What are the advantages and disadvantages of using topical medications?
Topical medications offer few systemic adverse effects and drug-drug interactions. They have a clinical advantage in that they can be added to a patient’s current list of medications for pain or other comorbid conditions. There is extensive evidence showing their effectiveness and safety in treating a range of conditions like neuropathic pain and chronic pain syndromes that may otherwise be refractory to prior traditional treatments. The benefits to patients are clear; they are generally easy and nonpainful to apply on the skin and take effect relatively quickly. The possible side effects of topical analgesics that may include erythema or rash are often minimal and self-limited. Topical anesthetics are a helpful alternative for patients who fear needles or who are unable to take oral tablets and capsules. Some skin patches can be shaped to cover the painful area.
The disadvantages of topical medications vary on the specific dosage formulation used. Sometimes ointments, creams, and lotions can stain clothing. Careful attention must be used with children who may remove the medication and accidentally eat it or put it in the ears or eyes. Some formulations require measurement or are dosed according to weight (e.g., for use on children). Skin patches may lead to localized reactions, causing the skin area to become pale, itchy, red, or inflamed. Long-term adherence to the skin is difficult if the skin is oily or hairy. Patients may not be able to shower or swim while wearing the skin patch. One newly available type of skin patch, Synera, contains a built-in heating element to improve drug delivery that may cause thermal burns if the top cover is removed. Another skin patch requires a device that creates a mild electrical current to run through the patch and skin to increase the permeability and absorption of the drug through the skin. This drug, however, should only be applied by a health care professional at the office, clinic, or hospital.
