Ointments - Definition, Types, and Uses

What Is an Ointment?

An ointment is a semisolid preparation applied topically for protective, emollient, or medicinal effects. The base (vehicle) determines how the drug is absorbed, released, and tolerated by the skin. In contrast to creams (where the base is absorbed into the skin), in an ointment only the medication is absorbed from the greasy base - making ointments especially useful for dry, scaly skin conditions, while creams are preferred for weeping/moist lesions. - Scott-Brown's Otorhinolaryngology, p. 323

A key pharmacological point: an ointment formulation is often more potent than the same molecule in cream or lotion form because the occlusive vehicle enhances percutaneous absorption by hydrating the stratum corneum. - Dermatology 2-Volume Set 5e

Classification of Ointment Bases

Ointments are classified into 4 major bases by the USP:

Base Type	Composition	Properties	Examples
1. Hydrocarbon / Oleaginous	Petrolatum, mineral oil	Greasy, anhydrous, occlusive, cannot absorb water	White petrolatum, White Ointment
2. Absorption	Oleaginous + w/o surfactant	Anhydrous but can absorb water; promotes hydration	Hydrophilic petrolatum, Anhydrous lanolin, Aquaphor
3. Water-Removable (O/W emulsion)	Oil-in-water emulsion	Water-washable, non-greasy, good drug release	Hydrophilic Ointment, Dermabase
4. Water-Soluble	Polyethylene glycols (PEGs)	Completely greaseless, water-washable	PEG Ointment, Polybase

Types of Ointments by Clinical Use

1. Antibiotic Ointments

Used to prevent/treat localized skin and wound infections. Applied over abrasions, lacerations, and sutured wounds.

Bacitracin ointment - active against gram-positive organisms; does not commonly cause contact dermatitis
Triple antibiotic (neomycin + bacitracin + polymyxin B / Neosporin) - broad-spectrum protection; neomycin can rarely cause contact dermatitis (~1%)
Mupirocin (Bactroban) 2% - effective against Staphylococcus and Streptococcus; also used intranasally to decolonize MRSA carriers
Erythromycin ointment - alternative for patients allergic to neomycin and bacitracin
Roberts and Hedges' Clinical Procedures in Emergency, Dermatology 5e

Key point: Antibiotic ointments also prevent the wound dressing from adhering to the wound surface, reducing crust formation and aiding healing.

2. Antifungal Ointments

Miconazole nitrate 2% - available as ointment for dermatophyte and yeast infections (tinea, candidiasis)
Clotrimazole, terbinafine - used for ringworm, athlete's foot, jock itch
Goodman & Gilman's Pharmacological Basis of Therapeutics

3. Corticosteroid Ointments

Used for inflammatory skin conditions (eczema, psoriasis, contact dermatitis, lichen planus). Ointments are more potent than equivalent creams because of enhanced absorption.

Hydrocortisone 1% - mild; suitable for face, intertriginous areas
Triamcinolone acetonide 0.1% - medium potency; thick psoriatic plaques
Clobetasol propionate - ultra-high potency; severe inflammatory dermatoses
Mometasone furoate, fluticasone propionate - low systemic absorption; preferred for long-term use
Avoid high-potency ointments on the face/body folds due to risk of skin atrophy and steroid rosacea
Dermatology 5e, Goodman & Gilman's

4. Calcineurin Inhibitor Ointments

Tacrolimus ointment (Protopic) - 0.03% for children ≥2 years, 0.1% for adults; approved for atopic dermatitis (eczema); steroid-sparing agent also used in lichen planus and other inflammatory skin conditions
Goodman & Gilman's, Andrews' Diseases of the Skin

5. Ophthalmic Ointments

Applied to the conjunctival sac (approximately a 0.5-inch ribbon) for:

Bacterial eye infections (e.g., erythromycin ophthalmic ointment)
Neo-Polymyxin ophthalmic ointment for conjunctivitis
Lubricating ointments for dry eye (especially overnight)
The Harriet Lane Handbook 23e

6. Topical Anesthetic Ointments

Lidocaine 5% ointment - used for topical anesthesia of mucous membranes and skin; also relieves pruritus
Benzocaine ointment - topical airway anesthesia, wound dressings; onset 5-10 minutes, duration 30-60 minutes
EMLA (lidocaine + prilocaine) - eutectic mixture in ointment; used before minor procedures
KJ Lee's Otolaryngology, Andrews' Diseases of the Skin

7. Antiviral Ointments

Acyclovir ointment - used for HSV (herpes simplex) skin and mucosal lesions
Goodman & Gilman's

8. Keratolytic and Antiparasitic Ointments

Sulfur ointment - used for scabies, acne, and seborrheic dermatitis
Whitfield's ointment (benzoic acid + salicylic acid) - antifungal/keratolytic

9. Topical Vitamin D Analogues (Ointment form)

Calcipotriene/calcipotriol 0.005% ointment - used for psoriasis; max weekly dose guidelines apply
Dermatology 5e

10. Burn and Wound Ointments

Silver sulfadiazine (Silvadene) - used for burns, graft sites, donor sites
Nitrofurazone ointment - increases granulation tissue; used in crush wounds
Sabiston Textbook of Surgery, Schwartz's Principles of Surgery

Key Principles: Ointment vs. Cream vs. Gel

Vehicle	Best Used For	Notes
Ointment	Dry, scaly, thickened lesions	Most occlusive; highest potency for corticosteroids
Cream	Weeping, moist, intertriginous areas	Cosmetically acceptable
Lotion	Large surface areas, face	Elegant, low occlusion
Gel/Foam	Hairy areas, scalp	Drying effect; good absorption

Important Cautions

Strong topical corticosteroids (e.g. 0.1% triamcinolone acetonide) can retard wound healing by up to 60% - avoid on fresh wounds
Neomycin can cause contact dermatitis, especially with repeated use
Do not apply antibiotic ointments over tissue adhesive (glue) wound closures - they dissolve the adhesive
EMLA (lidocaine + prilocaine) can cause methemoglobinemia in infants and on impaired skin

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