Analgesics skin reactions

In a follow-up study of 78 patients with cancer who participated in a crossover, randomized study of transdermal fentanyl (mean final dose 100 pg/hour) and oral morphine for 4 weeks, the incidences of skin reactions and gastrointestinal symptoms were low (56). Other adverse effects reported were breakthrough pain, light-headedness, and diarrhea. In the original randomized study, which lasted 15 days, there was significantly less constipation with fentanyl than with morphine (57). These results suggest that many patients have stable analgesic requirements with transdermal fentanyl up to the time of death, with no need for additional medication. 

The incidence of skin reactions to drugs has been analysed from spontaneous reports in Italy (200). Antibiotics most commonly caused skin reactions, followed by NSAIDs, analgesics, and radiocontrast agents, which were responsible for 2.7% of the reactions (71 cases) these included nine cases of exanthemas and 36 cases of urticaria. 

Skin reactions are often reported with NSAIDs, but the true incidences with individual NSAIDs are unknown. There are very few specific epidemiological studies, and most information comes from single case reports and data from national spontaneous reporting systems. A major study on nearly 20 000 patients showed that 0.3% of 9118 patients taking analgesics and NSAIDs developed skin reactions that could be attributed to these drugs (164). 

Salicylic acid is widely used in dermatology because of its keratolytic properties. MethylsaUcylate (the main constituent of oil of wintergreen) is a topical analgesic that is also a constituent of Red Flower Oil and White Flower Oil formulations, popular herbal analgesics used topically in Southeast Asia (1). Some users take small amounts of the oil orally to enhance its analgesic effects. It has been responsible for rare cases of allergic skin reactions. 

Capsaicin is supplied pharmaceutically as a cream, gel. or lotion. The First application of the piepatation produces intense pain and irritation at the site of application, but usually no skin reaction occurs. Repeated applications cause desensitization, and eventually analgesic and anti-inflammatory effects occur., Stimulation of afferent nerve tracts causes a heat. sensation. 

ARNICA FLOWERS are the flower heads of Arnica montana L, family Asteraceae. The flowers contain sesquiterpenes such as helenalin and dihydrohelenalin which have antiinflammatory and analgesic effects which explain the popularity of Arnica as a remedy for bruises and aches and sprains. It must be stressed that Arnica should not be used internally because of cardiotoxicity. Equally important is the fact that the sesquiterpenes, like most if not all of those from the Asteraceae (e.g. in Chamomile and Yarrow), are highly allergenic and patients must be advised to discontinue use if a skin reaction develops and to avoid Arnica and Chamomile if they are known to have a sensitivity to other Asteraceae such as Asters, Daisies and Chrysanthemums. 

Adjuncts to therapeutic radiography, used under patient group directions, include analgesics, laxatives, anti-diarrhoeals, antiemetics and drugs for wound care and skin reactions. 

Type B effects are not related to the pharmacological properties of these drugs. Serious side effects may occur. Allergic skin and liver reactions to aspirin and paracetamol have been reported with risk of fibrosis, particularly in the retroperitoneal region for methysergide and hypersensitivity reactions with NSAID and pure analgesics. 

Therapeutic doses of the opioid analgesics produce flushing and warming of the skin accompanied sometimes by sweating and itching CNS effects and peripheral histamine release may be responsible for these reactions. Opioid-induced pruritus and occasionally urticaria appear more frequently when opioid analgesics are administered parenterally. In addition, when opioids such as morphine are administered to the neuraxis by the spinal or epidural route, their usefulness may be limited by intense pruritus over the lips and torso. 

PORFIMER I. ACE INHIBITORS -enalapril 2. ANALGESICS -celecoxib, ibuprofen, ketoprofen, naproxen 3. ANTIARRHYTHMICS — amiodarone 4. ANTIBIOTICS -ciprofloxacin, dapsone, sulphonamides, tetracyclines 5. ANTICANCER AND IMMUNOMODULATING DRUGS -fluorouracil (topical and oral) 6. ANTIDIABETIC DRUGS-glipizide 7. ANTIMALARIALS -hydroxychloroquine, quinine 8. ANTIPSYCHOTICS -chlorpromazine, fluphenazine 9. CALCIUM CHANNEL BLOCKERS - diltiazem 10. DIURETICS -bumetanide, furosemide, hydrochlorothiazide II. PARA-AMINOBENZOIC ACID (TOPICAL) 12. RETINOIDS-acitretin, isotretinoin 13. SALICYLATES (TOPICAL) t risk of photosensitivity reactions Attributed to additive effects Avoid exposure of skin and eyes to direct sunlight for 30 days after porfimer therapy... 

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