This is actually a really complicated question. For the most part, they need some kind of solvent in order to get the cream (which is typically water-based) past the skin (which relies on oils to be waterproof). There are multiple chemicals that can do this, for example surfactants will temporarily dissolve the oils, or emulsifiers or alcohols can allow the water-based cream to bind with the oils in your skin. If you read the inactive ingredients list on medicinal creams, you’ll find a lot of these chemicals
Source: https://biomeddermatol.biomedcentral.com/articles/10.1186/s41702-020-0058-7
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