Resultados sobre la aplicación cráneo-facial del parche de capsaicina 8 % en una serie de 5 casos

espanolLos parches de capsaicina al 8 % son una alternativa de segunda linea para el tratamiento del dolor neuropatico periferico. Aunque tiene pocos efectos secundarios, no tiene indicacion para el tratamiento craneo-facial debido a la posible irritacion de mucosas por la capsaicina. Solo hemos encontrado tres publicaciones que refieren la aplicacion del parche en estas localizaciones, describiendo 7 casos clinicos. Hemos recogido 4 casos en los que se realizan 5 aplicaciones en total, 3 mujeres (repitiendo aplicacion en una de ellas) y 1 hombre, entre 58 y 84 anos, con los siguientes diagnosticos: necrosis caustica en labio inferior tras limpieza dental, neuralgia del trigemino y neuropatia postherpetica. Tras comprobar ineficacia de otros tratamientos, se propuso el parche de capsaicina al 8 %, con firma previa de los consentimientos informados de la aplicacion de parche en regimen de hospital de dia y de tratamiento fuera de ficha tecnica. Previamente a la aplicacion del parche en la zona cutanea dolorosa, se procedio a realizar proteccion ocular de ambos ojos con parche oftalmico quirurgico, y de mucosas oral y nasal con mascarilla facial quirurgica sellada. La proteccion se mantuvo durante toda la aplicacion del parche y se quito una vez retirado este y limpiada la zona de aplicacion. Unicamente se reportaron 3 efectos secundarios leves del total de las 5 aplicaciones: un paciente presento piel eritematosa que cedio espontaneamente, otra paciente refirio sensacion de quemazon y dolor que cedio con analgesia endovenosa, y otra paciente explico dolor leve bien tolerado, que cedio de manera espontanea. En ninguno de los casos se apreciaron efectos secundarios a nivel de mucosas. En cuanto a resultados, dos pacientes notaron mejoria durante uno y dos meses, colocando nuevamente el parche en una de ellas, sin lograr esta segunda vez alivio. Las otras dos pacientes no notaron ningun cambio. El tratamiento con parches de capsaicina 8 % en superficies craneo-faciales parece tener similar eficacia a su aplicacion en otras areas de la piel. Los efectos secundarios en su aplicacion en estas superficies son escasos, al igual que en otras aplicaciones corporales. Creemos que con las medidas de precaucion adecuadas en las regiones craneo-faciales, la utilidad clinica observada del parche de capsaicina 8 % lo situa como otra opcion de tratamiento para dolor neuropatico, sin complicaciones anadidas. No obstante, estudios clinicos con mayor numero de pacientes deberian llevarse a cabo para confirmar estos hallazgos. EnglishThe capsaicin 8 % patch is a secondary line alternative to neuropathic peripheral pain treatment. Although it has few secondary effects, is not indicated in head and facial treatment due to the possibility of the irritation of mucosa. We have only found three publications related with the patch application in those locations, describing 7 clinical cases. We have analyzed 4 cases in which we have applied 5 patches in total. There were 3 women (repeating the application in one of them) and 1 man, between 58 and 84 years old, with the following diagnosis: caustic necrosis in the inferior lip after dental cleaning, trigeminal neuralgia and post-herpetic neuropathy. Inefficacy of other treatments was confirmed, and after that, the capsaicin 8 % patch was proposed. Informed consent of the application of the patch at day clinic and treatment out of technical data sheet were previously signed. Before the patch was applied to the painful cutaneous area, we proceed with ocular protection of both eyes with surgical ophthalmic patch and oral and nasal mucosa protection with surgical mask hermetically seal. That protection was maintained during the whole application of the patch, and was removed once the capsaicin patch was taken off and the application area was cleaned. There were only 3 mild secondary effects of the total 5 applications: one patient showed erythematic skin that was resolved spontaneously, another patient related burn and pain sensation which was solved with endovenous analgesia. Finally, another patient explained mild pain well tolerated, that was resolved also spontaneously. In no cases there were secondary effects in mucosa. Related with the results, 2 patients felt improvement between one and two months, applying again the patch in one of them, not reaching this time relief in the pain. The other 2 patients did not notice any change. The capsaicin 8 % patch treatment in head and facial-areas seems to have similar efficacy as the application in other skin-areas. Secondary effects in these surfaces are very low, the same as in other corporal locations. We believe that with the adequate preventive measures in head and facial areas, clinical utility observed with capsaicin 8 % patch places it as another treatment option for neuropathic pain, with no complications added. However, clinical studies with a higher number of patients should carry on to confirm these findings.