For wounds at risk of infection or with active infection:

• Aqueous chlorhexidine 0.05% for erosive lesions 1
• Silver sulfadiazine should be avoided in neonates due to percutaneous absorption risk 1
• Povidone-iodine may reduce healing time compared to chlorhexidine (mean difference -2.21 days) 8

Critical warning: Active substances like urea, salicylic acid, or silver sulfadiazine must be avoided in neonates and areas with compromised skin barrier due to systemic absorption risk. 1

Antifungal Ointments

• Clotrimazole cream for fungal infections on macerated skin areas 1, 9
• Ciclopirox 8% lacquer applied once daily for up to 48 weeks for onychomycosis 1
• Tioconazole 28% solution for nail fungal infections, though with lower cure rates 1

Tar-Based Ointments

• Ichthammol 1% in zinc ointment for lichenified eczema, less irritant than coal tar 1
• Coal tar solution 1% combined with hydrocortisone for chronic eczema 1

Urogenital Skin Care Protocol

For urogenital skin conditions with erosions or inflammation 10:

• Apply fatty emollient every 2-4 hours during acute phase 10
• Use potent topical corticosteroid ointment once daily on non-eroded affected surfaces 10
• Apply silicone dressing to eroded areas 10
• Daily examination during acute phase is essential 10

Catheterization may be necessary to reduce pain during urination and assess fluid balance in severe cases. 10

Key Clinical Pitfalls to Avoid

• Underuse of emollients: Inadequate quantities lead to treatment failure 2
• Using creams instead of ointments: Results in uneven drug distribution and reduced efficacy 3
• Overuse of potent steroids: Causes skin atrophy and systemic effects including pituitary-adrenal suppression 1
• Early discontinuation: Leads to rapid recurrence of symptoms 2
• Contamination of ointments: Use latex-free gloves and single-use packets to prevent infection 1