In EB a lot of ointments and creams are used. These are described in this module. Which ointment or cream is best in a particular treatment is determined in consultation with the doctor in attendance. It is often a matter of trying out which cream works best.

Ointments and creams are applied to the skin and/or wound and may have, amongst other things, a cooling, protective, antipruritic, soothing, greasing and occlusive property.

This module describes what is meant by ointments and creams and how the various ointments and creams can be used.

Creams are semi-solid, spreadable preparations that consist of a mixture of water and oil, two substances that do not, or only partially mix. The oil is, with the aid of one or more emulsifiers, divided into very fine drops in the water. Creams have a soothing and protective effect on the skin.

The use of ointments and creams in EB is primarily directed towards:

• maintaining or obtaining a good skin condition;

• suppressing itching;

• fighting possible bacterial and/or fungal infections.

In order to maintain or obtain a good skin condition in an EB-patient, several agents are used.

In general indifferent creams and ointments are used. An indifferent cream or ointment consists of a neutral base. To this base specific agents may be added for a therapeutic effect. However, the neutral base itself also has a number of important physical properties, such as:

• cooling the skin;

• protecting the parts of the skin that are no longer covered

by the epidermis;

• counteracting loss of fluid.

Creams or ointments that are used to maintain or obtain a good skin condition include:

• Cetomacrogol Cream FNA;

• Vaseline Cetomacrogol Cream FNA;

• Vaseline Lanette Cream FNA;

• Lanette Cream;

• Eucerine cum aqua LNA.

These creams and ointments prevent or control a dry skin. Often, a hydrophillic cream will be picked that is easily absorbed by the skin. Besides the use of creams and ointments, lotions may be used as well.

Creams and ointments that are used for the care of wounds which have almost healed include:

• Calendula® Cream;

• Cetomacrogol Ointment FNA;

• Vaseline Ointment FNA;

• Zinc oxide Ointment 10% FNA;

• Cooling Ointment FNA.

These creams and ointments protect the (epidermis-stripped) skin against damage and dehydration. They are usually greasy and form a protective layer. The cream or ointment is applied to the wound and subsequently covered with waste linen or lint to prevent loss of the cream or ointment and their protective effect.

EB-patients are often troubled by itching, especially on the sites of wounds that are healing. Here, the skin is dry and quick to scale. It is important to prevent itch as much as possible. Itching is not only annoying but it is also often a reason for the patient to start scratching. This must be prevented as much as possible; because scratching damages the skin again. Ointments or creams that are used to prevent or control itching are usually also the ointments and creams that counteract dry skin;

• Cetomacrogol Cream FNA;

• Vaseline Cetomacrogol Cream FNA;

• Eucerine cum aqua LNA;

• Zinc oxide Ointment 10% FNA.

If the wounds are infected, ointments and creams with an antimicrobial effect are used. These are preferably effective against at least staphylococci and streptococci because these are the main causes of skin infections.

Furthermore, the ointment and cream should cause as little sensitization as possible. Examples of ointments and creams with an antimicrobial effect include:

• Flamazine® Cream;

• Tetracycline Cream/Ointment FNA;

• Fucidin® Cream/Ointment;

• Bactroban® Ointment;

Whether an ointment or cream should be applied thickly or thinly depends on the effect desired.

If it is a matter of protecting the wound thick layers should be applied. If a pharmacological effect is intended (for example, in corticosteroids or antimicrobial effect) a thin layer will be sufficient: only the thin layer of ointment that is situated directly on the skin contributes to the effect of the ointment. In this case a thick layer is superfluous. In general, this means that only the amount of hydrophillic cream that seems absorbable by the skin should be applied. Hydrophobic creams and ointments should be applied in a thin layer so that the skin feels just a bit greasy.

The application of ointments on the entire skin and in addition the possible topical application of extra greasy ointments, corticosteroids or antimicrobial creams and ointments, demands a lot of time and is therefore a great burden for the patient and his/her carers. For that reason, ointment is generally not applied more than once a day, sometimes even once in two days. Locally, ointments might be needed more often. Preferably, the ointment is put on the skin after a bath/shower. The ointment or cream provides physical protection of the wound and, depending on which ointment or cream that is used, it has a pharmacotherapeutic effect. In order to increase this protection and its pharmacotherapeutic effect, parts of the skin that have been covered in ointment may be covered with dressing material. For this, waste linen and lint are usually used. Cotton dressing gloves might be worn on the hands.