Cooling ointments from bruises

With a bruise, a closed-type injury, the first treatment procedure should be cooling, as a rule, it's ice, a cold compress. On the second day, the trauma can be treated with drugs such as cooling ointments, they are saved from bruises and as a local irritant, which removes the edema, and as a method of anesthesia.

In contrast to warming external preparations, which are shown on the third or fourth day, cooling ointments do not have a pronounced effect of irritation of the nerve receptors of the skin, but they remove the primary symptoms after a bruise due to the anesthetic, anticoagulant components included in the preparation.

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Indications for use

Virtually all bruises are accompanied by damage to the subcutaneous tissue in varying degrees. Tela subcutanea (subcutaneous tissue or hypodermis) is saturated with fat tissue and is capable of damping, softening impacts and other mechanical effects on the soft tissues of the body. Taking the first blow to yourself, the fiber is damaged, small vessels are injured, edema and hematoma develop. In order to stop the process, a tool is needed that can quickly restore microcirculation, stop local hemorrhage due to distracting, irritating skin receptors of action. Such drugs are MRS - topical irritants for external use. They are divided into groups - warming and cooling ointments, which, as a rule, are both anti-inflammatory drugs against bruises. Cooling does not mean a local decrease in body temperature in the area of trauma, but the subjective sensation of "cold" due to the effect on the receptors helps to relieve the pain, so MRS with a cooling effect has indications for use not only with soft tissue contusions, but also in the treatment of other diseases of the musculoskeletal system, motor apparatus. The task of such dosage forms: 

• Local anesthesia.
• Distracting action due to the reaction of menthol or essential oils with skin receptors.
• Local influence on the inflammatory process in the hypodermis.
• Activation of microcirculation in the area of damage.
• Cupping of the puffiness zone.

Cooling ointments, indications for use: 

• Myalgia.
• Arthralgia.
• Contusions of soft tissues, including those with closed fractures.
• Sprains of ligaments.
• Edema.
• Neuralgia.
• Bruises, bruises.
• Tendonitis.
• Tendovaginitis.
• Sports injuries.
• Extra-articular rheumatism.
• Lumbago.

Pharmacodynamics

Cooling ointments with bruises are now most often combined composition, which includes anti-inflammatory, anticoagulant components, as well as menthol or essential oils that have a cooling effect. The main effect of sensation of "cold" is due to menthol - the most active organic matter that "distracts" the nerve receptors of the skin from the main function - to carry out a pain signal. Skin covers are equipped with temperature receptors, which include such groups: 

• Close location, directly skin - cold flasks of Krause.
• Deep location in the dermis, subcutaneous fatty tissue - bulbous corpuscles Ruffini.
• Deep location in the apical skin cells - the calf of Golgi-Mazzoni.

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

1. If the external drug contains less than 1% of Metronum, it can reduce the sensitivity of the thermal receptors responsible for thermoregulation. 
2. If the concentration exceeds 1.2-1.5%, menthol stimulates the nerve endings rather intensely, causing a change of sensations - from cold to irritation, heat.

Cooling ointment is always applied only externally, in the area of the injury, provoking a short-term local inflammation, acting as a distracting stimulus. Pharmacodynamics of the main active ingredients of ointments with a cooling effect is due to inhibition of the function of lipoxygenase and cyclooxygenase of both types. The inhibition of the reaction of the arachidonic cascade of synthesis of oxidized PUFAs (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 some extent, exerting an anti-inflammatory effect.

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

Pharmacokinetics

When applying any ointments to the skin, there is practically no absorption and penetration of the active substances into the bloodstream. A little faster and easier to overcome the barrier gel forms of external means, their pharmacokinetics is dynamic, the ointments are more slowly absorbed, their action is mainly aimed at arresting a certain painful and inflamed zone. Thus, the therapeutic concentration of the drug substance in the cooling ointment is only at the site of the injury, not spreading widely, and without affecting the separated areas of the skin. The amount of active ingredient in the subcutaneous layers is proportional to the diameter of the injury and may depend on the frequency of application of the agent.

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

• Camphor - 41 ± 5.8 ng / ml.
• Menthol - 31,9 ± 8,8 ng / ml.

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

The most intensive pharmacokinetics of ointments containing camphor. Like other terpenoids, it is able to overcome the blood-brain barrier, and can also penetrate the placenta into the bloodstream. Therefore, there are contraindications to the use of such drugs 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 enters the lungs and is excreted through them with mucus. This way of elimination is possible in the treatment of bruises of the upper half of the body, the head.

Cooling ointments from bruises: a list of drugs

The list of drugs that can be used immediately after the injury is great. Cooling external preparations can anesthetize the trauma, provide an anticoagulant effect and prevent the development of a hematoma, provided that the ointment or gel in the area of the injury is applied carefully (it can not be rubbed) with a thin layer. 

• Gevkamen. The composition includes menthol, clove flowers extract, eucalyptus oil. Ointment belongs to the category of MRS and is shown as an anesthetic, a local irritant for bruises, myalgia, arthritis.
• Bom-Bengu. The composition includes methyl salicylate and mint oil. The ointment is shown as a distracting and anti-inflammatory agent for pain in muscles, joints, sprains and bruises. A thin layer provides a short-term cooling, a denser application can cause a burning sensation.
• Ben-Gay. As part of the ointment - racemetol and methyl salicylate. The drug is intended for external treatment of myositis, bruises, for massage, and as an anesthetic for lumbago and arthralgia.
• Bengin. The composition includes methyl salicylate as an anti-inflammatory component and menthol as a cooling agent. 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 into which troxerutin enters. Oxidation-reduction process, which starts the drug, promotes relief of bruising, reducing swelling and restoring normal microcirculation in the area of injury.
• Menovasin Gel. The composition includes novocaine, menthol, anestezin. The gel is indicated as an anesthetic and cooling place of an injury remedy.
• Menthol Ointment containing methyl salicylate, lanolin, menthol, is indicated for any kind of muscle pain, and also successfully copes with the primary symptomatology in case of soft tissue contusion (bruises).
• The gel was repaired, it contains horse chestnut extract, heparin. It is shown as an anesthetic, cooling agent for swelling, lymphostasis, with bruises.
• Efkamon. When applying a thin layer has a local cooling effect due to camphor in combination with menthol and essential oil of eucalyptus, cloves. Methylsalicylate as a component of the ointment removes the local inflammatory process.
• Flexall, a gel that includes camphor, menthol, salicylates, aloe extract and vitamin E Helps with bruises, arthritis, bursitis, lumbago.

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How to apply cooling ointments from bruises?

Cooling ointments should be applied either immediately after receiving a closed-type injury, or after a day, when the cold and compressive bandage was applied. The feeling of "cold" helps to anesthetize the area of the bruise, to prevent the spread of internal local hemorrhage. Ointment is applied in a thin layer, I do not rub it to avoid additional injury to the subcutaneous tissue. After the product has absorbed, the damaged part of the body can be wrapped with a bandage, make a dry compress. It is believed that the bruise is quickly treated with a gel form, as this consistency is absorbed more quickly, and the active substances of the gel are well absorbed into the rather deep layers of the dermis. The gel is recommended to be applied immediately after getting an injury, it is advisable to apply an ointment with a cooling effect later - on days 2 or 3. It should be noted that an excessively thick layer of gel does not provide rapid analgesia, on the contrary, it creates a kind of film that interferes with the absorption of the drug.

Mode, method of application and dose depend on the severity of the injury, on the vastness 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 symptomatology of the injury does not subside, but rather intensifies, you should consult your doctor for accurate diagnosis of damage and excluding fracture or dislocation. You also need to be attentive to any atypical reactions from the skin, with a rash, itching, severe irritation, the remedy should be removed and discontinued.

Here is an example of applying Gevcamen ointment for adults: 

• The skin should be clean and dry.
• Ointment should be applied in a thin layer, evenly spreading it throughout the diameter of the injury.
• After applying the ointment, you should thoroughly wash your hands to avoid getting the product on the mucous membranes (eyes, nose).
• On the area of up to 800 square meters. Cm (diameter of the knee joint) requires up to 4 grams of ointment.
• The strip of ointment should not exceed 3-4 centimeters in length.
• The maximum mode of application of ointment - 4 times a day.
• The maximum dose is 8 grams per day.
• Duration of treatment should not exceed 5 days.

Special recommendations: 

• It is not recommended to apply cooling ointment in combination with a compress, it is indicated after complete absorption of the agent.
• For an injury that is diagnosed as acute, the most suitable form is a gel, not an ointment.
• After a two-three-day course with cooling agents, it is recommended to use warming ointments with bruises.
• You can not visit the solarium, take solar procedures after applying the ointment to avoid photodermatitis and allergies.
• MRS with a cooling effect is not applied before visiting the sauna or sauna.

Use during pregnancy

During the entire period of pregnancy, care should be taken in the use of any medicines, therefore, despite relative safety, external agents are also part of a group of drugs that should not be prescribed during gestation. As for cooling ointments, their use in pregnancy and breast-feeding is not recommended.

1. Camphor, which is part of ointments, can overcome the GEB (hemoencephalic barrier), it can penetrate the placenta. In the ointment, it is contained in a minimal amount and the degree of its absorption is low, but there is still this risk to be taken into account with the constant use of a cooling ointment
2. And menthol, and camphor, and other components of cooling external agents can provoke an allergic reaction in the future mother
3. There is an opinion that terpenes are able to penetrate into the systemic bloodstream and partially excrete with breast milk, so cooling ointments with bruises during lactation are not recommended
4. Many doctors are convinced that menthol as an active terpenoid can influence the level of estrogen, and carries the risk of activating premature labor

Use during pregnancy of any external means, including drugs aimed at treating injuries, should be controlled by the attending physician, since combined MRS (topical irritants) can cause unwanted side effects and even complications.

Contraindications for use

Since all the MDCs with a cooling effect contain active skin irritants, they have contraindications for use.

Cooling ointments from bruises can not be used for such diseases and conditions: 

• Pregnancy, especially the 1st trimester.
• Lactation period.
• Childhood. Children ointment from bruises appointed doctor. As a rule, such funds are not recommended until 5-7 years.
• The allergy in the anamnesis.
• 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 AMB (peptic ulcer disease), duodenal ulcer, diseases associated with bleeding disorders. This contraindication refers to cooling ointments, which include methyl salicylate.
• With prolonged use, kidney disease may become worse.

Side effects

Side effects of ointments with a cooling effect due to active ingredients - racemtol, essential oils, plant extracts, camphor and anti-inflammatory ingredients. Most often, side effects are associated with an allergic reaction, which develops as skin manifestations - edema, hyperemia, rash, itching. If the ointment is multicomponent and contains the above substances, it is advisable to make a skin test before applying it - apply a minimal amount to the skin and wait 10-15 minutes. If the skin reaction is normal, the remedy can be used for its intended purpose.

The instructions, which must necessarily be in the factory packaging, indicate a rather large list of possible side effects, but this is more likely due to the prevention of all potential risks than to actual statistical facts of complications. Here is a list of the alleged side effects that can occur with careless or too long use of MRS with a cooling effect: 

• Exudative erythema.
• Photosensitivity when sunlight hits the skin. This is especially important if the ointment contains essential oils of citrus and methyl salicylate.
• Rash, itching.
• Hyperemia of the area of injury.
• Puffiness.
• 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 - a violation of the heart rate or a change in the blood pressure.

Overdose

Cases of classic overdosage in the use of local irritants with cooling effect are not described, but often side effects and complications are associated with over-zealous application of such drugs. In an effort to quickly anesthetize the site of a bruise, a person can use the ointment too often or apply it to large areas of the skin.

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

To avoid such complications, you should use ointment, either on the advice of a doctor, or consult a pharmacist.

When buying and before applying a cooling ointment, pay attention to the following properties: 

• Ointment, gel should be applied easily as well as removed with a dry cotton cloth or napkin.
• Ointment or gel should be uniform in consistency.
• Factory packaging should not have any signs of damage, and the tube must be sealed.

Interactions with other drugs

Unlike other types of ointments with bruises, cooling agents are more active in interaction with other medicines. This is due to their composition, which can 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 poorly combine such substances, neutralizing each other: 

• Resorcinol.
• Camphor (allowed only in small doses in the presence of neutralizing the activity of camphor ingredient).
• Thymol.
• Antipyrine.
• Salicylates.
• Chloral hydrate.

This combination leads to liquefaction of components and the product loses its effectiveness. Almost all terpenes, when there is interaction with other drugs, weaken the activity of both their own and their "opponents". This is well understood and taken into account by pharmacists, who create cooling external drugs from the category of MRS (local irritants). Therefore, there are no fears of side effects from the ointment itself, often consisting of several components. A combination of ointments with other external agents is unlikely, because they are applied alternately. Another possible way of interacting the coolant with oral preparations is also not capable of causing complications due to the low degree of absorption of the gel or ointment. The only peculiarity concerns the combination of terpenes and terpenoids (cineole, menthol, carvone and other species) with drugs from the group of NSAIDs (non-steroidal anti-inflammatory drugs). Simultaneous use of such drugs greatly activates their effect, contributing to deeper penetration into the deep layers of the dermis, but this is more a positive aspect of interaction than a contraindication to such a combination. Also, the preliminary application with the application of DMSO-dimethyl sulfoxide or, more simply, dimexide, can enhance the action of the cooling ointment. Dimexide allows to accelerate the systemic absorption of all active ingredients of the ointment, such absorption leads to rapid anesthesia and neutralization of swelling at the site of the injury.

Storage conditions

The most convenient in storing external preparations in the form of ointments on a fat basis, the emulsion-based ointment is more sensitive to environmental conditions.

The storage conditions for gels with cooling effect presuppose placing them in a place inaccessible to children. It is best to store the ointment, gel in a special medicine cabinet, in a dry place at a temperature not exceeding 15 degrees. In addition, in order to preserve the activity of the ingredients of the ointment, which are most often terpenes of essential oils, the tube should be opened just before the application of the drug, after application of the drug it must be tightly closed. In the future, before the next application of MPA, it must be stored in a sealed tube.

Standard storage conditions for external cooling agents are indicated on the original packaging in the same way as the drug series and its shelf life.

Shelf life

Shelf life of the cooling ointment does not exceed 3 years, the exact date of manufacture of the drug and the final period 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 an agent with an expired end date is not only not recommended, but also categorically prohibited in order to avoid adverse reactions and complications.

Cooling ointments with bruises are considered one of the most effective methods of treatment, which allows you to quickly neutralize puffiness and stop the process of trophic soft tissue disorders. The variety of types of ointments offered by the modern pharmaceutical industry helps to choose the most effective and effective drug, and the choice can be made by a doctor or pharmacist at a pharmacy.