Definition
What are ointments?
The ointments are preparations for external use with a semi-solid consistency, formulated to be applied on healthy or diseased skin or on mucous surfaces,
Classification
The ointments are not defined by the official pharmacopoeia and - included in the broader category of semi-solid preparations for skin application - are implicitly divided into ointments and creams, depending on the physical system of which they are made.
- Ointments: they are anhydrous or almost anhydrous preparations (ie low in water and very rich in fat), consisting of a low water base rich in fatty and resinous substances. The peculiarity of the ointments is precisely that of having a considerable content of fatty substances; for this characteristic, they are indicated in the treatment of dry, scaly dermatoses with a lichenoid and hyperkeratotic imprint (in general in all cases of marked dry skin, while they are contraindicated in the presence of significant skin inflammations, especially in the acute phase). They are not absorbed by the skin, but form a superficial layer on it, which is difficult to spread and particularly greasy; consequently, due to its occlusive and "barrier" properties, this layer of fat exerts an advantageous long-lasting emollient effect, with a reduction in TEWL. Being water-free, ointments generally keep very well, making the use of preservatives unnecessary.
- Creams: they are emulsions formed by two phases - greasy (O) and aqueous (A) - one of which prevails over the other (in the more common O / A, the aqueous phase prevails and for this reason they are defined hydrophilic; in those A / O the fatty phase prevails and for this reason they are defined hydrophobic or lipophilic as they are closer to ointments.) They are generally used as a carrier for medicaments, as above all O / A emulsions are easily absorbed by the skin; greasy to the touch and are mainly used in products whose functionality is linked to the permanence on the skin surface, such as protective cosmetics for the sun, massage creams and those with a barrier effect. Containing water, the creams require preservatives.
PLEASE NOTE: in the common imagination, the ointment is often understood as an ointment or as a lipophilic O / A cream; not surprisingly, it is generically described by the layman as a "fat cream".
Many authors also include other semi-solid preparations for skin application in the category of ointments:
- Gels: are liquids transformed into gelatinous masses by means of suitable gelling agents, such as pectin, arabic gum, isinglass, tragacanth, cellulose derivatives, starch, carbomers etc .; they are indicated in exudative forms, or if a vehicle is desired transparent, non-greasy and non-occlusive, as well as pleasant and refreshing.
- Pastes: they contain a high proportion of solid substances reduced to powder (starch, calcium carbonate, kaolin, zinc oxide, vegetable powders, etc.), which do not dissolve but are finely dispersed in the excipients (fats → fatty pastes - or aqueous → aqueous pastes that include gelled water). Their main characteristic is that they are very absorbent, therefore they are able to retain harmful or unwanted substances, such as the typical exudates of some skin diseases or the ammonia produced by bacterial alteration of the urine. used in pediatrics as a protection for the buttock-perineal region; we think, for example, of zinc oxide pastes in irritative dermatitis, such as diaper dermatitis or perioral licking dermatitis
In their simplest formulation, ointments consist of a simple base (such as petroleum jelly, animal fat or beeswax) in which one or more active ingredients are dissolved or dispersed.
Among the lipophilic or oily excipients most commonly contained in the bases of ointments are petroleum jelly, cocoa butter, beeswax, animal fat (lard or pork fat, cod or shark liver oil, spermaceti ...), almond oil, olive oil, sunflower oil, argan oil, jojoba oil; lanolin stands out among the hydrophilic excipients. Clearly the typical excipients of folk medicine (such as animal fats), although easily available they have rather limiting negative aspects, such as bad odor, ease of rancidity, therefore poor shelf life, and excessive greasiness.
Preparation
How to make creams and ointments
On the market there are basic formulations in which to incorporate the active substances, making the preparation of the ointments much easier and within everyone's reach (just ask the pharmacist, for example the Essex base cream). Alternatively, the inexperienced will have to take into account possible initial failures, even following the advice of the recipes to the letter; in fact several tests are needed to "get an eye" and correct the original recipes if necessary:
- in general the oily bases (for ointments or ointments intended as "fat creams") are prepared by melting the lipid bases by placing them inside a saucepan (preferably glass), gently heated in a bain-marie; you can only use a lipid substance or waxy solid or semi-solid (lanolin, hen or pork fat, beeswax, etc.), or mix it with a part of oil (olive and sweet almond oils are widely used). Once the oily base has melted, the vegetable extracts are added and everything is mixed for a few minutes, continuing to heat over low heat. It is filtered with a cloth or gauze letting out the melted liquid, which once solidified inside the jars will take on a semi-solid or solid consistency.
- creams require a more articulated and complex preparation to prevent the two phases (aqueous and oily) from separating. Basically, it is like preparing a mayonnaise, so the use of an immersion mixer can help, while the emulsifiers (which in the mayonnaise are given by the lecithins of the egg) are used to prevent the phases from separating. to the fat part it is therefore necessary to add a certain percentage of water and an aqueous base (such as glycerin). A recipe for an A / O cream involves the melting of about 150 grams of pure beeswax placed in a heated glass jar in a water bath, then, mixing vigorously, add 70 g of glycerin and 80 ml of water; at this point the vegetable extracts are also added, mixing and then letting it simmer over low heat for a few tens of minutes (always using the bain-marie); everything will then be filtered with gauze and mixed until it has cooled down and thickened like a cream. Pour and mix with the help of a spatula: first put a little cream around the edge, then fill the center of the container. The "leaner" preparations are often more problematic and require the addition of specific emulsifiers such as glyceryl stearate.
NOTE: to test the consistency of the ointment or cream, during processing it is possible to drop a few drops of the mixture on a cold plate: if the sample remains too soft, a certain amount of thickener must be added (e.g. cocoa butter, beeswax or lanolin); if, on the contrary, it is too dense, a further quantity of water or oil must be added.
Natural ingredients
Among the plant extracts most used in the formulation of phytotherapeutic ointments we find:
- calendula extracts: against redness, cuts, burns, sunburn, venous circulatory disorders (varicose veins, phlebitis, hemorrhoids) and pressure sores. Applied locally, calendula accelerates healing and hinders inflammation and staphylococcal infections; finally, it improves skin circulation, making the skin more elastic, therefore more resistant to mechanical insults.
- extracts of horse chestnut, centella, witch hazel: hemorrhoids, varicose veins, tired and heavy legs, fragile capillaries
- propolis: antiseptic, antibiotic action
- hypericum: softening, healing, anti-inflammatory action
- Arnica montana, devil's claw, willow, uncaria, spirea: anti-inflammatory action against bruises and rheumatism
Important recommendations for those wishing to produce ointments directly at home
To produce ointments at home - where the technologies and tools present in a laboratory or in an industry are certainly not available - it is necessary to follow some indications, in order to avoid obtaining unsuitable products (for consistency, odor, etc. .), or worse, dangerous to health.
- cleaning first of all: to ensure the effectiveness and duration of homemade creams and ointments, it is necessary to carefully clean the worktops, utensils, containers etc. This implies their "sterilization" in boiling water, with the "possible use of detergent which in any case must be rinsed thoroughly and with particular care.
- prefer glass containers over metal ones
- prefer dark glass jars for storage
- the fats must be melted in a bain-marie over low heat, reaching the minimum temperature of complete melting (the oils are very delicate, and even more so are the vegetable extracts added in the ointments)
- protect yourself with gloves or pot holders to avoid burns when handling hot mixtures
- in general, homemade creams and ointments can be kept for a short time (since they do not normally require the use of specific preservatives); therefore, it is better to keep them in the refrigerator and avoid using them after a couple of months from production.
- in the preparation of creams (emulsions) prefer the use of minimally mineralized bottled water to tap water
- become aware of the possible side effects (see next chapter); in any case, avoid self-treatment.
Examples
Examples of Galenic Formulations and Do-It-Yourself Ointments
In addition to the commercial products available in pharmacies, in the literature there are recipes for numerous galenic preparations, handed down over the centuries by folk medicine and particularly sought after by internet users interested in natural medicine and phytocosmetics. The preparation of these ointments should take place exclusively in a pharmacy or herbalist's shop, with dispensing to the patient upon specific advice from the doctor or the pharmacist or herbalist himself.
Simple and commonly used ingredients, in fact, could be contraindicated in certain circumstances and trigger even important side effects.
- In general, these products should not be applied on open wounds (unless otherwise indicated): talcum powder is not used on open lesions due to the possible onset of granulomas; similarly, the application of mineral oils (vaseline, paraffin) on open wounds could cause the appearance of paraffinomas.
- Maximum caution in atopic patients (prone to allergies); if necessary, test the tolerability of the preparation by applying it in small quantities to the skin of the forearm; if swelling or redness appears in the area of application, avoid using it.
- Attention to sun exposure in case of application of photosensitizing preparations, even if natural (eg. St. John's wort, often included in healing and anti-inflammatory ointments)
- Any essential oils should never be used pure, but suitably diluted (1-2%)
Below are some examples of galenic and commercial ointments, reiterating that their preparation and indication is the sole responsibility of qualified doctors, pharmacists and herbalists. On the one hand, these are examples extracted from traditional and popular phytotherapeutic recipe books, whose therapeutic value is generally mild and whose safety profile must be evaluated in the specific case by an expert before use; on the other hand, it is possible an immediate comparison with commercial preparations.
Ointments against hemorrhoids and anal fissures
Yarrow ointment against hemorrhoids
- Yarrow, flowering tops 20 grams
- Raspberry, leaves 20 gr
- Lard 10g
Preparation: an ointment is prepared by heating the drugs in 10 gr. of melted lard for a bain-marie. It is left to rest, after turning everything, and warms up in the same way the next day. It is then filtered hot through 1 linen cloth, placed in a glass jar and stored in the refrigerator. Massage the painful area with this ointment.
Rectogesic 4mg / g Rectal Ointment - indicated to relieve pain associated with chronic anal fissure
One gram of rectal ointment contains 40 mg of glycerin in propylene glycol corresponding to 4 mg of glycerin (TNG). 375 mg of this formulation contains approximately 1.5 mg of TNG. Each gram of rectal ointment also contains 36 mg of propylene glycol and 140 mg of lanolin.
A 4 mg / g dose of ointment contains 1.5 mg of glyceryl trinitrate. This dose should be applied intra-anal every twelve hours. Treatment can be continued until pain subsides, up to a maximum of 8 weeks.
Horse chestnut ointment against hemorrhoids
- Horse chestnut E.F. (7g)
- Mallow E.F. (5g)
- Witch hazel E.F. (3 g)
- Rusco E.F. (3 g)
- Calendula (3 g)
- Base cream to taste (100 g)
Preparation: by simple cold incorporation of the extracts into the base cream (E.F. means fluid extract, they can be found in pharmacies)
Doxiproct - Topical ointment.
100 g of ointment contain:
Active principles:
- calcium dobesilate 4 g
- lidocaine hydrochloride 2 g
- dexamethasone acetate 0.025 g.
Excipients: polysorbitan monoleate, propyl gallate, butylhydroxyanisole, anhydrous citric acid, cetyl alcohol, polyethylene glycols, propylene glycol.
Indicated for internal and external hemorrhoids. Anal itching. Anitis, perianitis, cryptitis, papillitis, acute hemorrhoidal thrombosis, fissures. Pre and post operative treatment of hemorrhoidectomy. Hemorrhoids of pregnancy.
Astringent ointment against hemorrhoids and varicose veins
- Ratania E.S. 8g
- Ippocastno E.S. 10g
- Lanolin 40g
- Vaseline 40g
POMATA RECTO-REPARIL GEL 1%
100 g of ointment contain:
Active ingredients: escin 0.5 g, Tetracaine hydrochloride 4.5 g.
Excipients: Polyglycolic cotenside of fatty acids g 2.0, polyglycolic ester of fatty acids g 21, polyglycol ester of saturated fatty alcohols g 3, partial glyceride of fatty acids g 7, methyl-p-hydroxybenzonate g 0.1, ethyl ester of "linol-linoleic acid g 20, anoxid SBN g 0.5, deionized water g 41.4.
Indicated for: Anorectal varicose syndrome, external and internal hemorrhoids; complications of hemorrhoids: anal congestion, anal itching. Proctiti. Anal fissures.
Ointment against anal itching
- Liquid tar 5g
- Lanolin 5 g
- Zinc oxide 7g
- Vaseline 20g
Ointments Against Varicose Veins
- Agrimonia, whole plant 50g
- Pork lard, 200/300 g
An ointment is prepared by mixing the drug with 200-300 g of heated pork lard. Pour it into boiling oil and turn everything over, frying briefly. It is left to rest for 4-5 hours, then the mixture is heated slightly and filtered, conserving it in glass jars. Use: massage the affected limbs with the ointment once a day.
VENOSMINE ointment
100 g of ointment contain: Active ingredient: diosmin g 4. Excipients: semisynthetic glycerides (softisan 100), anionic emulsifying wax (lanette SX), anhydrous lanolin, polysorbate 80, dimethyl polysiloxane 100, dimethyl polysiloxane 500, methyl p-hydroxybenzoate, propyl p-hydroxybenzoate, lemon essence, purified water.
Indicated for the topical treatment of varicose disease (varicose ulcers, phlebitis, superficial venous thrombosis, malleolar edema, superficial venous stasis ...).
Adjuvant in the treatment, in general, of the states of capillary fragility and their manifestations (ecchymosis, hematomas, purpura ...).
POMADE AGAINST CAPILLARY FRAGILITY
- Marigold, T.M. 4 g
- Centella, T.M. 4 g
- White Vaseline F.U. q.s. to 100
Ointments Against Dermatitis
Pasta Lassar (fatty pasta)
- Zinc Oxide 25g
- Corn starch 25g
- Vaseline 25g
- Lanolin 25g
- Salicylic acid 2g
Suitable for surfaces and intertriginous areas, diaper rash, irritative and macerative intertrigines, chronic and lichenified eczema in the post critical phase (nummular eczema, prurigo, strophulus), dry phase dyshidrosis, hand eczema, etc. Well adherent to the skin, it cannot be removed with water but with oil.
Dermatop 0.25% lipophilic cream
1 g of cream contains: 2.5 mg prednicarbate.
Excipients: Purified water, edetic acid, glycerol monoleate, magnesium sulfate hydrate, octyldodecanol, white petroleum jelly
Indicated for dermatosis, including contact dermatitis, atopic dermatitis, seborrheic eczema, psoriasis, psoriasis of the head and in general all inflammatory skin forms sensitive to topical corticosteroid therapy.
Ointments against burns and burns
Calendula ointment
- Marigold, T.M. 4 g
- White Vaseline 96g
It is applied to the margins and on burns because it hastens the healing process.
FOILLE BURNS
100 g of cream contain:
Active principles:
benzyl alcohol 4 g
benzocaine 5 g
chloroxylenol 0.10 g.
Excipients: Hydrogenated vegetable oil, ceresin (solid paraffin), yellow beeswax, monodiglycerides (of higher fatty acids), corn oil, calcium hydrate, sodium borate, PEG 32, sodium lauryl sulfate, maleic anhydride, eugenol, sodium calcium EDTA , 8-hydroxyquinoline, purified water.
Indicated for minor burns, sunburn, skin irritation from various chemical-physical agents, insect bites. In the dressing of excoriations, abrasions and superficial skin wounds.
Ointments Against Rheumatism and Joint Pain
Arnica ointment
- mother tincture of arnica 5g
- Vaseline to taste 100
Indicated for insect bites, bruises and sprains.
LASOARTRO 5% CREAM
100 g of cream contain:
active ingredient: ketoprofen lysine salt 5 g
Excipients: Stearic acid, purified water, lanolin, methyl p-hydroxybenzoate, methyl polysiloxane, polyethylene glycol monostearate, petroleum jelly, propyl p-hydroxybenzoate.
Indicated for the symptomatic treatment of acute painful episodes occurring in the course of inflammatory diseases of the musculoskeletal system. Treatment of local painful inflammatory diseases.
Ointments Against Psoriasis
- Tar 15 g
- Lard 90 g
Foruma alternative
- Tar 15 g
- sublimated sulfur 15 g
- neutral soap 50g
- hot water 50g
For external use 1-2 times a day.
Cortical cream 0.2%
100 g of cream contain:
Active ingredient: diflucortolone valerianate 0.2 g
Excipients: polyethylene glycol monostearate g 3, stearyl alcohol g 8, liquid paraffin g 10, white vaseline g 10, sodium edetate g 0.1, carboxypolymethylene g 0.3, sodium hydroxide g 0.067, methyl p-hydroxybenzoate g 0.07, propyl p-hydroxybenzoate g 0.03, purified water to taste to g 100.
Indications: resistant localized plaques of: psoriasis, lichenification, discoid lupus erythematosus, hypertrophic lichen. Hypertrophic scars
