Introduction to diclofenac gel
Diclofenac gel is a topical nonsteroidal anti-inflammatory drug (NSAID) formulation that provides effective local pain relief for musculoskeletal conditions while minimizing systemic absorption and associated adverse effects. The gel formulation contains diclofenac, a potent NSAID with well-established analgesic, anti-inflammatory, and antipyretic properties, in a vehicle that allows for percutaneous absorption and targeted delivery to underlying tissues including muscles, tendons, ligaments, and joints. Diclofenac gel has become increasingly popular as a first-line treatment option for localized pain conditions, particularly osteoarthritis of the hands and knees, and for acute musculoskeletal injuries such as sprains, strains, and sports injuries. The availability of diclofenac gel over the counter in many countries has made it accessible to patients seeking effective pain relief without the need for a prescription.
The development of topical diclofenac formulations was driven by the need to provide effective local pain relief while reducing the systemic adverse effects associated with oral NSAIDs. Oral NSAIDs, including oral diclofenac, are effective for pain and inflammation but carry significant risks including gastrointestinal bleeding, cardiovascular events, renal impairment, and hepatotoxicity, particularly with long-term use or in high-risk patients. By delivering diclofenac directly to the site of pain through the skin, topical formulations achieve therapeutic concentrations in local tissues while maintaining low systemic drug levels, thereby reducing the risk of systemic adverse effects. This targeted delivery approach makes diclofenac gel particularly suitable for patients who require long-term pain management, such as those with chronic osteoarthritis, and for patients who are at increased risk of NSAID-related adverse effects, including the elderly and those with medical conditions that contraindicate oral NSAID use.
Diclofenac gel is available in various concentrations, with the most common formulations being 1 percent and 2.32 percent (which delivers diclofenac sodium equivalent to 2.32 percent of the gel weight). The 1 percent formulation is typically available over the counter in many countries, while the higher concentration formulations may require a prescription. The gel is applied directly to the skin over the painful area, typically two to four times daily, and is gently rubbed into the skin to facilitate absorption. The amount of gel applied depends on the size of the area being treated, with dosing guidelines typically recommending 2 to 4 grams per application for the hands and knees. Patients should follow the dosing instructions provided with their specific product and should not exceed the maximum recommended daily dose to minimize the risk of systemic adverse effects.
The pharmacokinetics of topical diclofenac differ from oral diclofenac, which is the basis for its improved safety profile. When applied to the skin, diclofenac penetrates the stratum corneum and diffuses through the epidermis and dermis, reaching underlying tissues including the synovial fluid and joint structures. The systemic absorption of topical diclofenac is approximately 5 to 10 percent of that achieved with oral dosing, resulting in peak plasma concentrations that are 10 to 20 times lower than those with oral diclofenac. This limited systemic absorption means that the risk of gastrointestinal, cardiovascular, renal, and hepatic adverse effects is lower with topical diclofenac compared to oral formulations, making it a safer option for many patients. However, some systemic absorption does occur, and caution is still warranted in patients with significant renal impairment, bleeding disorders, or other conditions that may be affected by NSAID exposure.
For patients seeking access to diclofenac gel, it is available through various pharmacy channels including online platforms such as Happy Family Store. When purchasing topical NSAIDs online, patients should ensure that the product is obtained from a reputable source to guarantee product quality, stability, and sterility. Patients should also consult with a healthcare provider before using diclofenac gel, particularly if they have underlying medical conditions, are taking other medications, or have experienced adverse reactions to NSAIDs in the past. While diclofenac gel is generally safe and effective when used as directed, proper patient selection and education about appropriate use are essential for achieving optimal therapeutic outcomes and minimizing potential risks.
Medical uses and indications
The primary indication for diclofenac gel is the relief of pain associated with osteoarthritis of the hands and knees. Osteoarthritis is a degenerative joint disease characterized by the progressive breakdown of articular cartilage, leading to pain, stiffness, swelling, and reduced function in affected joints. The hands and knees are among the most commonly affected joints, and pain from osteoarthritis in these locations can impact patients’ quality of life and ability to perform daily activities. Clinical guidelines from the American College of Rheumatology, the Osteoarthritis Research Society International, and other professional organizations recommend topical NSAIDs such as diclofenac gel as first-line treatment for osteoarthritis of the hands and knees, particularly in patients aged 75 years and older who are at increased risk of toxicity from oral NSAIDs.
Acute musculoskeletal injuries including sprains, strains, and contusions are another important indication for diclofenac gel. Sprains involve stretching or tearing of ligaments, while strains involve stretching or tearing of muscles or tendons. These injuries commonly occur during sports activities, workplace incidents, or accidents and involve pain, swelling, bruising, and limited function. Diclofenac gel applied to the injured area can reduce pain and inflammation, promote healing, and facilitate earlier return to normal activities. The medication is most effective when applied early after injury and used consistently for the first several days. Compared to oral NSAIDs, topical diclofenac provides comparable pain relief for acute soft tissue injuries with a lower risk of systemic adverse effects.
Tendinitis and bursitis are inflammatory conditions affecting tendons and bursae (fluid-filled sacs that cushion bones, tendons, and muscles near joints) that respond well to treatment with diclofenac gel. Common forms of tendinitis include tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), Achilles tendinitis, and rotator cuff tendinitis. Bursitis commonly affects the shoulder (subacromial bursitis), elbow (olecranon bursitis), hip (trochanteric bursitis), and knee (prepatellar bursitis). These conditions cause localized pain, tenderness, and restricted movement, and they often result from repetitive motion, overuse, or trauma. Diclofenac gel applied directly over the affected tendon or bursa can reduce local inflammation and provide effective pain relief, often with more rapid onset than oral NSAIDs due to the high local drug concentration achieved.
Soft tissue rheumatism, including conditions such as fibromyalgia and myofascial pain syndrome, may be treated with diclofenac gel in some cases. While these conditions are more complex and typically require multimodal treatment approaches, the use of topical NSAIDs for localized areas of tenderness or trigger points can provide symptomatic relief as part of a comprehensive management plan. The safety advantages of topical diclofenac make it particularly suitable for patients with chronic pain conditions who require ongoing pain management and may be at risk of adverse effects from long-term oral NSAID use. However, patients with widespread pain or systemic inflammatory conditions may benefit more from other treatment modalities, and the use of diclofenac gel should be discussed with a healthcare provider.
Peripheral neuropathic pain conditions such as postherpetic neuralgia, diabetic neuropathy, and complex regional pain syndrome may also benefit from treatment with topical diclofenac in some patients. While the primary treatment for neuropathic pain typically involves medications such as gabapentinoids, tricyclic antidepressants, or SNRIs, topical NSAIDs can provide additional pain relief in patients who have a neuropathic component to their pain that overlaps with inflammatory or musculoskeletal pain. The mechanism of action of diclofenac in neuropathic pain may involve local anti-inflammatory effects at the site of nerve injury and modulation of peripheral nociceptor activity. However, the evidence for the efficacy of topical NSAIDs in neuropathic pain is less robust than for inflammatory conditions, and patients should discuss their specific pain condition with a healthcare provider to determine the most appropriate treatment approach.
Post-surgical pain management is a potential application for diclofenac gel, particularly for superficial surgical procedures or for incisional pain following orthopedic or other surgeries. The topical application of diclofenac gel around surgical incisions can reduce local pain and inflammation, potentially reducing the need for oral analgesic medications including opioids. However, the use of topical NSAIDs in the perioperative setting requires careful consideration of wound healing and infection risk, as NSAIDs may theoretically impair the inflammatory phase of wound healing and increase the risk of surgical site complications. Patients should discuss the use of diclofenac gel for post-surgical pain with their surgeon before initiating therapy.
Mechanism of action and pharmacokinetics
The mechanism of action of topical diclofenac is primarily through local inhibition of cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2, which are responsible for the conversion of arachidonic acid to prostaglandins and other inflammatory mediators. When applied to the skin, diclofenac penetrates the cutaneous barrier and diffuses into underlying tissues, where it achieves concentrations sufficient to inhibit COX activity and reduce the local production of prostaglandins that mediate pain, inflammation, and hyperalgesia. The local anti-inflammatory effects of topical diclofenac are comparable to those achieved with oral diclofenac, but the systemic prostaglandin inhibition is lower, explaining the improved safety profile of the topical formulation.
The penetration of diclofenac through the skin depends on several factors including the concentration of the drug in the formulation, the vehicle or base used, the integrity and hydration of the skin, the area of application, the duration of contact, and the presence of occlusion. Diclofenac gel formulations are designed to optimize percutaneous absorption by using vehicles that enhance drug partitioning into the stratum corneum and facilitate diffusion through the epidermis. The gel formulation typically contains a combination of water, alcohol, propylene glycol, and other penetration enhancers that create a favorable environment for drug absorption. The application of the gel to intact skin followed by gentle massage promotes drug penetration and distribution within the underlying tissues.
The pharmacokinetics of topical diclofenac involve high local tissue concentrations with low systemic exposure. After application of diclofenac gel to the skin, the drug accumulates in the epidermal and dermal layers, with a reservoir effect that sustains drug release into deeper tissues over time. The concentration of diclofenac in synovial fluid and periarticular tissues after topical application is comparable to or higher than that achieved with oral dosing, despite plasma concentrations being 10 to 20 times lower. This pharmacokinetic profile demonstrates the targeted delivery advantage of topical formulations, which achieve therapeutic concentrations at the site of action while minimizing systemic drug exposure and associated adverse effects.
The systemic absorption of topical diclofenac occurs slowly and is limited by the barrier function of the stratum corneum. Peak plasma concentrations after topical application are typically achieved 6 to 12 hours after dosing, compared to 1 to 2 hours for immediate-release oral formulations. The extent of systemic absorption depends on the dose applied (amount of gel and concentration), the area of skin treated, the condition of the skin, and the frequency of application. Systemic absorption is increased when the gel is applied to larger areas of skin, to broken or irritated skin, or when occlusive dressings are used. The systemic half-life of diclofenac after topical administration is similar to that after oral administration (1 to 2 hours for the parent drug), but the prolonged absorption phase results in sustained low-level systemic exposure rather than the high peak concentrations seen with oral dosing.
The metabolism of topically absorbed diclofenac is the same as that of orally administered diclofenac, with extensive hepatic metabolism through cytochrome P450 (primarily CYP2C9) and glucuronidation pathways, followed by renal excretion of metabolites. Because the systemic dose from topical application is lower than from oral dosing, the metabolic burden on the liver is reduced, and the risk of drug interactions involving hepatic enzymes is lower with topical diclofenac. However, patients with significant hepatic impairment may still accumulate diclofenac from topical use, and caution is advised in this population. Similarly, patients with renal impairment may be at increased risk of adverse effects from the small amount of systemically absorbed diclofenac, and the lowest effective dose should be used.
Application and usage guidelines
Proper application technique is essential for maximizing the therapeutic benefits of diclofenac gel while minimizing the risk of adverse effects. Before applying the gel, the skin over the affected area should be clean and dry. The gel should be applied in a thin layer to the skin over the painful joint or muscle, covering the entire area of pain but avoiding application to broken skin, open wounds, cuts, or irritated skin. The gel should be gently massaged into the skin until it is fully absorbed, which typically takes one to two minutes. After application, hands should be washed thoroughly with soap and water unless the hands are the area being treated, in which case the gel should be allowed to dry completely before touching other surfaces or objects.
For osteoarthritis of the hands, the recommended dose of 1 percent diclofenac gel is 2 to 4 grams applied to the affected joints four times daily. A 2-gram dose of gel is approximately the amount that fits on the length of the index finger from the fingertip to the first finger crease, while a 4-gram dose is approximately the amount that fits from the fingertip to the second finger crease. For osteoarthritis of the knees, the recommended dose is 4 grams applied to the affected knee four times daily. For other joints, the dose should be adjusted based on the size of the joint, with smaller joints requiring less gel and larger joints potentially requiring more. The maximum daily dose of 1 percent diclofenac gel should not exceed 32 grams total (applied to all affected joints combined), and treatment should be limited to the smallest area of skin necessary to cover the painful region.
The timing of applications should be spaced evenly throughout the day to maintain consistent drug levels in the affected tissues. For most patients, applying diclofenac gel in the morning, at midday, in the late afternoon, and at bedtime provides adequate coverage. The gel should not be applied more frequently than every 4 to 6 hours, and the total daily dose should not exceed the maximum recommended amount. Patients should avoid showering, bathing, swimming, or vigorous exercise for at least one hour after applying the gel to allow adequate time for absorption. If the treated area becomes wet, the gel should be reapplied after the skin has been dried gently without rubbing.
Several practical considerations can optimize the effectiveness of diclofenac gel therapy. The gel should be stored at room temperature away from direct sunlight, heat, and moisture, and should not be refrigerated or frozen. The tube should be kept tightly closed when not in use to prevent evaporation of the alcohol and water components. Patients should avoid applying other topical products including lotions, creams, ointments, cosmetics, sunscreens, and insect repellents to the same area where diclofenac gel has been applied, as these products can interfere with drug absorption or increase the risk of skin irritation. Occlusive dressings, bandages, or wraps should not be applied over the gel unless specifically instructed by a healthcare provider.
Treatment duration with diclofenac gel should be based on the nature and severity of the underlying condition. For acute musculoskeletal injuries, treatment for 7 to 14 days is typically sufficient, with symptoms beginning to improve within the first few days of therapy. For chronic conditions such as osteoarthritis, diclofenac gel can be used for extended periods under the supervision of a healthcare provider, with regular reevaluation of the need for continued therapy. If symptoms worsen or do not improve after 7 days of treatment, or if the condition persists for more than 14 days, patients should consult a healthcare provider for further evaluation. Patients should not use diclofenac gel continuously for more than 3 months without medical supervision.
Adverse effects and safety profile
The adverse effect profile of diclofenac gel is dominated by local skin reactions at the site of application, which occur in approximately 5 to 15 percent of patients. The most common local reactions include dryness, erythema (redness), pruritus (itching), rash, burning or stinging sensation, and scaling of the skin. These reactions are typically mild to moderate in severity and often resolve with continued use or after application of a moisturizer to the treated area. Application site reactions may be more common in patients with sensitive skin, those who apply the gel to large areas, or those who use higher than recommended doses. Patients who develop severe or persistent skin reactions should discontinue the gel and consult their healthcare provider.
Systemic adverse effects from topical diclofenac are less common than with oral diclofenac due to the limited systemic absorption of the topical formulation. The risk of gastrointestinal adverse effects including dyspepsia, abdominal pain, nausea, and diarrhea is lower with topical diclofenac compared to oral formulations, and the risk of serious gastrointestinal events such as ulcers and bleeding is minimal. However, systemic absorption does occur, and patients with a history of gastrointestinal bleeding or peptic ulcer disease should use topical diclofenac with caution, particularly when applied to large areas of skin or when used for prolonged periods.
Cardiovascular adverse effects are less common with topical diclofenac compared to oral formulations, as the low systemic drug levels achieved with topical application are unlikely to affect blood pressure or cardiovascular risk. However, the prescribing information for diclofenac gel includes warnings about cardiovascular risk based on the class effects of NSAIDs, and patients with established cardiovascular disease or significant cardiovascular risk factors should use topical diclofenac with caution. Blood pressure should be monitored in patients using topical diclofenac for extended periods, and the medication should be discontinued if significant hypertension develops.
Renal adverse effects from topical diclofenac are rare but can occur, particularly in patients with preexisting renal impairment or those using the gel on large areas of skin for prolonged periods. The systemic absorption of topical diclofenac can cause a mild reduction in renal blood flow and glomerular filtration rate, which is usually clinically insignificant in patients with normal renal function. However, patients with preexisting renal impairment, heart failure, cirrhosis, or volume depletion may be more susceptible to the renal effects of even small amounts of systemically absorbed diclofenac. These patients should use topical diclofenac with caution and at the lowest effective dose, and renal function should be monitored if prolonged use is anticipated.
Photosensitivity reactions, characterized by exaggerated sunburn-like reactions in areas where the gel has been applied, can occur with diclofenac gel use. Patients should avoid exposing treated skin to sunlight, tanning beds, and sunlamps for the duration of treatment and for several days after discontinuing the gel. When going outdoors, patients should protect treated areas with clothing or use a broad-spectrum sunscreen with a high sun protection factor on areas where the gel has been applied. Patients who develop a severe photosensitivity reaction should discontinue the gel and seek medical evaluation.
Contact sensitization, in which patients develop an allergic reaction to diclofenac or other components of the gel formulation, can occur with prolonged use. Signs of contact sensitization include severe itching, redness, swelling, blistering, or weeping at the application site. Once sensitization occurs, subsequent use of diclofenac gel can trigger more severe reactions, and patients may also cross-react with other NSAIDs or topical medications containing similar chemical components. Patients who develop signs of contact sensitization should discontinue the gel and use alternative treatments for their condition.
Contraindications and precautions
Diclofenac gel is contraindicated in patients with known hypersensitivity to diclofenac, aspirin, other NSAIDs, or any component of the gel formulation. Patients who have experienced asthma, urticaria, or other allergic reactions after taking aspirin or other NSAIDs should not use diclofenac gel, as the potential for cross-sensitivity and allergic reactions exists even with topical administration. While severe systemic allergic reactions are rare with topical use, patients with a history of NSAID allergy should avoid all formulations of these medications to prevent potentially life-threatening reactions including bronchospasm, angioedema, and anaphylaxis.
The gel should not be applied to areas of broken, damaged, or irritated skin, including areas with open wounds, cuts, abrasions, burns, or active dermatologic conditions such as eczema, psoriasis, or dermatitis. Application to compromised skin can increase systemic absorption and the risk of adverse effects, and cause local irritation and delayed wound healing. Patients should also avoid applying the gel to the eyes, nose, mouth, or mucous membranes. If accidental contact with these areas occurs, the area should be flushed thoroughly with water, and medical attention should be sought if irritation persists.
Pregnancy and lactation considerations apply to diclofenac gel use. The medication should not be used during pregnancy, particularly in the third trimester, as NSAIDs can cause premature closure of the ductus arteriosus in the fetus and may impair fetal renal function. Women who are trying to conceive should avoid topical diclofenac, as NSAIDs have been associated with impaired fertility through effects on ovulation. The safety of diclofenac gel during breastfeeding has not been established, and nursing mothers should use the medication with caution, avoiding application to the breast area to prevent infant exposure through breast milk or direct skin contact.
Patients with a history of gastrointestinal bleeding, peptic ulcer disease, or inflammatory bowel disease should use diclofenac gel with caution, as the systemic absorption may be sufficient to increase the risk of gastrointestinal adverse effects in susceptible individuals. Patients who require long-term topical diclofenac therapy and who have risk factors for gastrointestinal complications may benefit from concurrent use of gastroprotective agents such as proton pump inhibitors, although the need for such prophylaxis is less well established than with oral NSAIDs. Patients who develop any signs of gastrointestinal bleeding, including black or bloody stools, abdominal pain, or vomiting of blood or coffee-ground material, should discontinue the gel and seek immediate medical evaluation.
Clinical studies and evidence
The efficacy of diclofenac gel for osteoarthritis of the hands and knees has been evaluated in numerous randomized controlled trials and summarized in several systematic reviews and meta-analyses. A Cochrane review of topical NSAIDs for chronic musculoskeletal pain, which included multiple studies of diclofenac gel, concluded that topical diclofenac is more effective than placebo for reducing pain in osteoarthritis, with a number needed to treat of approximately 4 to 6 for clinically meaningful pain relief. The efficacy of topical diclofenac was found to be comparable to that of oral NSAIDs in head-to-head trials, but with fewer gastrointestinal adverse effects and a better overall safety profile. The onset of pain relief with topical diclofenac is typically within the first week of treatment, with continued improvement over the first several weeks of regular use.
Studies have also evaluated the effectiveness of diclofenac gel for acute musculoskeletal injuries, including sprains, strains, and sports injuries. A meta-analysis of randomized trials in patients with acute soft tissue injuries found that topical diclofenac was superior to placebo and comparable to oral NSAIDs for pain relief and functional improvement, with a faster onset of action in some studies. The time to treatment response was typically 3 to 7 days, with most patients experiencing significant pain reduction within the first few days of therapy. The proportion of patients achieving treatment success with topical diclofenac was approximately 60 to 70 percent, compared to 30 to 40 percent with placebo, supporting the effectiveness of the topical formulation for acute pain.
The safety advantages of topical diclofenac over oral NSAIDs have been confirmed in large observational studies and meta-analyses. A systematic review comparing topical and oral NSAIDs found that the risk of gastrointestinal adverse effects was reduced by approximately 50 to 75 percent with topical formulations, and the risk of serious gastrointestinal events was minimal. The rate of discontinuation due to adverse effects was also lower with topical diclofenac compared to oral NSAIDs. These findings support the role of topical diclofenac as a safer alternative to oral NSAIDs for patients who require effective pain relief, particularly those at increased risk of NSAID-related adverse effects.
Frequently asked questions
Is diclofenac gel available over the counter? Yes, in many countries including the United States, Canada, the United Kingdom, and Australia, 1 percent diclofenac gel is available over the counter without a prescription for the treatment of minor pain and inflammation. Higher concentration formulations (such as 2.32 percent) may require a prescription in some jurisdictions. Online pharmacies such as Happy Family Store offer various formulations of diclofenac gel for patients seeking convenient access to this medication.
How quickly does diclofenac gel work? The onset of pain relief with diclofenac gel varies depending on the condition being treated and individual patient factors. Many patients begin to experience pain relief within 30 to 60 minutes of application, although the full therapeutic effect may take several days to develop with regular use. For acute injuries, pain relief is typically noticeable within the first few applications, while for chronic conditions such as osteoarthritis, optimal results are usually achieved after 7 to 14 days of consistent use.
Can diclofenac gel be used with oral pain medications? Diclofenac gel should not be used with oral NSAIDs or other topical NSAIDs due to the increased risk of systemic adverse effects from combined NSAID exposure. However, diclofenac gel may be used with acetaminophen (paracetamol) for additional pain relief if needed. Patients should consult with their healthcare provider before combining diclofenac gel with any oral pain medication to ensure safety and appropriateness.
How much diclofenac gel should I use? The amount of gel to use depends on the size of the area being treated. For the hands, typically 2 grams of gel is applied to each affected hand four times daily. For the knees, typically 4 grams of gel is applied to each affected knee four times daily. A 2-gram dose is approximately the amount of gel that fits on the length of the index finger from the fingertip to the first finger crease, while a 4-gram dose extends from the fingertip to the second finger crease. The maximum daily dose should not exceed 32 grams total.
Can diclofenac gel be used on multiple joints at the same time? Yes, diclofenac gel can be applied to multiple affected joints, but the total daily dose should not exceed 32 grams of gel. The gel should be applied to each affected joint according to the dosing recommendations, and the combined total should be monitored to avoid exceeding the maximum daily limit. If multiple large joints (such as both knees) require treatment with maximum doses, the gel should be used at the recommended frequency but with attention to the total amount applied.
Can I use diclofenac gel with a heating pad or ice pack? Heating pads and ice packs should not be applied directly over diclofenac gel. Heat can increase systemic absorption of the medication by promoting vasodilation, potentially increasing the risk of adverse effects. Cold packs may reduce absorption by causing vasoconstriction. If heat or cold therapy is desired, it should be applied either before diclofenac gel application or after the gel has been fully absorbed, with the area cleaned gently before application of the temperature therapy.
What should I do if I miss an application of diclofenac gel? If a scheduled application of diclofenac gel is missed, it should be applied as soon as remembered, unless it is almost time for the next scheduled application. In that case, the missed application should be skipped and the regular schedule resumed. Patients should not double the amount applied or apply the gel more frequently than recommended to make up for a missed dose, as this increases the risk of adverse effects.
Can diclofenac gel be used in children? The safety and efficacy of diclofenac gel in children under 14 years of age have not been established, and the medication should not be used in this age group unless specifically prescribed by a healthcare provider. For children with musculoskeletal injuries or pain, alternative treatments such as acetaminophen or ibuprofen (oral or topical formulations approved for pediatric use) should be considered under the guidance of a pediatrician.
Does diclofenac gel cause skin discoloration? Diclofenac gel may cause temporary skin discoloration in some patients, typically as a result of the gel drying on the skin or from the effects of the medication on superficial blood vessels. This discoloration is usually not a sign of a serious problem and typically resolves on its own. However, if skin discoloration persists, worsens, or is accompanied by other symptoms such as pain, blistering, or peeling, patients should discontinue the gel and consult their healthcare provider.
Can I wear clothing over diclofenac gel? Yes, clothing can be worn over areas where diclofenac gel has been applied, but patients should wait until the gel has dried completely (typically 5 to 10 minutes) before covering the area with clothing or bandages. Loose-fitting clothing is preferable to tight clothing, which may rub the medication off the skin or increase local irritation. Occlusive dressings, wraps, or bandages should not be used over the gel unless specifically instructed by a healthcare provider.