Aqueous creams

Fluocinonide 0.05% Lidex anhydrous cream, gel, soln 0.05% Lidex-E aqueous cream 0.05% High... 

Different types of evidence exist for the clinical efficacy of 10% urea in the treatment of psoriasis (Table 19.1). Early clinical data from a clinical study on various types of hyperkeratosis showed no superior effects on from 10% urea cream compared to ordinary aqueous cream BP in the treatment of psoriasis.10 However, five psoriatic patients with chronic therapy-resistant lesions obtained soft and pliable skin after treatment with 10% urea, but no effect on erythema was observed.17 Psoriatic lesions on the extremities (at least 5 cm in diameter in size) also showed clinical improvement after two weeks of treatment with an ointment containing 10% urea (Basodexan S ointment) in a placebo-controlled study on ten patients.26 Higher values of skin capacitance (suggested to reflect skin hydration) were also noted on urea-treated areas. Increased hygroscopicity and water content were also obtained after treatment with 10% urea ointment in patients with psoriasis vulgaris.27 Moreover, urea treatment reduced epidermal proliferation, measured as an altered expression of involucrin and cytokeratins.26 Treatment of psoriasis vulgaris with 10% urea-formulations support clinical efficacy at evidence-level lb (cf. Figure 19.1). 

Randomized, double-blind, bilateral No difference to aqueous cream BP 10... 

In a clinical study on cracked, chapped hands, which often occur in winter time and as a result of wet-work, the effect from a 10% urea cream (Calmurid ) was not superior to that of aqueous cream BP.10 Two preparations containing 10% urea were found to be helpful therapeutic agents in a doubleblind, bilateral study.31 Both investigators and patients expressed preference for the cream containing multisterols, phospholipids, and fatty diols (pH of about six) to the other cream (Calmuril ) containing betaine and lactic acid (pH about three). Some patients noted burning sensations after treatment with the latter cream (Calmuril ). 

Hydrophilic (aqueous) cream is an oil-in-water emulsion formed with the aid of an emulsifier it may also be considered an oil-in-water emulsion of an emulsifying ointment. 

Using SEM and x-ray microanalysis. King and co-workers [25] followed the distribution of topically applied sulfur (10% precipitated sulfur in an aqueous cream base), lead (20% w/w, subacetate solution), zinc (calamine lotion), and fluorinated corticosteroids after topical application on the forearm of a human subject. It was found that the amount of sulfur, zinc, and lead were at higher concentrations in the deeper layers of the SC with increasing application time. The fluorinated corticosteroids were not detected within the skin. Information was not provided about the exact depth of penetration or the amount of each element found at different depths within the SC. It was, however, acknowledged that the combined SEM and x-ray microanalysis... 

Emulsifying ointment is made from emulsifying wax (cetostearyl alcohol and sodium lauryl sulphate) and paraffins. Aqueous cream is an oil-in-water emulsion of emulsifying ointment. 

Emollients hydrate the skin and soothe and smooth dry scaly conditions. They need to be applied frequently as their effects are short-lived. There is a variety of preparations but aqueous cream in addition to its use as a vehicle (above) is effective when used as a soap substitute. Various other ingredients may be added to emoUients, e.g. menthol, camphor or phenol for its mild antipruritic effect and zinc and titanium dioxide as astringents. 

A cooling application such as 0.5-2% menthol in aqueous cream is antipruritic, probably by weak local anaesthetic action. 

Pruritus ani is managed by attention to hygiene, emollients, e.g. washing with aqueous cream, and a weak corticosteroid with antiseptic/anticandida application used as briefly as practicable (some cases are a form of neurodermatitis). Secondary contact sensitivity, e.g. to local anaesthetics, is common. 

An emollient such as aqueous cream will reduce the inflammation. The proliferated cells may be eliminated by a dithranol (antimitotic) preparation applied accurately to the lesions (but not on the face) for 1 hour and removed begin with 0.1% and increase to 1%. Dithranol is available in cream bases or in Lassar s paste (the preparations are not interchangeable). It is used daily until the lesions have disappeared it is irritant to normal skin and stains skin and fabrics. Tar preparations are less effective alternatives, and are commonly used for psoriasis of the scalp. 

Nappy rash Prevenfjon, rid reusable nappies of soaps, detergents and ammonia by rinsing. Change frequently and use an emollient cream, e.g, aqueous cream, to protect skin. Costly disposable nappies are useful, Cure n lild Zn cream or calamine lotion, plus above measures.Severe Adren al steroid topically, plus antimicrobiat. ... 

A formulation containing menthol 1 % w/w in aqueous cream has been reported to be stable for up to 18 months when stored at room temperature. ... 

Gallagher P, Jones S. A stability and validation study of 1% w/w menthol in aqueous cream. Int ] Pharm Pract 1997 5 101-104. 

Anionic emulsifying wax is used in cosmetics and topical pharmaceutical formulations primarily as an emulsifying agent. The wax is added to fatty or paraffin bases to facilitate the production of oil-in-water emulsions that are nongreasy. In concentrations of about 2%, emulsions are pourable stiffer emulsions, e.g., aqueous cream BP, may contain up to 10% of anionic emulsifying wax. 

Many modern dermatological formulations are washable oil-in-water systems. Simple aqueous lotions are also used as they have a cooling effect on the skin. Ointments are used for the application of insoluble or oil-soluble medicaments and leave a greasy film on the skin, inhibiting loss of moisture and encouraging the hydration of the keratin layer. Aqueous creams combine the characteristics of the lotions and ointments. A classification of semisolid bases is given in Fig. 9.24. 

Complexes which form are not always fully active. A well-known example is the complex between neomycin sulfate and sodium lauryl sulfate that will form when Aqueous Cream BP is used as a vehicle for neomycin sulfate. Aqueous cream comprises 30% emulsifying ointment, which itself is a mixture of emulsifying wax which contains 10% of sodium lauryl sulfate or a similar anionic surfactant. 

Both tinplate and aluminium sheet may be used to produce shallow drawn containers, the choice depending on cost versus product resistance. Dry products and nonaqueous creams are usually satisfactory in tinplate, whereas aqueous creams are better packed in aluminium. Alternatively, lacquered tinplate can be used for aqueous creams but there is always a chance of corrosion at any raw edges. Tinplate is stronger than aluminium for a given thickness. 

When slip lid containers are used for aqueous creams or ointments with volatile constituents, a glassine or foil laminate membrane is often placed across the rim of the container resting on the product. This serves to reduce losses on storage and in use and the membrane can also carry additional instructions to the customer or patient. Sometimes this membrane is sized to overlap the rim so as to become entrapped on closuring. In this case allowances must be made when specifying tolerances of fit for the container and lid. The slip lid should support the weight of the filled pack when it is lifted by the lid. 

Adapalene cream, 0.1%, contains adapalene 0.1% in an aqueous cream emulsion consisting of carbomer 934P, cyclomethicone, edetate disodium, glycerin, methyl glucose sesquistearate, methylparaben, PEG-20 methyl glucose... 

The anthralin cream 1.0% USP is a smooth, yellow cream containing 1% anthralin USP in an aqueous cream base of glyceryl monolaurate, glyceryl monomyristate, citric... 

The ketoconazole 2% cream contains the broad-spectrum synthetic antifungal agent ketoconazole 2%, formulated in an aqueous cream vehicle consisting of propylene glycol, stearyl and cetyl alcohols, sorbitan monostearate, polysor-... 

Proprietary alternatives are often available, so compounding of semisolids is not an extensive activity in paediatrics. Standard compounding conditions apply. Aqueous creams are prone to microbial growth which... 

Other reports indicate that aqueous cream may cause local skin irritations such as stinging, burning, itching and redness, when it is used as a leave-on emollient, particularly in children with atopic eczema. The reactions, which are not generally serious, often occm within 20 min but can occur later. However, patients and those who care for them should be warned of this risk dming an eczema treatment consultation [15 ]. 

Anonymous. Aqueous cream. May cause skin irritation, particularly in children with eczema. WHO Newslet 2013 3 9. 

Application of Salicylic Acid and Sulphur, B,P,C. Contains 2 08 per cent each of salicylic acid and sublimed sulphur in aqueous cream. 

---