Journal Scan / Commentary · August 15, 2020

Pearls in Mitigating Application Pain of Topical Nonsteroidal Agents

Dermatology (Basel, Switzerland)

TAKE-HOME MESSAGE

• Although nonsteroidal topical medications including tacrolimus, pimecrolimus, and crisaborole are safe and effective alternatives to corticosteroids, they are all associated with pain on application. Based on evidence and clinical experience, the authors suggest tips for minimizing this pain.

• Avoid the use of steroid-sparing agents on inflamed skin by treating areas with a short course of topical corticosteroids to repair the barrier prior to switching to steroid-sparing agents. Patients should be counseled to apply these agents to dry rather than damp skin. Applying a moisturizer, especially one that has been kept cold, prior to applying steroid- sparing agents may also be effective. Adult patients could also consider taking aspirin 500 mg 1 hour prior to tacrolimus application, although evidence for this practice is limited and has not been studied in children.

– Margaret Hammond, MD

Abstract

BACKGROUND

Topical steroid-sparing agents (SSA), such as tacrolimus, pimecrolimus, and crisaborole, represent an important therapeutic option in the treatment of inflammatory dermatoses such as atopic dermatitis. While these agents lack the common side effects associated with topical corticosteroids, they all share application site pain as an important adverse effect.

SUMMARY

Based on the available evidence and our experience, we suggest the following 7 practical strategies for decreasing the pain associated with SSA use. (1) Use a topical corticosteroid for a few days to reduce inflammation before starting the SSA treatment. (2) Use SSAs strategically. (3) Apply moisturizer before applying SSAs. (4) Store moisturizers in the refrigerator. (5) Ask the patient to apply the SSA on a small test area before broader application. (6) Apply the SSA on dry rather than on damp skin. (7) Consider using aspirin when appropriate for the patient.

Dermatology (Basel, Switzerland)

Pearls in Mitigating Application Pain of Topical Nonsteroidal Agents

Dermatology (Basel) 2020 Jul 13;[EPub Ahead of Print], S Madsen, KN Price, VY Shi, PA Lio 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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