Chapter 15: Medicines optimization: ensuring quality and safety
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Topical administration
Definition
Topical administration involves medication applied onto the skin and mucous membranes primarily for its local effects, for example creams, ointments and lotions (Perry [281]).
Related theory
Creams
Creams are emulsions of oil in water and are generally well absorbed into the skin. They are usually more cosmetically acceptable than ointments because they are less greasy and easier to apply (Aulton and Taylor [16], BNF [25]). They may be used as a ‘base’ in which a variety of drugs may be applied for local therapy (BNF [25]).
Ointments
Ointments are greasy and/or oily preparations that are normally anhydrous and insoluble in water, and are more occlusive than creams (BNF [25]). They are absorbed more slowly into the skin and leave a greasy residue. They have similar uses to creams and are particularly suitable for dry, scaly lesions (BNF [25]). Care should be taken with extensive use of ointments as they pose a risk to the patient of their clothes or skin catching fire (NPSA [265]).
Lotions
Lotions have a cooling effect and may be preferred to ointments or creams for application over a hairy area (BNF [25]). Lotions are more liquid than ointments and creams and spread easily; they can become a slip hazard if spilt on the floor.
Pastes
Wound products
See Chapter c18: Wound management.
Evidence‐based approaches
The risk of serious effects from topical administration is generally low, but systemic effects can occur if the skin is thin, if the drug concentration is high or if contact is prolonged (Perry [281]). This is a particular problem with topical corticosteroids, as systemic absorption can occur. Mild and moderately potent corticosteroids are associated with few side‐effects but particular care is required when treating neonates and babies and when using potent and very potent corticosteroids. Absorption through the skin can sometimes (rarely) cause adrenal suppression and even Cushing's syndrome (BNF [25]). Central serous chorioretinopathy is a retinal disorder that has been reported after local administration of corticosteroids. Patients should be advised to report any blurred vision or other visual disturbances (MHRA [213]).
Pre‐procedural considerations
Specific patient preparation
The condition of the affected site should be assessed for altered skin integrity as applying medicines to broken skin can cause them to be absorbed too rapidly, resulting in systemic effects (Chernecky et al. [39], Perry [281]). The affected area must be washed and dried before applying the topical medicines where appropriate, unless the prescription directs otherwise.
Procedure guideline 15.3
Medication: topical applications
Post‐procedural considerations
Ask the patient to report any itching, skin colour change or signs of a rash following application.
Complications
Local skin reaction
The skin site may appear inflamed, and oedema with blistering indicates that subacute inflammation or eczema has developed from worsening of skin lesions. Patients may also complain of pruritus and tenderness, which could indicate slow or impaired healing and should be referred to the prescriber; alternative therapies may be required (Perry [281]).
