What topical agents can be added to the regimen to manage painful skin in a patient with a severe groin rash due to friction, who is currently undergoing wound care with barrier devices and taking oxycodone (oxycodone) and antibiotics?

From the Guidelines

For a patient with a severe, painful groin rash from friction with open skin areas, I recommend adding a topical anesthetic such as 2% lidocaine gel or 5% lidocaine ointment applied thinly to the affected area 3-4 times daily before dressing changes or as needed for pain. This approach is based on the principle of providing pain relief while minimizing the risk of further irritation or infection. According to the provided evidence, there is no direct recommendation for the use of topical anesthetics in the management of EGFR-TKI-induced skin reactions 1. However, the use of topical agents to manage pain and inflammation is a common practice in dermatology.

When considering the addition of topical agents to the patient's regimen, it is essential to prioritize the use of gentle, non-irritating products that will not exacerbate the condition. The evidence suggests that greasy creams, topical acne medications, and topical retinoids should be avoided due to their potential to irritate the skin or worsen the rash 1. Instead, emollients and moisturizers can be used to help soothe and protect the skin.

Some key points to consider when applying topical agents to the affected area include:

• Ensuring the area is clean and dry before application
• Applying a thin layer of the topical agent
• Allowing the agent to dry before covering with any barrier device
• Avoiding the use of topical steroids for prolonged periods, especially in sensitive areas like the groin, due to the risk of skin thinning

The patient's current regimen, which includes wound care with barrier devices, oxycodone, and antibiotics, should be continued and monitored for effectiveness. If the pain persists despite the addition of topical anesthetics, consideration can be given to adding a short course of a mild topical steroid like hydrocortisone 1% cream, under the guidance of a dermatologist or healthcare provider.

From the FDA Drug Label

Helps to Numb Away Pain Non-Greasy Maximum Strength External Analgesic with 4% Lidocaine BACITRACIN ZINC, NEOMYCIN SULFATE, POLYMYXIN B SULFATE & PRAMOXINE HCL First Aid Antibiotic / Pain Relieving Ointment Active Ingredient Hydrocortisone 1%

The patient has a severe groin rash and is already optimized with wound care and medications. To help with painful skin, topical agents can be added to the regimen.

• Lidocaine 4% 2 can help numb away pain.
• Pramoxine HCl in the triple antibiotic ointment 3 can also provide pain relief.
• Hydrocortisone 1% 4 may help with inflammation and skin irritation.

From the Research

Topical Agents for Painful Skin

The patient's severe groin rash from friction with open skin areas can be addressed with various topical agents. Considering the patient is already optimized with wound care and barrier devices, and is on oxycodone and antibiotics, the following options can be explored:

• Topical antimicrobial creams, such as silver sulfadiazine, Sulfamylon, and gentamicin sulfate, have been shown to exhibit superior bacterial inhibition and bactericidal properties 5.
• Antifungal agents, such as azoles or allylamines, may be effective in treating tinea cruris (groin) infections, which can cause painful skin 6.
• Topical corticosteroids can be used to reduce inflammation and alleviate painful skin conditions, such as psoriasis and atopic dermatitis 7.
• However, it is essential to note that topical medicaments, including antibiotics, steroids, anesthetics, and antifungals, can cause allergic contact dermatitis 8.

Considerations for Topical Agent Selection

When selecting a topical agent, it is crucial to consider the patient's specific needs and potential sensitizers. The following factors should be taken into account:

• The patient's medical history and current medications, including oxycodone and antibiotics.
• The severity and location of the groin rash.
• The potential for allergic reactions to topical medicaments 8.
• The need for antimicrobial and antifungal properties in the topical agent 5, 6.
• The importance of correct patient application and usage of topical corticosteroids 7.