Topical Anti-Inflammatory Creams

Introduction

Topical anti-inflammatory medications are medicines applied directly to the skin over a painful area rather than swallowed as a pill. Most contain a type of medication called a non-steroidal anti-inflammatory drug (NSAID). Diclofenac is the most commonly used topical NSAID in the United States. These medications are available as gels, creams, liquids, sprays, or patches. They are usually rubbed onto the skin over a painful joint or other musculoskeletal area several times a day. The medication passes through the skin into the tissues underneath, where it can decrease inflammation and pain. An important advantage is that relatively little medication enters the bloodstream compared with taking an NSAID by mouth. This can provide pain relief while reducing, although not eliminating, some of the whole-body side effects associated with oral NSAIDs.

The History of Topical Anti-Inflammatory Creams

Topical NSAIDs have been used for several decades, particularly in Europe and other parts of the world. Diclofenac was developed in the 1960s and became widely used as an oral anti-inflammatory medication before topical preparations became increasingly popular. Topical diclofenac products were introduced to provide anti-inflammatory treatment directly to painful areas while limiting the amount of medication circulating throughout the body. Over time, several formulations were developed, including gels, solutions, and patches. In the United States, prescription topical diclofenac became available in the 2000s. Diclofenac sodium 1% gel, commonly sold under the brand name Voltaren Arthritis Pain, subsequently became available without a prescription in the United States. Topical NSAIDs are now widely used for localized musculoskeletal pain, particularly arthritis involving joints close to the skin.

How Anti-Inflammatory Creams Work

Topical NSAIDs work by blocking enzymes called cyclooxygenase (COX) enzymes, which are involved in producing prostaglandins. Prostaglandins are chemicals that contribute to inflammation and make painful tissues more sensitive. By reducing prostaglandin production in and around the painful area, topical NSAIDs can decrease pain and inflammation. Studies have demonstrated that topical NSAIDs can provide meaningful pain relief for certain musculoskeletal conditions. The evidence is particularly strong for knee and hand osteoarthritis, where topical NSAIDs can improve pain and function compared with placebo. For knee osteoarthritis, the American Academy of Orthopaedic Surgeons strongly recommends topical NSAIDs in patients without contraindications. They may provide pain relief similar to oral NSAIDs for some patients with localized osteoarthritis while producing fewer gastrointestinal side effects. However, topical medications may be less useful for deep joints, such as the hip, because relatively little medication penetrates deeply enough to reach the joint.

When Anti-Inflammatory Creams are Used

A doctor may recommend a topical NSAID when pain is localized to a relatively small and superficial area, particularly when inflammation contributes to the symptoms. One of the most common uses is knee osteoarthritis. They may also be helpful for arthritis of the hands and other superficial joints. Topical NSAIDs are sometimes used for localized soft-tissue problems, including certain sprains, strains, tendon problems, and other minor musculoskeletal injuries. Anti-inflammatory creams can be particularly attractive for older patients or people who are at increased risk of side effects from oral NSAIDs. However, topical NSAIDs are not equally effective for every condition. For example, they are unlikely to provide much direct benefit for arthritis of the hip because the joint is located deep beneath the skin. They also do not reverse arthritis or repair damaged cartilage. Their main purpose is to reduce pain and make it easier for patients to remain active.

Using Anti-Inflammatory Creams

Several topical NSAID preparations are available, and the exact dose depends on the medication and formulation. Diclofenac (Voltaren™) is by far the most common. Over-the-counter diclofenac sodium 1% gel is commonly applied four times per day for arthritis pain. For Voltaren Arthritis Pain gel, the labeled amount is 2 grams for each affected hand, wrist, or elbow and 4 grams for each affected foot, ankle, or knee per application, using the supplied dosing card. Prescription formulations may contain different concentrations of diclofenac and may be applied once, twice, or several times daily depending on the product. Other countries also use topical NSAIDs containing medications such as ibuprofen, ketoprofen, or other anti-inflammatory drugs. Patients should follow the directions for their particular product rather than assuming that all anti-inflammatory creams are used in the same way. Applying more medication or using it more frequently than recommended does not necessarily improve pain relief and can increase side effects.

Potential Side Effects of Topical Anti-Inflammatory Creams

Topical NSAIDs generally produce fewer whole-body side effects than oral NSAIDs, but they are not completely risk-free. The most common problems occur where the medication is applied and include dry skin, redness, itching, rash, or irritation. The medication should generally not be placed on broken, infected, or severely irritated skin, and patients should avoid getting it into their eyes or mouth. Some medication is absorbed into the bloodstream, so the potential risks associated with NSAIDs—including stomach ulcers or bleeding, kidney problems, cardiovascular complications, and allergic reactions—are reduced but not eliminated. Patients with a previous serious reaction to aspirin or another NSAID should generally avoid topical NSAIDs unless specifically advised otherwise. People with significant kidney disease, a history of stomach ulcers or gastrointestinal bleeding, cardiovascular disease, or those taking blood thinners should discuss their use with a healthcare professional. Using a topical NSAID together with an oral NSAID can increase total NSAID exposure and should also be discussed with a doctor. NSAIDs should generally be avoided later in pregnancy, particularly at 20 weeks or later unless specifically advised by a clinician, because of potential risks to the developing baby.

Summary

In summary, topical anti-inflammatory medicines are rubbed onto the skin to help decrease pain and inflammation. Diclofenac gel is the most common example. These medicines work best for painful areas that are close to the skin, especially an arthritic knee or hand. They can also help with some sprains, strains, and other minor injuries. Because less medicine reaches the bloodstream than with an anti-inflammatory pill, topical NSAIDs usually cause fewer whole-body side effects. However, they can still cause problems and should be used as directed. For many people with localized arthritis pain, a topical NSAID can be a useful way to decrease pain and stay active.

Edited by Stephen Pinney MD, September 28th 2026.