Pain management in dermatology.

BACKGROUND: The dermatologist has to deal with many situations where the patient feels pain, and must therefore know how to manage it.

SUMMARY: The aim of this review is to explore the treatments available to manage pain in dermatology in different circumstances, with an emphasis on pharmacological and non-pharmacological interventions specifically studied in dermatology.

KEY MESSAGES: The therapeutic arsenal of analgesics available is vast but still little studied specifically in dermatology: classic analgesic drugs, divided into 3 levels according to the WHO classification, or antidepressants and anticonvulsants, used for neuropathic pain, are often recommended as first line treatment but not specifically studied in skin disorders, except in post-herpetic neuralgia. With regard to the analgesic management of certain chronic dermatoses such as psoriasis or atopic dermatitis, it is accepted that treatment of the cause relieves pain, but the studies do not specifically evaluate this criterion in the first line, as opposed to pruritus. Additional analyses have recently been conducted in this area, with positive results in terms of skin pain reduction, particularly for biotherapies. Finally, new data are emerging on non-pharmacological interventions such as musical intervention, virtual reality and hypnosis, which allow a significant reduction of anxiety during skin surgeries. However, the results are contradictory with regard to pain reduction. These interventions can be proposed in association with traditional therapies. As a result, a wide range of analgesic methods is available and can be combined for optimal management.