From the Guidelines
If you're experiencing red rings on your wrists and arms after applying Voltaren (diclofenac) topical gel, you should discontinue use immediately and contact your healthcare provider. This reaction is likely a delayed hypersensitivity reaction, which can occur with NSAIDs like diclofenac, as reported in a 2022 practice parameter update on drug allergy 1. The update notes that NSAIDs are common causes of delayed drug hypersensitivity reactions, which can include cutaneous phenotypes such as generalized maculopapular exanthem and urticarial drug eruption, and can occur more than 6 hours after dosing.
Some key points to consider in this situation include:
- The reaction may be T-cell–mediated, as suggested by the update 1
- Cross-reactivities within the same chemical class are well described, and for severe reactions, avoidance without rechallenge within that class is recommended 1
- Lesional or general patch testing have been employed for diagnosis of cutaneous delayed reactions associated with NSAIDs, but with varying sensitivity 1
To manage the reaction, you can:
- Wash the affected area gently with mild soap and water to remove any remaining product
- Apply a cool compress to reduce irritation
- Consider taking an oral antihistamine like Benadryl (diphenhydramine) to help with itching if present
- For temporary pain relief while awaiting medical advice, you could try acetaminophen (Tylenol) instead, as it is a different class of medication and less likely to cause a similar reaction.
It's essential to consult your healthcare provider for further guidance and to determine the best course of action for managing your pain and preventing future reactions.
From the FDA Drug Label
Application Site Reactions: In this controlled trial, application site reactions were characterized by one or more of the following: dryness (22%), exfoliation (7%), erythema (4%), pruritus (2%), pain (2%), induration (2%), rash (2%), and scabbing (<1%) Application Site Reactions: In controlled trials, application site reactions were characterized by one or more of the following: dryness, erythema, induration, vesicles, paresthesia, pruritus, vasodilation, acne, and urticaria The most frequent of these reactions were dry skin (32%), contact dermatitis characterized by skin erythema and induration (9%), contact dermatitis with vesicles (2%) and pruritus (4%).
Red rings on wrists and arms after using Voltaren topical (diclofenac) may be related to application site reactions, which can include erythema (redness) and rash.
- Possible causes include:
From the Research
Red Rings on Wrists and Arms after Using Voltaren Topical
- The studies provided do not directly address the issue of red rings on wrists and arms after using Voltaren topical 3, 4.
- However, it is mentioned in the study 3 that local skin reactions occurred more frequently in patients treated with topical NSAIDs, which could be related to the red rings on wrists and arms.
- The study 3 compared the use of topical versus oral NSAIDs in the treatment of acute and chronic musculoskeletal injury, and found that topical NSAIDs may be considered as comparable alternatives to oral NSAIDs, with fewer serious adverse events.
- Another study 4 evaluated the efficacy and safety of a fixed dose combination of diclofenac sodium and acetaminophen injection in postoperative pain, but did not mention any skin reactions or red rings on wrists and arms.
- It is possible that the red rings on wrists and arms are a local skin reaction to the Voltaren topical, but more research is needed to confirm this 3.
- The exact cause of the red rings on wrists and arms after using Voltaren topical is not clear from the provided studies, and further investigation is required to determine the relationship between the use of Voltaren topical and this specific side effect.