Facial seborrheic dermatitis (FSD) is a chronic, recurrent dis-ease that can have a profound effect on quality of life.1,2 The clinical features include facial erythema and superficial scal-ing with flares and periods of improvement; symptoms are of itching or burning sensation.3 The role of the sebaceous glands and Malassezia yeast in susceptible individuals is part of the pathogenesis of FSD,4 and Staphylococcus epidermidis is now also considered an aggravating factor.5 Other relevant factors such as environmental insults, irritants, stress, certain foods, and lack of sleep can aggravate FSD.6,7,8
The pharmacological management of this condition includes topical antifungals, anti-inflammatories, and keratolytics. Topical corticosteroids such as hydrocortisone can be used to inhibit inflammation; however, their prolonged use is contraindicated due to potential side effects.9 Topical non-pharmacological therapy with cosmetics, cosmeceuticals, and medical devices improves the symptoms by improving the barrier condition and providing anti-inflammatory and antifungal benefits, avoiding the excessive or prolonged use of topical drugs.6 A non-steroidal facial cream (NSFC) was developed containing a combination of piroctone olamine, zinc salt of L-pyrrolidone carboxylate (PCA), hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate. This topical product was previously studied and demonstrated excellent clinical short-term efficacy and good tolerance in patients with SD on the face and chest, with properties of skin barrier reinforcement.10,11 The product is thought to work due to the combination of ingredients, acting on the multiple pathogen-ic factors involved in SD: piroctone olamine is an antifungal, stearyl glycyrrhetinate has anti-inflammatory, antioxidant, and skin-soothing properties, dihydroavenantramide has anti-itch, soothing, antioxidant, and anti-inflammatory properties,12 zinc pidolate is sebo-regulating and astringent, acetamide MEA is a kerato-regulating humectant and conditioning agent, biosaccharide gum-2 is anti-inflammatory and soothing, hydroxyphenyl propamidobenzoic acid is anti-irritant, anti-itch, and antihistaminic, and polymethyl methacrylate is a hydrator and moisturization enhancer.6 We wanted to add further data on the clinical efficacy of this product by studying its use in a further number of patients.
When it comes to anti-inflammatory medication, there are various options ranging in effectiveness and side effects.
The most powerful anti-inflammatory effect can be gained by a corticosteroid injection (cortisone). This is like a water bomber dropping water on a fire. There are some risks such as infection, flare of pain, possible short term weakening of tissue and anxiety.
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The next most effective option is oral anti-inflammatory medications such as prednisolone (steroid – prescription only) and Non Steroidal Anti Inflammatories (NSAIDs), which are available over the counter (Nurofen, Voltaren, etc) or via prescription (Naprosyn, Celebrex, Mobic, etc). This is like using a garden hose to squirt water on a fire but it goes everywhere (systemic). Short-term side effects are rare but can affect the gastro-intestinal tract, kidneys, blood pressure, those with asthma, etc. It is advisable to consult a GP or pharmacist before commencing NSAIDs.
Finally, the topic of this blog involves the use of anti-inflammatory gels and creams, which include steroid based (not covered) and non steroid based such as voltaren and nurofen gel. These are like throwing a bucket of water at a targeted section of the fire. Less of the drug is absorbed into the blood stream when compared to oral medication, therefore the risk of harmful side effects is significantly lower.
Do Anti-inflammatory Gels and Creams Actually Work
The short answer is yes! A recent review of the literature (research evidence) by Cochrane revealed that topical NSAIDs provided good levels of pain relief in acute conditions such as sprains, strains and overuse injuries, probably similar to that provided by oral NSAIDs.
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But if it’s like using a bucket of water compared to a hose, how can we maximize the effectiveness? For a topical NSAID to be effective, it has to reach the inflamed tissue in sufficient concentration to produce a relevant anti-inflammatory effect.
Factors Influencing the Effectiveness of Anti-inflammatory Gels and Creams
- Concentration – The concentration of anti-inflammatory medication in the gel/cream obviously has a strong bearing on how much is absorbed by the tissues. Voltaren has recently released their voltaren gel osteo 12 hourly product, which has twice the concentration of diclofenec (medication) compared to their standard product.
- Formula – The formulation is crucial for skin penetration. Without getting into too much detail, gel is more effective than cream.
- Blood Flow – If blood flow to the area is increased due to exercise, a heat pack, a hot shower, massage, etc there is a better chance of the medication being absorbed.
- Wraps – Sports Doctors often recommend wrapping the affected area in glad wrap after applying the anti inflammatory gel to increase the time the gel has to penetrate the skin before being rubbed off or evaporating.
- Massage – Don’t forget about the beneficial effects of massage including pain relief and increased blood flow. Some believe that the beneficial effects of anti-inflammatory creams can be attributed in full to the massage and not the actual cream/gel. However research has proven that anti-inflammatory gels and creams provide significantly more pain relief than placebo gels and creams when massaged into the affected area.
What Conditions do Anti Inflammatory Gels and Creams Help?
As discussed, the anti-inflammatory gel has to penetrate the skin before it can reach the affected tissues, so the problem area mustn’t lie too far away from the skin surface. Therefore anti-inflammatory gels are more likely to assist the following conditions:
- plantar fasciitis
- patellar tendinitis
- Achilles tendinitis
- ITB syndrome
- shin splints
- tennis and golfer’s elbow
- ligament strains
- bursitis
- acute muscle strains
Although pain from the neck and back often comes from deep structures it doesn’t hurt to try anti-inflammatory gels.
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Summary
- Anti-inflammatory gels are likely to provide pain relief for conditions that are close to the surface of the skin.
- Voltaren Osteo 12 Hourly Gel is likely to be the most effective due to it’s high concentration of anti-inflammatory agent.
- Massage the gel in if comfortable and consider wrapping the area in glad wrap over night.
Considerations
- Don’t apply topical creams or gels to broken skin.
- If you have eczema or other hand problems, wear a latex glove when applying gel.
- Allergic reactions are uncommon, but on first use only apply a small amount to a clean, healthy area of skin and gently rub in until absorbed. Wait a while to test how you respond to the ingredients before using more. If skin redness, irritation or itching occurs, wash off and seek medical advice.
- Wash your hands immediately after applying the treatment.
- Don’t touch or rub your eyes while you have topical cream on your hands.
- Follow the directions on the package.
- Do not use any topical treatments if you are pregnant or breastfeeding, without seeking advice from a pharmacist or doctor.
Posted in Patient Education and tagged Back Pain, Chronic Pain, Knee, Ligament, Muscle Strain, Neck Pain, Shoulder, Sports Injuries, Tendinopathy