Dermatitis ointments for adults

For almost all nosological forms of skin inflammation, combined into a group of dermatoses, patients are prescribed one or another ointment against dermatitis.

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

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

Release form

We present the names of ointments against dermatitis, which are currently most often used in the treatment of this disease.

In case of chronic atopic dermatitis, external agents containing glucocorticosteroids (GCS) are used – natural hormones of the adrenal cortex (in the form of hydrocortisone) or similar synthetic substitutes.

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

Dermatitis can often be complicated by bacterial or fungal infections, and then an antibiotic ointment for dermatitis or an antifungal ointment should be used. Today, tetracycline ointment, which is effective for infectious purulent inflammation; bacteriostatic erythromycin ointment for the treatment of pyoderma and trophic ulcers; chloramphenicol-containing synthomycin ointment (synthomycin liniment) and Levomekol ointment, as well as nystatin ointment and Clotrimazole ointment used for fungal skin lesions are being replaced by more modern combination drugs.

Such ointments are a combination of GCS with antibiotics or antifungal agents: Akriderm ointment (other trade names are Betamethasone, Diprogent, Belogent); Kremgen and Oxycort; Lorinden S or Dermozolone. Their advantage is the simultaneous effect on pathogens and on the symptoms of dermatitis: that is, they promote the death of microorganisms and relieve inflammation and itching, preventing excoriation (scratching).

Dermatologists also recommend non-hormonal ointments for dermatitis: Dermadrin (Psilo-balm), Protopic, Bepanten ointment (other trade names - Dexpanthenol, D-Panthenol, Pantoderm), zinc ointment (or Desitin), salicylic-zinc ointment (Yam ointment), methyluracil ointment (Methyluracil, Stizamet), retinoic ointment (analog of Videstim), Calendula ointment.

In theory, the most effective ointments for dermatitis should relieve all symptoms of the pathology, but, unfortunately, not in every case they can 100% cope with the manifestations of this complex disease, which is often immune-dependent in nature.

Pediatricians believe that Bepanten and Desitin are very good ointments for diaper dermatitis. When prescribing ointments for contact dermatitis, doctors prefer drugs containing GCS (Lorinden, Fluorocort, Akriderm, etc.).

Ointment for perioral dermatitis (rashes on the face in the area of the mouth, paranasal and nasolabial folds): streptocide ointment, Streptonizole, Protopic (Tacrolimus).

Ointment for solar dermatitis: Dermadrin (Psilo-balm), Lorinden and other steroid agents.

Locally irritating antiseptics are not used in the treatment of dermatitis - ichthyol ointment and Vishnevsky ointment, as well as sulfur ointment, prescribed for scabies, mycosis, seborrhea and sycosis. Antiseptic salicylic ointment, which helps clean 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. Heparin ointment, effective for thrombophlebitis, is not used for dermatitis and any skin rashes.

Online pharmacies offer the Chinese ointment Qicun Baxuan gao, as well as the herbal remedy Qicun Zhenyang mituoga gao, which help relieve itching and inflammation. A major drawback of almost all such products is the lack of translation of their annotations, that is, accessible information about their composition. For example, when buying the Chinese ointment for atopic dermatitis Pi Kang Shuang, you do not suspect that it contains the corticosteroid triamcinolone, the antifungal agent miconazole and the antibiotic neocin sulfate.

It should be noted that papaverine ointment is not listed in any database of pharmacological agents. The antispasmodic papaverine (available in the form of tablets, powder, injection solution and rectal suppositories) is an opium alkaloid and is used for visceral and vasospasms of various localizations, as well as for intracavernous therapy of erectile dysfunction.

The cheapest ointments for dermatitis: zinc ointment, Desitin, hydrocortisone ointment, Dermozolone, Streptonizole, 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 allergies, reducing swelling, redness and itching - are identical, although the active substance of Lorinden ointment is the synthetic GCS flumethasone pivalate, hydrocortisone ointment - hydrocortisone acetate, Uniderm - mometasone furoate, Fluorocort - triamcinolone acetonide.

Combination ointments against dermatitis contain corticosteroids such as betamethasone dipropionate (Akriderm ointment), fluocinonide (Kremgen), hydrocortisone (Oxycort), flumethasone (Lorinden ointment), prednisolone (Dermozolone).

GCS act on certain cell receptors, increasing leukocyte synthesis of lipocortins, as a result of which lysosomal enzymes are blocked, the production of inflammatory reaction mediators and the release of histamine by mast cells are reduced, with a simultaneous increase in the impermeability of the walls of blood and lymphatic capillaries of the skin.

In addition to corticosteroids, the combination drugs Akriderm and Kremgen contain the aminoglycoside antibiotic gentamicin, which causes the death of bacteria by blocking their ability to synthesize proteins and reproduce.

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

How do non-hormonal ointments work against dermatitis?

The pharmacodynamics of Dermadrin ointment, which helps relieve skin itching and swelling in various forms of dermatitis, is based on the blockade of H1-histamine receptors by diphenhydramine (diphenhydramine).

Streptocide ointment and Streptonitol are sulfanilamide agents and act bacteriostatically by inhibiting protein synthesis in microbial cells (strepto- and staphylococci, Pseudomonas aeruginosa, clostridia, etc.). Streptonitol also contains aminitrazole, which has antiprotozoal activity.

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

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

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

Methyluracil ointment is considered a means of promoting the restoration of damaged tissues. The pyrimidine derivative methyluracil stimulates the formation of leukocytes and erythrocytes in the blood (the biochemistry of this effect is not explained in the instructions, as it has not been reliably established); it is possible that the acceleration of tissue restoration is associated with the activation of their trophism and the exchange of nucleic acids. And the reduction in inflammation, in all likelihood, occurs due to the inhibitory effect of methyluracil on proteolysis, which leads to a decrease in the synthesis of inflammatory mediators kinins.

Retinoic ointment contains isotretinoin – 13-cis-retinoic acid (analogue Videstim contains retinol palmitate). 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 of various terpene compounds and flavonoids in this plant.

[ 11 ], [ 12 ]

Pharmacokinetics

Manufacturers of external hormonal agents most often do not provide their pharmacokinetics 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 enter the blood, bind to plasma proteins and are broken down in the liver, followed by elimination of metabolites by the kidneys.

The pharmacokinetics of most non-hormonal ointments for dermatitis are not presented.

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

The active substance of Protopic ointment penetrates into the systemic bloodstream, and the larger 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.

After using Bepanten ointment, pantothenic acid and salicylic acid, which is part of the 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, Kremgen, Dermozolone, Akriderm 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. Applying bandages is contraindicated.

Streptocide ointment, Streptonitol, methyluracil ointment – no more than twice a day.

Dermadrin, Bepanten ointment – 4-5 times a day (it is better not to apply to wet areas).

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

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

Use dermatitis ointments during pregnancy

During pregnancy, any ointment against dermatitis containing glucocorticosteroids should be prescribed by a doctor with maximum caution and taking into account the degree of risk to the development of the fetus. Therefore, in the first trimester of pregnancy, such drugs are prohibited, and in later stages their use is undesirable and is allowed only in case of extreme necessity.

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

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

The use of anti-dermatitis ointments – Bepanten, zinc ointment, Desitin, methyluracil ointment, Calendula ointment – is permitted during pregnancy.

Contraindications

All of the listed hormonal ointments for dermatitis, as well as combination drugs containing GCS, are contraindicated in the presence of herpes, chickenpox, rosacea, perioral dermatitis, tuberculosis or syphilis of the skin, malignant dermatological neoplasms. GCS are not used in young children.

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

Akriderm ointment, Protopic, Dermadrin are not used for children under two years of age.

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

Contraindications to streptocide ointment and Streptonitol include hypersensitivity, thyroid gland pathologies and hematopoietic system; Streptonitol is prohibited for use in the treatment of children.

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

Retinoic ointment is contraindicated in cases of hypervitaminosis A, elevated blood lipid levels, and functional liver failure.

[ 20 ], [ 21 ]

Side effects dermatitis ointments

It is important to know the most likely side effects of anti-dermatitis ointments.

Lorinden, Fluorocort, hydrocortisone ointment and other drugs with GCS can cause itching, burning and dry skin at the site of application; atrophy of the superficial layers of the skin; striae; acne formation; changes in pigmentation; rosacea. Long-term use of these ointments leads to suppression of the functions of the adrenal glands and pituitary gland, which entails a decrease in the synthesis of endogenous steroids and is manifested in a violation of carbohydrate metabolism and increased bone fragility. In children, growth retardation is possible.

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

Side effects:

• Streptonitol ointments - hyperemia and itching of the skin, weeping urticaria or exfoliation, headache, bowel disorders, decreased levels of leukocytes in the blood;
• Dermadrin ointments – development of contact dermatitis, dry mouth, bladder spasms;
• Protopic ointments - skin rashes, increased itching, hyperemia, secondary infection;
• Bepanten ointment, Calendula ointment, zinc ointment, Desitin - allergic reactions in the form of redness and itching of the skin;
• salicylic-zinc ointment (Yam ointment) – skin allergic reaction, tinnitus (ringing in the ears), hyperhidrosis, dizziness;
• methyluracil ointment - burning of the skin at the site 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

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

Information about overdose of other ointments mentioned in the review is either absent from the instructions, or the unlikelihood of exceeding the dose is noted.

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

Interactions with other drugs

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

Dermadrin ointment may enhance the effects of sleeping pills and opioid painkillers.

Methyluracil ointment can be used with antiseptics 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, Akriderm, Dermozolone, Uniderm, Bepanten ointment, Protopic, salicylic-zinc ointment (Yam ointment) require storage temperature of +15-25ºС;

Streptocide ointment, Streptonitol, Dermadrin, methyluracil ointment – not higher than +18-20ºС;

Zinc ointment (Desitin), Calendula ointment – no higher than +15ºС; 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 (Yam ointment) – 4 years; hydrocortisone ointment, Protopic, methyluracil ointment – 3 years; Lorinden, Fluorocort, Uniderm, Akriderm ointment, Streptonitol, Bepanten ointment – 2 years; Calendula ointment – 12 months.

[ 37 ], [ 38 ]