Skin Sensitivity and Transdermal Drug Delivery

Abstract

Transdermal devices are now marketed for the delivery of systemic medication through the skin. Advantages associated with transdermal drug delivery include avoidance of first-pass metabolism and improved patient compliance. Drugs currently available by this route include scopolamine (hyoscine), nitroglycerin (glyceryl trinitrate), estradiol, nicotine and clonidine. This novel development has brought in its wake a specific constellation of skin sensitivity problems, which vary widely in incidence between drugs. Varying the site of drug administration to minimise these reactions is important. Any eczematous reaction can be treated with a moderately potent topical steroid. Tolerance to oral challenge in those with topical sensitivity occurs, but caution is still advocated before proceeding to this step. The increasing use of transdermal drug delivery systems across many specialties means that problems of skin sensitivity are of growing relevance to the dermatologist, the hospital specialist and the primary care physician.

Dermal and Transdermal Drug Delivery Systems: Current and Future Prospects

“…The skin as an immunological barrier may be provoked by exposure to certain stimuli, this may include drugs, excipients, or components of delivery devices resulting in erythema, oedema, etc. (Hogan and Maibach 1990;Carmichael 1994;Toole et al 2002;Murphy and Carmichael 2000).…”

Transdermal Drug Delivery Systems: Skin Perturbation Devices

“…The skin as an immunological barrier may be provoked by exposure to certain stimuli, this may include drugs, excipients, or components of delivery devices resulting in erythema, oedema etc (129,130,131,132). …”

Allergic Contact Dermatitis from Nitroglycerin Contained in 2 Transdermal Systems

“…However, irritant contact dermatitis may occur in about 15% of cases in the application area [1], whereas allergic contact dermatitis is fairly rare [2, 3]. We report a case of allergic contact dermatitis to nitroglycerin delivered in a transdermal therapeutic system (TTS).…”

“…Allergic contact dermatitis to TTS has been reviewed by Carmichael [3]. Nitroglycerin may be tested at 2% in petrolatum and at 0.02% in water, and contact dermatitis to adhesives must be ruled out.…”

“…Allergic contact dermatitis to nitroglycerin is rare: no case of allergic contact dermatitis was observed in a large cohort of 3,273 patients [2, 3]. The cases of allergic contact dermatitis to nitroglycerin reported in the literature have been mainly isolated cases [2].…”