Skin abscess after the use of transdermal buprenorphine. Case report

ABSTRACT

BACKGROUND AND OBJECTIVES:

Buprenorphine is a partial agonist semi-synthetic opioid used as an option in the treatment of patients with moderate to severe pain. The only presentation of buprenorphine available in Brazil is for transdermal use. This is an important route of drug administration, especially for the treatment of chronic pain, as it has several advantages, however it is not free from complications. The objective of this study was to present a serious adverse skin reaction after the use of transdermal buprenorphine, requiring surgical intervention.

CASE REPORT:

Female patient, 63 years old, hypertensive and diabetic, diagnosed with rheumatoid arthritis, fibromyalgia syndrome and lumbar disc herniation, with severe chronic pain, advised to use transdermal buprenorphine 10 mg to help control algic. After 24 hours of use, the patient developed erythema and local itching, requiring removal of the adhesive, but the lesion progressively worsened with the formation of an abscess and the need for surgical drainage.

CONCLUSION:

Transdermal buprenorphine has a favorable safety and tolerability profile, as it reduces the risk of unwanted effects such as respiratory depression, constipation and suicidal ideation. However, its use in senior patients with comorbidities, such as the immunosuppression described in this case, requires greater vigilance, due to the possibility of developing more serious adverse reactions.

Keywords
Abscess; Buprenorphine; Pain

HIGHLIGHTS

Buprenorphine is a semi-synthetic opioid drug, partial agonist of the μ receptor and antagonist of the δ and κ receptors, indicated for the treatment of moderate to severe pain.

The buprenorphine available in Brazil is transdermal, a drug presentation associated with reduced aggression to the gastrointestinal system, which bypasses hepatic first-pass metabolism, and greater patient adherence to treatment.

Transdermal buprenorphine can be associated with pruritus, erythema and rash, which, in immunocompromised patients, can result in the appearance of abscess, requiring debridement and surgical drainage.