How does Vaseline (petroleum jelly) work and is A&D (vitamins A and D) ointment more effective for patients with dry or irritated skin, particularly in pediatric or geriatric populations?

How Vaseline Works and Comparison with A&D Ointment

For dry or irritated skin in both pediatric and geriatric populations, petroleum jelly (Vaseline) is the superior first-line choice over A&D ointment due to its proven occlusive barrier function, minimal allergenicity, and strong evidence base from dermatology guidelines. 1

Mechanism of Action: Petroleum Jelly

Petroleum jelly functions as an occlusive emollient that creates a physical barrier on the skin surface 1:

• Prevents transepidermal water loss by forming a lipid film that traps moisture in the stratum corneum, reducing evaporative losses by approximately 5.59 g·m⁻²·h⁻¹ in damaged skin 2
• Improves skin barrier function without adding active ingredients that could cause sensitization 3, 1
• Provides maximum occlusion and penetration compared to creams or lotions, making it ideal for severe dryness and thick, lichenified skin 1, 4
• Requires no metabolic processing and works purely through physical occlusion 1

Why Petroleum Jelly is Preferred Over A&D Ointment

Petroleum jelly has the lowest allergenicity profile of any topical moisturizer, which is critical for irritated or compromised skin 1:

• Fragrance-free petrolatum-based products are recommended as first-line by the American Academy of Dermatology because they carry the lowest risk of contact dermatitis 1
• A&D ointment contains vitamins A and D as active ingredients, which increase the risk of sensitization reactions without proven superiority for basic moisturization 1
• Contact dermatitis occurs in 34.3% of treatment arms with various emollient formulations, but petrolatum has the most favorable safety profile 1

Evidence-Based Application Protocol

Apply petroleum jelly immediately after bathing when skin is still slightly damp to maximize moisture trapping 3, 1:

• Use after a 10-15 minute lukewarm bath or shower (not hot water, which disrupts lipid structure) 3, 1
• Pat skin dry rather than rubbing to minimize irritation 1
• Apply liberally and frequently throughout the day, with minimum twice-daily application for moderate-to-severe dryness 4
• For children with atopic dermatitis, a petroleum jelly bath technique can be used: apply a thin layer while skin is wet, eliminating the "greasiness" complaint while maintaining efficacy 5

Special Population Considerations

Pediatric Patients

Petroleum jelly is safe from infancy onward with no age restrictions, unlike some active ingredients 1:

• No risk of systemic absorption concerns that exist with active compounds 1
• Particularly effective for atopic dermatitis, which affects the majority of pediatric dry skin cases 3
• Can be combined with low-potency topical corticosteroids when inflammation is present 3

Geriatric Patients

Ointment formulations are preferred over creams in elderly patients with severe xerosis 1, 4:

• Aging skin has compromised barrier function requiring maximum occlusion 1
• Petroleum jelly provides superior hydration without risk of irritation from preservatives or fragrances 1
• Can be applied at night when greasiness is better tolerated, with lighter formulations during the day if needed 1

When A&D Ointment Might Be Considered

A&D ointment has no evidence-based advantage for simple dry skin and should not be preferred over petroleum jelly 1:

• The vitamins A and D provide no documented benefit for barrier repair compared to pure occlusion 1
• Increased allergenicity risk from additional ingredients outweighs any theoretical benefits 1
• May be used for diaper dermatitis specifically, but this is a distinct indication from general dry/irritated skin 1

Critical Pitfalls to Avoid

Do not use petroleum jelly under latex or rubber medical gloves, as it compromises glove integrity, though it is safe with nitrile, vinyl, and latex gloves when combined with alcohol-based sanitizers 1

Avoid "greasy creams" marketed as emollients that may worsen skin condition through occlusive properties without proper formulation 1

Do not delay application after bathing—the 3-minute window after patting skin dry is critical for trapping moisture 4

Integration with Other Treatments

Continue petroleum jelly even when using topical corticosteroids for inflammatory conditions like eczema 3, 4:

• Emollients have documented steroid-sparing effects in atopic dermatitis 3, 4
• Apply corticosteroid first, then petroleum jelly over it (not mixed together) 3
• Maintain aggressive emollient use during and after corticosteroid treatment 4

Expected Outcomes and Follow-Up

Reassess after 2 weeks of consistent twice-daily application 1:

• Improvement in skin hydration should be measurable by corneometry within 1 week 6
• If no improvement occurs, consider referral to dermatology rather than switching to A&D ointment 1
• For chronic conditions like nummular eczema, expect to use 200-400 grams per week when applying twice daily 4