What are the potential harms of using petroleum jelly (petrolatum) on the skin?

Petroleum Jelly Safety Profile

Petroleum jelly (petrolatum) is generally safe for topical use with minimal harms in most clinical contexts, though specific risks include potential folliculitis development when used as a greasy base cream, rare foreign body reactions with injection or inappropriate use, and species-specific dermal irritation documented in rabbits but not clinically relevant to humans.

Primary Safety Concerns

Risk of Folliculitis with Occlusive Application

• Greasy creams including petrolatum-based products may facilitate the development of folliculitis due to their occlusive properties and should be avoided for basic skin care in acne-prone or folliculitis-susceptible individuals 1
• This concern is specifically relevant when petrolatum is used as a vehicle for other medications or as a primary moisturizer on facial or acne-prone skin 1

Appropriate Clinical Uses

Despite the folliculitis concern, petrolatum has established beneficial uses in specific contexts:

• Petrolatum is recommended for prevention of paronychia around nails due to its lubricant and smoothing effects, preventing moisture evaporation by forming a protective film 1
• Coal tar in petroleum jelly (0.5-10% crude coal tar) is considered extremely safe and effective for psoriasis treatment, though messier than refined products 1
• Petrolatum application around fissures is recommended when using topical cholesterol and statins for CHILD syndrome 1

Documented Adverse Effects

Injection-Related Complications

• Penile injection of petroleum jelly by non-medical practitioners causes foreign body reactions with resultant scarring, deformity, and ulceration requiring surgical excision 2
• This represents misuse rather than appropriate topical application 2

Neonatal Sepsis Risk

• A randomized controlled trial in very low-birthweight infants (<1250g) showed a trend toward increased culture-proven nosocomial sepsis (54% vs 41%) and necrotizing enterocolitis (20% vs 8%) with twice-daily whole-body petroleum jelly application, despite improved skin condition 3
• This finding is specific to premature neonates and should not be extrapolated to general topical use in other populations 3

Animal Toxicology (Not Clinically Relevant)

• New Zealand white rabbits exhibited moderate to severe erythema and histologic dermal irritation with petrolatum application, but rats, mice, and minipigs showed no such reactions 4
• This species-specific finding has limited relevance to human use, as petrolatum remains widely used in cosmetics and pharmaceuticals without similar human reactions 4

Comparative Efficacy Data

• Petrolatum performs equivalently to "skin-identical lipids" formulations in promoting barrier repair in experimentally damaged human skin, with no advantage demonstrated for more complex lipid mixtures 5
• In incontinence-associated dermatitis prevention, petroleum jelly applied after zinc oxide improved skin pH and moisture better than mixed products 6

Clinical Recommendations

For general moisturization and barrier protection: Petrolatum is safe and effective for intact skin, wound edges, and protective applications around nails 1

Avoid in these contexts:

• As a base cream for facial care or acne-prone skin where folliculitis risk exists 1
• Whole-body application in premature neonates due to sepsis risk 3
• Never for injection or inappropriate routes of administration 2

Preferred applications:

• Nail fold protection during chemotherapy or frequent hand washing 1
• Vehicle for coal tar in psoriasis treatment 1
• Barrier protection for specific dermatologic conditions 1, 6