I love browsing pharmacy shelves like my husband loves browsing bookstores. I realize that for most people all the creams and ointments sold over the counter in Africa can be overwhelming. The pharmacy clerk often ends up being the one to give advice. The purpose of this post is to describe the uses of different creams and ointments. There are actually very few to choose from in a limited resource setting and unlike in places with more regulations, all of these can be purchased straight off the shelves. For this reason, I like for my patients to be informed.
First, turn the box over. The back of the box is most helpful. On the back of the box you will see the medicines listed.
Here’s What’s Out There:
Mupirocin (Supirocin or Bactorban):
This is a prescription strength antibiotic ointment useful for skin infections. WASH ALL WOUNDS WITH SOAP AND WATER AT TIME OF INJURY and twice a day until healed.
If showing signs of infection (redness, swelling, warm to touch, and/or drainage) then apply Mupirocin three times a day for 7 to 14 days.
Go to the clinic if no improvement in 3 to 5 days, fever, or red streaks coming from the site.
Silver Sulfadiazine Topical: This is an antibiotic cream designed specifically to treat burns. Burns need to be properly cleaned and debrided then the cream is applied once to twice daily. Sadly, there are a lot of burns in Africa. Most nurses are skilled in wound care. Any burn that is deep, covering a lot of surface area, or on the face, pubic area, or hands should be treated at a medical clinic or hospital.
Hydrocortisone Cream: This is a steroid cream or ointment used to treat inflammatory skin conditions. It’s used for eczema, insect bites, contact dermatitis, and any non-infected inflammation. The strength increases based on the percentage listed beside the name. As a general rule, try to use the lowest strength that is effective. It’s handy for little itchy bumps that aren’t infected.
Betamethasone Dipropionate Topical: This is a prescription strength steroid, prescribed for more severe eczema, contact dermatitis, or other diagnosed skin inflammation in children older than 13. If your inflammatory skin condition cannot be managed with hydrocortisone, then you should see a health care provider. The 0.05% ointment is a high potency steroid. The 0.05% cream is high/medium potency. Because steroids can thin the skin and cause scarring over time, it should not be used on the face.
Clotrimazole Topical: This is an antifungal cream used to treat ringworm, athlete’s feet, jock itch, and tinea versicolor. It should be applied twice a day for 2 to 4 weeks for a known or diagnosed fungal infection to see full results. (If in doubt see a clinician.) This can also be used for a yeast-based diaper rash. Fungal infections on the head (tinea capitis) can’t be effectively treated with a topical medicine and should be evaluated by a health care provider.
Miconazole is another antifungal cream available over the counter in Africa.
Triple Action Creams such as FunBact: These are the “catch all” topical creams popular in Africa. More medicine is not always best. These creams combine an anti-inflammatory, antibiotic, and anti fungal. For instance FunBact contains betamethasone, neomycin, and clotrimazole (see photo at top of post). If you live far away from skilled medical care and you can’t identify that rash, it may be your best option. Because of the betamethasone, it should not be used on the face. I don’t prescribe these as most skin diagnoses need only one topical medicine designed specifically for the problem.
Should I get a cream or ointment?
Sometimes the answer is “What is available?” Often there’s only one choice, so get that one. Ointments have more oil and should be used for drier, flaky skin conditions. Creams have more water and are better for more moist skin conditions.
Some rashes are quite serious and should not be self treated. Please refer to this amazing article with pictures by the NHS about pediatric rashes and when to see a doctor.
(I do not endorse any brands. I simply went into a local pharmacy and took photos of topical medicines that are for sale locally.)