Cooling ointments for bruises

In case of a bruise, a closed type injury, the first treatment procedure should be cooling, usually ice, a cold compress. On the second day, the injury can be treated with such drugs as cooling ointments, they save from bruises both as a local irritant, reducing swelling, and as a method of pain relief.

Unlike warming external preparations, which are indicated on the 3rd-4th day, cooling ointments do not have a clearly expressed effect of irritating the nerve receptors of the skin, but they relieve the primary symptoms after a bruise well due to the anesthetic, anticoagulant components included in the preparation.

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Indications for use

Almost all bruises are accompanied by damage to the subcutaneous tissue to one degree or another. Tela subcutanea (subcutaneous tissue or hypodermis) is saturated with fatty tissue and is able to cushion, soften blows and other mechanical effects on the soft tissues of the body. Taking the first blow, the tissue is damaged, small vessels are injured, edema and hematoma develop. In order to stop the process, a remedy is needed that can quickly restore microcirculation, stop local hemorrhage due to a distracting, irritating effect on skin receptors. Such drugs are MRS - local irritants for external use. They are divided into groups - warming and cooling ointments, which, as a rule, are also anti-inflammatory drugs against bruises. Cooling does not mean a local decrease in body temperature in the area of injury, but the subjective sensation of "cold" due to the effect on receptors helps relieve pain, therefore MRS with a cooling effect are indicated for use not only in soft tissue contusions, but also in the treatment of other diseases of the musculoskeletal system. The task of such dosage forms:

• Local anesthesia.
• Distracting effect due to the reaction of menthol or essential oils with skin receptors.
• Local impact on the inflammatory process in the hypodermis.
• Activation of microcirculation in the damaged area.
• Relief of swelling areas.

Cooling ointments, indications for use:

• Myalgia.
• Arthralgia.
• Contusions of soft tissues, including closed fractures.
• Sprains.
• Edema.
• Neuralgia.
• Bruises, hematomas.
• Tendinitis.
• Tendonitis.
• Sports injuries.
• Extra-articular rheumatism.
• Lumbago.

Pharmacodynamics

Cooling ointments for bruises currently most often have a combined composition, which includes anti-inflammatory, anticoagulant components, as well as menthol or essential oils that have a cooling effect. The main effect of the sensation of "cold" occurs due to menthol - the most active organic substance, which "distracts" the nerve receptors of the skin from the main function - to conduct a pain signal. The skin is equipped with temperature receptors, which include the following groups:

• Close location, directly on the skin – Krause cold flasks.
• Deep location in the dermis, subcutaneous fat tissue - Ruffini's bulbous bodies.
• Deeply located in the apical cells of the skin are the Golgi-Mazzoni bodies.

The effect, or rather the pharmacodynamics of menthol can be different, it all depends on the concentration.

1. If the external medicinal product contains less than 1% Mentholum, it can reduce the sensitivity of thermal receptors responsible for thermoregulation.
2. If the concentration exceeds 1.2-1.5%, menthol quite intensively stimulates nerve endings, causing a change in sensations - from cold to irritation, warmth.

Cooling ointment is always applied externally only, in the area of the bruise, causing short-term local inflammation, acting as a distracting irritant. The pharmacodynamics of the main active ingredients of ointments with a cooling effect is due to the inhibition of the function of lipoxygenase and cyclooxygenase of both types. Inhibition of the reaction of the arachidonic cascade of synthesis of oxidized PUFA (polyunsaturated fatty acids) leads to a slowdown in the production of prostaglandins in the area of the bruise, thereby reducing the sensation of pain and to a certain extent providing an anti-inflammatory effect.

Instant stimulation of receptors provokes a reflex response, activating blood circulation due to the expansion of small vessels. Impulses from thermoregulatory skin receptors enter the brain, creating local excitation in the cortex cerebri – the cerebral cortex. In these zones, biologically active substances of the endogenous type are released – peptides, enkephalins, kinins, endorphins, responsible for the regulation of sensations. Thus, the distraction of the nerve impulse with the help of cutaneous-visceral reflexes in accordance with the innervation zones helps to temporarily redistribute the subjective sensation of pain.

Pharmacokinetics

When applying any ointments to the skin, absorption and penetration of active substances into the bloodstream practically does not occur. Gel forms of external agents overcome the barrier a little faster and easier, their pharmacokinetics are dynamic, ointments are absorbed more slowly, their action is mainly aimed at relieving a certain painful and inflamed area. Thus, the therapeutic concentration of the drug in the cooling ointment is only at the site of the injury, without spreading widely, and without affecting the separated areas of the skin. The amount of the active ingredient in the subcutaneous layers is proportional to the diameter of the injury and may depend on the frequency of application of the product.

When applied to skin that does not have visible damage - wounds, scratches or ulcers, the absorption rate of the cooling ointment is no more than 2.8 mm per hour. Absorption into the systemic bloodstream does not exceed 0.1%, when studying blood plasma 8 hours after applying ointments with menthol or camphor in a dosage of 4 grams twice a day, the level of active substances does not exceed the following indicators:

• Camphor – 41±5.8 ng/ml.
• Menthol - 31.9±8.8 ng/ml.

The higher the concentration of menthol and camphor in the ointment and the higher the dose of the product, the higher the number of their traces in the plasma; when using 2 grams of ointment or gel, active substances are not detected in the blood.

The pharmacokinetics of ointments containing camphor is the most intense. Like other terpenoids, it is able to overcome the blood-brain barrier and can also penetrate the placenta into the blood. Therefore, there are contraindications to the use of such agents in the treatment of pregnant women and during lactation. Camphor is excreted mainly by the kidneys, but due to volatile substances, a small part of it gets into the lungs and is excreted through them with mucus. This route of excretion is possible in the treatment of bruises of the upper half of the body, head.

Cooling ointments for bruises: list of preparations

The list of products that can be used immediately after a bruise is large. Cooling external preparations can relieve pain from the injury, provide an anticoagulant effect and prevent the development of a hematoma, provided that the ointment or gel is applied to the bruise area carefully (it cannot be rubbed in), in a thin layer.

• Gevkamen. Contains menthol, clove flower extract, eucalyptus oil. The ointment belongs to the category of MPC and is indicated as an analgesic, local irritant for bruises, myalgia, arthritis.
• Bom-Benge. Contains methyl salicylate and peppermint oil. The ointment is indicated as a distracting and anti-inflammatory agent for muscle pain, joint pain, sprains and bruises. A thin layer provides short-term cooling, a denser application may cause a burning sensation.
• Ben-Gay. The ointment contains racementhol and methyl salicylate. The drug is intended for external treatment of myositis, bruises, for massage, and also as a pain reliever for lumbago and arthralgia.
• Bengin. Contains methyl salicylate as an anti-inflammatory component and menthol as a cooling agent. The ointment helps with closed-type injuries, arthritis, myalgia, myositis.
• Troxevasin. Although the ointment or gel does not have a pronounced cooling effect, they successfully treat bruises as angioprotectors due to the composition, which includes troxerutin. The oxidation-reduction process that the drug starts helps to stop hematomas, reduce swelling and restore normal microcirculation in the injury area.
• Menovazin gel. Contains novocaine, menthol, anesthesin. The gel is indicated as a pain reliever and a cooling agent for the injured area.
• Menthol ointment, containing methyl salicylate, lanolin, menthol, is indicated for any type of muscle pain, and also successfully copes with the primary symptoms of soft tissue contusions (bruises).
• Reparil gel, contains horse chestnut extract, heparin. It is indicated as a pain reliever, cooling agent for swelling, lymphostasis, and bruises.
• Efkamon. When applied in a thin layer, it has a local cooling effect due to camphor in combination with menthol and essential oils of eucalyptus and cloves. Methyl salicylate as a component of the ointment relieves local inflammation.
• Flexall, a gel containing camphor, menthol, salicylates, aloe extract and vitamin E. Helps with bruises, arthritis, bursitis, lumbago.

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How to use cooling ointments for bruises?

Cooling ointments should be applied either immediately after a closed injury or a day later, when cold and a compression bandage have been applied. The sensation of "cold" helps to numb the area of the bruise, prevent the spread of internal local hemorrhage. The ointment is applied in a thin layer, do not rub it in to avoid additional injury to the subcutaneous tissue. After the product is absorbed, the injured part of the body can be wrapped in a bandage, make a dry compress. It is believed that a bruise is treated faster with a gel form, since such a consistency is absorbed faster, and the active substances of the gel are well absorbed into fairly deep layers of the dermis. It is recommended to apply the gel immediately after the injury, it is advisable to use an ointment with a cooling effect later - on the 2nd or 3rd day. It should be noted that an excessively thick layer of gel does not provide rapid pain relief, on the contrary, it creates a kind of film that interferes with the absorption of the drug.

The regimen, method of application and dosage depend on the severity of the injury, the extent of the affected area, but as a rule, the ointment is applied 2-3 times a day for a maximum of 5 days. If after a three-day course the symptoms of the injury do not subside, but rather intensify, you should consult a doctor for an accurate diagnosis of the injury and to rule out a fracture or dislocation. You should also be attentive to any atypical reactions from the skin; if a rash, itching, or severe irritation occurs, the product should be removed and its use discontinued.

Here is an example of applying Gevkamen ointment for adults:

• The skin should be clean and dry.
• The ointment should be applied in a thin layer, evenly distributing it over the entire diameter of the bruise.
• After applying the ointment, wash your hands thoroughly to avoid the product getting on mucous membranes (eyes, nose).
• For an area of up to 800 sq. cm (the diameter of the knee joint), up to 4 grams of ointment is required.
• The strip of ointment should not exceed 3-4 centimeters in length.
• The maximum dosage for using the ointment is 4 times a day.
• The maximum dose is 8 grams per day.
• The duration of treatment should not exceed 5 days.

Special recommendations:

• It is not recommended to apply the cooling ointment in combination with a compress; it is indicated after the product has been completely absorbed.
• For an injury that is diagnosed as acute, the most appropriate form would be a gel rather than an ointment.
• After a two- to three-day course of cooling agents, it is recommended to use warming ointments for bruises.
• You cannot visit a solarium or take sun treatments after applying the ointment to avoid photodermatitis and allergies.
• MRS with a cooling effect is not applied before visiting a bathhouse or sauna.

Use during pregnancy

During the entire period of pregnancy, caution should be exercised in the use of any medications, therefore, despite their relative safety, external agents are also included in the group of drugs that should not be prescribed during gestation. As for cooling ointments, their use during pregnancy and breastfeeding is not recommended.

1. Camphor, which is part of the ointments, can overcome the BBB (blood-brain barrier) and can penetrate the placenta. It is contained in the ointment in minimal quantities and the degree of its absorption is low, but this risk should still be taken into account when using the cooling ointment on a regular basis.
2. Both menthol and camphor and other components of cooling external agents can provoke an allergic reaction in the expectant mother.
3. There is an opinion that terpenes are able to penetrate into the systemic bloodstream and are partially excreted with breast milk, therefore, cooling ointments for bruises during lactation are not recommended.
4. Many doctors are convinced that menthol, as an active terpenoid, can affect estrogen levels and carries the risk of activating premature labor.

The use of any external agents during pregnancy, including drugs aimed at treating bruises, should be supervised by the attending physician, since combined MRS (local irritants) can cause unwanted side effects and even complications.

Contraindications for use

Since all MRS with a cooling effect contain active skin-irritating components, they have contraindications for use.

Cooling ointments for bruises should not be used in the following diseases and conditions:

• Pregnancy, especially the 1st trimester.
• Lactation period.
• Childhood. For children, ointment for bruises is prescribed by a doctor. As a rule, such products are not recommended for children under 5-7 years of age.
• History of allergies.
• Contact dermatitis.
• Violation of the integrity of the skin - cuts, abrasions, wounds.
• Individual sensitivity to the components of the ointment.
• The so-called aspirin triad - with caution in case of gastric ulcer, duodenal ulcer, diseases associated with blood clotting disorders. This contraindication applies to cooling ointments that contain methyl salicylate.
• Long-term use may worsen kidney disease.

Side effects

Side effects of cooling ointments are caused by active components - racementol, essential oils, plant extracts, camphor and anti-inflammatory ingredients. Most often, side effects are associated with an allergic reaction, which develops in the form of skin manifestations - swelling, hyperemia, rash, itching. If the ointment is multicomponent and contains the above substances, it is advisable to conduct a skin test before using it - apply a minimum amount to the skin and wait 10-15 minutes. If the skin reaction is normal, the product can be used as directed.

The instructions, which must be in the factory packaging, indicate a fairly large list of possible side effects, but this is more likely to be associated with warnings of all potential risks than with real statistical facts of complications. Here is a list of expected side effects that may occur with careless or too long use of MRS with a cooling effect:

• Exudative erythema.
• Photosensitivity when skin is exposed to sunlight. This is especially important if the ointment contains citrus essential oils and methyl salicylate.
• Rash, itching.
• Hyperemia of the bruised area.
• Swelling.
• Allergy, rarely a complication in the form of Quincke's edema.
• Headache as a reaction to essential oils, camphor or menthol.
• Rarely – bronchospasm, exacerbation of bronchial asthma.
• Rarely - disturbance of heart rhythm or changes in blood pressure.

Overdose

Cases of classic overdose in the use of local irritants with a cooling effect have not been described, but often side effects and complications are associated with overzealous application of such drugs. In an effort to quickly relieve pain in the bruise, a person may use the ointment too often or apply it to large areas of skin.

In addition, an overdose is potentially possible when using MRS on damaged skin, i.e. on wounds, abrasions or scratches. In this case, the active components of the drug are able to penetrate into the systemic bloodstream and have a negative effect on the body.

To avoid such complications, you should use the ointment either as recommended by your doctor or consult a pharmacist.

When purchasing and before applying the cooling ointment, pay attention to its properties:

• The ointment and gel should be easy to apply and remove with a dry cotton cloth or napkin.
• The ointment or gel should be uniform in consistency.
• The factory packaging must not show any signs of damage, and the tube must be hermetically sealed.

Interactions with other drugs

Unlike other types of ointments for bruises, cooling agents are more active in interaction with other drugs. This is due to their composition, which may include menthol, essential oils, camphor and other components containing volatile substances, terpenes (limonene, carvone, menthol, dihydrocarvone).

As a rule, in a combined cooling ointment with menthol, the following substances do not combine well, neutralizing each other:

• Resorcinol.
• Camphor (allowed only in small doses if there is an ingredient that neutralizes the activity of camphor).
• Thymol.
• Antipyrine.
• Salicylates.
• Chloral hydrate.

This combination leads to the dilution of the components and the product loses its effectiveness. Almost all terpenes, when interacting with other drugs, weaken the activity of both themselves and their "opponents". This is well understood and taken into account by pharmacists who create cooling external drugs from the category of local irritants (local irritants). Therefore, there is no need to fear side effects from the ointment itself, which often consists of several components. And the combination of ointments with other external agents is unlikely, since they are applied alternately. Another possible way of interaction of a cooling agent with oral drugs is also not capable of causing complications due to the low degree of absorption of the gel or ointment. The only feature concerns the combination of terpenes and terpenoids (cineole, menthol, carvone and other types) with drugs from the NSAID group (non-steroidal anti-inflammatory drugs). The simultaneous use of such agents significantly activates their effect, promoting deeper penetration into the deep layers of the dermis, but this is rather a positive aspect of interaction than a contraindication to such a combination. Also, the effect of the cooling ointment can be enhanced by preliminary application of DMSO - dimethyl sulfoxide or, more simply, dimexide. Dimexide allows you to accelerate the systemic absorption of all active ingredients of the ointment, such absorption leads to rapid pain relief and neutralization of swelling at the site of the injury.

Storage conditions

The most convenient for storage are external preparations in the form of ointments on a fat base; ointments based on an emulsion are more sensitive to environmental conditions.

Storage conditions for gels with a cooling effect suggest placing them in a place inaccessible to children. It is best to store the ointment, gel in a special first aid kit, in a dry place at a temperature not exceeding 15 degrees. In addition, to preserve the activity of the ointment ingredients, which are most often terpenes of essential oils, the tube should be opened immediately before applying the product, and after using the drug it must be tightly closed. In the future, until the next application of MRS, it should be stored in a hermetically sealed tube.

Standard storage conditions for external cooling preparations are indicated on the factory packaging, as well as the batch of the drug and its expiration date.

Best before date

The shelf life of the cooling ointment does not exceed 3 years, the exact date of manufacture of the drug and the final date of use or sale are always indicated on the packaging of the manufacturer. If the expiration date has expired, the drug should be disposed of. The use of a product with an expired end date is not only not recommended, but also strictly prohibited in order to avoid side effects and complications.

Cooling ointments for bruises are considered one of the most effective treatments, which allows you to quickly neutralize swelling and stop the process of soft tissue trophic disorders. The variety of ointments offered by the modern pharmaceutical industry helps to choose the most effective and efficient drug, and a doctor or pharmacist at the pharmacy will help you make the choice.