Psoriatic Arthritis treatments: Topical Analgesics

Difflam 3% Cream contains the active ingredient benzydamine hydrochloride, which belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

Difflam Cream is a topical treatment used for the short-term relief of pain and inflammation associated with sprains, strains, bruises, sore muscles and stiff joints.

How does it work?

Benzydamine works locally to reduce pain and inflammation. It reduces the production and activity of substances involved in inflammation, helping to relieve pain, swelling and tenderness.

Benzydamine also has a local anaesthetic effect, which can cause temporary numbness and provide additional pain relief at the site where the cream is applied.

Who can get it?

Difflam 3% Cream is available without a prescription for adults and children, although children should use it only as advised by a pharmacist or healthcare professional.

Do not use Difflam Cream if you are allergic to benzydamine or any of the other ingredients.

Take care when using the cream if you have previously had an allergic reaction to NSAIDs.

How is it used?

The amount of cream needed depends on the size of the area being treated. Usually, between half and one full finger-length of cream is gently rubbed into the affected area.

The cream can normally be applied three times a day.

Rub the cream gently into the affected area until it disappears.

Do not use the cream in or near the eyes, mouth, nose or genital or anal areas. Wash the area with cold water if the cream accidentally comes into contact with these areas.

Difflam Cream is intended for short-term use. If your symptoms get worse or do not improve, speak to a doctor or pharmacist.

What are the side effects?

Like all medicines, Difflam Cream can cause side effects, although not everybody will experience them.

Possible side effects include:

• itching or skin irritation
• skin redness or rash
• burning, stinging or temporary numbness where the cream is applied
• allergic reactions such as swelling or difficulty breathing

Stop using the cream and seek medical advice if you develop a severe skin reaction or signs of an allergic reaction.

Some ingredients in the cream can cause skin irritation or allergic reactions.

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Difflam is marketed in the UK by Viatris UK Healthcare Ltd 

Review date: September 2026
Version ID: 2/DIF/PAT/09/26

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID). It is applied to the skin to relieve local pain and inflammation associated with rheumatic and mild arthritic pain, sprains, strains and other soft-tissue injuries.

Felbinac has been available in gel and foam preparations. The gel formulation may also be used as a coupling agent during ultrasound treatment, where applicable.

How does it work?

Felbinac works by reducing the production of substances called prostaglandins. These substances are produced by the body in response to injury and inflammation and contribute to pain, swelling and inflammation.

When felbinac is applied to the skin, it is absorbed into the underlying tissues, where it acts locally to reduce pain and inflammation.

As with other topical NSAIDs, some medicine may enter the bloodstream. The amount absorbed is generally lower than with NSAIDs taken by mouth, although absorption may increase if large amounts are used, if the gel or foam is applied over large areas, or if it is used for prolonged periods.

Who can get it?

Felbinac topical preparations have been available on prescription for adults aged 18 years and over.

They should not be used by anyone who has had an allergic reaction to felbinac, aspirin or another NSAID. Speak to a doctor or pharmacist before use if you have asthma triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the preparation to the affected area and gently rub it into the skin.

The amount and frequency depend on the formulation:

• Gel: approximately 1g applied to the affected area two to four times daily.
• Foam: apply a golf-ball-sized amount to the affected area two to four times daily.

Do not exceed the recommended maximum daily amount stated on the product information.

• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth, nose and other mucous membranes.
• Rinse with cold water if accidental contact occurs.
• Wash your hands after applying the medicine, unless the hands are being treated.
• Do not cover the treated area with airtight or waterproof dressings, including nappies, unless advised by a healthcare professional.
• Keep felbinac foam away from naked flames, as it is inflammable.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical felbinac. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Redness or mild irritation at the application site
• Itching
• Skin inflammation or dermatitis
• Tingling, numbness or altered sensation
• Skin rash or increased sensitivity to sunlight
• Rarely, allergic reactions such as wheezing, facial swelling or difficulty breathing

Stop using the medicine and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral NSAIDs, excessive use or application over large areas may increase the risk of systemic NSAID-related side effects.

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Felbinac is marketed in the UK by Goldshield Pharmaceuticals Ltd and is known commercially as Traxam.

Review date: September 2026
Version ID: 2/FEB/PAT/09/26

Feldene contains the active ingredient piroxicam, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Piroxicam is not usually a first-choice NSAID because it has a higher risk of serious gastrointestinal side effects and certain skin reactions compared with some other NSAIDs. It should only be prescribed after an individual assessment of the potential benefits and risks.

Piroxicam relieves symptoms such as pain and stiffness but does not alter the underlying disease process and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Piroxicam works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury, illness and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, piroxicam helps relieve pain and inflammation.

Piroxicam has a long duration of action, so it is usually taken once a day. Feldene capsules should be swallowed with a drink, preferably with or after food. Feldene Melt tablets are designed to dissolve quickly in the mouth and can be swallowed with saliva or water.

Who can get it?

Feldene is available on prescription for adults. Treatment should be initiated by a doctor experienced in treating inflammatory or degenerative rheumatic conditions.

It may not be suitable for people with:

• A current or previous stomach or intestinal ulcer, bleeding or perforation
• Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• Severe heart failure or significant heart or circulation problems
• Kidney or liver disease
• Asthma or allergic reactions triggered by aspirin or other NSAIDs
• A previous serious skin reaction to piroxicam or another medicine

Piroxicam should not be taken with another NSAID, including ibuprofen, naproxen, diclofenac or aspirin used for pain relief. It should also generally be avoided with anticoagulants such as warfarin unless specifically directed by a specialist.

Piroxicam should not be used during the last three months of pregnancy. It is not recommended while breastfeeding unless specifically advised by a doctor. It may also affect female fertility and is not recommended for women trying to conceive.

How is it used?

The usual adult dose is:

• 20mg once daily, usually as a single dose
• Some people may be maintained on 10mg once daily
• A dose of up to 30mg daily may occasionally be prescribed, but doses above 20mg carry an increased risk of gastrointestinal side effects and should only be used under specialist supervision

The lowest effective dose should be used for the shortest time necessary. Treatment should be reviewed within 14 days, and continued treatment should involve regular reassessment.

A proton pump inhibitor, such as omeprazole, may be prescribed to help reduce the risk of stomach or duodenal ulcers in people who require NSAID treatment and are at increased gastrointestinal risk.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with piroxicam. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

• Indigestion, stomach pain, nausea, vomiting, diarrhoea, constipation or wind
• Loss of appetite or inflammation of the mouth
• Headache, dizziness, drowsiness or tiredness
• Skin rash, itching or increased sensitivity to sunlight
• Fluid retention, swelling or increased blood pressure
• Changes in kidney or liver function
• Changes in blood counts

NSAIDs, including piroxicam, can cause serious gastrointestinal complications, including ulcers, bleeding or perforation. These may occur without warning and can occasionally be fatal.

Rarely, piroxicam can cause serious skin reactions, including blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes. Stop taking the medicine and seek urgent medical advice if these symptoms occur.

Seek urgent medical attention if you develop vomiting of blood, black or tar-like stools, severe abdominal pain, swelling of the face or throat, difficulty breathing, chest pain or sudden weakness.

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Feldene is marketed in the UK by Pfizer Ltd.

Review date: September 2026
Version ID: 2/FED/PAT/09/26

Fenbid Gel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is applied to the skin to relieve local pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains and some minor joint conditions.

Fenbid Gel and Fenbid Forte Gel may be used for painful muscular and joint conditions, including sprains, strains, backache, rheumatic pain and minor arthritic conditions.

How does it work?

Ibuprofen works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, ibuprofen helps relieve pain and inflammation in the area where it is applied.

When ibuprofen is applied to the skin, it is absorbed into the underlying tissues, where it acts locally. Generally, less ibuprofen reaches the bloodstream than when ibuprofen is taken by mouth. However, some absorption into the bloodstream still occurs, particularly when large amounts are applied, when used over large areas or when used for prolonged periods.

Who can get it?

Fenbid Gel and Fenbid Forte Gel are available from pharmacies. They may be suitable for adults and children aged 14 years and over, depending on the specific product.

They should not be used by anyone who has had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Speak to a pharmacist or doctor before use if you have asthma that is triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the gel to the affected area and gently massage it into the skin.

The usual directions are to apply the gel three or four times a day, following the instructions on the product packaging or leaflet.

• Wash your hands after applying the gel, unless the hands are the area being treated.
• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth and other sensitive areas.
• Do not cover the treated area with an airtight or waterproof dressing.
• Do not use more frequently or for longer than recommended.

If symptoms worsen or do not improve after the recommended period, seek advice from a pharmacist or doctor.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical ibuprofen. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Skin irritation, itching, redness or rash
• Burning or stinging at the application site
• Increased sensitivity to sunlight
• Allergic reactions, including wheezing or worsening asthma
• Rarely, more serious allergic reactions such as swelling of the lips, face, throat or tongue, or difficulty breathing

Stop using the gel and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral ibuprofen, using excessive amounts or applying the gel over large areas may increase the risk of NSAID-related side effects, including stomach, kidney or other systemic effects.

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Review date: September 2026
Version ID: 2/FEN/PAT/09/26

Ibugel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains, neuralgia and some minor arthritic conditions.

Ibugel is available as a 5% gel and Ibugel Forte as a 10% gel.

How does it work?

Ibuprofen works by reducing the production of substances called prostaglandins. Prostaglandins are produced in response to injury or disease and are involved in causing pain, swelling and inflammation.

When ibuprofen is applied to the skin, it passes through the skin into the underlying tissues where it helps reduce pain and inflammation in the affected area. The aqueous-alcoholic gel can also have a cooling and soothing effect when applied.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth. However, some absorption into the bloodstream can occur, particularly when large amounts are used or large areas of skin are treated.

Who can get it?

Ibugel 5% and Ibugel Forte 10% are available in the UK. The appropriate product and supply status depends on the strength and pack.

They are generally not recommended for children under 12 years unless advised by a doctor.

Ibugel should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, particularly where these medicines have caused asthma, rhinitis or urticaria.

How is it used?

Apply the gel to the affected area and massage gently into the skin until absorbed.

For Ibugel 5%, apply to the affected area up to three times a day, or as directed by a doctor.

For Ibugel Forte 10%, apply 2–5 cm of gel to the affected area up to three times a day, or as directed by a doctor. Wash your hands after application unless the hands are being treated.

Do not apply the gel to broken or damaged skin. Avoid contact with the eyes and mucous membranes.

Treatment should normally be limited to a few weeks unless your doctor advises you to continue for longer.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. Having a side effect listed here does not mean that everyone using the medicine will experience it.

Topical ibuprofen is generally well tolerated, but possible side effects include:

• Skin irritation, redness, itching or rash
• Burning or stinging at the site of application
• Increased sensitivity to sunlight
• Allergic reactions

Rarely, ibuprofen absorbed through the skin can cause effects similar to those associated with oral NSAIDs, including breathing difficulties or other allergic reactions.

Stop using the gel and seek medical advice if you develop a significant skin reaction, difficulty breathing, swelling of the face or throat, or other signs of a serious allergic reaction.

Ibugel should not be used at the same time as other NSAIDs without advice from a doctor or pharmacist.

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Ibugel and Ibugel Forte are marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBU/PAT/09/26

This page is for reference only as this product is now discontinued

Ibumousse contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It was used as a topical treatment for pain and inflammation caused by backache, rheumatic and muscular pain, sprains, strains, neuralgia and common arthritic conditions.

Ibumousse contains ibuprofen 5% and was supplied as a mousse (foam) for application to the skin.

Please note: Ibumousse is no longer listed as a current UK product on the electronic Medicines Compendium (eMC), and appears to no longer be generally available. Current topical ibuprofen products are available in other formulations.

How does it work?

Ibuprofen works by blocking the action of cyclo-oxygenase (COX), an enzyme involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When ibuprofen is applied to the skin, it is absorbed into the tissues around the affected area, where it can help reduce local pain and inflammation. Less ibuprofen generally reaches the bloodstream than when ibuprofen is taken by mouth, although some absorption can still occur.

Who can get it?

Ibumousse was intended for adults, older people and children over 12 years of age. Children under 12 years were only to use it if advised by a doctor.

It should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, including some people with asthma, allergic rhinitis or urticaria triggered by these medicines.

It should not be applied to broken, damaged, infected or diseased skin.

How is it used?

Ibumousse was for application to the affected area of skin.

The usual instructions were to dispense approximately 1–2g of mousse into the palm of the hand and gently massage it into the affected area until absorbed. It could be applied three to four times a day, or as directed by a doctor.

It should not be applied near the eyes, nose or mouth. The mousse was flammable and should be kept away from flames and other sources of ignition.

Because some ibuprofen can be absorbed into the bloodstream, people taking aspirin or other NSAIDs should speak to their doctor or pharmacist before using a topical ibuprofen product.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with topical ibuprofen. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin irritation, redness, itching or rash
• Burning or stinging at the application site
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the face, lips, tongue or throat (angioedema)
• Severe allergic reactions, including anaphylaxis

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used over large areas of skin.

Stop using the product and seek medical advice if you develop a significant skin reaction, breathing difficulties or swelling of the face, lips, tongue or throat.

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Ibumousse was marked by Dermal Laboratories/Diomed Developments in the UK.

Reviewed: September 2026
Version ID: 2/IBU/PAT/09/26

Ibuspray contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains and neuralgia. It can also be used to relieve pain associated with non-serious arthritic conditions.

Ibuspray contains ibuprofen 5% and is applied directly to the skin over the painful area.

How does it work?

Ibuprofen works by blocking the action of an enzyme called cyclo-oxygenase (COX). COX is involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When Ibuspray is applied to the skin, ibuprofen passes through the skin into the tissues underneath, where it acts directly on the painful area. The spray also has a soothing and cooling effect.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth, although some absorption does occur.

Who can get it?

Ibuspray is available from pharmacies and on NHS prescription.

It can be used by adults, older people and children over 12 years of age. Children under 12 should only use Ibuspray if advised by a doctor.

Ibuspray should not be used by anyone who has previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Particular caution is needed in people who have asthma, rhinitis or urticaria associated with these medicines.

It should not be used on broken, damaged, infected or diseased skin.

Ibuspray should not be used during pregnancy or breastfeeding.

How is it used?

Hold the bottle approximately 10–15 cm (4–6 inches) from the skin and spray over the affected area.

After every 2–3 sprays, gently massage the preparation into the skin and spread it over the area around the painful site.

Normally, 5–10 sprays (approximately 1–2 ml) are sufficient. This can be repeated three to four times a day, or as directed by a doctor. Do not use excessively.

Wash your hands after applying the spray, unless the hands are the area being treated.

Treatment should not normally continue for more than a few weeks unless advised by a doctor.

Ibuspray is flammable. Do not spray it near naked flames, cigarettes, electric heaters or other sources of ignition. Clothing, bedding and dressings that have come into contact with the product can also present a fire risk.

If you are taking aspirin or another NSAID by mouth, speak to your doctor or pharmacist before using Ibuspray, as this may increase the risk of side effects.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with Ibuspray. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin rash, itching or irritation
• Redness or other skin reactions at the application site
• Increased sensitivity of the skin to sunlight
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the lips, face, tongue or throat (angioedema)
• Rarely, more serious allergic reactions

Serious skin reactions have very rarely been reported with ibuprofen. Stop using Ibuspray and seek medical attention if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used.

Marketed by

Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBS/PAT/09/26

Oruvail prolonged-release capsules contain the active ingredient ketoprofen, a non-steroidal anti-inflammatory drug (NSAID). They are used to relieve pain, stiffness and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

Oruvail capsules are prolonged-release capsules, which release ketoprofen gradually over several hours. They are available in 100 mg and 200 mg strengths.

How does it work?

Ketoprofen reduces the production of prostaglandins, chemicals involved in pain, swelling and inflammation.

By reducing prostaglandin production, ketoprofen can help relieve pain, stiffness and inflammation affecting the joints, muscles and other tissues.

Oruvail can be used for a range of painful inflammatory conditions, including rheumatoid arthritis, osteoarthritis, problems affecting the spine such as ankylosing spondylitis, lower back pain, sprains and strains.

Oruvail treats symptoms but does not alter the underlying cause of rheumatoid arthritis or other inflammatory conditions.

Because Oruvail is a prolonged-release preparation, it releases ketoprofen slowly and is normally taken once daily.

Who can get it?

Oruvail is available on prescription for adults.

It may not be suitable if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

Particular care is needed in people aged 65 and over and in people with heart or circulation problems, asthma, Crohn's disease or ulcerative colitis.

How is it used?

The usual dose is 100 mg or 200 mg once a day, depending on your condition and your response to treatment.

The capsules should be swallowed whole with water and should not be opened, chewed or crushed, as this could affect the prolonged-release action.

Oruvail should preferably be taken with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Oruvail should not be taken with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

Like other NSAIDs, Oruvail can cause side effects. These may include:

• Indigestion or stomach pain
• Nausea or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash or itching
• Swelling caused by fluid retention

More serious side effects can include stomach ulcers or gastrointestinal bleeding, kidney or liver problems, raised blood pressure and cardiovascular problems.

Seek urgent medical attention if you vomit blood, pass black or tarry stools, develop severe breathing difficulties or swelling of the face or throat, or develop a severe skin reaction with blistering or peeling.

NSAIDs such as ketoprofen may be associated with a small increased risk of heart attack or stroke. This risk is more likely with higher doses and prolonged treatment.

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Oruvail prolonged-release capsules are marketed in the UK by Sanofi.

Reviewed: September 2026
Version ID: 2/ORV/PAT/09/26

Pennsaid belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It contains the active ingredient diclofenac sodium and is used to relieve pain associated with osteoarthritis in superficial joints, such as the knee or wrist.

How does it work?

Diclofenac works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing prostaglandins, chemicals that contribute to pain, swelling and inflammation.

When Pennsaid is applied to the skin, diclofenac passes through the skin into the tissues underneath. This allows it to act locally to reduce pain and inflammation.

Pennsaid is intended for osteoarthritis affecting superficial joints. There is no evidence for its use in large, deep joints covered by muscle or other soft tissue, such as the hip or spine.

Who can get it?

Pennsaid is available on prescription for adults.

It should not be used by people who have previously had an allergic reaction, asthma, breathing difficulties or other allergic symptoms after taking aspirin or another NSAID.

How is it used?

The painful joint should be washed with soap and water and allowed to dry before applying Pennsaid.

The usual amount is:

• 20 drops for a medium-sized joint, such as the wrist.
• 40 drops for a large joint, such as the knee.

The drops should be applied in small amounts over the painful joint and spread evenly without rubbing or massaging. Treatment is normally repeated four times a day, as directed by your doctor.

Pennsaid is for application to the skin only and must not be taken by mouth.

Do not apply it to broken, damaged, infected or diseased skin. Avoid contact with the eyes, mouth and other mucous membranes. Do not cover the treated area with an airtight dressing.

Wash your hands after applying Pennsaid, unless your hands are the area being treated.

Because some diclofenac can be absorbed into the bloodstream, side effects associated with NSAIDs can still occur, particularly if large areas are treated or the medicine is used for a prolonged period.

What are the side effects?

Possible side effects include:

• dry skin
• redness, itching or irritation where the medicine is applied
• skin rash or other skin reactions.

Systemic side effects, such as indigestion, stomach pain or other NSAID-related effects, are possible because some diclofenac is absorbed through the skin. The risk is generally lower than with oral diclofenac, but it is not completely eliminated.

Stop using Pennsaid and seek medical advice if you develop signs of an allergic reaction, severe skin reaction, stomach bleeding or other serious symptoms.

Do not use Pennsaid with another NSAID, such as ibuprofen, naproxen or diclofenac tablets, unless advised by a healthcare professional.

Pennsaid should not be used during pregnancy unless specifically advised by a doctor. NSAIDs should not be used during the last three months of pregnancy.

Marketed by

Pennsaid is marketed in the UK by Dimethaid International.

Reviewed: September 2026
Version ID: 2/PEN/PAT/09/26

Axsain 0.075% cream contains capsaicin, a topical analgesic used to relieve certain types of nerve pain. It is licensed for the symptomatic relief of neuralgia associated with, or following, herpes zoster infection (post-herpetic neuralgia), once any open skin lesions have healed. It is also used for painful diabetic peripheral polyneuropathy under the supervision of a hospital consultant.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers. It acts on pain-sensing nerves in the skin. Although its precise action is not fully understood, capsaicin is thought to reduce pain signalling by depleting and preventing the re-accumulation of a chemical called substance P in peripheral sensory nerve cells.

Axsain provides symptomatic relief. It does not treat the underlying cause of nerve damage.

Who can get it?

Axsain is available on prescription for adults, including older people.

It is not suitable for use in children.

Axsain should only be applied to unbroken skin. It must not be used on broken, inflamed or irritated skin, or by anyone who is allergic to capsaicin or any of the ingredients.

How is it used?

Axsain should be applied sparingly to the affected area, usually three or four times a day, or as directed by your doctor.

• Apply only a small amount, approximately pea-sized, to the affected area.
• Rub the cream in gently until no residue remains on the skin.
• Space applications evenly throughout the day and do not apply more often than every four hours.
• Wash your hands immediately after applying the cream, unless your hands are the treated area. If treating the hands, wash them 30 minutes after application.
• Avoid contact with the eyes, mouth, nose and other mucous membranes.
• Do not use under tight bandages or dressings.
• Avoid taking a hot bath or shower immediately before or after applying the cream, as this may increase the burning sensation.
• Avoid inhaling vapours from the cream.

When used for painful diabetic peripheral polyneuropathy, Axsain should be used under the direct supervision of a hospital consultant with access to specialist resources. Treatment should initially be assessed after eight weeks and reviewed regularly before continuing.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with Axsain. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Axsain commonly causes a temporary burning sensation when it is applied. This may be more noticeable if:

• Too much cream is used.
• The cream is applied more than four times a day.
• The cream is applied shortly before or after a hot bath or shower.

Other possible side effects include:

• Skin irritation, redness or discomfort at the application site.
• Contact dermatitis or other local skin reactions.
• Irritation of the eyes, nose or throat if vapours are inhaled.
• Runny nose, coughing, sneezing or watery eyes.
• Rarely, breathlessness, wheezing or worsening of asthma.

Avoid contact with the eyes and seek medical advice if the condition worsens. If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Axsain 0.075% w/w Cream is marketed in the UK by Ennogen IP Ltd.

Reviewed: September 2026
Version ID: 2/AXS/PAT/09/26

Balmosa Cream is a warming pain-relieving cream containing menthol, camphor, methyl salicylate and capsicum oleoresin. It is a topical analgesic and rubefacient used for the symptomatic relief of muscular rheumatism, fibrositis, lumbago, sciatica and pain associated with unbroken chilblains.

Balmosa is an older product and may not be readily available. Check with a pharmacist about current availability and suitable alternatives.

How does it work?

Balmosa contains four active ingredients that work together to produce a cooling or warming sensation and relieve pain.

• Menthol produces a cooling sensation and has mild pain-relieving properties.
• Camphor acts as a counter-irritant and has mild local analgesic effects.
• Methyl salicylate has pain-relieving and counter-irritant properties.
• Capsicum oleoresin produces warmth and redness of the skin and may help reduce the perception of pain.

These ingredients provide symptomatic relief. They do not treat the underlying cause of a rheumatic or musculoskeletal condition.

Who can get it?

Balmosa is intended for adults and older people. It is not generally recommended for children under 12 years.

It should not be used by anyone who is allergic to any of its ingredients or who has previously experienced sensitivity to aspirin or other non-steroidal anti-inflammatory drugs.

Speak to a pharmacist or doctor before use if you are pregnant, planning a pregnancy or breastfeeding.

How is it used?

Apply the cream to the affected area and gently massage it into the skin as required.

• Use only on unbroken skin.
• Avoid contact with the eyes, mouth, nostrils and other sensitive areas.
• Do not apply to inflamed, irritated, infected or broken skin.
• Wash your hands thoroughly immediately after use, unless the hands are the treated area.
• Do not use with airtight or watertight dressings.
• Avoid exposing treated skin to excessive sunlight.
• If irritation develops, stop using the cream.

Do not apply large amounts. If the cream is accidentally swallowed, seek medical advice.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with Balmosa. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Possible side effects include:

• Skin redness, irritation, itching or rash.
• Contact dermatitis or other skin sensitivity reactions.
• A temporary sensation of warmth, burning or stinging.
• Allergic reactions, particularly in people sensitive to salicylates or other ingredients.

Stop using the cream if irritation or a rash develops. Seek urgent medical help if you experience swelling of the face, lips, tongue or throat, difficulty breathing or another serious allergic reaction.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Balmosa  is marketed in the UK by Galen Consumer

Reviewed: September 2026
Version ID: 2/BAL/PAT/09/26

Qutenza is a cutaneous patch containing capsaicin. It belongs to a group of medicines known as topical analgesics and is used to treat peripheral neuropathic pain in adults, either on its own or alongside other medicines for pain.

Qutenza contains a high-strength preparation of capsaicin and must be applied by a doctor or healthcare professional under the supervision of a doctor.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers.

Capsaicin initially activates pain-sensing nerves in the skin, which can cause burning and redness. Following exposure, these nerves become less sensitive to a range of painful stimuli. This process, sometimes called desensitisation, is thought to produce pain relief.

The effects on the pain-sensing nerves are generally temporary and can gradually reverse over time.

Who can get it?

Qutenza is available on prescription for adults only.

It may be used for different types of peripheral neuropathic pain, including:

• Post-herpetic neuralgia following shingles.
• Painful diabetic peripheral neuropathy.
• HIV-associated neuropathy.

Qutenza should not be used in children, as its safety and effectiveness have not been established in people under 18.

The patch must only be applied to intact, dry, non-irritated skin. It must not be applied to broken skin, the face, near the eyes or close to mucous membranes.

How is it used?

Qutenza must be applied by a doctor or healthcare professional under medical supervision.

• The most painful areas are identified and marked on the skin.
• The area is cleaned and dried before treatment.
• A topical anaesthetic or an oral painkiller may be given before application to reduce discomfort.
• Up to four patches may be applied at one time.
• Patches are left in place for 30 minutes when treating the feet and 60 minutes when treating other areas.
• Treatment may be repeated after 90 days, if necessary, when pain persists or returns.
• In some circumstances, repeat treatment before 90 days may be considered by a doctor following an individual assessment. A minimum interval of 60 days must be observed.

After the patches are removed, a cleansing gel is applied to the treated area to remove any remaining capsaicin. The area is then cleaned.

Patients may experience burning or pain during and shortly after treatment. Healthcare professionals should monitor this and provide appropriate supportive treatment if needed.

What are the side effects?

Like all medicines, Qutenza can cause side effects, although not everybody gets them. The following are some of the side effects associated with this medicine.

Very common side effects:

• Pain at the application site.
• Redness at the application site.

Common side effects:

• Burning sensation.
• Itching, bumps, blisters, swelling or dryness at the application site.
• Increased blood pressure.
• Pain in the limbs.
• Muscle spasms.
• Swelling of the limbs.

Uncommon side effects:

• Wheals or hives.
• Prickling, tingling or increased sensitivity.
• Skin inflammation, dermatitis, irritation or other skin reactions.
• Bruising at the application site.
• Reduced sensation in the limbs.
• Changes in taste.
• Eye irritation.
• Throat irritation.
• Fast heartbeat or awareness of the heartbeat.
• Temporary slowing of electrical signals through the heart.

Burns, including serious burns, have been reported following treatment with capsaicin patches. If severe pain occurs during treatment, the patch should be removed and the skin examined.

Accidental contact with capsaicin may irritate the eyes, skin, throat or airways. This can cause eye pain, coughing, sneezing or throat irritation. Anyone experiencing breathing difficulties should receive appropriate medical attention.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Qutenza 179 mg cutaneous patch is marketed in the UK by Grünenthal Ltd.

Reviewed: September 2026
Version ID: 2/QUT/PAT/09/26

Zacin 0.025% cream contains capsaicin, a topical analgesic used to relieve pain associated with osteoarthritis.

How does it work?

Capsaicin is a compound found naturally in capsicum, including chilli peppers.

The precise mechanism is not fully understood. Capsaicin is thought to act on pain-sensing nerves in the skin, initially causing a warming or burning sensation before reducing the ability of these nerves to send pain signals.

Capsaicin may reduce pain signalling by depleting and preventing the re-accumulation of substances involved in transmitting pain, including substance P.

Zacin provides symptomatic relief. It does not treat the underlying cause of osteoarthritis.

Who can get it?

Zacin is available on prescription for adults and older people.

It is not suitable for use in children.

Zacin should only be applied to unbroken skin. It must not be used on broken, irritated or inflamed skin, or by anyone who is allergic to capsaicin or any of the ingredients.

How is it used?

Apply a small amount of Zacin cream to the affected area four times daily, or as directed by your doctor.

• Use approximately a pea-sized amount for the affected area.
• Rub the cream gently into the skin until no residue remains.
• Space applications evenly throughout waking hours and do not apply more often than every four hours.
• Wash your hands immediately after applying the cream, unless your hands are being treated.
• Avoid contact with the eyes, mouth, nose and other sensitive areas.
• Do not apply to broken, irritated or inflamed skin.
• Do not use under tight bandages or dressings.
• Avoid taking a hot bath or shower immediately before or after applying the cream, as this may increase the burning sensation.

Pain relief usually begins during the first week of treatment and may increase with regular application over the following two to eight weeks.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with Zacin. Experiencing a side effect does not mean that everyone using the medicine will develop it.

Zacin may cause a temporary burning sensation after application. This usually becomes less noticeable after several days of treatment, although it may persist in some people.

The burning sensation may be increased if:

• Too much cream is applied.
• The cream is applied more often than recommended.
• The cream is applied shortly before or after a hot bath or shower.

Other possible side effects include:

• Skin redness or irritation.
• Itching or rash.
• Contact dermatitis or other local skin reactions.
• Irritation of the eyes, nose or throat if the cream is accidentally transferred or vapours are inhaled.
• Coughing, sneezing or breathing difficulties, particularly in people with asthma.

Stop using the cream if significant irritation or a rash develops. Seek urgent medical help if you experience swelling of the face, lips, tongue or throat, or difficulty breathing.

If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.

Marketed by

Zacin 0.025% w/w Cream is marketed in the UK by Ennogen IP Ltd.

Reviewed: September 2026
Version ID: 2/ZAC/PAT/09/26