Dermatology Case No 10. Pityriasis Versicolor

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Dermatology Case No 10. Pityriasis Versicolor

Pityriasis Alba Pityriasis Versicolor

Pityriasis Versicolor lesion গুলো একছুচ্ছ হয়ে থাকে,,অনেক সময় একসাথে মিশে অনেক বড় আকারের Pigmentation ও হয়ে থাকে But Pityriasis Alba তে lesion গুলো আলাদা আলাদা ছোট ছোট (1-20) হয় & বড় ও হয়।।

P_Alba বাচ্চাদের বেশি হয়

P. Alba অনেক সময় Associate with Atopic dermatitis কিন্তু Pity versicolor এ Usually এমনটা দেখা যায় না___

P Versicolor a Skin surface smooth থাকে আর Pity alba তে Skin surface rough দেখা যায়

Pityriasis Versicolor hypopigmented or

Hyperpigmentd দুই রকমই হয়ে থাকে কিন্তু P.alba শুধু Hypopigmented দেখা যায়_________

এইবার আসি Treatment

Normally No treatment Needed In Pityriasis Alba

Bt Pityriasis Versicolor e Treatment দিতে হয়

• Pityriasis Alba Without Treatment এই ভালো হয়ে যায় কিন্তু কখনো মাস থেকে বছর খানেক সময় লেগে যায়**

Pityriasis Alba associate with Atopic dermatitis ***

1st Treatment Moisture **

-সাথে Ketoconazol shampoo ও দিতে পারেন

-sun exposure Avoid করবে

-Oil avoid করবে

Follow up দিবেন & কাউন্সেলিং ________

Improve না হলে sometimes Topical

steroid দেয়া হয়___

Pityriasis Versicolor & alba

2 ta tei Ketoconazol shampoo

Treatment Management :-

Ketoconazole (Ketoconazole, Nizoral, others) cream, gel or shampoo
Ciclopirox (Loprox, Penlac) cream, gel or shampoo
Fluconazole (Diflucan) tablets or oral solution
Itraconazole (Onmel, Sporanox) tablets, capsules or oral solution
Selenium sulfide (Selsun) 2.5 percent lotion or shampoo

Shampoo 1.Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Indications of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Shampoo: Dancel shampoo is indicated for the treatment and prophylaxis of infections in which the yeast Malassezia (previously called Pityrosporum) is involved, such as pityriasis versicolor (localized), seborrhoeic dermatitis and pityriasis capitis (dandruff).

Cream: Cream is used for topical application in the treatment of dermatophyte infections of the skin such as tinea corporis, tinea cruris (dhobie itch), tinea manus and tinea pedis (athlete’s foot) infections due to Trichophyton spp, Microsporon spp and Epidermophyton spp. Dancel 2% cream is also indicated for the treatment of cutaneous candidosis (including vulvitis), candidal intertrigo (sweat rash), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp.

Tablet: Treatment of superficial and deep mycoses:

Infections of the skin, hair and nails by dermatophytes and/or yeasts (dermatomycosis, onychomycosis, perionyxis, pityriasis versicolor, chronic mucocutaneous candidiasis etc.) especially when topical treatment is difficult or not very effective, owing to involvement of large skin surfaces or to lesions affecting deeper dermal layers, nails and hairs
Yeast infection of the mouth (oral thrush, perleche) and the gastrointestinal tract
Vaginal candidiasis, especially chronic recurrent cases or cases responding poorly to topcial treatment
Systemic mycotic infections such as systemic candidiasis, paracoccidioidomycosis, histoplasmosis, coccidioidomycosis etc.

Maintenance treatment to prevent recurrence in systemic mycotic infections and in chronic mucocutaneous candidiasis.

Prophylactic treatment to prevent mycotic infection in patients with reduced host defenses, e.g., patients with cancer, organ transplant and burns.

Medicated bar: Medicated bar is indicated for All Kinds of Body Fungus.

Pharmacology of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Ketoconazole interacts with 14-α-sterol demethylase, a cytochrome P-450 enzyme necessary for the conversion of lanosterol to ergosterol. This results in inhibition of ergosterol synthesis and increased fungal cellular permeability due to reduced amounts of ergosterol present in the fungal cell membrane. This metabolic inhibition also results in accumulation of 14α-methyl-3,6-diol, a toxic metabolite. The increase in membrane fluidity is also thought to produce impairment of membrane-bound enzyme systems as components become less closely packed.

Dosage & Administration of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Shampoo: The affected areas of the skin or the scalp should be washed with ketoconazole 2% shampoo, which should be left on the skin/scalp for 3 to 5 minutes before rinsing.

Treatment:

Pityriasis versicolor: Once daily for 5 days.
Seborrhoeic dermatitis and pityriasis capitis: Twice weekly for 2 to 4 weeks.

Prophylaxis:

Pityriasis versicolor: Once daily for 3 days during a single treatment course before the summer.
Seborrhoeic dermatitis and pityriasis capitis: Once every 1 or 2 weeks.

Cream:

Tinea pedis: Ketoconazole cream should be applied to the affected areas twice daily. The usual duration of treatment for mild infections is 1 week. For more severe or extensive infections (e.g. involving the sole or sides of the feet) treatment should be continued until a few days after all signs and symptoms have disappeared in order to prevent relapse.
For other infections: Ketoconazole cream should be applied to the affected areas once or twice daily, depending on the severity of the infection. The treatment should be continued until a few days after the disappearance of all signs and symptoms. The usual duration of treatment is: tinea versicolor 2-3 weeks, tinea corporis 3-4 weeks. The diagnosis should be reconsidered if no clinical improvement is noted after 4 weeks. General measures in regard to hygiene should be observed to control sources of infection or reinfection. Seborrhoeic dermatitis is a chronic condition and relapse is highly likely.

Tablet:

Vaginal candidiasis: 1 tablet (200 mg) tablet twice daily for 5 days.
All other indications: 1 tablet (200 mg) once daily until at least one week after the symptoms have disappeared and the cultures have become negative.

Duration of Treatment-

Pityriasis versicolor: 1 to 6 weeks
Dermatomycoses: 2 to 8 weeks
Onychomycoses: 1 to 12 months
Mycoses of hair and scalp: 1 to 2 months
Chronic mucocutaneous candidiasis : 1 to 12 months
Oral mycoses: 5 to 10 days
Systemic candidiasis: 1 to 2 months
Paracoccidioidomycosis,histoplasmosis
and other systemic mycosis: 1 month to 2 years

Ketoconazole bar: Body Fungus: rub gently on the overall body to produce lather. Leave for 4-5 minutes. Rinse of thoroughly with water.

Contraindications of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Contraindicated in patients with known hypersensitivity to ketoconazole.

Side Effects of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Shampoo: Topical treatment with Dancel shampoo 2% is generally well tolerated. As with other shampoos, a local burning sensation, itching or contact dermatitis (due to irritation or allergy) may occur on exposed areas. Oily and dry hair have been reported rarely with the use of Dancel shampoo 2%.

Cream: Commonly observed adverse reactions to Dancel cream in clinical trials were skin application site burning sensation, erythema and pruritus. Uncommon adverse reactions are application site bleeding, discomfort, dryness, inflammation, irritation, paraesthesia and reaction; bullous eruption, dermatitis contact, rash, skin exfoliation and sticky skin.

Tablet: Dancel is very well tolerated. Nausea and itching may occasionally occur. In some patients, an idosyncratic liver reaction may occur (incidence 1:10000).

Therapeutic Class of Shampoo:-Dancel 2% 100ml bottle (AS A Ketoconazol Drugs for subcutaneous and mycoses).

Drugs for subcutaneous and mycoses

Ciclopirox :-

Cream 2.Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Indications of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Candirox Cream is indicated for the topical treatment of the following dermal infections: Tinea pedis, Tinea cruris and Tinea corporis due to Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum and Microsporum canis, candidiasis (moniliasis) due to Candida albicans, and Tinea (pityriasis) versicolor due to Malassezia furfur. Candirox Cream is also highly effective against some gram negative & some gram-positive bacteria. Owing to its anti-inflammatory effects, Candirox alone is sufficient to treat mild to moderate inflammatory fungal infections.

Pharmacology of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Ciclopirox Olamine is a synthetic broad spectrum antifungal agent that inhibits the growth of pathogenic dermatophytes, yeasts, and Malassezia furfur. Ciclopirox Olamine exhibits fungicidal activity in vitro against isolates of Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, and Candida albicans. The mode of action of Ciclopirox Olamine was studied mainly in Candida albicans. It is presumed that Ciclopirox Olamine mediated growth inhibition or death of fungal cells is primarily caused by in vitro cellular depletion of some essential substrates and/or ions and that such effects are brought about through blockage of their uptake from the medium.In addition to its broad spectrum of antifungal action, Ciclopirox also exerts antibacterial activity against many Gram-positive and Gram-negative bacteria. Theanti-inflammatory effects of Ciclopirox have been demonstratedin human polymorphonuclear cells, where Ciclopirox has inhibited the synthesis of prostaglandin and leukotriene. Ciclopirox can also exhibit its anti-inflammatory effects by inhibiting the formation of 5-lipoxygenase and cyclooxygenase.

Dosage & Administration of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Ciclopirox Cream should be gently massaged onto the affected and surrounding skin areas twice daily for four weeks. Clinical improvement with relief of pruritus and other symptoms usually occurs within the first week of treatment. If a patient shows no clinical improvement after four weeks of treatment with Ciclopirox cream, the diagnosis should be redetermined. Patients with Tinea versicolor usually exhibit clinical and mycological clearing after two weeks of treatment.

Use in children: Safety and effectiveness in children below the age of 10 years have not been established.

Contraindications of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Ciclopirox Olamine cream is contraindicated in individuals who have shown hypersensitivity to any of its components.

Side Effects of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Candirox cream is well tolerated with a low incidence of adverse reactions reported in clinical trials.

Pregnancy & Lactation of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Pregnancy category B. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Ciclopirox Olamine cream or is administered to nursing women.

Precautions & Warnings of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Candirox cream is not for ophthalmic use.

Therapeutic Class of Cream:-Candirox 0.77% 15gm tube (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Topical Antifungal preparations

Fluconazole:-

Capsule 3.Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Indications of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Flugal is indicated in-

Vaginal Candidiasis
Oropharyngeal Candidiasis
Esophageal Candidiasis
Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea
Kerion
Pityriasis versicolor
Onychomycosis
Invasive candidal infections and cryptococcal infections (including meningitis)
Prevention of cryptococcal meningitis
Prevention of fungal infections in immunocompromised patients
Systemic Candidiasis and Cryptococcal infection
In Superficial Candidiasis
In Systemic Candidiasis & Cryptococcal infection

Other indications-

Fungal urinary tract infections
Disseminated candidiasis
Prophylaxis for fungal infection in neutropenic cancer patients.
Acute treatment of other systemic fungal infections such as coccidioidomycosis and histoplasmosis.

Pharmacology of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Fluconazole is a triazole antifungal agent. It is a potent inhibitor of fungal cytochrome P-450 dependent enzymes. Cytochrome P-450 enzyme system is essential component of fungal cell membrane which is responsible for the synthesis of ergosterol.

Dosage & Administration of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Adults:

Vaginal Candidiasis: 150 mg as a single dose.
Oropharyngeal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14 days.
Oesophageal Candidiasis: 200 mg in 1st day followed by 100 mg daily for 14-30 days.
Tinea corporis/Tinea cruris/Tinea pedis/Other Tinea: 150 mg weekly for 4-6 weeks.
Kerion: 50 mg daily for 20 days.
Pityriasis versicolor: 400 mg as a single dose.
Onychomycosis: 150 mg weekly for 12 months.
Invasive candidal infections and cryptococcal infections (including meningitis): Orally or by IV infusion, 400 mg on first day then 200-400 mg daily.
Prevention of cryptococcal meningitis: Orally or by IV infusion 200 mg daily.
Prevention of fungal infections in immunocompromised patients: Orally or by IV infusion, 50-400 mg daily.

Child over 1 year-

In Superficial Candidiasis: 1-2 mg/kg daily.
In Systemic Candidiasis & Cryptococcal infection:3-6 mg/kg daily.

In serious life threatening infections upto 12 mg/kg daily has been given to children aged 5-13 years (Maximum 400 mg daily)

1 year: 9 kg: 1/2 measuring spoonful
1-2 years: 12 kg: 1 measuring spoonful
2-3 years: 14 kg: 1½ measuring spoonful
3-4 years: 16 kg: 2 measuring spoonful
4-6 years: 20 kg: 2½ measuring spoonful

Use in Specific Population-

Elderly patient: The normal dose should be used if there is no evidence of renal impairment.

Renal Impairment: No adjustment in single dose therapy is required. In multiple dose therapy of patients with renal impairment, normal doses should be given on days 1 and 2 of treatment and there after the dosage intervals should be modified as follows:

Creatinine clearance (>41 ml/min): Dosage interval (hours) 24
Creatinine clearance (21-40 ml/min): Dosage interval (hours) 48
Creatinine clearance (10-20 ml/min): Dosage interval (hours) 72
Patients receiving regular dialysis: One dose after every dialysis session

Children: Renal clearance in children may be proportionately more rapid than in adults and doses up to 12 mg/kg is recommended.

Contraindications of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Fluconazole should not be used in patients with known hypersensitivity to Fluconazole or to related triazole compounds.

Side Effects of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Flugal is generally well tolerated. The commonest side-efects associated Flugal are symptoms associated with the gastrointestinal tract; these include nausea, abdominal discomfort, diarrhoea and fatulence. Other adverse events such as rash are rarely encountered (Incidence less than 1%). In rare cases, as with other azoles, anaphylaxis has been reported.

Pregnancy & Lactation of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Fluconazole adverse fetal efects have been seen in animals only at dose levels associated with maternal toxicity. These levels are many times in excess of those recommended for therapeutic use. There has been little use during human pregnancy. Accordingly, fuconazole should not be used in pregnancy or in women of child bearing potential unless adequate contraception is employed.

Therapeutic Class of Capsule:-Flugal 200 mg (AS A Fluconazole AS A Drugs for subcutaneous and mycoses).

Drugs for subcutaneous and mycoses

Itraconazole:-

Tablet 4.Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Indications of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Itra is used for the treatment of oropharyngeal candidiasis, vulvovaginal candidiasis, pityriasis versicolor, tinea pedis, tinea cruris, tinea corporis, tinea manuum, onychomycosis, histoplasmosis. It is indicated in the treatment of systemic candidiasis, aspergillosis, and cryptococcosis (including cryptococcal meningitis). It is also used for maintenance therapy in AIDS patients to prevent relapse of underlying fungal infections and in the prevention of fungal infection during prolonged neutropenia.

Pharmacology of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Itraconazole inhibits Cytochrome P-450 dependent enzymes resulting in impairment of the biosynthesis of ergosterol, a major component of the cell membrane of yeast and fungal cells. Being integral to the proper functioning of the cell membrane, inhibition of the synthesis of ergosterol leads to a cascade of abnormalities in permeability, membrane bound enzyme activity, and co-ordination of chitin synthesis leading to inhibition of growth, abnormal cell wall formation and accumulation of intracellular lipids and membranous vesicles.

SUBA (Super Bio-available) technology is a novel technology for enhancing the bioavailability of poorly soluble drugs. This technology utilizes a solid dispersion of drug in a polymer that improves the dissolution of poorly soluble drugs compared to their normal crystalline form. SUBA technology Itraconazole is an orally active triazole antifungal drug that has demonstrated a broad spectrum of activity and favorable pharmacokinetic profile.

Dosage & Administration of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

100 & 200 mg preparation:
For non-systemic fungal disease-

Vulvovaginal candidiasis: 200 mg twice daily for 01 day
Pityriasis versicolor: 200 mg once daily for 07 days
Tinea corporis, tinea cruris: 100 mg once daily for 15 days or 200 mg once daily for 7 days
Tinea pedis, tinea manuum: 100 mg once daily for 30 days
Oropharyngeal candidiasis: 100 mg once daily for 15 days, Increase dose to 200 mg once daily for 15 days in AIDS or neutropenic patients because of impaired absorption in these groups.
Onychomycosis (toenails with or without fingernail involvement): Either 200 mg daily for 3 months or course (pulse) of 200 mg twice daily for 7 days, subsequent courses repeated after 21 days’ interval. Fingernails two courses, toenails three courses.

For systemic fungal disease-

Aspergillosis: 200 mg once daily for 2-5 months Increase dose to 200 mg twice daily in case of invasive or disseminated disease
Candidiasis: 100-200 mg once daily for 3 weeks-7 months. Increase dose to 200 mg twice daily in case of invasive or disseminated disease
Non-meningeal Cryptococcosis: 200 mg once daily for 10 weeks
Cryptococcal meningitis: 200 mg twice daily for 2-6 months
Histoplasmosis: 200 mg once daily twice daily for 8 months
Maintenance in AIDS: 200 mg once daily until immune recovery
Prophylaxis in neutropenia: 200 mg once daily until immune recovery

The dose and duration of treatment for systemic antifungal disease should be adjusted depending on the clinical response.

65 mg & 130 mg preparation:
For non-systemic fungal disease-

Vulvovaginal candidiasis: 130 mg twice daily for 1 day
Pityriasis versicolor: 65 mg twice daily for 7 days
Tinea corporis and tinea cruris: 65 mg daily for 15 days OR 65 mg twice daily for 7 days
Tinea pedis and tinea manuum: 65 mg once daily for 30 days
Oropharyngeal Candidiasis: 65 mg once daily for 15 days, increase dose to 65 mg twice daily for 15 days in AIDS or neutropenic patients because of impaired absorption in these groups.
Onychomycosis (toenails with or without fingernail involvement): Either 65 mg twice daily for 3 months or course (pulse) of 130 mg twice daily for 7 days, subsequent courses repeated after 21 days interval. Fingernails two courses, toenails three courses.

For systemic fungal disease-

Aspergillosis: 65 mg twice daily for 2-5 months.Increase dose to 130 mg twice daily in case of invasive or disseminated disease
Candidiasis: 65-130 mg once daily for 3 weeks-7 months. Increase dose to 65 mg twice daily in case of invasive or disseminated disease
Non-meningeal Cryptococcosis: 65 mg twice daily for 10 weeks
Cryptococcal meningitis: 130 mg twice daily for 2-6 months
Histoplasmosis: 130 mg once daily-twice daily for 8 months
Maintenance in AIDS: 65 mg twice daily until immune recovery
Prophylaxis in neutropenia: 65 mg twice daily until immune recovery

The dose and duration of treatment for systemic anti-fungal disease should be adjusted depending on the clinical response.

pediatric use: The efficacy and safety of the Itraconazole capsule have not been established in pediatric patients.

Contraindications of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Itraconazole is contraindicated in patients with known hypersensitivity to the drug or any ingredient in the formulation. Patients who have severe hepatic disease are not advised to take Itraconazole. It is not advisable to use the drug in patients taking rifampin, which appears to initially inhibit and then enhance the metabolism of Itraconazole.

Side Effects of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Nausea, abdominal pain, dyspepsia, constipation, headache, dizziness, raised liver enzymes, menstrual disorders, allergic reactions (including pruritus, rash, urticaria and angioedema), hepatitis and cholestatic jaundice, peripheral neuropathy and Stevens-Johnson syndrome reported. On prolonged use hypokalaemia, oedema and hair loss reported.

Pregnancy & Lactation of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Itraconazole is contraindicated in pregnancy. Breast feeding while receiving Itraconazole is not recommended.

Therapeutic Class of Tablet:-Itra 200 mg (AS A Itraconazole AS A Drugs for subcutaneous and mycoses).

Drugs for subcutaneous and mycoses

Raiyyan Tahsan Date:22-01-2025 Wednesday Time:1-06-35 PM

Raiyyan Tahsan

Raiyyan Tahsan