How to manage flared rosacea and breastfold fungus after cortisone shots in a 90-year-old?

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Voltaren and A535 are the good choice for pain relief. Both creams penetrate to skin in a slower fashion and act immediately at the site of pain. Thus, the minimal drug gets absorbed, which is harmless. The minimum dose when reaching the blood, gets diluted and, thus is insignificant. None of the above drugs can be settled in the body, they always get excreted through the kidney. So, my advice is to apply Voltaren and A535 four times a day. voltaren will show nil side effects. Whereas, A535 may show irritation to the skin. This irritation happens in children and soft skin. In case A535 shows any local skin changes, then it can be applied 2 or 3 times a day. Otherwise, both are to be applied whenever pain is there (or 4 times a day), whichever is convenient. Do not apply more doses. Just apply like a coating. That is enough.

I hope it helps.

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Voltaren is actually diclofenac sodium (a non-steroidal anti-inflammatory drug). While applied on the skin (topical), it will reach the site of action (muscle) in less quantity and will reach the blood in a negligible quantity. This will not affect her internal organs. I am sure about this. If the same drug is taken orally or by injection, then definitely affects the kidney - as a high dose is reaching the blood. So, this cream can be continuously applied twice daily.

A535 can cause mild irritation to the skin. But, never cause damage to the internal organ damage. But, this drug can reduce local pain instantly. So, this cream can be applied once a day or whenever the pain is more. But, more frequent application of A535, may cause skin irritation.

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The Voltaren if reaches the blood in adequate quantity, then it can cause diarrhea. But, the cardiovascular effect is nil at this age. So in pregnancy to protect the fetal heart, it is stopped in pregnant. This drug will close the ducts of arteriosis in the fetus. But in adults, it is already closed during delivery. Thus no worry about the heart. Only in very very less patients, the skin application enters into the blood in considerable amounts. If your mother Belongs to this category, then she is likely to get gastric trouble. To avoid this effect, you can apply only one time in a day. When you apply two or three times a day, this leads to accumulation in blood, thus side effect is seen. So, a once-a-day application is safe for your mother.

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In your mother, Voltaren is working well in reducing pain. At the same time, she is sensitive to it, thus causing diarrhea even with a single application. Whereas, another drug is less likely beneficial for her.

So, you may apply the Volteran every alternate day one application in the morning. Next day, do not apply it. Then third day, again one more application is required. This is how you can use Voltaren.

Another drug can be applied whenever she has more pain, it has some beneficial role to reduce pain.

By that time, you can try the following two herbal drugs to reduce Voltaren-induced diarrhea or to control IBS.

Alternatively, you can combine two herbal powders, and take them together in hot water or buttermilk or yogurt. Another option is giving zinc supplements to reduce gastric excitation due to Voltaren. For this matter, you may consult a local physician.

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Metamucil is the herb, that is the fiber. It bulges after attracting water in the colon, thus reducing stool frequency and hardening the stool. Zinc-based traditional Indian drugs (zinc treated with herbal juices at high temperatures) have a good beneficial effect. Another option is off-capsule or powder. This is an allopathic drug that reduces intestinal secretions and controls diarrhea. For muscular pain, even capsaicin cream is also good. But, Voltaren is the direct drug to reduce inflammation and pain. Another dietary practice is lemon tea. Lemon juice (half of the lemon) is added to black or green tea. This can be tried. Daily three times consumption can control diarrhea.

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Diclofenac enters very small quantities into blood (from the skin-applying area) and may not cause organ damage in normal persons. In my opinion, it never causes organ failure as you worry. It may add up to the existing organ failure process. Still, there is 0.1 % organ damage with skin application. Ketamine is a good pain killer. Again, a very small amount of ketamine can enter into the blood and it may cause sedation, a slight reduction in blood pressure, mild headache some mood elevation, etc. As such lidocaine can not cross intact skin. It can cross skin only if the skin has some aberration, wound, etc. If a moderate amount reaches through the wound, then it may cause cardiac palpitation and if more amount reaches the blood, then it may cause mild sedation and drowsy.

In general, all these drugs are very safe by topical skin application. Even if it reaches blood, then maximum they may cause sedation or drowsy.

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Menthol gets vaporized and enters into lungs through the nose. In some people, it irritates the airway of the lungs, then causes lung tightness symptoms. This is a rare phenomenon. The other most likely possibility is that a small quantity of menthol can get absorbed if applied more quantity. It can stimulate the heart to cause chest tightness.

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Regarding your query "anti-inflammatory (NSAID) topical application creating water retention", my points are given below;

1. All NSAIDs upon reaching blood inhibit Prostaglandin synthesis (in the kidney), thus water retention. Not all NSAIDs are available as topical. Those that are available as topical are less likely to enter (large amounts enough to cause water retention) into the blood. I think your mother's skin becomes more loosened due to age, which may allow more entry from the skin into the blood.
2. I feel the water retention is insignificant compared to its benefit in pain relieving. You may keep a pillow below the legs to elevate your feet. Thus, you can prevent leg swelling. Mild diuretics (tablet thiazide) can be given once in a while to reduce edema. But, the cardiologist should decide as he needs to see drug interactions and cardiac conditions.
3. There is no rebound effect for NSAIDs. In the absence of a drug, the pain reappears, But it may be the normal one, not the exaggerated (rebound) phenomenon.

I hope this helps.