What are examples of petroleum-based ointments and creams for patients with dry skin and a history of eczema (atopic dermatitis) or psoriasis?

Petroleum-Based Ointments and Creams for Dry Skin in Eczema and Psoriasis

Petroleum-based products include petrolatum (petroleum jelly) as a primary occlusive ingredient, zinc ointment formulations, and various commercial emollient creams containing mineral oil and paraffin—these serve as the foundation of barrier repair therapy for patients with atopic dermatitis and psoriasis. 1

Specific Petroleum-Based Formulations

Pure Occlusive Agents

• Petrolatum (100% petroleum jelly) is the gold standard occlusive emollient that creates a surface lipid film to retard evaporative water loss from the epidermis 1
• Zinc ointment (such as 1% ichthammol in zinc ointment) combines petroleum base with therapeutic additives for lichenified eczema 1

Commercial Petroleum-Containing Products

Many over-the-counter and prescription emollient creams contain petroleum derivatives as inactive ingredients, including: 2

• Mineral oil (liquid petroleum derivative)
• Paraffin (solid petroleum derivative)
• Petrolatum (semisolid petroleum derivative)

A representative FDA-approved formulation contains petrolatum, mineral oil, and paraffin as key occlusive ingredients alongside humectants like glycerin and propylene glycol 2

Application Strategy for Maximum Benefit

Timing and Frequency

• Apply emollients immediately after bathing while skin remains damp to lock in moisture—this is when they are most effective 1, 3
• Use at least twice daily and as needed throughout the day, with liberal application being essential 3, 4
• Continue daily use even when skin appears clear to maintain barrier function 4

Quantity Considerations

• Prescribe in large quantities (up to 600 g/week for adults) to enable truly liberal use—underprescribing is a critical pitfall 4, 5
• Demonstrate proper application technique rather than relying on verbal instructions alone 3, 4

Choosing Between Ointments and Creams

Use ointment formulations for very dry skin and cream formulations for areas prone to sweating 6

Ointments (Petroleum-Heavy)

• Contain higher concentrations of occlusive agents
• More effective for severe xerosis and lichenified areas 1
• May feel greasy but provide superior barrier protection

Creams (Petroleum-Containing)

• Better tolerated in intertriginous areas and during warm weather 6
• Less occlusive but more cosmetically acceptable for daytime use

Critical Caveats About Petroleum-Based Products

The Paraffin Paradox

Simple paraffin-based emollients without humectants may actually reduce the skin's natural moisturizing factor (NMF) despite widespread prescription 5. Recent evidence shows that paraffin cream alone had no effect on skin barrier function and reduced NMF levels compared to formulations combining petroleum bases with humectants like urea and glycerol 5.

Optimal Formulation Strategy

• Petroleum-based products work best when combined with humectants (glycerin, urea) rather than petroleum alone 5, 7
• Products containing 25% paraffin with 5% glycerine demonstrated significant improvements in skin hydration and barrier function 7
• Formulations with urea and glycerol markedly improved skin barrier and protected against irritation better than simple paraffin cream 5

Integration with Other Therapies

Soap Substitution

• Replace all soaps and detergents with petroleum-based dispersible cream cleansers to prevent stripping natural lipids 1, 3, 4
• This is non-negotiable for patients with atopic dermatitis or psoriasis 1

Corticosteroid Enhancement

• One study showed that combining a water-in-oil cream with betamethasone dipropionate increased efficacy while achieving control with fewer steroid applications 1
• The steroid-sparing effects are attributed to restoration of normal hydration and water barrier function 1

Bath Oil Addition

• Add bath oils according to patient preference for both cleansing and hydration 1, 3
• Use lukewarm water and limit bath time to 5-10 minutes to prevent excessive drying 3

When Petroleum-Based Products Are Insufficient

If dry skin persists despite appropriate petroleum-based emollient therapy and environmental modifications, consider: 3

• Allergic contact dermatitis requiring patch testing
• Secondary bacterial infection (look for crusting or weeping) requiring flucloxacillin 4
• Herpes simplex superinfection (grouped vesicles or punched-out erosions) requiring prompt acyclovir 3, 4
• Need for topical corticosteroids using the least potent preparation necessary 1, 6, 4