Allergic contact dermatitis from nitroglycerin contained in 2 transdermal systems

Contact dermatitis due to transdermal therapeutic systems: a clinical update

Transdermal therapeutic systems (TTS) have become a popular method of drug delivery because they allow drugs to be delivered in a rate-controlled manner, avoiding first-pass metabolism and the fluctuating plasma concentrations encountered with oral medications. Unfortunately, TTS may provoke adverse skin reactions as irritating contact dermatitis and allergic contact dermatitis: TTS seem to be ideally suited to produce sensitization because they cause occlusion, irritation, due to the repeated placement of the allergen in the same skin location. Since TTS consist of an adhesive, an active pharmaceutical drug and enhancing agents, sensitization may develop owing to one of these three agents. The purpose of this manuscript is to review known responsible allergens of contact dermatitis due to TTS.

Corticosteroid transdermal delivery to target swelling, edema and inflammation following facial rejuvenation procedures

BACKGROUND AND AIM

The use of transdermal therapeutic systems has spread worldwide since they allow effective local drug delivery. In the present study, we investigated the efficacy and safety of a new betamethasone valerate medicated plaster (Betesil®) to manage facial swelling, edema, inflammation, ecchymosis, and hematoma, when applied immediately after a facial rejuvenation procedure.

MATERIALS AND METHODS

We applied the plaster to the skin of 20 healthy patients for 12 hours immediately after hyaluronic acid-based procedure performed with the aim of erasing facial wrinkles of perioral and nasolabial folds and improving chin and eye contour. A further 20 patients underwent the same cosmetic procedure, but they were treated with an aescin 10% cream (applied immediately after the procedure, in the evening, and the morning after) and served as control group.

RESULTS

Betesil® application resulted in a significant improvement in swelling/edema/inflammation score, if compared with aescin 10% cream (P < 0.01). As for facial ecchymosis and hematoma around the needle injection track, only two patients in the active treatment group displayed minimal ecchymosis and hematoma. In the control group, two patients presented minimal ecchymosis and three slight hematoma. However, using the ecchymosis/hematoma score, no significant difference between Betesil® and aescin 10% cream groups was observed. Patients' satisfaction was significantly higher among subjects receiving Betesil®, if compared to patients receiving aescin 10% cream (P < 0.01).

CONCLUSION

The present study supports the use of Betesil® plaster immediately after facial cosmetic procedures in order to safely control swelling, edema, and inflammation.

Cutaneous Reactions to Transdermal Therapeutic Systems

Transdermal therapeutic systems have been increasingly used in the past two decades. However, cutaneous side effects are fairly common and may result in poor patient compliance. This review article summarizes the spectrum of reactions due to transdermal therapeutic systems and provides a current list of known allergens.

Treatment options for a patient experiencing pruritic rash associated with transdermal testosterone: a review of the literature

A 22-year-old man with hypogonadotropic hypogonadism was receiving monthly intramuscular injections of testosterone replacement therapy. The patient refused to self-administer the injections because of discomfort, so the therapy was switched to testosterone patches. He experienced a pruritic, macular, erythematous rash underneath the reservoir area of two different transdermal formulations, which did not improve after pretreatment with topical corticosteroids. Eventually, he tolerated application of a testosterone gel and his serum testosterone levels returned to normal after 1 month of therapy. Commercially available and investigational testosterone products and therapeutic monitoring guidelines for androgen replacement are reviewed.