Review of effective ointments for psoriasis: which is the safest

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most popular pharmaceutical products. They are prescribed during the treatment of a number of diseases and conditions, often in entire courses. Even with clear instructions from the attending physician, many compatriots have doubts and look for information about drugs on the Internet. And then they come to the pharmacy and ask the pharmacist questions, hoping to justify their guesses or dispel doubts. In this situation, the head manager needs, on the one hand, to help the pharmacy visitor, and on the other hand, not to take on the role of a doctor. It is in this vein that we will cover the topic of topical NSAIDs today - in the form of competent answers to customer questions.

What does “when used correctly” mean? Anointed, and that’s it.

It is advisable to rub in topical forms of NSAIDs for a while rather than just apply them. The analgesic and anti-inflammatory effect of the ointment will be much higher if you do not just “anoint” it, but actively rub the product into the skin over the sore spot for some time. In the course of relevant studies, it was found that even 45 seconds of rubbing diclofenac diethylamine gel five times increased the transdermal delivery of the drug compared to simple application to the skin. And you need to remember that pain-relieving ointments based on NSAIDs act on areas of pain located immediately under the skin. If we talk about joints, then these are the knees, elbows and small joints of the hands. The local form most likely “will not reach the hip joint.” It should be rubbed “around the circumference” of the limb, for example, not only into the dorsum, but also into the palmar surface of the interphalangeal joint [6, 7].

Fleming's ointment during pregnancy

With the birth of a long-awaited baby, mothers devote all their time and energy to the child. Meanwhile, during this period it is necessary to create high-quality conditions for full recovery after childbirth. Despite being busy, a woman must find time to visit a doctor if symptoms of hemorrhoids appear.

In the postpartum period, the disease can rapidly progress, and the appearance of strangulated nodes and thrombophlebitis cannot be ruled out. These complications are accompanied by severe pain, intoxication of the body, and a sharp increase in temperature.

The cause of hemorrhoids after childbirth can be increased physical activity. Babies grow quickly and gain weight, which can put them at risk for knots. Mothers need to take care in advance to eliminate the problem. Now there are many devices that can provide assistance: portable cradles, slings, backpacks, deck chairs.

Fortunately, only a small proportion of women during pregnancy and after childbirth require intensive medical care and surgical intervention. But the danger of this disease should not be underestimated. Timely consultation with a doctor is a prerequisite for maintaining health and avoiding serious complications.

What are the dangers of hemorrhoids during pregnancy?

• Pain during bowel movements and when sitting down
• Bleeding from the anus
• Prolapse of hemorrhoids
• Severe discomfort and stress
• Complications during labor and the postpartum period
• Surgical intervention for advanced forms of hemorrhoids

Effect of Fleming's Ointment for hemorrhoids:

• Eliminates itching and pain
• Reduces inflammation
• Strengthens the walls of blood vessels
• Normalizes blood circulation

Recommendations for treating hemorrhoids during pregnancy:

• Proper nutrition, as well as avoidance of fatty, fried and spicy foods to maintain intestinal health and prevent constipation
• Maintain good hygiene: wash regularly and use wet sanitary napkins or soft toilet paper
• Avoid heavy lifting except for specific muscle strengthening therapy
• Daily light exercise and walks in the fresh air against blood stagnation in the pelvic area
• Contrast shower to strengthen blood vessels and normalize blood circulation
• Using Fleming's Ointment to relieve pain and unpleasant symptoms of hemorrhoids
• Mandatory consultation with the attending physician

• Starts working immediately
• 95% positive feedback

1Lomova N.A., Dubrovina N.V., Dragun I.E., Tolstopyatova E.S. Hemorrhoids in pregnant and postpartum women: principles of therapy. Medical advice. 2016; No. 2

Which topical NSAID is best?

Everything is individual. If the analgesic effect of oral and injectable forms of NSAIDs can be more or less ranked, then an objective comparative assessment of topical drugs is very difficult. The reason for this is that, along with the actual active substance, the intensity of rubbing, excipients (for example, dimethyl sulfoxide) and the placebo effect play a significant role. Most studies on the effectiveness of topical NSAIDs have focused on diclofenac and ketoprofen. The increased attention to them is due to the fact that diclofenac is the only NSAID whose topical forms are approved by the American Food and Drug Administration (FDA), and ketoprofen, accordingly, is approved in most other countries of the world. Reliable data comparing these two drugs with each other have not yet been published. No one questions the effectiveness of other non-steroidal anti-inflammatory drugs for external use (ibuprofen, phenylbutazone, piroxicam, nimesulide, etc.); each of them was the subject of several clinical trials at one time, but the geography of their use is much more modest and is often limited to a few developing countries [2, 8].

Hormonal ointments for psoriasis

The active components of hormonal ointments are glucocorticosteroids - hormones that can suppress the activity of the immune system and reduce inflammation. Most often, such ointments contain the following components:

• Hydrocortisone: Laticort, Oxycort, Hydrocortisone.
• Triamcinolone: ​​Triacort, Fluorocort.
• Betamethasone: Beloderm, Akriderm, Celestoderm.
• Clobetasol: Powercourt, Cloveit.
• Methylprednisolone: ​​Campoderm, Advantan.

The only advantage of hormonal ointments is the rapid appearance of results. There are many more disadvantages, and these include:

• getting used to it over time;
• presence of withdrawal syndrome;
• serious side effects;
• impossibility of using long-term courses;
• influence on hormonal levels;
• risk of relapse after discontinuation of the drug.

Dermatologists do not recommend the use of hormonal ointments if more than 20% of the skin is affected. Also, do not apply them to areas of sensitive skin: in the neck, skin folds, face, areas of diaper rash. Such drugs cannot be used without a doctor's prescription, even if they are sold without a prescription. Due to uncontrolled use, the functioning of the adrenal glands may be disrupted, which will lead to serious problems and diseases.

Do excipients in the local form of NSAIDs matter?

Yes, they improve skin permeability and perhaps enhance the therapeutic effect in a certain way. In separate studies, for example, topical formulations of diclofenac with dimethyl sulfoxide (DMSO) and diclofenac diethylamine 1.16% have been shown to penetrate the skin faster than “regular” diclofenac sodium gels. In addition, DMSO itself may have a slight anti-inflammatory effect. There is no solid evidence of an increase in the analgesic effect due to the listed supplements, but their use at least helps to overcome the individual characteristics of the skin [7, 9–11].

When is the drug contraindicated?

The homeopathic remedy is gentle and well tolerated by most patients. Side effects are virtually eliminated. It has few contraindications:

• individual hypersensitivity to components, frequent symptoms of which are: a sharp increase in discharge, itching and burning, severe dryness, tissue swelling;
• children under 2 years of age: the mucous membrane of infants has an imperfect structure, which is why unpredictable reactions to the medicine are possible.

Pregnancy is not a contraindication for the ointment; it does not have a teratogenic effect on the fetus or the health of the mother. But it should be used with caution, taking into account the individual characteristics of the body.

Can I take NSAID tablets and use the topical form at the same time?

This is not directly prohibited by the instructions for use, but it is not recommended, and, apparently, does not make sense. According to the only credible study on this topic, there was no significant increase in the analgesic effect when combining local and systemic forms of NSAIDs. At the same time, this use of drugs slightly increased the frequency of rectal bleeding. In clinical trials, oral administration of diclofenac and ibuprofen at doses 2 and 3 times higher than recommended also did not lead to increased pain relief. The effect of a combination of tablets and a topical form of NSAIDs will most likely not be pronounced. At the same time, the likelihood of unwanted reactions slightly increases. Therefore, this combination is not recommended. Usually, if a local remedy does not help, the doctor cancels it and transfers the patient to oral administration [12, 13].

Which ointment to choose

Only a professional dermatologist should decide which ointment to treat psoriasis. His task is to choose the safest and at the same time effective drug. For more than 25 years, the PsorMak clinic has been practicing treatment with ointment against psoriasis, made according to the original recipe. There are no hormonal components in the composition, which provides the product with the following advantages:

• Possibility of use by children and pregnant women;
• absence of withdrawal and addiction syndrome;
• mild impact without provoking relapses;
• no contraindications.

But our specialists understand that even the most effective ointment for the treatment of psoriasis must be suitable for the patient. Therefore, before prescribing, we make sure to conduct a complete diagnosis.

In addition, an integrated approach is important in the treatment of psoriasis.
In this regard, our dermatologists develop an individual diet for the patient, and, if necessary, provide a referral for acupuncture and psychotherapy. If you want to achieve a long-term relapse and stop struggling with unpleasant symptoms every day, sign up for a consultation at PsorMac and we will select an individual treatment regimen for you. April 27, 2020
Author of the article: dermatologist Mak Vladimir Fedorovich

Is it possible to use topical NSAIDs for stomach erosions or ulcers?

According to the instructions, it can be done “with caution.” The concentration of the active substance in the blood plasma after the use of topical NSAIDs is less than 10% of that achieved by oral administration. The incidence of adverse reactions from the gastrointestinal tract when using local forms of NSAIDs does not differ from that when rubbing placebo and is significantly lower than when using systemic agents. However, just in case, these drugs are not recommended to be applied to the skin during gastrointestinal bleeding and exacerbation of gastric or duodenal ulcers [5, 14].

Indications for use of Fleming's ointment: instructions

It is recommended to use the drug for diseases of the nasal mucosa and hemorrhoidal lesions of the rectum:

• at the first and second stages of hemorrhoids: the presence of external and internal nodes, with frequent exacerbations, irritation of the epithelium, swelling of the anal veins;
• with vasomotor rhinitis: increased nasal discharge, swelling of the mucous membrane;
• with a deviated nasal septum and associated symptoms: difficulty in nasal breathing, congestion;
• for allergic dermatitis, regardless of the type of allergen and seasonality of the pathology;
• with hay fever.

According to user reviews, Fleming's ointment helps well with uncomplicated hemorrhoids: it relieves itching, pain, and swelling for a long time. There is evidence that the drug effectively eliminates the signs of initial sinusitis, reduces purulent discharge, and relieves the feeling of heaviness and fullness in the paranasal sinuses.

How many times a day and for how long can you apply such drugs?

Typically three to four times a day for two weeks. Topical NSAIDs act quite quickly - the effect occurs within an hour - and help control acute somatic pain of moderate intensity. They cope worse with chronic pain. If there is no effect within two weeks of proper use, you should consult a doctor. There is a chance that he will recommend switching to oral forms or another group of drugs.

Sources

1. Derry S, Conaghan P, Da Silva JA, et al. Topical NSAIDs for chronic musculoskeletal pain in adults. Cochrane Database Syst Rev. 2016; 4: CD007400. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007400.pub3/full
2. Derry S, Wiffen PJ, Kalso EA, et al. Topical analgesics for acute and chronic pain in adults – an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017; 5: CD008609. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008609.pub2/full
3. Klinge SA, Sawyer GA. Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: a comprehensive review. Phys Sportsmed. May 2013; 41(2): 64–74. https://www.ncbi.nlm.nih.gov/pubmed/23703519
4. Kloppenburg M, Kroon FP, Blanco FJ, et al. 2021 update of the EULAR recommendations for the management of hand osteoarthritis Annals of the Rheumatic Diseases 2019; 78: 16–24. https://ard.bmj.com/content/78/1/16
5. Honvo G, Leclercq V, Geerinck A, et al. Safety of Topical Non-steroidal Anti-Inflammatory Drugs in Osteoarthritis: Outcomes of a Systematic Review and Meta-Analysis. Drugs Aging. 2019; 36(Suppl 1): 45–64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509095/
6. Hasler-Nguyen N, Fotopoulos G. Effect of rubbing on the in vitro skin permeation of diclofenac-diethylamine 1.16% gel. BMC Res Notes. 2012 Jun 21; 5: 321. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424122/
7. Hagen M, Baker M. Skin penetration and tissue permeation after topical administration of diclofenac. Curr Med Res Opin. 2021 Sep; 33(9):1623–1634. https://www.tandfonline.com/doi/full/10.1080/03007995.2017.1352497
8. Rafanan BS Jr, Valdecañas BF, Lim BP, et al. Consensus recommendations for managing osteoarthritic pain with topical NSAIDs in Asia-Pacific. Pain Manag. 2018; 8 (2): 115–128. https://www.futuremedicine.com/doi/10.2217/pmt-2017-0047?url_ver=Z39.88-2003&rfr_id=ori:rid:…
9. Pradal J, Vallet CM, Frappin G, Bariguian F, Lombardi MS. Importance of the formulation in the skin delivery of topical diclofenac: not all topical diclofenac formulations are the same. J Pain Res. 2019; 12: 1149–1154. https://www.dovepress.com/importance-of-the-formulation-in-the-skin-delivery-of-topical-diclofen-pee…
10. Galer BS. A comparative subjective assessment study of PENNSAID® and Voltaren Gel®, two topical formulations of diclofenac sodium. Pain Pract. 2011; 11 (3): 252–60. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1533-2500.2010.00420.x
11. Tieppo Francio V, Davani S, Towery C, Brown TL. Oral Versus Topical Diclofenac Sodium in the Treatment of Osteoarthritis. J Pain Palliat Care Pharmacother. 2021 Jun; 31 (2): 113–120. https://www.tandfonline.com/doi/abs/10.1080/15360288.2017.1301616?journalCode=ippc20
12. Simon LS, Grierson LM, Naseer Z, et al. Efficacy and safety of topical diclofenac containing dimethyl sulfoxide (DMSO) compared with those of topical placebo, DMSO vehicle and oral diclofenac for knee osteoarthritis. Pain. 2009; 143(3):238–45. https://insights.ovid.com/article/00006396-200906000-00016
13. Van Amburgh J. Can Topical and Oral NSAIDs Be Combined for Pain Relief? Medscape. https://www.medscape.com/viewarticle/861740
14. Roth SH. Nonsteroidal anti-inflammatory drug gastropathy: new avenues for safety. Clin Interv Aging. 2011; 6: 125–31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131982/
15. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) – classification, diagnosis and management: review of the EAACI/ENDA and GA2LEN/HANNA. Allergy 2011; 66:818–829. https://www.eaaci.org/attachments/668_Kowalski%20Hypersensitivity%20to%20nonsteroidal%20anti-inflamm…
16. Rogers NV, Rowland K. An alternative to oral NSAIDs for acute musculoskeletal injuries. J Fam Pract. Mar 2011; 60 (3): 147–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183960/