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Application protocol: Product: Hydrocortisone 1% cream (available at any pharmacy without prescription) Timing: Apply after noticing the reaction, not before injection Amount: Thin layer covering the entire affected area plus a 1-centimeter margin Frequency: Twice daily (morning and evening) until the reaction resolves Duration: Typically 2 to 5 days, do not use for more than 7 consecutive days without medical guidance Important: Do NOT apply hydrocortisone before injection, as it can interfere with medication absorption For reactions that do not respond to 1% hydrocortisone, a healthcare provider can prescribe stronger topical corticosteroids (triamcinolone 0.1% or betamethasone 0.05%)

Shots may be reviewed when a patient wants more direct delivery or when the treatment goal involves localized recovery

61 Buesing, S., Costa, M., Schilling, J

However, this is only in cases where severe B12 deficiency is caused by anemia

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Adjustments may be required to reflect accuracy in the estimated costs of the diagnoses and procedures under consideration