Ointments for dermatitis for adults

Practically for all nosological forms of inflammation of the skin, united in a group of dermatoses, patients are assigned this or that ointment against dermatitis.

These remedies are symptomatic, and indications for using each drug are the presence of such typical signs of dermatitis as redness of the skin (erythema), the appearance of rashes (in the form of urticaria, vesicles or papules with exudation), swelling, burning and itching. Of course, specific reasons for their occurrence are taken into account.

[1], [2], [3], [4], [5]

Release form

Here are the names of ointments against dermatitis, which today are most often used in the treatment of this disease.

In atopic dermatitis, which has a chronic form of flow, external means containing glucocorticosteroids (SCS) - natural hormones of the adrenal cortex (in the form of hydrocortisone) or similar synthetic substitutes are used.

Hormonal ointments for dermatitis include: Lorinden, Fluorocort (Triamcinolone, Triacort), hydrocortisone ointment (Akortin, Lokoid, Laticort), Advantan (and other ointments with methylprednisolone), Uniderm (mometasone, Avekort, Elokom), Celestoderm, etc.

Often, dermatitis can be complicated by bacterial or fungal infections, and then an ointment with an antibiotic against dermatitis or an antifungal ointment should be used. To date, tetracycline ointment, effective in infectious purulent inflammation; bacteriostatic erythromycin ointment for the treatment of pyoderma and trophic ulcers; containing chloramphenicol synthomycin ointment (liniment synthomycin) and Levomekol ointment, as well as nystatin ointment and clotrimazole ointment used for fungal skin lesions are replaced by more modern combined preparations.

Such ointments are a combination of SCS with antibiotics or antifungal agents: Acriderm ointment (other trade names - Betamethasone, Diprogen, Belogent); Cremegen and Oxicort; Lorinden S or Dermozolone. Their advantage is the simultaneous effect on the pathogens of infection and the symptoms of dermatitis: that is, they contribute to the death of microorganisms and relieve inflammation and itching, preventing the excoriation (combs).

Also dermatologists recommend non-hormonal ointments for dermatitis: Dermadrin (Psilo-balm), Protopic, Bepantene ointment (other trade names - Dexpanthenol, D-Panthenol, Pantoderm), zinc ointment (or Desitin), salicylic zinc ointment (Yam ointment), methyluracil ointment (Methyluracil, Stisamet), retinoic ointment (analogue Videstim), ointment Calendula.

In theory, the most effective dermatitis ointments should relieve all the symptoms of the pathology, however, unfortunately, not in every case they can fully cope with the manifestations of this complex disease, often having an immunologically dependent nature.

Pediatricians believe that very good ointment from diaper dermatitis - Bepanten and Desitin. Assigning ointment from contact dermatitis, doctors prefer drugs containing GCS (Lorinden, Fluorocort, Acriderm, etc.).

Ointment from perioral dermatitis (rashes on the face in the mouth, paranasal and nasolabial folds): streptocid ointment, Streptonisol, Protopic (Tacrolimus).

Ointment from sun dermatitis: Dermadrin (Psilo-balm), Lorinden and other steroid products.

Local antirulent antiseptic agents are not used in the treatment of dermatitis - ichthyol ointment and Vishnevsky ointment, as well as sulfuric ointment prescribed for scabies, mycoses, seborrhea and sycosis. Antiseptic salicylic ointment, which helps to cleanse open wounds and soften scabs, is also not used in its pure form, although in some ointments, for example, Lorinden A, salicylic acid performs keratolytic functions. Effective in thrombophlebitis heparin ointment is not used for dermatitis and any rashes on the skin.

In online pharmacies, Chinese ointment Qicun Baxuan gao, as well as a product of Qicun Zhenyang mituoga gao of vegetable origin, which help relieve itching and inflammation, is offered. The big drawback of almost all such tools is the lack of translation of their annotations, that is, available information about their composition. For example, buying a Chinese ointment from atopic dermatitis Pi Kang Shuang, you do not suspect that it includes corticosteroid triamcinolone, antifungal miconazole and antibiotic sulfate neocin.

It should be noted that no ointment with papaverine appears in any pharmacological database. Spasmolytic papaverine (available in the form of tablets, powder, solution for injections and rectal suppositories) is an alkaloid of opium and is used for visceral and vasospasm of different localization, as well as for intracavernous therapy of lack of erection.

The cheapest ointments for dermatitis: zinc ointment, Desitin, hydrocortisone ointment, Dermozolone, Streptonisol, Dermadrin, Calendula ointment.

[6], [7], [8], [9], [10]

Pharmacodynamics

It should be noted that the pharmacodynamics of all hormonal ointments - relieving local inflammation, reducing the manifestation of allergy, reducing swelling, redness and itching - is identical, although the active substance of the Lorinden ointment is the synthetic GC of flumethasone pivalate, hydrocortisone ointment - hydrocortisone acetate, Uniderma - mometasone furoate, triamcinolone acetonide.

Combined ointments against dermatitis contain corticosteroids such as betamethasone dipropionate (Acriderm ointment), fluocinonide (Cremegen), hydrocortisone (Oxycort), flumethasone (Lorinden ointment), prednisolone (Dermozolone).

SCS acts on certain receptors of cells, increasing leukocyte synthesis of lipocortins, which blocks lysosomal enzymes, reduces the production of inflammatory mediators and the release of histamine mast cells, while increasing the impermeability of the walls of the blood and lymphatic capillaries of the skin.

In addition to corticosteroids, the combination drugs Acriderm and Cremegen contain an aminoglycoside antibiotic gentamicin, which causes the death of bacteria, blocking their ability to synthesize proteins and multiply.

And in Lorinden C and Dermozolone ointments, there is a substance called clioquinol, bacteriostatically active against staphylococci, yeast-like fungi, dermatophytes and protozoa.

How do nonhormonal ointments work against dermatitis?

Pharmacodynamics ointment Dermadrin, which helps to remove the itching and swelling in various forms of dermatitis, is based on blockade of H1-histamine receptors with diphenhydramine (diphenhydramine).

Streptocide ointment and streptonitol are sulfonamide drugs and act bacteriostatically by inhibiting the synthesis of proteins in microbial cells (strepto- and staphylococci, Pseudomonas aeruginosa, clostridia, etc.). Streptonitol also contains aminitrazole, which has antiprotozoal activity.

The active substance of the ointment Protokik tacrolimus inhibits the activity of the calcineurin phosphazine regulating the immune response, which leads to a decrease in the synthesis and release of basophils, eosinophils and mediators of inflammation.

Dexpanthenol, which contains Bepanten ointment, penetrating the skin, is transformed into pantothenic acid and promotes metabolism in skin tissues and the regeneration of damaged epithelium.

The main component of zinc ointment and ointment Desitin - zinc oxide - is an antiseptic and adsorbent. Denaturing the proteins present in the exudate, zinc oxide dries wet rashes, reduces the intensity of inflammation and irritation of the skin. And in salicylic-zinc ointment and ointment Yam, in addition to zinc oxide, there is salicylic acid, which exfoliates the keratinized cells.

Methyluracil ointment is considered to be a remedy for the repair of damaged tissues. The pyrimidine derivative methyluracil stimulates the formation of leukocytes and blood erythrocytes (the biochemistry of this effect is not explained in the instructions, so it is not reliably established); perhaps, the acceleration of tissue repair is associated with the activation of their trophism and the exchange of nucleic acids. A reduction in inflammation, in all probability, is due to the inhibitory effect of methyluracil on proteolysis, which leads to a decrease in the synthesis of inflammatory mediators of kinins.

Retinoic ointment contains isotretinoin - 13-cis-retinoic acid (analogue Videstim contains palmitate retinol). The drug has a regenerating effect on skin cells by accelerating the synthesis and maturation of new keratinocytes; The anti-inflammatory effect of this ointment is due to a decrease in the formation of cytokines.

Calendula ointment has antibacterial and anti-inflammatory properties due to the presence in this plant of various terpenic compounds and flavonoids.

[11], [12]

Pharmacokinetics

Manufacturers of external hormonal drugs, their pharmacokinetics are most often not given in the instructions, since with this method of application the active substances are concentrated in the skin and the level of systemic absorption is minimal. However, GCS - especially hydrocortisone and prednisolone - still fall into the blood, bind to plasma proteins and are split in the liver with subsequent elimination of metabolites by the kidneys.

The pharmacokinetics of most non-hormonal ointments from dermatitis is not represented.

Diphenhydramine in the ointment Dermadrin is adsorbed in the skin tissue and subcutaneous fat, in the blood its amount is insignificant, however, the effect of the drug can last up to 5-6 hours.

The active substance of the ointment Protopik penetrates into the systemic bloodstream, and the more the area of application of the drug, the higher the level of tacrolimus in the blood; the drug is metabolized in the liver and excreted in the urine.

Pantothenic acid after application of ointment Bepanten and salicylic acid, which is part of salicylic-zinc ointment, also enter the blood and are excreted by the kidneys.

[13], [14], [15], [16], [17], [18], [19],

Dosing and administration

Hydrocortisone Ointment, Dermozolone, Lorinden Ointment, Cremegon, Dermozolone, Acriderm Ointment, Protopic, Retinoic Ointment, Calendula Ointment are applied to the damaged skin in a thin layer - twice a day. Uniderm is used once a day. Apply bandages contraindicated.

Streptocide ointment, streptonitol, methyluracil ointment - no more than twice a day.

Dermadrin, Bepantin ointment - 4-5 times during the day (do not apply to wet areas).

Zinc ointment (Desitin) - 2-3 times a day for a week; salicylic-zinc ointment - 1-2 times a day (use no more than 14 days).

[24], [25], [26], [27]

Use of the ointments for dermatitis during pregnancy

During pregnancy, any ointment against dermatitis containing glucocorticosteroids should be prescribed by a doctor with the utmost care and consideration of the risk for developing the fetus. Therefore, in the first trimester of pregnancy, such drugs are prohibited, and at later dates, their use is undesirable and is allowed only in case of emergency.

Ointments Dermadrin, Streptonitol, Protopik, as well as salicylic-zinc ointment for pregnant and lactating are contraindicated.

Retinoic ointment is strictly prohibited during pregnancy due to its teratogenic effects on the fetus.

Use of ointments against dermatitis - Bepanten, zinc ointment, Desitin, methyluracil ointment, Calendula ointment - during pregnancy is allowed.

Contraindications

All listed hormonal ointments for dermatitis, as well as combined preparations containing GKS is contraindicated to use in the presence of herpes, chicken pox, rosacea, perioral dermatitis, tuberculosis or syphilis of the skin, poor-quality dermatological neoplasms. SCS is not used in young children.

Pure hormonal ointments (without combination with antibiotics and antimycotics) can not be used for bacterial, fungal or viral skin lesions after vaccinations.

Akriderm ointment, Protopic, Dermadrin is not used in children under two years of age.

Salicylic-zinc ointment (Yam ointment) is contraindicated for children under three years old, as well as for poor blood clotting, hemorrhagic diathesis and increased dryness of the skin.

Contraindications streptocid ointment and streptonitol include hypersensitivity, thyroid pathology and hematopoiesis system; Streptonitol is not allowed in children.

Methyluracil ointment is not used in patients with leukemia, lymphogranulomatosis or bone marrow cancer.

Retinoic ointment is contraindicated in hypervitaminosis A, increased lipid levels in the blood, and functional liver failure.

[20], [21]

Side effects of the ointments for dermatitis

Be sure to know the most likely side effects of ointments against dermatitis.

Lorinden, Fluorocort, hydrocortisone ointment and other preparations with GCS can cause itching, burning and dryness of the skin at the site of application; atrophy of superficial layers of skin; stria; acne education; change in pigmentation; couperose. Prolonged use of these ointments leads to suppression of adrenal and pituitary functions, which leads to a decrease in the synthesis of endogenous steroids and is manifested in a violation of carbohydrate metabolism and increased bone fragility. Children may have a slower growth.

Streptocide ointment can provoke allergic reactions, headaches, nausea and vomiting, changes in the blood.

Side effects:

• streptonitol ointments - hyperemia and itching of the skin, dying urticaria or exfoliation, headache, stool disorders, lowering of the level of leukocytes in the blood;
• ointments Dermadrin - development of contact dermatitis, dry mouth, bladder spasms;
• ointment Protopik - rashes on the skin, increased itching, hyperemia, attachment of secondary infection;
• Bepantin ointment, Calendula ointment, zinc ointment, Desitin - allergic reactions in the form of reddening and itching of the skin;
• salicylic-zinc ointment (ointment Yam) - skin allergic reaction, tinnitus (ringing in the ears), hyperhidrosis, dizziness;
• methyluracil ointment - burning of the skin in the place of application, a feeling of tightness of the skin;
• retinoic ointment - hyperemia, dryness and increased exfoliation of the skin; inflammation of the red border of the lips.

[22], [23]

Overdose

An overdose of hormonal and combined ointments with GCS in the instructions to these drugs is presented as a result of their too long use, which can lead to the development of systemic side effects of corticosteroids: hypercorticoid syndrome, erosion of the gastrointestinal mucosa, myopathy, osteoporosis.

Information on overdose of other ointments mentioned in the review is either not available in the instructions, or there is a low probability of exceeding the dose.

[28], [29], [30], [31]

Interactions with other drugs

Interactions of hormonal ointments against dermatitis with other drugs: joint use with erythromycin or salicylic acid preparations potentiates the action of SCS; simultaneous use with anticoagulants, antidiabetic and antihypertensive agents reduces the therapeutic effect of the latter; corticosteroids increase the effect of NSAIDs and immunosuppressive drugs.

Ointment Dermadrin can increase the effect of hypnotics, as well as anesthetic class of opioids.

Methyluracil ointment can be used with antiseptic agents and ointments containing antibiotics or sulfonamides. Tetracycline and hormonal ointments reduce the therapeutic effect of retinoic ointment.

[32]

Storage conditions

Lorinden, Lorinden S, hydrocortisone ointment, Acriderm, Dermozolone, Uniderm, Bepanten ointment, Protopic, salicylic-zinc ointment (Yam ointment) require a storage temperature of + 15-25 ° C;

Streptocid ointment, Streptonitol, Dermadrin, methyluracil ointment - not above + 18-20 ° C;

Zinc ointment (Desitin), ointment Calendula - no higher than + 15 ° C; retinoic ointment - in the range of + 5-10 ° C.

[33], [34], [35], [36]

Shelf life

Streptocide ointment, Dermadrin, retinoic ointment - 5 years; zinc ointment (Desitin), salicylic-zinc ointment (ointment Yam) - 4 years; hydrocortisone ointment, Protopic, methyluracil ointment - 3 years; Lorinden, Fluorocort, Uniderm, Acriderm Ointment, Streptonitol, Bepanten ointment - 2 years; ointment Calendula - 12 months.

[37], [38]