Swollen knee after a hike, stiff shoulder upon waking, twisted ankle on a sidewalk: we often look for a tube at the pharmacy before even consulting. The reflex is understandable, but not all over-the-counter anti-inflammatory ointments are equal, and certain precautions affect their effectiveness as much as the choice of active ingredient.
Photosensitization and anti-inflammatory ointment: the unknown trap
We apply a gel on the knee before going out for a run, without thinking about sun exposure. Some topical active ingredients, particularly plant extracts aimed at reducing inflammation, can cause a photosensitization reaction on areas exposed to the sun. The result can range from simple redness to a persistent localized burn.
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This risk also concerns synthetic molecules. Ketoprofen gel, for example, is among the substances known to trigger photodermatoses. The ground rule is simple: if the treated area is likely to see the sun in the following hours, cover it or postpone the application until evening.
To browse a list of over-the-counter anti-inflammatory ointments and compare active ingredients, you must first check this information on the package insert: the mention “avoid sun exposure” is included when applicable.
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Diclofenac, ibuprofen, or ketoprofen: which active ingredient for which pain
The three main molecules available in gel or ointment form without a prescription belong to the NSAID (non-steroidal anti-inflammatory drugs) family. Their mechanism is similar (inhibition of the enzymes responsible for inflammation), but their usage profile differs.
Diclofenac gel
Diclofenac (Voltaren Emulgel and generics) remains the reference for joint pain related to superficial osteoarthritis, particularly in the fingers or knee. Its skin penetration is suitable for shallow inflammations. However, feedback varies on this point concerning deep muscle pain, such as a calf strain.
Topical ibuprofen
Topical ibuprofen primarily targets muscle pain and mild sprains. It is available in gel form to be applied directly to the painful area. Its advantage: generally good skin tolerance and a less pronounced photosensitization profile compared to ketoprofen.
Ketoprofen gel
Powerful, ketoprofen is often recommended for tendonitis and post-traumatic pain. But it is also the one that imposes the strictest precautions regarding sun exposure. It should not be applied to an area that will be exposed in the following hours.
Duration of use and limits of topical NSAIDs without a prescription
A tube bought at the pharmacy sometimes gives the impression of being an innocuous product. However, health authorities remind us that an over-the-counter medication is not a risk-free medication. NSAIDs, even when applied locally, can cause adverse effects when the recommended duration of use is exceeded.
In practice, most package inserts limit self-medication to a few days. Beyond that, the persistence of pain justifies a consultation. The risks of prolonged use without medical supervision include:
- Local skin irritations (redness, contact eczema) that can become chronic if application continues
- Low but real systemic absorption, which can contribute to digestive or cardiovascular effects in at-risk individuals
- A delay in diagnosis: relieving pain without identifying the cause sometimes masks a lesion that requires different treatment
The HAS also reminded that ibuprofen is contraindicated in infectious contexts, including during viral sore throats or suspected Covid-19, due to a risk of aggravation. This precaution, valid for oral forms, is extended out of caution to local forms in a patient presenting an infectious syndrome.
Concrete criteria for choosing your ointment at the pharmacy
In front of the shelf, we find several tubes that seem interchangeable. A few operational criteria allow for quick decision-making.
- Location of pain: superficial joint (finger, ankle, knee) → diclofenac. Large muscle (thigh, back) → ibuprofen. Strained tendon (elbow, shoulder) → ketoprofen, checking for absence of sun exposure
- Skin history: reactive skin or history of eczema → prefer a water-based gel rather than a greasy ointment, and test on a small area
- Current treatments: if already taking an oral NSAID (ibuprofen tablet, daily aspirin), adding a local NSAID increases the risk of adverse effects. Discuss with the pharmacist before purchasing
- Infectious context: fever, sore throat, ongoing infection → avoid topical NSAIDs and turn to paracetamol or seek medical advice
Non-drug local alternatives
When NSAIDs are contraindicated or the pain does not warrant an anti-inflammatory, other options exist at the pharmacy. Arnica-based gels remain popular for minor bruises, even if their level of clinical evidence is more modest than that of NSAIDs.
Some essential oils (wintergreen, lemon eucalyptus) are included in the composition of balms used for muscle pain. They provide a warming or cooling effect that can offer temporary relief. Their use requires the same photosensitization precautions as synthetic molecules, as several plant extracts are phototoxic.
Cold (ice pack, cryogenic spray) remains the safest method as a first-line treatment for a sprain or recent trauma, even before applying anything else.
Choosing an over-the-counter anti-inflammatory ointment is not just about grabbing the first tube you see. The type of pain, the area concerned, sun exposure, and ongoing treatments determine the right choice. In case of doubt, the pharmacist remains the quickest filter between appropriate self-medication and necessary consultation.