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Recommendations for Opioid Use in Dermatology

Most pain following dermatologic procedures can be managed with acetaminophen and ibuprofen, said the authors of a recently published consensus on opioid use in dermatologic surgery.

“Opioid overprescribing is a major contribute to the opioid crisis,” the authors said. One contributing factor to overprescribing is the lack of procedure-specific guidelines, they added.

To create opioid-prescribing consensus guidelines, the authors conducted a systematic discussion among a panel of providers in general dermatology, dermatologic surgery, and cosmetics and phlebology using the 4-step modified Delphi method. They developed guidelines for common dermatologic procedural scenarios for opioid-naïve patients and defined opioid tablets as oxycodone 5 mg oral equivalents.

Acetaminophen and/or ibuprofen can adequately manage postoperative pain after most uncomplicated procedures, the authors said. The consensus group also found no specific dermatological scenario that required more than 15 oxycodone 5-mg oral equivalents to manage pain after procedures. In addition, 23% of procedural scenarios were found to routinely require 1 to 10 opioid tablets but only 1 scenario routinely required 1 to 15 opioid tablets, they added.

“Procedure-specific opioid-prescribing guidelines may serve as a foundation to produce effective and responsible postoperative pain management strategies after dermatologic interventions,” the authors concluded.

“These recommendations are based on expert consensus in lieu of quality evidence-based outcomes research,” they added, and should be individualized based on patient factors, including comorbidities.


McLawhorn JM, Stephany MP, Bruhn WE, et al. An expert panel consensus on opioid-prescribing guidelines for dermatologic procedures [published online November 12, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.080

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