What is the difference between cream, ointment and lotion?

In this article we explore the different formulations of topical medications

At Bellevue Acne Clinic, topical medications are commonly prescribed. ‘Topical’ refers to a type of medication that is applied directly to the skin, as opposed to being taken by mouth. (Topical medications can also be put in the eye or ear, but that is not very common in our clinic).

Topical medications and over-the-counter products can be formulated in different ways. You have probably seen the words cream, lotion and ointment, and never gave a thought as to what might be the difference among them. These terms are actually defined differently and can make a difference when you apply the medication to your skin.

Creams are a semi-solid emulsion, half oil and half water. This formulation is typically the easiest to use and is preferable by most patients. They spread easily, absorb quickly and wash off with water. They have a medium viscosity or heaviness, and are reasonably hydrating without feeling too heavy on your skin. Creams are always packaged in a tub or a tube; they are too thick to be dispensed in a pump. Creams are often used to treat acne in patients whose skin is somewhat dry, as the creams promote hydration. Creams are also more beneficial in darker skin, which in general is more easily irritated than lighter skin.

Lotions are thinner than creams, and are often packaged in a pump. They absorb very quickly and feel very light on the skin. They are easier to distribute on hairy areas. Most over-the-counter body moisturizers are lotions.

Ointments are 80% oil and 20% water. These products feel greasy, do not absorb well and are generally not easy to use on large areas. They are ‘occlusive,’ which means they trap moisture and heat in very well. Ointments promote medication absorption over all other formulations. If an ingredient is in an ointment, it is always more potent than the exact same ingredient packaged in a cream or lotion. For example, amcinonide is a topical steroid. In an ointment it is considered high potency, and in a cream or lotion it is considered medium-high potency.

Gels are emulsions that contain oil-in-water. They usually have an alcohol base. They dry into a thin, greaseless, nonstaining film.  Like lotions and foams, they are ideal for spreading on hairy areas and large areas. Gels are often ideal in the treatment of acne, because they are a bit drying and most individuals with acne have oily skin.

Foams are pressurized collections of gaseous bubbles in a matrix of liquid film. Foam preparations spread readily and are easier to apply than other preparations. In acne they are particularly useful for application to the back, which is a very difficult area to reach (unless you have a buddy).

Clindamycin is an often-used acne medication that is available in most of the formulations above. The gel version can be helpful in drying oily skin and as an alternative to harsh alcohol-based aftershave in men. Clindamycin foam is easy to distribute on the back and chest. The lotion and solution may be helpful for individuals who need a bit of hydration.  It also is available as a pledget on a stick that can easily reach the mid-back. Finally, it is available as a combination product with benzoyl peroxide or tretinoin.

The choice of delivery system for topical acne medications depends upon your skin type (oily versus dry) and preference. Gels are drying; they may be appropriate for individuals with oily skin. Creams and lotions tend to be moisturizing. Foams are easy to apply to hair-bearing areas.

There are many topical acne medications available to help clear your skin. With the help of your dermatology provider at Bellevue Acne Clinic, you can find the perfect product to improve your complexion and lead you to happy, healthy acne-free skin.