The selection between an ointment and a cream is a common point of confusion when choosing a topical treatment or moisturizer. These preparations, known as vehicles, deliver active ingredients or moisture to the skin. Their effectiveness depends entirely on the specific formulation, the condition being treated, and the location of application. Determining which is better relies completely on the intended use and the severity of the skin issue.
Fundamental Differences in Composition
The primary distinction between creams and ointments lies in their ratio of oil to water. Ointments are predominantly oil-based, containing at least 80% oil and typically less than 20% water, or sometimes no water at all (anhydrous). This high oil concentration, often utilizing ingredients like petrolatum, gives the ointment its thick, greasy texture.
Creams, by contrast, are emulsions—stable mixtures of oil and water. They are generally formulated with an approximate 50% oil and 50% water ratio. This balanced composition requires emulsifying agents to prevent separation. Due to their significant water content, creams frequently contain preservatives to inhibit microbial growth.
Mechanism and Practical Feel
The compositional differences translate directly into distinct modes of action and varied user experience. Ointments are highly occlusive, forming a dense barrier on the skin’s surface that prevents water from evaporating. This barrier minimizes transepidermal water loss (TEWL), making them effective at locking in moisture and hydrating the skin.
The occlusive nature of ointments results in a heavy, greasy, and slow-absorbing feel, often making them less appealing for daytime use. This prolonged contact also enhances the penetration of active medicinal ingredients into the deeper layers of the skin. Creams, with their higher water content, are far less occlusive and absorb more quickly.
Creams are perceived as lighter, smoother, and easier to spread, leaving minimal residue. This makes them more acceptable for daily application, especially on the face or other visible body areas. While creams provide hydration, their effect is less intense and shorter-lived than the moisture retention offered by an ointment.
Choosing the Right Vehicle for the Condition
The choice between the two vehicles should be guided by the specific therapeutic goal and the characteristics of the skin condition. Ointments are preferred for maximum hydration and barrier function, such as treating severely dry, cracked skin or chronic, thick patches seen in eczema or psoriasis. They also protect minor wounds and burns, as the occlusive layer creates an ideal moist environment for healing.
Creams are better suited for mild to moderate dryness and for application over large or hairy body areas, where a greasy preparation is impractical. Due to their quick absorption, creams are a popular choice for daytime use. Additionally, the reduced need for preservatives in ointments makes them a better choice for highly sensitive skin that might react to chemical additives in creams.
Creams should also be used on intertriginous areas, which are skin folds like the groin or under the breasts. Applying an occlusive ointment there can trap moisture and heat, potentially leading to maceration or worsening fungal infections. The decision ultimately depends on whether the priority is intense, barrier-forming moisture (ointment) or a lighter, more spreadable vehicle (cream).