Zinc oxide ointment with soothing agents: how to choose and use it

What does zinc oxide ointment actually do?

Zinc oxide forms a protective layer that allows irritated skin to heal. Common uses include preventing and treating nappy rash and protecting skin exposed to urine or stool. Some zinc oxide preparations are also used for minor burns and irritation. These are different uses, so follow the directions for the particular product rather than treating every zinc oxide tub as interchangeable.145

Which added ingredients matter?

Petrolatum, also called petroleum jelly, and mineral oil are common moisturising ingredients. Moisturisers help restore water and oils to skin and maintain hydration. Zinc oxide, lanolin and petrolatum can also form protective barriers against moisture exposure. Barrier protection and moisturising are different jobs, even when both arrive in a tub.24

An ointment is oil based, with little or no water. Its occlusive nature means it forms a covering that helps retain moisture and can increase the penetration of medication. Creams combine oil and water, provide moisturising and cooling, and disappear as they are rubbed in. The ointment base matters as well as the zinc oxide, so the largest ingredient name on the front does not get all the credit.2

How do you choose a suitable formula?

• For nappy rash or dry, chapped skin, zinc and castor oil ointment is one barrier option. Check its ingredients carefully: the UK formulary preparations discussed here contain peanut oil.
• Avoid the peanut oil containing zinc and castor oil preparation if your family has a history of nut allergy or atopy, a tendency towards allergic conditions. Do not assume every product with a similar name has the same formula.
• For adult incontinence, choose a barrier compatible with the pads or containment products being used. Some oily preparations interfere with their function.
• For broken skin or a wound, check the product's permitted use. The Birmingham formulary lists Sudocrem for intact skin, not application to a wound.

How should you apply it?

1. 1Read the product label for the permitted skin area, amount and frequency. Wash your hands before application.
2. 2Clean the affected area. After urine or stool exposure, use mild, dilute soap and water, rinse well and gently pat dry. A suitable soap free cleanser is another option; follow its rinsing instructions.
3. 3Apply the amount directed for that formula. General zinc oxide directions call for a generous amount, while some named barrier creams specify a thin layer.
4. 4For nappy care, change nappies frequently and apply the barrier at each change. For incontinence care, clean and dry the skin after each episode, then reapply the cream or ointment.
5. 5Wash your hands afterwards. Do not cover the treated area with a bandage or dressing unless your care team tells you to.

Use is usually tied to skin care rather than a morning or evening skincare slot. The Birmingham formulary lists zinc and castor oil ointment as needed, up to four times daily or at each nappy change. Its Sudocrem directions specify a thin layer at each episode of hygiene. Do not transfer one product's schedule or layer thickness to another.3

A barrier preparation does not replace cleaning or frequent nappy changes, despite arriving in a container that suggests the problem has been delegated. Leaving skin exposed to air can also help urinary nappy rash clear.6

Can adults use it with incontinence pads?

Zinc oxide barriers can protect skin exposed to urine and stool, but pad compatibility depends on the whole formula. The Birmingham formulary advises against using its zinc and castor oil ointment with adult containment products because its peanut oil can repel urine or stool back onto skin. It gives a similar restriction for Sudocrem because of lanolin. Ask for a barrier specifically compatible with the containment product instead of assuming all barrier creams work with pads.3

What should you expect, and when should you get help?

The intended benefit is protection while irritated skin heals. Contact your care team if the treated area has not improved within a week, or sooner if irritation becomes severe. An itchy, red rash with small pimple like spots can occur with yeast infection during incontinence. A barrier alone is not the treatment for that infection; an antifungal treatment can be needed.146

Who should be careful?

Zinc oxide can cause local irritation or allergic reactions in people sensitive to it. Stop using the product and seek medical advice for a new rash, itching, hives or swelling. Tell your care team if you are pregnant, trying to become pregnant or breastfeeding. Check before using other skin products or prescription treatments on the same area. During radiation therapy, ask your provider before applying creams or lotions to the treated skin.145

Does a zinc oxide ointment count as sunscreen?

Only some zinc oxide products are intended to protect against the sun's ultraviolet rays. Choose a product labelled for sun protection rather than using a nappy rash ointment as sunscreen merely because both contain zinc oxide.1

Keep the product away from children and pets, and do not swallow it. If it enters the eyes, rinse with plenty of cool tap water. For suspected ingestion or overdose, contact poison control promptly. In the United States, call Poison Help on 1 800 222 1222 and have the container, ingredients and estimated amount swallowed ready.15