Cutaneous Reactions to Transdermal Therapeutic Systems

Andrea L. Musel; Erin M. Warshaw


Dermatitis. 2006;17(3):109-122. 

In This Article

Management of Cutaneous Reactions to TTS

Management of cutaneous reactions includes rotation of application sites, TTS placement on the buttocks, trials of alternate brands, a shorter duration of occlusion, and pretreatment of the skin with topical corticosteroids.[1,24,70,71,72,73,74] Davis and Winter evaluated 3,816 TTS sites on 53 women who were using Estraderm 0.05 placebo TTSs and who were tested against a control adhesive TTS. The authors found that irritant reactions were minimized (92% decrease in cumulative irritation score) by rotation of application sites and placement on the buttocks rather than the abdomen or lower back.[71] Kounis and colleagues reported that 10 of 21 (48%) patients who experienced cutaneous reactions to one brand of nitroglycerin TTS were able to successfully transition to another brand, with no cutaneous side effects, indicating that a change of brand in some cases might help avoid future reactions.[24] For 3 months, Weber and Drayer observed 101 patients using clonidine TTS and suggested that cutaneous reactions might be improved by decreasing the occlusion time from 7 days to 3 to 5 days.[70]

Pretreatment and coadministration of topical steroids with TTSs have been advocated as methods to improve irritation and allergic contact dermatitis at TTS application sites.[72,75,76] Pretreatment of TTS sites with topical corticosteroids was evaluated in an open-label controlled pilot study of 65 men who each served as his own control. Pretreatment of testosterone TTS placement sites with triamcinolone acetonide 0.1% cream was found to lower the incidence and severity of skin irritation.[77] Pretreatment of application sites with an aerosol spray containing beclomethasone dipropionate has also been shown to decrease skin reactions among users of clonidine TTSs.[1] In one report, pretreatment of testosterone TTS application sites with clobetasone butyrate 0.05% cream 30 minutes prior to placement was found to prevent dermatitis, without impairment of drug delivery.[33] This regimen enhanced compliance and may work for other patients who have allergic contact dermatitis and who are not candidates for other modes of drug delivery.


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