Dermatology Case No 11. 𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚

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Dermatology Case No 11. 𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚

𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚 একটি কমন Bacterial Bacterial স্কিন সমস্যা

এইটা কে শুরুতে Fungal infection ও ভাবা হয়ে ছিলো But পরে দেখা গেছে গ্রাম পজেটিভ 𝘾𝙤𝙧𝙮𝙣𝙚𝙗𝙖𝙘𝙩𝙚𝙧𝙞𝙪𝙢 𝙈𝙞𝙣𝙪𝙩𝙞𝙨𝙨𝙞𝙢𝙪𝙢 𝘽𝙖𝙘𝙩𝙚𝙧𝙞𝙖 দিয়ে হয়ে থাকে

𝙀𝙥𝙞𝙙𝙚𝙢𝙞𝙤𝙡𝙤𝙜𝙮:-

𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚 বেশি হয়ে থাকে Adult দের

বাচ্চাদের ক্ষেত্রে less Common

এটি Hot এবং Humid Climate এ বেশি দেখা যায়

Institution like -কলেজ Students in dorms, Soldiers in barracks, and Senior adults in nursing facilities more কমন

পুরুষদের ক্ষেত্রে বেশি দেখা যায়

𝐒𝐢𝐭𝐞:-

𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚 সাধারণত পায়ের আঙ্গুলের জালে (Toe Web)

𝐆𝐫𝐢𝐨𝐧 (কুঁচকিতে )দেখা যায়,,, 𝐀𝐱𝐢𝐥𝐥𝐚 তেও পাওয়া যায়.

𝐈𝐧𝐭𝐞𝐫𝐝𝐢𝐠𝐢𝐭𝐚𝐥 𝐬𝐩𝐚𝐜𝐞 𝐨𝐟 𝐅𝐞𝐞𝐭 বেশি দেখা যায় (4&5 toe তে)

𝐒𝐲𝐦𝐭𝐨𝐦𝐬:-

উপস্বগ বিহীন (𝘼𝙨𝙮𝙢𝙥𝙩𝙤𝙢𝙖𝙩𝙞𝙘 ) হয়ে থাকে but can be Pruritic

𝐃𝐢𝐬𝐜𝐨𝐥𝐨𝐮𝐫𝐚𝐭𝐢𝐨𝐧 হবে Affected Area তে

স্কিন Dark Red & Moist থাকবে..

এটি মাঝে মাঝে ডার্মাটোফাইট বা Candidal সংক্রমণের সাথে হয়ে থাকে

Fine scale & Macular Patch

পেশেন্ট 𝐒𝐜𝐚𝐥𝐢𝐧𝐠 𝐬𝐤𝐢𝐧 এর Complain করবে

Wrinkled appearance থাকবে স্কিনে

𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭:-

𝐅𝐮𝐬𝐢𝐝𝐢𝐜 𝐀𝐜𝐢𝐝:-𝐁𝐃–for 14 days(𝟏𝐬𝐭 𝐥𝐢𝐧𝐞 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭).

Cream 1.Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Indications of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Facid Ointment is indicated for treatment of skin infections caused by Staphylococci, Streptococci, Corynebacterium minutissimum and other Fusidate sensitive organisms. The most important indications being: impetigo, boils, abscess, varicose ulcers, skin grafts, hidradenitis, infected wounds, sycosis barbae, paronychia, folliculitis, carbuncles and erythrasma.

Pharmacology of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Sodium Fusidate, an antibiotic derived from Fusidium coccineum, exerts powerful activity against a number of gram-positive organisms. Staphylococci, including the strains resistant to penicillin or other antibiotics, are particularly susceptible to Sodium Fusidate. The therapeutic efficacy of topically applied Sodium Fusidate is due partly to the pronounced antibacterial activity of Sodium Fusidate against the organisms responsible for skin infection and partly to the unique ability of this antibiotic to penetrate intact skin.

Fusidic Acid is an anti-microbial agent that acts as an inhibitor of protein synthesis in the microorganism. It interferes with the translocation step by stabilizing the ribosome-guanosine dephosphate elongation factor G-complex. This prevents binding of aminoacyl t-RNA to the ribosome and thereafter stops transfer of additional amino acids to the growing polypeptide.

Dosage & Administration of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Sodium Fusidate Ointment or cream is applied to the affected areas 2 to 3 times daily, generally for a period of 7 days. It can be used with or without a covering dressing. Caution should be observed when applying Sodium Fusidate Ointment near the eye region as this preparation may cause irritation if it gets into the eye. No special dosage modifications or special precautions are required for children.

Contraindications of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Known hypersensitivity to Sodium Fusidate, severe hepatic failure.

Side Effects of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Facid Ointment is remarkably well tolerated, and there is an extremely low frequency of hypersensitivity reactions.

Pregnancy & Lactation of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Data no found

Precautions & Warnings of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Caution should be observed when applying Facid ointment in the eye region as Facid may cause irritation upon contact with the eye.

Therapeutic Class of Cream:-Facid 2% 15gm Tube (AS A Sodium Fusidate AS A Topical Antibiotic preparations).

Antibiotic preparations

𝐁𝐃–for 14 days(𝟏𝐬𝐭 𝐥𝐢𝐧𝐞 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭).

𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧:-

Tablet 2.Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

1+0+1—14 days(2nd 𝐥𝐢𝐧𝐞)

Indications of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Klarix is indicated for the treatment of-

Acute bacterial exacerbation of chronic bronchitis in adults
Acute maxillary sinusitis
Community-acquired pneumonia
Pharyngitis or tonsillitis
Uncomplicated skin and skin structure infections
Acute otitis media in pediatric patients
Treatment and prophylaxis of disseminated mycobacterial infections
Helicobacter pylori infection and duodenal ulcer disease in adults

Pharmacology of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Clarithromycin acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site. Clarithromycin is active against most Gram-positive bacteria and Chlamydia, some Gram-negative bacteria and Mycoplasmas. Clarithromycin’s activity is the same as, or greater than, that of Erythromycin in vitro against most Gram-positive bacteria. Clarithromycin is more acid-stable than Erythromycin and therefore, is better tolerated. Clarithromycin has twice the activity of Erythromycin against H. influenzae. Most species of Gram-negative bacteria are resistant to Clarithromycin because of failure to penetrate the target.

Dosage & Administration of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Adults:

Acute bacterial exacerbation of chronic bronchitis: 250 mg to 500 mg every 12 hours for 7 to 14 days.
Acute maxillary sinusitis: 500 mg every 12 hours for 14 days.
Community-acquired pneumonia: 250 mg every 12 hours for 7 to 14 days.
Pharyngitis or tonsillitis: 250 mg every 12 hours for 10 days.
Uncomplicated skin and skin structure infections: 250 mg every 12 hours for 7 to 14 days.
Treatment and prophylaxis of disseminated Mycobacterium avium disease: 500 mg every 12 hours until the patient is considered at low risk of disseminated infection.

Combination dosing regimens for H. pylori infection:

Triple therapy: Clarithromvcin/lansoprazole/amoxicillin: The recommended adult dosage is 500 mg clarithromycin, 30 mg lansoprazole and 1 g amoxicillin, all given every 12 hours for 10 or 14 days.

Triple therapy: Clarithromycin/omeprazole/amoxicillin: The recommended adult dosage is 500 mg clarithromycin, 20 mg omeprazole and 1 g amoxicillin; all given every 12 hours for 10 or 14 days. In patients with an ulcer present at the time of initiation of therapy, an additional 14 or 18 days of omeprazole 20 mg once daily is recommended for ulcer healing and symptom relief.

Dual therapy: Clarithromycin/omeprazole: The recommended adult dosage is 500 mg clarithromycin given every 8 hours and 40 mg omeprazole given once every morning for 14 days. An additional 14 days of omeprazole 20 mg once daily is recommended for ulcer healing and symptom relief.

Children: The recommended daily dosage is 15 mg/kg/day divided every 12 hours for 10 days. For treatment and prophylaxis of mycobacterial infections in pediatric patients, the recommended dose is 7.5 mg/kg every 12 hours up to 500 mg every 12 hours.

Renal and hepatic impairment: Clarithromycin is principally excreted via the liver and kidney. Clarithromycin may be administered without dosage adjustment to patients with hepatic impairment and normal renal function. However, in the presence of severe renal impairment with or without coexisting hepatic impairment, decreased dosaqe or prolonqed dosinq intervals may be appropriate.

Interaction of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Drug interaction with medication: Klarix is contraindicated when co-administration with HMG-CoA reductase inhibitors (e.g., lovastatin and simvastatin), gastroprokinetic agents (e.g., cisapride), ergot alkaloids (e.g., ergotamine and dihydroergotamine), antipsychotics (e.g., pimozide and quetiapine) and anti-gout agents (e.g., colchicine). Antiarrhythmics drugs (e.g., disopyramide, quinidine, dofetilide, amiodarone, sotalol and procainamide) are not recommended to use with Klarix.

Contraindications of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Clarithromycin is contraindicated in patients with known hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibacterial drugs or any other components of this product. It is also contraindicated in patients with a history of cholestatic jaundice or hepatic dysfunction associated with prior use of clarithromycin.

Side Effects of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Klarix is generally well tolerated. Side effects include nausea, vomiting, diarrhoea and abdominal pain. Stomatitis and glossitis have also been reported. Other side effects include headache, allergic reactions ranging from urticaria and mild skin reactions to anaphylaxis. Taste perversion may occur. There have been reports of transient central nervous system side effects including anxiety, dizziness, insomnia and hallucination.

Pregnancy & Lactation of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

The drug may be used in neonates and children in appropriate doses. Breast milk from mothers receiving Clarithromycin should not be given to infants until treatment is completed. There is as yet little experience in the treatment of pregnant patients and Clarithromycin is not recommended.

Therapeutic Class of Tablet:-Klarix 500mg (AS A 𝐂𝐥𝐚𝐫𝐢𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Macrolides).

Macrolides

𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧:-

Tablet 3. Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

1+0+1—-14 days(3rd 𝐥𝐢𝐧𝐞 )

Indications of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Eromycin DS is highly effective in the treatment of a wide variety of clinical infections.

Upper respiratory tract infections: Tonsilitis, Peritonsillar abscess, Pharyngitis, laryngitis, Sinusitis. Secondary infections in colds and influenza.
Lower respiratory tract infections: Tracheitis, acute and chronic bronchitis.
Ear infections: Otitis media, otitis externa, mastoiditis.
Eye infections: Blepharitis, established trachoma.
Skin and Soft tissue infections: Boils and carbuncles, impetigo, abscesses, pustular acne, paromychia, cellulitis, erysipelas.
Gastrointestinal tract infections: Cholecystitis, staphylococcal enterocolitis.
Prophylaxis: Pre and post-operative, trauma, burns, rheumatic fever.
Other infections: Osteomyelitis, diptheria, scarlet fever, whooping cough.

Description of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Eromycin DS belongs to the macrolides group of antibiotics. It exerts a bacteriostatic or bactericidal action based on specific interference with ribosomal protein synthesis within the bacterial cell. THROCIN is mainly used for the treatment of infections caused by penicillinase producing staphylococci. The following micro-organisms are particularly susceptible to Eromycin DS. Gram (+)ve : Cocci and bacilli. Gram (-)ve : Neisseria catarhalis, N.meningitis, N.gonorrhoea, Haemophilus influenzae, Brodetella, H. pertussis.Other micro-organisms : Mycoplasma pneumoniae, Legionella pneumophila, Bacteroides fragilis, B.oralis, B.melaninogenicus, Fusobacterium, Chlamydia trachomatis, Treponema pallidum.

Pharmacology of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Erythromycin inhibits microsomal protein synthesis in susceptible organisms by inhibiting the translocation process. Specific binding to the 50S subunit or 70S ribosome occurs in these organisms but there is no binding to the stable 80S mammalian ribosome. Erythromycin is active against many Grampositive bacteria, some Gram-negative bacteria and against mycoplasmas and chlamydia.

Absorption: Erythromycin base is destroyed by acid and is therefore administered in the form of stable ester. The rates of absorption of the base and esters are diminished by the presence of food. The stearate is hydrolyzed in the intestine and the free erythromycin absorbed.

Blood concentration: After an oral dose of 500 mg. of the base of stearate, peak serum concentrations of 0.9 to 1.4 or 0.4 to 1.8 mg/ml. respectively are attained in 1 to 4 hours. Half-life: The serum half-life is 1.2 to 4 hours. In subjects with oliguria, the half-life is about 5 hours.

Distribution: Erythromycin is widely distributed throughout body tissue and fluids with some retention in the liver and spleen, protein binding of erythromycin base is 73%. Erythromycin enters the cerebrospinal fluid when the meninges are inflamed. It also crosses the placenta and is excreted in the milk.

Excretion: 5 to 15 % of the dose of erythromycin is excreted in the urine and large amounts of the unchanged active substance are excreted in the bile.

Dosage & Administration of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Adult and Children over 8 years: 250-500 mg every six hours for mild to moderate infections. This may be increased upto 4 gm. or more daily in severe cases.

Elderly: No special dosage recommendation. Erythromycin may be administered if desired, three times daily or twice daily by giving one-third or half of the total daily requirement 8 hourly or 12 hourly respectively.

Children aged 2 to 8 years: 250 mg. every six hours or 30-50 mg/kg body weight per day divided into four equal dosage.

Infants and Children upto 2 years: 500 mg. in divided doses or 30-50 mg/kg body weight in divided doses.

Interaction of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Recent data from studies of Eromycin DS reveals that its use in patients who are receiving high dosage of theophylline may be associated with an increase of serum theophylline levels and potential theophylline toxicity. In such cases this dose of theophylline should be reduced.

Contraindications of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Known hypersensitivity to Erythromycin.

Side Effects of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Allergic reactions are rare and mild although anaphylaxis has occurred. Occasionally there is abdominal discomfort after oral administration, sometimes with nausea and vomiting. This discomfort usually subsides after a few days without it being necessary to reduce the dosage.

Pregnancy & Lactation of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Clinical and Laboratory studies have been shown no evidence in human of teratogenicity or toxicity. However, caution should be exercised when prescribing this drug to pregnant patients and lactating mothers since erythromycin crosses the placental barrier and is excreted in breast milk.

Therapeutic Class of Tablet:- Eromycin Ds 500mg (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Anti-diarrhoeal Antimicrobial drugs, Macrolides).

Anti-diarrhoeal Antimicrobial drugs, Macrolides

𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 Lotion:-

Lotion 4:-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Apply 1-2 times daily for 1 month

Indications of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

For topical treatment of acne, pimples & bacterial skin infections susceptible to Eromycin.

Pharmacology of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Erythromycin is a bacteriostatic macrolide antibiotic. But may be bactericidal in high concentrations. Although the mechanism by which Erythromycin acts in reducing the inflammatory lesions of acne vulgaris is unknown, it is presumably due to the antibiotic action of the drug.

Dosage & Administration of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Apply in morning and evening to the affected areas. Before applying thoroughly wash with warm water and soap, rinse and pat dry all areas to be treated. Apply with fingertips or applicator. Wash hands after use. Spread the medication lightly rather than rubbing it in. Acne lesions on the face, neck, shoulders, chest and back may be treated in this manner. Additional containers may be used, if needed. Each container should be used once and discarded.

Interaction of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Clindamycin interacts with Eromycin.

Contraindications of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Hypersensitivity to Erythromycin or to any of the other ingredients of the lotion.

Side Effects of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Erythema, desquamation, burning sensation, eye irritation, tenderness, dryness, oily skin etc.

Pregnancy & Lactation of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Safety for use during pregnancy has not been established. Use only when the potential benefits outweigh potential hazards to the fetus. Erythromycin is excreted in breast milk. Exercise caution when administering to a nursing mother.

Precautions & Warnings of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

For external use only. Keep away from eyes, nose, mouth and other mucous membrane. Use of antibiotics (especially prolonged or repeated therapy) may result in bacterial or fungal overgrowth of non-susceptible organisms. Such overgrowth may lead to a secondary infection. Take appropriate measures if superinfections occur.

Use in Special Populations of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Safety and effectiveness in children less than 12 years have not been established.

Therapeutic Class of Lotion :-Eromycin 3% 25ml bottle (AS A 𝐄𝐫𝐲𝐭𝐡𝐫𝐨𝐦𝐲𝐜𝐢𝐧 AS A Topical antibiotics for Acne).

Topical antibiotics for Acne

N:B– Extensive 𝐄𝐫𝐲𝐭𝐡𝐫𝐚𝐬𝐦𝐚 এর ক্ষেত্রে 𝐎𝐫𝐚𝐥 𝐀𝐧𝐭𝐢𝐛𝐢𝐨𝐭𝐢𝐜 দরকার হয় ,,না হলে শুধু Topical এই ভালো Response পাওয়া যায়

F𝐮𝐧𝐠𝐚𝐥 𝐈𝐧𝐟𝐞𝐜𝐭𝐢𝐨𝐧 থাক্লে 𝐀𝐧𝐭𝐢𝐟𝐮𝐧𝐠𝐚𝐥 দিতে হবে

𝐀𝐝𝐯𝐢𝐜𝐞

𝐊𝐞𝐞𝐩 𝐭𝐡𝐞 𝐀𝐫𝐞𝐚 𝐃𝐫𝐲

𝐀𝐯𝐨𝐢𝐝 𝐎𝐜𝐜𝐥𝐮𝐬𝐢𝐯𝐞 𝐟𝐨𝐨𝐭 𝐰𝐚𝐫𝐞

Raiyyan Tahsan Date:22-01-2025 Wednesday Time:-1-52-45 PM

Raiyyan Tahsan

Raiyyan Tahsan