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A crossover randomized comparison between two different transdermal oestradiol delivery systems has been performed in post-menopausal women of the Bangkok area. Clinical benefits were identical with the use of either a gel, applied once/day on 800 cm2 of skin which totally evaporated within 3 min, or a patch applied for 3-5 days on 20 cm2 of skin. There was no evidence of pharmacokinetic advantage with the patch, and the day to day intraindividual variations were even greater with patch than with gel. There were no cutaneous side effects with the gel, but unacceptable skin reactions, including itching, vesicular rash and residual pigmentation, were present in 58% of patients during patch use. ·Therefore a combination, in a small skin area, of adhesive, occlusive effect and high oestradiol concentration does not appear appropriate in hot and humid climate.
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