A moisturizing cream mixed with a steroid ointment is frequently prescribed to patients suffering from atopic dermatitis. However, there is a concern that the mixing operation causes destabilization. The present study was performed to investigate the stability of such preparations closely using magnetic resonance imaging (MRI). As sample preparations, five commercial moisturizing creams that are popular in Japan were mixed with an ointment base, a white petrolatum, at a volume ratio of 1 : 1. The mixed preparations were stored at 60°C to accelerate the destabilization processes. Subsequently, the phase separations induced by the storage test were monitored using MRI. Using advanced MR technologies including spin-spin relaxation time (T 2 ) mapping and MR spectroscopy, we successfully characterized the phase-separation behavior of the test samples. For most samples, phase separations developed by the bleeding of liquid oil components. From a sample consisting of an oil-in-water-type cream, Urepearl Cream 10%, a distinct phase-separation mode was observed, which was initiated by the aqueous component separating from the bottom part of the sample. The resultant phase separation was the most distinct among the test samples. To investigate the phase separation quantitatively and objectively, we conducted a histogram analysis on the acquired T 2 maps. The water-in-oil type creams were found to be much more stable after mixing with ointment base than those of oil-in-water type creams. This finding strongly supported the validity of the mixing operation traditionally conducted in pharmacies.Key words mixed external preparation; magnetic resonance imaging; quantitative T 2 map; emulsion stability Atopic dermatitis is one of the most common skin disorders in Japan. Dermatologists frequently prescribe moisturizing creams mixed with steroid ointments.1-4) This treatment approach is based on the concept that moisture retention of the skin is important for the treatment of atopic dermatitis, as is steroid therapy. To facilitate application of the cream and ointment, they are mixed in an operation that is widely performed at pharmacy level.Moisturizing creams are classified into two types: oilin-water (o/w) emulsions, which are composed of small oil droplets dispersed in a continuous aqueous phase, while water-in-oil (w/o) creams are composed of small water droplets dispersed in a continuous oily phase.5) The basic concept concerning the compatibility of the different types of emulsions with steroid ointments is described in the dispensing guidelines in Japan, Chozai Shishin.6) The guidelines show a greater preference for w/o-type moisturizing creams in mixing creams with ointments than for o/w-type creams. This description is often used as a rationale to argue that the mixing operation performed in the pharmacy is appropriate. However, as a whole, pharmaceutical emulsions are not designed under the assumption that they would be mixed with other preparations. Therefore, it remains a concern that the mixing operation could be a...