Anti-inflammatory ointments for bruises

When soft tissues are bruised, the integrity of the subcutaneous tissue is inevitably damaged, and therefore, small vessels, including those that conduct lymph. Swelling and hematoma in the injury area indicate a potential danger of developing a local inflammatory process, which can be stopped with external medications. Anti-inflammatory ointments for bruises are used both as monotherapy, immediately after injury, and a day after the initial cooling of the injury site, as is required for the treatment of bruises.

Quite often, ointments with PVNP (anti-inflammatory non-steroidal drug) or other components simultaneously have a cooling or warming, anti-inflammatory property. Such combined external agents are extremely effective and can be used not only for soft tissue contusions (bruises), but also as a treatment for other closed-type injuries.

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Indications for use

Anti-inflammatory ointments, as a rule, contain a component from the NSAID category - non-steroidal anti-inflammatory drugs, the action of which is aimed at pathoimmune inflammatory processes in connective and soft tissues. Indications for the use of such products are due to the universal mechanism, the chemical-pharmaceutical property of external NSAIDs to systemically affect non-infectious inflammatory foci. Anti-inflammatory ointments for bruises have the following effect on soft tissues, subcutaneous tissue and blood vessels:

• Anti-inflammatory effect – suppression of inflammation in the exudation phase, reduction of swelling.
• Anesthetic effect - the ointment reduces mild and moderate pain, the effect is more pronounced in muscles, soft tissues, to a lesser extent in joints, ligaments, tendons. Ointments are ineffective for visceral pain.
• Antiaggregatory action – suppression of platelet aggregation, especially if the ointment contains salicylates.

Immunosuppression – decreased permeability of small vessels and capillaries

Indications for the use of anti-inflammatory ointments for bruises:

• Closed bruises without damage to the integrity of the skin.
• Stretching of muscles and ligaments.
• Dystrophic, degenerative diseases of the musculoskeletal system.
• Inflammatory process in the joints.
• Radiculopathy.
• An inflammatory process in the synovial sac of the joint (bursitis).
• Myalgia, myositis.
• Fasciitis.
• Extra-articular rheumatism.
• Aponeurosis.
• Tendonitis.
• Osteoarthritis.
• Osteochondrosis.

Posttraumatic edema of non-skeletal tissues of the musculoskeletal system.

Pharmacodynamics

NSAIDs in ointment form may differ in chemical structure, but their pharmacodynamic principle is almost identical. More than 75% of anti-inflammatory ointments with NSAIDs have antiperitoneal, analgesic effect due to the ability to suppress mediators of the inflammatory process.

The group of drugs classified as non-steroidal anti-inflammatory drugs includes the following active ingredients:

• Saliclate derivatives – acetylsalicylic acid, mesalazine.
• Indole, indomethacin.
• Diclofenac is phenylacetic acid.
• Ibuprofen is propionic acid.
• Oxicam - piroxicam.

Almost all of them suppress the activity and production of cyclooxygenase (COX), block the connection of prostaglandins, providing a pronounced anti-inflammatory effect. In addition, inflammation is relieved by reducing the permeability of the walls of small vessels and capillaries, activating local blood circulation, reducing the production of histamine, and slowing down the production of ATP. Thus, the energy supply of the inflammatory process is stopped, and the slowdown in the production of bradykinin leads to a decrease in pain.

A clear reduction in inflammatory symptoms is noticeable after 3 days of using the ointment with NSAIDs, the anti-edematous effect is visible after 3-4 days.

Recent studies have shown that during trauma the body produces two types of cyclooxygenase – COX-1 and COX-2, which are well inhibited by non-steroidal anti-inflammatory drugs. These isoenzymes differ slightly in their functions. COX-1 is responsible for the production of prostaglandins, which control the regulation of the integrity and density of deep tissue layers, as well as for the activity of platelets, and partially for blood microcirculation. COX-2 is directly involved in the synthesis of lipid active substances (prostaglandins), which are mediators of the inflammatory process. Thus, the pharmacodynamic properties of ointment forms of NSAIDs depend on which active substance is the main one in them and on how actively it works with COX.

There is a classification that determines the pharmacodynamics of external agents with anti-inflammatory action.

High selectivity for COX-1	Indomethacin Salicylates Ketoprofen Piroxicam
Average selectivity of COX-1	Ibuprofen Diclofenac Naproxen
Moderate degree of COX-2 selectivity	Nimesulide

Pharmacokinetics

The pharmacokinetics of almost all external agents is characterized by their weak absorption properties. The degree of absorption is determined by the following factors:

• Frequency of application (2 or 4 times a day).
• The duration of action of the product (from 30 minutes to 3 hours).
• Area, zone of ointment application.
• Hydrophilicity of the active substance.
• Lipophilicity of the active component of the ointment.
• External application form: gel, ointment, emulsion, cream.

When applied locally (5-10% concentration), the ointment is absorbed very little and does not have a pronounced effect on internal organs and systems. Ointments containing NSAIDs slowly overcome the skin barrier, are retained in the subcutaneous tissue or synovial tissue, and most often concentrate there. Possible metabolic breakdown of the main active components occurs in shallow layers of soft tissue, then in small quantities in the liver, the products of biotransformation are excreted mainly by the kidneys. Some studies have described cases of concentration of salicylates and phenylbutazone in blood plasma when using anti-inflammatory external agents, but this is possible only with a long course of treatment with ointments, which is not practiced in principle for bruises.

Anti-inflammatory ointments for bruises, list

Many ointments with anti-inflammatory effect are based on the same active substance, but have different names determined by pharmaceutical manufacturing companies. Such "synonymous" drugs may have identical therapeutic effect, but may also differ from each other in the concentration of the main active component, as well as in the additional ingredients included in their composition.

External agents containing NSAIDs are divided into subgroups depending on the active ingredient:

1. Ibuprofen.
2. Salicylates.
3. Diclofenac.
4. Piroxicam.
5. Indomethacin.
6. Nimesulide.
7. Ketoprofen.

List of ointments and gels with anti-inflammatory effect:

• Dolgit.
• Ibuprofen (gel or ointment).
• Nurofen gel.
• Artrum gel.
• Bystrumgel.
• Voltaren.
• Diclac gel.
• Diclovit.
• Dolobene gel.
• Dicloran gel.
• Diclofenac (gel, ointment).
• Indovazin.
• Nise gel.
• Nimulite.
• Finalgel.
• Indomethacin ointment.
• Ortofen ointment.
• Voltaren.
• Ben-Gay.
• Orthoflex ointment.
• Fastum gel.
• Deep relief.
• Ketoprofen gel.
• Butadion ointment.
• Febrofid.
• Piroxicam gel.
• F-gel.
• Naklofen gel.
• Ketonal shell.
• Ultrafastin.

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How to use anti-inflammatory ointments for bruises?

How to use an ointment with an anti-inflammatory component is described either in the instructions or in the doctor's prescription. As a rule, the method of application and dosage are as follows:

• A small strip of ointment (5-10 cm) is applied to the cleansed skin at the site of the injury.
• The product is rubbed into the damaged area with light massage movements.
• The ointment should be applied 2-4 times a day (depending on the type of injury) or as prescribed by a doctor.
• The course of treatment is no more than 7 days, rarely it lasts 10 days in case of complex combined injuries.
• If after using the product the symptoms do not subside, atypical signs appear (redness, itching, swelling), the ointment should be removed with a dry napkin and a doctor should be consulted to replace the drug or conduct diagnostics to identify a possible hidden injury.
• If the injury is defined as extensive, severe, and accompanied by intense pain, the application of anti-inflammatory ointment is supplemented by taking oral analgesics.
• When applying the ointment, care must be taken to ensure that it does not come into contact with the mucous membranes of the mouth or eyes.
• Ointment with PVNP is not applied to an area of skin with a diameter greater than 10-15 centimeters.

Usually, anti-inflammatory external preparations do not require procedures in the form of compresses or compression bandages. Access of air to the site of injury after applying the ointment is desirable, as it ensures more active absorption of the product.

Use during pregnancy

Any drug containing NSAIDs is not indicated for use in pregnant women. A possible exception may be the ointment form, but even it is prescribed with caution, since the active substance of the drug can penetrate into the bloodstream in small quantities and overcome the placental barrier.

The use of many drugs during pregnancy is considered dangerous and is not recommended. Ointments or gels with anti-inflammatory action can be used only when their potential benefit exceeds possible risks and complications. The same principle applies during lactation. A categorical contraindication to the application of external anti-inflammatory drugs is the third trimester of gestation, starting from the 25th-26th week. Bruises in pregnant women are treated with cold, a compression bandage on the first day of injury, then external agents containing herbal components are indicated. Independent selection and application of ointments with active medicinal components during pregnancy is prohibited.

Contraindications for use

Despite the fact that external medications are not able to completely overcome the skin barrier, be absorbed into the bloodstream and have a pronounced systemic effect, they have their own contraindications for use. Depending on the main active substance, contraindications may be as follows:

1. Diclofenac:
   • Blood diseases, disorders of the hematopoiesis process.
   • Use with caution in case of exacerbation of gastric ulcer, especially with prolonged use of the ointment.
   • Wounds, scratches, cuts.
   • Eczema, dermatitis.
   • Pregnancy and breastfeeding period.
   • Age up to 5-6 years.
   • Individual intolerance to diclofenac.
2. Ibuprofen:
   • Salicylate intolerance, "aspirin" asthma.
   • Exacerbation of liver and kidney diseases.
   • Exacerbation of gastrointestinal disease.
   • Age up to 10 years.
   • History of allergies, urticaria.
   • Violation of the integrity of the skin, wounds, scratches.
   • Use with caution in case of allergic rhinitis.
   • Pregnancy and lactation period.
3. Indomethacin:
   • Diseases of the CNS (central nervous system).
   • Exacerbation of diseases of the gastrointestinal tract, kidneys or liver.
   • Children under 10 years old.
   • Pregnancy and lactation period.
   • An inflammatory process of infectious etiology.
4. Ketoprofen:
   • Infected wounds.
   • Dermatitis.
   • Eczema.
   • Children under 12 years of age.
   • Individual intolerance to ketoprofen.
   • During pregnancy or lactation only according to strict indications.
5. Nimesulide:
   • Age up to 2 years.
   • Pregnancy, lactation.
   • Infectious skin diseases.
   • Dermatitis.
   • Wounds, cuts, scratches.
6. Piroxicam:
   • Obvious renal failure.
   • Children under 12 years old.
   • Pregnancy.
   • Lability of the circulatory system, with caution in case of VSD.
   • Lactation.
   • Individual intolerance to piroxicam.

Any gel or ointment containing NSAIDs should be used with caution, preferably on the recommendation of a doctor or pharmacist.

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Side effects

Almost all non-steroidal anti-inflammatory drugs, regardless of their form, have side effects of varying severity. Ointments and gels, due to their specific form and external use, are considered the safest way to neutralize local inflammation in soft tissues, so their side effects are less pronounced and can be as follows: •

• NSAID gastropathy with long-term use (more than 14 days).
• Worsening of symptoms in renal failure due to a certain degree of inhibition of renal cyclooxygenase.
• Bronchospasm.
• Swelling at the site of application of the drug.
• Itchy skin.
• Hyperemia in the area of the injury.
• Rash.
• Hives.
• Rarely – Quincke's edema.

The most common side effects occur when applying ointments containing salicylates and dimethyl sulfoxide; the rarest complication when using external agents with NSAIDs is considered to be an immediate allergic reaction (Quincke's edema).

Overdose

It is almost impossible to overdose on an ointment containing an anti-inflammatory component. The product slowly penetrates the subcutaneous tissue, does not enter the bloodstream, so its overdose is unlikely and does not occur in clinical practice. The probability that an anti-inflammatory ointment can have a side effect is possible only in the case of an excessively thick layer when applied to the skin, as well as with too frequent or prolonged use of the drug - more than 4 times a day and use for more than 2 weeks. It should be remembered that many gels and ointments are not compatible with each other, so an external drug with NSAIDs must be applied separately or 2-3 hours after using another drug.

Interactions with other drugs

It is not recommended to experiment independently with the combination of all possible external agents. Anti-inflammatory ointments are usually prescribed a day after the injury, cold and a compression bandage are indicated in the first days. In addition, interaction with other drugs is due to the intersection of active substances, which can develop an immediate allergic reaction, in the best case, the drug will not work or will have low activity, in the worst case - side effects and complications are possible.

There are also positive aspects of interaction of NSAIDs with other drugs:

1. Products containing diclofenac:
   • With menthol – enhances the irritating, cooling and analgesic effect.
   • With salicylates – activation of anti-inflammatory action.
2. Ibuprofen with caffeine – enhances the pain-relieving effect.
3. Indomethacin with rutin, troxerutin – enhancement of the anti-edematous effect and angioprotective action in the damaged area.

It should be noted that many ointments that relieve inflammation are not compatible with ultraviolet radiation, so after applying them you cannot sunbathe or visit a solarium, even after completing the course of treatment for 14 days.

Storage conditions

Pharmaceutical manufacturers always indicate the storage conditions of the drug on the factory packaging. Cream, ointment, gel - this is a form of medicine that requires storage at room temperature (not higher than 20 degrees Celsius). If the ointment consists of several components, it includes menthol, it is possible to store the drug in the refrigerator. Gels, emulsions with NSAIDs should be kept in a dark, dry place to avoid consistency violation, ointments are also sensitive to heat and sunlight. Rule No. 1 - keep LS (medicines) in any form, be it tablets or ointment form, out of the reach of children, is mandatory.

Best before date

The following information should be indicated on the ointment’s factory packaging:

• The name of the product, its active ingredient and other components.
• The name of the manufacturer and the country where the drug is produced.
• Series and date of issue of the drug.
• The amount of the drug in grams.
• Method of administration of the drug.
• Expiry date and final sale date.
• Precautions when using drugs.
• Conditions for dispensing, sale - over-the-counter or prescription drug.

The shelf life of anti-inflammatory ointments should not exceed 3 years. Any unused preparation should be disposed of, as its application may cause side effects or complications.

Anti-inflammatory ointments for bruises are widely used not only in medical practice, but also as a method of self-treatment of minor injuries. Such great popularity of external agents that relieve local inflammation is due to many factors, including therapeutic effectiveness and the ability to purchase ointment without a doctor's prescription, almost in any pharmacy in any locality. In addition, the patient always has the opportunity to choose a remedy, as they say, "according to the wallet", since the modern pharmaceutical industry provides many analogues. The main thing is that the ointment with an anti-inflammatory effect helps to quickly cope with pain and other uncomfortable manifestations of the bruise.