TOPICAL AND SYSTEMIC DERMAL CARRIERS FOR PSORIASIS

Psoriasis is a non-infectious, dry, inflammatory (autoimmune) skin disorder. Treatment approaches include phototherapy, topical, oral and other systemic drug delivery. However, owing to the side effects and incomplete cure accompanying the oral administration as well as phototherapy, the topical route seemed to be more satisfactory for the medical team. Dermal treatment ensuring percutaneous penetration is now highly recommended in topical indications for psoriatic patients, which can be achieved using pharmaceutical carriers. Several carrier systems loaded with antipsoriatic drugs have demonstrated promising results, with some of them strictly being confined to the skin and others allowing for systemic involvement also. The evolution in this area will present a more useful and safer therapy by minimizing the drugs' degradation and loss, and increasing their bioavailability and effectiveness. Since patients require at least three topical applications for almost a 1-year period to gain health benefit, a reduction in the cost of the treatment will be of real value. A distinction of these carriers is made in the current review, to allow the choice of the most suitable pharmaceutical carrier for psoriatic patients requiring either local and/or systemic involvement

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely