How best to apply topical medication

June 12, 2022 10:38 AM

I'm to apply a medicated cream twice daily for a year to the sole of my foot, and have questions on how best to do so .. details and

This is to be done twice daily for a year so I hope to make it easy. Neither the pharmacist nor the podiatrist have given much information on best ways to do this. The medication is Verapamil in a Lipoderm base, supplied by a compounding pharmacy, for Ledderhose's disease (great name!) aka plantar fibromatosis. Verapamil is a calcium channel blocker and can affect heart, blood vessels, liver function, etc, so I'm supposed to get it only on the affected area. (Amusingly, the pharmacist perhaps misread the prescription, and labeled it "apply to affected area of penis").

I'm to apply 5 grams twice daily, which I've been doing by rubbing it against my sole with my finger in a nitrile glove. My soles are dry and leathery; I wear only sandals.

Questions:
Is there an alternative better/easier applicator than a gloved finger?
How much is five grams?
How long to rub for? It never seems to be all absorbed even after prolonged rubbing.
Would it be as good, or better, to apply the 5g then cover it with, say, padded tape (without rubbing), as this would keep it in a more specific spot and also stop it being rubbed off by sandals etc?
Is it better to have the skin very dry after washing before application, or is damp skin more permeable?
Would topical vitamin E increase skin permeability (suggested by pharmacist)?

Thanks for any advice

posted by anadem to Health & Fitness (8 answers total)

My experience with lotions of any kind, but especially medicated lotions or creams, is that they need at least a few minutes to absorb. So, if I were you, I’d apply the cream and then be off my feet letting it absorb for 5-10 minutes before putting sandals on or walking around. If you find this isn’t enough time for most of it to sink in, talk to your doctor about extra steps (like massaging it in more vigorously).

The vitamin E seems worth trying if the pharmacist suggested it. You could read some skincare blogs or subreddits (r/skincareaddiction is a big one) to learn more strategies for prepping skin to best absorb lotions. Also, since you mention your feet are leathery, you could do some gentle exfoliation on your feet to reduce the amount of tough dead skin the cream has to permeate. A weekly foot soak and exfoliating scrub could be a good idea.
posted by theotherdurassister at 11:10 AM on June 12, 2022

Some topicals come with a little plastic card that helps you measure the correct amount along a marked line. Maybe ask the pharmacist if they have something like that? Otherwise I would just get an inexpensive electronic scale and measure out five grams.
posted by corey flood at 11:47 AM on June 12, 2022

You might find the "fingertip unit" concept helpful in measuring out the cream (there is a photo at that link to help you understand what a fingertip unit is.) They estimate that for an adult male: 1 fingertip unit provides 0.5 g. At least for the evening application, I would apply it before you go to bed, and then put on an undyed/white 100% cotton sock to help keep the cream on your foot (and off of other stuff). Does not need to be a super tight sock, just something that won't fall off and that you can wear when you sleep. Should help a bit with retaining moisture as well.

After a shower or bath is a good time to apply creams and lotions. You do want to dry off, because if the skin is too wet the cream will be inclined to not stay where it is applied. Does not have to be "bone dry" though, just dry enough that it stays where you put it.
posted by gudrun at 12:02 PM on June 12, 2022

Is there an alternative better/easier applicator than a gloved finger?

A bit of paper towel, or if it's both feet and they're clean and mobility allows, dab directly on the soles and rub them against each other.
posted by trig at 12:07 PM on June 12, 2022

5g of a typical (i.e. not whipped/fluffy) medicated cream is roughly 1 teaspoon, if that helps at all.
posted by a box and a stick and a string and a bear at 12:30 PM on June 12, 2022

A cosmetic spatula may be helpful. They are washable/reusable as well and often used for skin care products.
posted by Crystalinne at 12:36 PM on June 12, 2022

After a shower or bath is a good time to apply creams and lotions.

My understanding is that this is recommended generally b/c you want moisturizing creams to hold in moisture - they essentially act as a barrier to hold in the moisture your skin already has. So it's not that it's a better time for your skin to absorb creams, it's just the best way to maximize how well your moisturizer works.

So my inclination would be to assume that the drier the skin, the more it will absorb the cream. But that's just my instinct, maybe you can go back to the doctor again to ask for better clarification?

Also, nitrile gloves are still permeable. I use them all the time in the chemistry lab, but as soon as a chemical gets on your gloves, you're supposed to take them off. Again, I don't know enough about this medication to know how quickly it would permeate a nitrile glove.
posted by litera scripta manet at 4:36 PM on June 12, 2022

Thanks all for advice. It turned out that "five grams" was totally wrong, and 0.5g is more like what's wanted (doc said, when back from vacation, "about the size of a small pea").

I'm using a spatula to put the cream on the pad of a Nexcare brand Max Hold adhesive bandage then sticking the Nexcare+med to my foot.
posted by anadem at 6:38 PM on July 12, 2022