Management of skin disease
Ronald Marks, Richard Motley in Common Skin Diseases, 2019
In many cases, topical treatments are also available and decisions as to whether to use a topical or a systemic agent need to be made. Some of the considerations are as follows. Systemic agents usually carry a greater risk of adverse side effects than topical agents.Systemic agents tend to have more potent therapeutic effects than topical agents.Many patients prefer a topical agent because they fear the side effects of systemic treatment.Some patients dislike using topical treatment and would prefer to take the risk of side effects.Topical treatment is impracticable in patients with widespread skin disease and in the elderly and infirm.
Facial pain
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
There are relatively few controlled clinical trials on the specific management of NOP, but generally the same principles and guidelines for other neuropathic pain conditions should be followed. Thus, low doses of tricyclic antidepressants would be the first choice.100[I] Antiepileptics, such as gabapentin and pregabalin, would be second choices followed by opioids and tramadol and selective serotonin reuptake inhibitors.100[I] Capsaicin and other topical formulations such as lidocaine patches have been reported to be efficient in some NOP conditions, but mainly in open trials. The advantage of topical medication is the potential to reduce the side effects but so far there is only relatively limited evidence for their efficacy.85, 101 [III] An important point is to avoid further trauma to the area, for example by avoiding further explorative oral surgery.
Microneedling in Clinical Practice
Boris Stoeber, Raja K Sivamani, Howard I. Maibach in Microneedling in Clinical Practice, 2020
Begin by ensuring there is a brand-new disposable needle cartridge in place. Apply the chosen topical agent to the skin in an adequate amount to minimize epidermal injury. Lower the device so that the needles are perpendicular to the skin while providing mild traction nearby with a free hand, taking care not to inflict a needlestick injury. Glide the device over the skin in all directions (horizontal, vertical, oblique) until pinpoint bleeding is visible, which usually occurs after 3–6 passes depending on the area treated. It may be helpful to treat thicker, less sensitive areas first to allow the patient to adjust to the pain he or she may experience. Once the procedure is complete, remove blood and the topical agent with sterile water-soaked gauze. Apply a post-procedure serum, also often provided by the manufacturer, to the treatment areas. Cooling masks without active ingredients may also be used to soothe any pain and swelling.
Clinical efficacy and safety of topical difamilast in the treatment of patients with atopic dermatitis: a systematic review and meta-analysis of randomized controlled trials
Published in Expert Review of Clinical Pharmacology, 2022
Li-Chin Lu, Chien-Ming Chao, Shen-Peng Chang, Shao-Huan Lan, Chih-Cheng Lai
Atopic dermatitis (AD) is a chronic inflammatory skin disease with typical manifestations that include eczematous, lichenified lesions and intense pruritus [1]. AD is a common skin disorder with an estimated prevalence of 15%–20% and 1%–3% in children and adults, respectively [1,2]. The pathogenesis of AD is complicated and involves genetic predisposition; epidermal dysfunction; skin microbiome dysbiosis; immune dysregulation; the neuroimmune system; and cytokines, including interleukin (IL)-4, IL-13, IL-17, IL-23, IL-31, and IL-33 [3–5]. Although topical corticosteroids and topical calcineurin inhibitors remain the standard treatment measures for AD [2], their use can be associated with local adverse events (AEs) or even systemic effects [6,7]. Therefore, a novel effective topical agent with fewer adverse effects is urgently needed.
Review of international psoriasis guidelines for the treatment of psoriasis: recommendations for topical corticosteroid treatments
Published in Journal of Dermatological Treatment, 2019
Elise C. Kleyn, Elaine Morsman, Lizelle Griffin, Jashin J. Wu, Peter Cm van de Kerkhof, Wayne Gulliver, Joelle M. van der Walt, Lars Iversen
Management is divided into different treatment modalities and reference to the management of different areas of the body is made within these categories (41). Topical therapy is recommended for mild to moderate psoriasis (PASI <10, DLQI <10), in keeping with other guidance. Specific information is given regarding the most effective use of each class of topical agent (e.g. salicylic acid as a keratolytic, dithranol as ‘short contact therapy’). There is detailed guidance regarding topical corticosteroids, including duration and strength of formulation for different areas of the body. It is advised that sensitive areas such as the face, flexures and infants should be treated with mild to moderate topical corticosteroids once to twice daily for 2 weeks only. A calcineurin inhibitor is advised as alternative therapy if this regime is unsuccessful. Up to 4 weeks of once-daily treatment with moderate to potent topical steroids is recommended for other sites. Combination therapy is advised for poor responders. No evidence is provided regarding the frequency of daily dosing, which features in other guidance. Thicker plaques and palmoplantar psoriasis may be treated with very potent steroids for 2–4 weeks, but a recommended limit of 50 g/week is made.
Ruxolitinib cream for the short-term treatment of mild-moderate atopic dermatitis
Published in Expert Review of Clinical Immunology, 2023
Piotr K Krajewski, Jacek C Szepietowski
Mild to moderate exacerbations of AD typically do not require systemic treatment and are managed by a combination of topical treatments and phototherapy [5]. The efficacy of topical therapy depends on the severity of exacerbation, strength, formulation of the topical agent, and the correct application [1]. Usually, topical anti-inflammatory drugs are applied directly on hydrated skin. However, patients with excessive oozing and excoriation may need the application of wet dressings. Traditionally, topical agents were used to treating exacerbations and would have been stopped after the clearance of lesions. Currently, anti-inflammatory medication in a long-term, proactive regimen (2 days a week) seems to significantly decrease the flare-up severity and increase the duration between them [3].
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