Ointments for eczema

Among the dermatotropic drugs used to treat inflammatory skin diseases, which include eczema (or atopic dermatitis), the most commonly prescribed is eczema ointment - a local symptomatic agent.

Indications for the use of ointments with various compositions are a diagnosis of eczema established by a dermatologist in the presence of its symptoms in the form of severe hyperemia and swelling of the affected areas of the skin, itchy rashes (vesicles and serous papules), oozing, cracks, keratinized crusts and peeling.

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Release form

It is difficult to list absolutely all the names of ointments for eczema in one article, so we will focus on those that dermatologists most often recommend to their patients.

If there is no severe inflammation, then to reduce itching and other symptoms, non-hormonal ointments for eczema are used, such as: zinc ointment (Tsindol, Desitin), ichthyol ointment, naphthalan ointment (Naftaderm), 2-5% sulfur ointment (for seborrheic eczema), 2% salicylic ointment, Dermalex.

Possessing antiseptic properties, ichthyol ointment can relieve inflammation, see more in our Medicines Directory - Ichthyol ointment. And how salicylic ointment works and how to use it correctly, read the article - Salicylic ointment

However, in many cases, only corticosteroid or hormonal ointments for eczema can help, for example: Hydrocortisone ointment, Flucinar (other trade names - Flucort, Sinaflan, Sinoderm), Trimistin, Diprosalik (Betasalik), etc.

Typically, drugs containing corticosteroids (synthetic hormones of the adrenal cortex) are used as an ointment for eczema and dermatitis.

A doctor should prescribe an ointment for eczema for a child, depending on his age and the severity of the disease, since many drugs have age-related contraindications. Thus, ointments with corticosteroids are not used for children under two years of age due to higher systemic absorption of corticosteroids than in adults. Moisturizing the skin is of decisive importance in the treatment of eczema in a child, and doctors recommend using emollient ointments, such as D-Panthenol (Dexpanthenol, Bepanten), in the absence of exudation of the rash. But perhaps the dermatological cream Dermaleks Repair Eczema Babies (according to the manufacturer, safe for children from two months) or cosmeceuticals with extracts of chamomile, calendula or aloe vera (based on lanolin or medical petroleum jelly) would be more suitable for the child.

Treatment of microbial eczema with ointments is recommended using such drugs as Prefusin (Fuziderm), Triderm, Argosulfan. Also strong ointments for eczema are Trimistin and Flucinar.

Ointment for dry eczema, which is characterized by increased peeling of the epidermis: 3% ichthyol ointment, naphthalan ointment (5-15%), Diprosalik (Betasalik), Prednicarb, Dermaleks. Also, for dry dermatoses, a homeopathic ointment for eczema can be used - Psoriaten.

If you need an ointment for weeping eczema, it is better to use zinc ointment or Delaskin. Outside the acute stage of the disease, retinol ointments for eczema, such as Videstim, can be prescribed to speed up skin regeneration. And for those who prefer traditional oriental medicine, Chinese ointments for eczema and dermatitis are offered - Shi Zhen Gao (brand Blue Poppy Herbs), Qumixin Rugao, etc.

As for the prices of the listed drugs, the cheapest ointments for eczema are zinc, ichthyol, salicylic, hydrocortisone, Diprosalic, Sinaflan ointment.

Even dermatologists find it difficult to answer the question of what are the most effective ointments for eczema, since different drugs are used at different stages of various forms of this disease, and, in addition, each patient’s sensitivity is individual.

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Pharmacodynamics

The antiseptic and adsorbent effect that zinc ointment has is provided by zinc oxide, which changes the structure of proteins of the inflammatory exudate formed in papules, absorbs secretions from weeping rashes and reduces inflammation and irritation of the skin.

The pharmacodynamics of the antiseptic ointment naphthalan (Naftaderm) are due to the properties of thick naphthalan oil (naphthalan). Naphthalan is half polymethylene hydrocarbons (cycloparaffins), which have keratolytic and hydrophilic properties, and 15% of the substances in this oil are aromatic hydrocarbons, which have bacteriostatic and anti-inflammatory properties.

Sulfur ointment, effective against seborrheic eczema, also acts as an antiseptic due to the formation of polysulfanesulfonic acids when sulfur interacts with skin secretions.

The ointment for eczema and dermatitis Dermalex contains modified aluminosilicates (with aluminum and silicon anions), alkaline minerals and magnesium chloride hexahydrate as an active component, which together act as a moisturizing, anti-inflammatory, regenerating and skin-protecting agent.

The antimicrobial and healing action of Argosulfan ointment is based on the bactericidal sulfanilamide sulfathiazole and silver ions.

Delaskin ointment for weeping eczema contains sulphonated polycondensate of phenol-methanal-urea, a synthetic substance that has an astringent and tanning effect on epidermal cells, as well as stearyl alcohol, which moisturizes the skin, and liquid silicone (dimethicone), which prevents moisture loss.

The active substance contained in the retinol ointment for eczema Videstim is retinol palmitate, which has a stimulating effect on the skin's retinol receptors and thus slows down keratinization and promotes the regeneration of normal skin cells.

Homeopathic ointment for eczema Psoriaten reduces inflammation and redness of the skin, and also reduces itching and squamous formations due to the action of alkaloids from the bark of the evergreen plant Mahonia aquifolium.

It is worth understanding what the Chinese ointments for eczema Shi Zhen Gao and Qumixin Rugao consist of. The composition of Shi Zhen Gao includes vegetable oil, beeswax and alum, as well as Huang Bai (Chinese velvet bark), Kang Zhu (rhizome of atractylodes), Zhuang Zi (seeds of the plant stinging root), Bai Zhi (root of angelica dahurica), Tian Hua Feng (root of trichosanthes or Chinese snake gourd).

The manufacturers of Qumixin Rugao do not indicate its active ingredient, although – judging by the listed side effects, primarily skin atrophy and hypercorticism – one can conclude that this drug belongs to glucocorticosteroids (GCS).

Pharmacodynamics of hormonal ointments for eczema

Hydrocortisone ointment and all preparations with topical GCS are effective means for relieving all symptoms of eczema and other dermatoses.

Hydrocortisone (hydrocortisone ointment), prednisolone (in Prefusin and Prednicarb ointments), fluocinolone acetonide (in Flucinar and Sinaflan ointments), triamcinolone acetonide (Trimistin ointment), betamethasone dipropionate (Triderm and Diprosalik ointments) act in the same way. By affecting the cytoplasmic receptors of GCS, drugs of this pharmacological group block the enzyme phospholipase A2, which leads to the cessation of the synthesis of arachidonic acid, which is necessary for the formation of protein mediators of the inflammatory reaction. Also, the release of histamine from mast cells is blocked, the activity of T-lymphocytes and macrophages is suppressed, the permeability of the vascular walls decreases and their lumen narrows (providing an anti-edematous effect).

In addition to GCS, combination drugs used to treat microbial eczema with ointments contain:

• Triderm is an antibiotic gentamicin and an antifungal imidazole derivative clotrimazole;
• Prefusin is an antimicrobial agent in the form of fusidic acid (active against staphylococci, corynebacteria, clostridia, etc.);
• Trimistin is an antimicrobial and fungicidal agent miramistin, which helps restore damaged skin cells.

Ointment for dry eczema Diprosalik (Betasalik) contains salicylic acid, which has antimicrobial properties. And Prednicarb ointment contains urea, which not only helps to retain moisture in the skin, but also easily softens the keratinized crusts that form after the weeping rash dries.

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Pharmacokinetics

In the instructions for such drugs as zinc ointment, naphthalan ointment, Dermalex, Triderm,

Delaskin, Trimistin, retinol ointment for eczema Videstim, no information on pharmacokinetics.

As the manufacturers assure, the active substances of the ointment Trimistin, as well as the homeopathic ointment for eczema Psoriaten, are not absorbed into the systemic bloodstream; sulfur and Vaseline of sulfur ointment also practically do not enter the blood.

Hydrocortisone and prednisolone penetrate into the blood and bind to proteins, and are broken down by liver enzymes and excreted by the kidneys in the urine.

Flucinar ointment and Sinaflan ointment, i.e. their active component fluocinolone acetonide, penetrate the dermis and accumulate (showing pharmacological activity for two weeks); the degree of systemic absorption is low, but may increase with prolonged use (more than seven days) and application to damaged skin.

The instructions for Prefusin ointment do not contain information regarding its pharmacokinetics, but it is known that fusidic acid is able to penetrate into the deep layers of the skin and remain in the intercellular fluid for up to 12 hours and can enter the blood; it undergoes transformation in the liver and is excreted in the feces.

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Dosing and administration

Any ointment for eczema and dermatitis is applied in a very thin layer and only on dry skin. Zinc ointment is used 4-5 times a day; sulfur ointment, Dermalex, hydrocortisone ointment, Prednicarb, Delaskin, Argosulfan - no more than three times a day.

Naphthalan ointment should be applied twice a day (it should not be rubbed in).

It is recommended to use the ointment for dry eczema Diprosalik (Betasalik) twice a day; the hormonal ointments Flucinar (Sinaflan) and the combined drug Trimistin - once or twice a day (for children over two years old - only once); Prefusin - no more than twice a day; Triderm - three times a day (the ointment can be easily rubbed into the skin).

Hormonal ointments for eczema and any dermatological diseases are recommended to be applied as carefully as possible, without affecting healthy skin; it is necessary to take into account that the maximum permissible area of skin treated with these preparations should not exceed 20% of the entire body surface.

Retinol ointment Videstim should be applied to the skin, treated with some alcohol-free antiseptic, twice a day - morning and evening.

Homeopathic ointment for eczema Psoriaten is applied three times a day; Chinese ointments (Shi Zhen Gao and Qumixin Rugao) – twice a day.

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Use eczema ointments during pregnancy

Only zinc ointment and Delaskin ointment are approved for use during pregnancy without reservations.

In the first trimester of pregnancy, neither hydrocortisone ointment nor any other ointment with GCS is used. And the use of these products at a later stage is possible provided that the expected benefit to the mother is much higher than the possible risk to the condition and development of the fetus. This applies to sulfur ointment and the homeopathic remedy Psoriaten.

Pregnant women are prohibited from using: naphthalan ointment, Trimistin, Argosulfan and all retinol ointments without exception for eczema.

Contraindications

All hormonal ointments for eczema are contraindicated for use in bacterial,

Viral and fungal skin pathologies; open wounds; malignant skin neoplasms; acne and rosacea; after vaccination; children under two years of age.

Prefusin ointment is not used to treat eczema in children; Prednicarb is contraindicated in weeping eczema.

Contraindications to Argosulfan ointment include hypersensitivity to sulfonamides, children under two months of age and congenital hemolytic non-spherocytic anemia.

Zinc ointment is not used in the presence of purulent inflammation; sulfur ointment is contraindicated for children under three years of age.

Naphthalan ointment is contraindicated in cases of anemia, problems with the kidneys, adrenal glands and liver, hemorrhagic diathesis, oncology, and young children. Dermalex is not used if there are skin infections.

Retinol ointments for eczema are contraindicated during periods of exacerbation, as well as in cases of excess vitamin A in the body.

Homeopathic ointment for eczema Psoriaten is not used for infants.

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Side effects eczema ointments

The use of zinc and sulfur ointments, Dermalex, Trimistin, homeopathic ointment Psoriaten, retinol ointments for eczema may be accompanied by side effects in the form of a skin reaction of an allergic nature (and these are the same itchy rashes and hyperemia of the skin at the site of application of the ointments). When using naphthalan ointment, inflammation of the hair follicles may develop.

The most likely side effects of eczema ointments containing corticosteroids may include: skin allergies, acne, persistent dilation of skin capillaries, atrophy of the skin and subcutaneous tissues, changes in skin color, increased blood pressure, secondary infections. And the use of topical GCS in the treatment of eczema in children can lead to suppression of the hypothalamic-pituitary-adrenal system with impaired glucocorticoid synthesis, growth retardation, and increased cerebral pressure.

Due to the presence of sulfanilamide, Argosulfan can negatively affect the composition of the blood.

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Overdose

According to official instructions, clinical cases of overdose of hydrocortisone, sulfur and zinc ointments, naphthalan ointment, Videstim ointment have not been described.

No overdose of the drugs Dermalex, Trimistin, Argosulfan was observed.

Overdose of Flucinar (Sinaflan) occurs when the ointments are used longer than 5-7 days, as prescribed by the instructions. In such cases, systemic side effects develop, and immunity is sharply reduced.

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Interactions with other drugs

The instructions for the described drugs state that naphthalan ointment (Naftaderm) can be combined with other local remedies, and that Dermalex ointment can be used simultaneously with hormonal ointments.

While corticosteroid-based ointments should not be used together with salicylates, non-steroidal anti-inflammatory drugs, erythromycin-type antibiotics, anticoagulants and immunosuppressant drugs.

Sulfur ointment, when used simultaneously with hydrogen peroxide or potassium permanganate, can cause a chemical burn to the skin.

Treatment of microbial eczema with Prefusin and Argosulfan ointments cannot be combined with any other external agents.

The interaction of Trimistin ointment with antibiotics enhances their effect. And retinol ointment for eczema (Videstim) is not used with other vitamin A preparations and tetracycline.

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Storage conditions

Zinc ointment, sulfur ointment, Dermalex, hydrocortisone ointment, Flucinar (Sinaflan), Trimistin, Prednicarb, Delaskin, Psoriaten should be stored at a temperature not exceeding +25°C; Diprosalic and Triderm ointments – not higher than +20°C.

Naphthalan and Argosulfan ointments should be kept in a dark place at a temperature of +5-15°C; Videstim ointment – at a temperature of +2 to +8°C.

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Shelf life

The expiration date of the described drugs, indicated in their instructions, is:

• Flucinar (Sinaflan), Psoriaten – 5 years; hydrocortisone ointment, Diprosalik, Triderm, Prefusin – 3 years; zinc and sulfur ointments, naphthalan ointment, Trimistin, Prednicarb, Argosulfan, Chinese ointments (Shi Zhen Gao, Qumixin Rugao) – 2 years;
• retinol ointment for eczema Videstim – 12 months; Delaskin (after opening the tube) – no more than 6 months.