Comparison of effectiveness of lotions, ointments and creams in Eczema
Eczema which is called Atopic Dermatitis is a chronic skin condition commonly seen in children. Eczema usually starts in childhood and may continue into adulthood with several flares and remissions throughout life. However it can go into total remission around 12 years and may not reappear. Sometimes Eczema can occur in adults for the first time and it is called “Adult onset Eczema”.
Eczema has a genetic predisposition and can run in families. These families may also have Hay fever and Bronchial asthma as associated illnesses. The main symptoms of Eczema are inflammation and itching. Therefore treatment should aim at reducing these symptoms.
Treatment of Eczema is divided in to 3 main parts;
- Topical application of lotions, creams or ointments with active ingredients
- Reduction of itching by using antihistamines like Cetrizine, fexofenadine, Loritidine or Chlorpheniramine.
- Reduction of inflammation with a short course of oral steroids or immunosuppressant drugs – this is not needed for all patients with Eczema
In addition to above, certain other treatment methods are used for uncontrolled eczema, such as; phototherapy with UVB (Ultraviolet B) light and using Biologics which are administered to the blood stream as infusions to target specific parts of immune system that trigger inflammation.
Eczema cure is very difficult. However you can control it by adhering and being compliant to the treatment plan given by your doctor. Topical applications whether it is in cream, lotion or ointment form plays a major role in controlling Eczema. You have to always go with the best lotion for Eczema.
What is a lotion?
A lotion is a low viscosity topical preparation intended for application to skin. Since it has higher water content than creams and ointments, it is more liquid and can be applied easily to external skin with a brush, cotton wool, clean cloth or with your bare hands. Such lotions can be the best lotion for Eczema.
What is a cream?
A cream is a preparation used for application to the skin. Creams are semisolid emulsions (a mixture of more than one liquid that are normally immiscible) like water and oil. Roughly water and oil in a cream preparation is 50:50. One should always use the best eczema cream for better results.
Creams come in 2 forms;
- O/W creams (Oil in water) are composed of small droplets of oil dispersed in a continuous water phase.
- W/O creams (water in oil) are composed of small droplets of water dispersed in a continuous oily phase. Out of these two types oil in water creams are cosmetically better as they are less greasy and easily washable with water, thus it is more comfortable to use.
However water in oil creams are more moisturizing because they provide an oily barrier. This reduces the loss of water from the outermost layer of the skin.
What is an ointment?
Ointment is a semisolid preparation usually containing medicinal substances, which is intended for external application to skin.
What are the types of Eczema?
Eczema is broadly divided into 2 main forms; Dry and Wet Eczema.
In Dry Eczema, there are red inflamed patches which can be scaly and cracked associated with dry skin. In Wet Eczema, there is oozing from lesions followed by crusting. Lesions can be raw and angry looking as the lesions are weeping. In Wet Eczema, the risk of infection is more. Constant and habitual scratching can lead to thick, discolored and leathery areas which are rough to touch.
General rules when treating Eczema…..
- When the lesions are dry and localized, it is best to use ointments, because it is occlusive, it penetrates the active ingredients well and moisturizes the area better.
- When the Eczema is wet and oozing, it is best to use a cream as the greasiness is less and absorption is better and quick. Doctors recommend the best eczema cream over here.
- If a large area is affected by Eczema, a lotion or a cream is better as it can cover large areas of skin. You can always go with the best lotion for Eczema over here.
- If the lesions are infected, better to have combinations of topical products with an antibiotic.
- Best moisturizers come in ointment form. If you have very dry skin always go for an ointment based moisturizer.
- If your skin is sensitive and prone to allergies, select an ointment because it has less sensitizing preservatives than a cream.
Many medications which are intended for topical application for Eczema treatment are packaged both as creams and ointments.
Ex: Corticosteroids, Antibiotics, Moisturizers, Combination products
Qualities of lotions, creams and Ointments
Eczema cure mainly depends on the quality of lotions, creams and Ointments. Lotions have more water content. So they are packaged in bottles. They spread easily and are well absorbed. They can be dispensed easily in a pump. Lotions are easily washed off.
Creams are packaged in a tub or a tube. They are too thick to be dispensed in a pump. They spread easily and well absorbed as the mixture of a cream is roughly 50% water and 50% oil. Just like lotions, creams are easily washed off with water.
Ointments are usually 80% oil and 20% water. Therefore ointments feel greasy. They are “occlusive” (stay on the surface of the skin). Ointments are not well absorbed. The oil component is made from Hydrocarbons like Petroleum jelly or mineral oil.
What is meant by “Vehicle” of a cream and ointment?
The water and oil components of creams and ointments carry active ingredients or medication to the site needed to act on. So these components act primarily as a vehicle of transportation.
What do people prefer?
Most people prefer to use the best eczema cream than ointment because cream is less sticky and less greasy. Ointments feel heavier on skin and it is uncomfortable and messy.
What is the doctor’s point of view?
It is best to treat an oozing or wet eczema with a cream, because of high water content and evaporation which occurs following application, eczema cream works better on wet eczematous lesions. If the Eczema is wide spread, it is easier to cover large areas with a cream as thickness or viscosity of a cream is less than an ointment.
Doctors prefer to use ointments on dry eczema lesions. Ointments are occlusive and thick. It traps moisture and is not well absorbed into skin. Therefore ointment keeps the skin moist for a longer period of time. It promotes complete absorption of the active ingredient or the medication, as it is left on the skin for long.
Creams have more preservatives in it than in an ointment. It has higher chance of producing an allergic reaction. So doctors prescribe ointments for those with sensitive skin.
How does a lotion work?
Lotion can be used as a moisturizing agent on dry skin conditions like eczema. They are best applied after a bath, while the skin is still damp. This promotes absorption. Make sure you take a short bath and pat dry with a soft towel rather than wiping the skin which grabs away the natural moisture. Lotions are easy to use as it can be dispensed with a pump and applied with your hands. It absorbs easily and spreads well. It is always recommended to us the best lotion for Eczema.
However as ointments has higher viscosity they are usually best moisturizers. They form a barrier on the skin which helps to seal in the moisture.
Examples of ointment based moisturizers are Aquaphor, Vaseline and Eucerin.
If you feel uncomfortable using ointment based moisturizers as they are greasy and too thick, go for a cream based moisturizer such as Aqueous cream. Creams are better moisturizing than lotions. Lotions need to be used several times a day as a moisturizer. However ointment based moisturizers can be used twice a day as the moisture is kept longer.
What are the active ingredients or medications found in topical preparations used for Eczema?
Topical steroids or Corticosteroids
These are commonly used topical medications for eczema treatment. They come in varying strengths and help to treat and control inflammation in Eczema.
- Mild or weak corticosteroids – They are used to treat mild inflammatory skin conditions. As they are generally harmless, they are available as over the counter products.
Ex: 1% Hydrocortisone, Cortaid, Cortizone 10
- Stronger corticosteroid preparations – As they are more potent, they are available to a doctor’s prescription only.
Ex: Diprosone, Betamethasone, Triamcinolone, Kenalog, Clobetasol, Mometasone
Your doctor will decide which type is best for your Eczema.
Mometasone, Triamcinolone and Hydrocortisone has less side effects, therefore they can be used on face. Betamethasone which is stronger can be used on limbs and trunk. Clobetasol is strong and used in elbows and knees and for thick eczematous lesions but use only for short durations because long term use can make skin hypo pigmented (lighter in color) and thinner. Side effects are more when using a stronger topical steroid over large areas of skin for prolonged periods of time. They can get absorbed to the blood stream and lead to side effects. Make sure you comply with doctor’s advice to minimize side effects.
Corticosteroids are prepared in both cream and ointment forms. The potency is different depending on which form it is made. Ointment allows active ingredients (corticosteroid) to enter the skin more completely than a cream as it is occlusive. Therefore, even if same dosage is used, if a corticosteroid is packaged as an ointment, it is classified as stronger than it is packaged as a cream.
Topical preparations of antibiotics are useful for Eczema cure if there is an infection. When you scratch, the skin gets damaged. Germs like bacteria especially Streptococcus and Staphylococcus can get in and cause infection. Infection is more common in wet Eczema. Antibiotics are also prepared topically as both creams and ointment form.
Ex: Neosporin – This consists of 3 antibiotics namely Neomycin sulfate, Bacitracin and Polymyxin B Sulfate.
Polysporin – This consists of 2 antibiotics namely Polymyxin B sulfate and Bacitracin.
Combination forms of Corticosteroids and Antibiotics
They reduce redness and inflammation while killing bacteria. They are usually used no longer than 2 weeks as that period is generally adequate to treat an infection. Eczema cure is possible with these combinations.
Ex: Corticosporin – This contains Hydrocortisone, Neomycin and Polymyxin B.
Betnovate N – This contains betamethasone as the corticosteroid and Neomycin as the antibiotic.
Once the infection is settled with the topical antibiotic or the combination product containing the antibiotic, this should be stopped and depending on the inflammation, a corticosteroid cream will have to be continued until the inflammation is totally controlled. Gradually the potency of the topical corticosteroid is reduced and it can be stopped once the inflammation is well controlled. As patients with eczema is prone for dry skin, even after lesions are settled you should continue with a good moisturizer (ointment or cream form) to prevent any flares of eczema.