সোরিয়াসিস_চিকিৎসা

একটা সোরিয়াসিস এর পেশেন্ট কে যখন আপনি চিকিৎসা করবেন,

১.. Regular emollient for life long.

২.. Dermasol cream

সকালে ১ বার, (৪ সপ্তাহ)

৩.. Dyvon cream

সন্ধ্যায় একবার (৪ সপ্তাহ)

৪ সপ্তাহ পরে আসতে বলবেন ফলোআপ —

যদি ভালো হয়ে যায়, তাহলে

Emollient regular চলবে,

আর Dermasol সোমবারে একদিন,

dyvon শুক্রবার একদিন করে নিয়মিত চলবে (৩-৬ মাস)

এইটাকে মেইনটেনেন্স ট্রিটিমেন্ট বলে, এইটা দিবে যেনো relapse না হয়,

৪ সপ্তাহ পরে আসলো, ভালো হলোনা,, কি করবেন—-

Cream 1: Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Indications of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Dermasol is indicated for adults, elderly and children over 1 year in following dermatoses.

• Psoriasis (excluding widespread plaque psoriasis)
• Recalcitrant dermatoses
• Lichen planus
• Discoid lupus erythematosus
• Other skin conditions which do not respond satisfactorily to less potent steroids.

Composition of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate Cream: Each gram cream contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Ointment: Each gram ointment contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Scalp Application: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Shampoo: Each gram shampoo contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Lotion: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Spray: Each gram spray contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Pharmacology of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate is a very potent topical corticosteroid. It has anti-inflammatory, antipruritic and vasoconstrictive properties. It shows anti-inflammatory activity via multiple mechanisms to inhibit late phase allergic reactions. It decreases the density of mast cells, chemotaxis and activation of eosinophils. It also reduces cytokine production and inhibits the metabolism of arachidonic acid.

Dosage of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Cream, Ointment: Adults, elderly and children over 1 year: Apply a thin layer of Clobetasol Propionate Cream or Ointment to the affected skin areas twice daily and rub in gently and completely. Repeated short courses of Clobetasol Propionate may be used to control exacerbations. In more resistant lesions, especially where there is hyperkeratosis, the effect of Clobetasol can be enhanced, if necessary, by occluding the treatment area with polythene film. Overnight occlusion only is usually adequate to bring about a satisfactory response.

Clobetasol Propionate is super-high potency topical corticosteroids; therefore, treatment should be limited to 2 consecutive weeks. The maximum weekly dose should not be exceeded 50 gm/week. In case of children, courses should be limited if possible to five days and reviewed weekly.

Spray: Apply required quantity of spray of once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Propionate scalp solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Propionate scalp solution for brief periods only.

Shampoo: It should be applied to the dry (not wet) scalp once a day to the affected areas only. It should be massaged gently into the lesions and left in place for 15 minutes before lathering and rinsing. Treatment should be limited to 4 consecutive weeks. Total dosage of shampoo should not exceed 50 g per week. Under 18 years this preparation is not recommended.

Scalp Solution: Apply required quantity of spray of Clobetasol Scalp Solution once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Scalp Solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Scalp Solution for brief periods only.

Administration

Route of administration: Cutaneous. Creams are especially appropriate for moist or weeping surfaces. Ointments are especially appropriate for dry, lichenified or scaly lesions.

Interaction of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Co-administered drugs that can inhibit CYP3A4 (eg ritonavir, itraconazole) have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.

Contraindications of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

• Rosacea, acne vulgaris and perioral dermatitis. Primary cutaneous viral infections (e.g. herpes simplex, chickenpox).
• Hypersensitivity to the preparation.
• The use of Clobetasol Propionate skin preparations is not indicated in the treatment of primarily infected skin lesions caused by infection with fungi (e.g. candidiasis, tinea), or bacteria (e.g.impetigo): perianal and genital pruritus.
• Dermatoses in children under one year of age, including dermatitis and napkin eruptions.

Side Effects of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

• As with other topical corticosteroids prolonged use of large amounts, or treatment of extensive areas can result in sufficient systemic absorption to produce the features of hypercorticism.
• Prolonged and intensive treatment with a highly active corticosteroid preparation may cause local atrophic changes in the skin such as thinning, striae and dilatation of the superficial blood vessels, particularly when occlusive dressings are used or when skin folds are involved.
• In rare instances, treatment of psoriasis with corticosteroids (or its withdrawal) is thought to have provoked the pustular form of the disease.
• There are reports of pigmentation changes and hypertrichosis with topical steroids. Dermasol is usually well tolerated, but if signs of hypersensitivity appear, application should be stopped immediately. Exacerbation of symptoms may occur.

Pregnancy & Lactation of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

There are limited data from the use of Clobetasol Propionate cream in pregnant women. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. The relevance of this finding to humans has not been established. However, the administration of Clobetasol Propionate Cream during pregnancy and lactation should only be considered if the expected benefit to the mother outweighs the possible risks of treatment.

It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Clobetasol Propionate Cream is administered to a nursing woman.

Therapeutic Class of Cream : -Dermasol 0.05% 20gm tube( AS A Clobetasol Propionate AS A Other Topical corticosteroids).

 

Other Topical corticosteroids

সকালে একবার (৮ সপ্তাহ)

Cream 2 : Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Indications of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Dyvon cream & ointment is indicated for the topical treatment of chronic stable plaque type psoriasis vulgaris in adult patients.

Pharmacology of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Calcipotriol is a non-steroidal antipsoriatic agent, derived from vitamin D. Calcipotriol exhibits a vitamin D-like effect by competing for the 1,25(OH)2D3 receptor. Calcipotriol is as potent as 1,25(OH)2D3, the naturally occurring active form of vitamin D, in regulating cell proliferation and cell differentiation, but much less active than 1,25(OH)2D3 in its effect on calcium metabolism. Calcipotriol induces differentiation and suppresses proliferation (without any evidence of a cytotoxic effect) of keratinocytes, thus reversing the abnormal keratinocyte changes in psoriasis. The therapeutic goal envisaged with calcipotriol is thus a normalization of epidermal growth.

Dosage & Administration of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Calcipotriol cream & ointment should be applied topically to the affected area twice daily (i.e. in the morning and in the evening). Less frequent application may be indicated after the initial period of treatment. After satisfactory improvement has occurred, treatment should be discontinued. If recurrence takes place after discontinuation, the treatment may be reinstituted. Experience is lacking in the use of calcipotriol for periods longer than 1 year. The maximum recommended weekly dose of calcipotriol cream is 100 gm/week.

Contraindications of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Calcipotriol cream & ointment is contraindicated in those patients with a history of hypersensitivity to any of the components of the preparations. It is also contraindicated in patients with known disorders of calcium metabolism.

Side Effects of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Photosensitivity reactions, skin discolouration, bullous eruption, skin exfoliation, contact dermatitis and allergic reactions have been reported with topical calcipotriol therapy.

Pregnancy & Lactation of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Safety for use in pregnancy has not been established. Therefore calcipotriol should not be used during pregnancy unless benefits clearly outweigh the risks. It is not known whether calcipotriol is excreted in breast milk, therefore, the drug should be used during lactation only if the benefits clearly outweigh the risks. Calcipotriol should not be applied to the chest area during breast feeding to avoid possible ingestion by infants.

Precautions & Warnings

Dyvon cream & ointment is not recommended for use in patients with generalized pustular psoriasis, guttate psoriasis and erythrodermic exfoliate psoriasis. Dyvon cream & ointment is not recommended for use on the face.

Use in Special Populations

Dyvon cream & ointment should not be used in children, as there is inadequate experience with its use.

Therapeutic Class of Cream  : -Dyvon 0.005%w/w 20gm tube (AS A Calcipotriol Monohydrate Topical Vitamin D & related preparations).

Topical Vitamin D & related preparations

সকালে + সন্ধায় (৮ সপ্তাহ)

৮ সপ্তাহ পরে ফলোআপ –

যদি ভালো হয়ে যায়, তাহলে মেইন্টেনেন্স থেরাপি (৬ মাস)

Emollient Regular (but Dermasol Should not use for long time,. It will be used when symptoms appear again, শুধু Maintenance therapy হিসাবে সপ্তাহে ১-২ বার করে ব্যবহার করবে,)

আর যদি ভালো না হয় তাহলে–

cream: dermasol

সকালে + সন্ধ্যায় (৮ সপ্তাহ)

Cream: dyvon

সকালে + সন্ধায় (৮ সপ্তাহ)

যদি ভালো হয়ে যায়, তাহলে

Emollient regular চলবে,

E Sara o amra aro kisu medicine management dite pari:-

Emollient Cream/Lotion 3:-Depiwhite Advance ACM Topical Preparation 40ml Bottle.

Lotion 2:-Sensitelial Emollient Care ACM 200ml Bottle.

সাথে মেইনটেনেন্স থেরাপি ৩-৬ মাস

Dermasol and Dyvon BD করার পরেও যদি ভালো না হয়, তাহলে এইটা আর GP case হিসাবে চিকিৎসা দেওয়া যাবেনা,

স্পেশালিষ্ট এর কাছে রেফার করে দিবেন——-

[[NICE guidelines ]]

Note:

পেশেন্ট কে একটু আশ্বস্ত রাখার জন্য আপনি Trade name change করে দিতে পারেন.

Dermasol (এইটা potent steroid Clobetasol propionate)

বাজারে Dermasol, clovesol, topiclo ইত্যাদি নামে পাওয়া যায়,

Dyvon, এইটা ভিটামিন D analogue. (calcipotriol)

বাজারে Dyvon, planex, Dyvonex নামে পাওয়া যায়।

Topical Retinoids: Derived from vitamin A, these help normalize skin cell turnover (e.g., tazarotene).

Cream 4:Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Indications of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Tazoskin is used to treat plaque psoriasis of the skin. It also works to treat acne on the face.

Pharmacology of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Tazarotene is a retinoid prodrug which is converted to its active form, the cognate carboxylic acid of tazarotene, by rapid deesterification in animals and man. In cell culture and in vitro models of skin, tazarotene suppresses expression of MRP8, a marker of inflammation present in the epidermis of psoriasis patients at high levels. In human keratinocyte cultures, it inhibits cornified envelope formation, whose build-up is an element of the psoriatic scale.

Dosage & Administration of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

For psoriasis: Tazarotene cream should be applied once per day, in the evening, to psoriatic lesions, using enough (2 mg/cm²) to cover only the lesion with a thin film. If a bath or shower is taken prior to application, the skin should be dried before applying the cream. If emollients are used, they should be applied at least one hour before application of Tazarotene cream.

For acne: Cleanse the face gently. After the skin is dry, apply a thin layer (2mg/cm²) of Tazarotene cream 0.1% once per day, in the evening, to the skin areas where acne lesions appear. Use enough to cover the entire affected area.

Interaction of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Concomitant dermatologic medications and cosmetics that have a strong drying effect should be avoided. It is also advisable to “rest” a patient’s skin until the effects of such preparations subside before use of Tazoskin cream is begun. Topical steroid may be hazardous in psoriasis; careful patient supervision is important. Consider if infection spreads. Do not use near a naked flame.

Contraindications of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Retinoids may cause fetal harm when administered to a pregnant woman. Tazarotene cream is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, treatment should be discontinued and the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be warned to the potential risk and use adequate birth-control measures when Tazarotene cream is used.

Side Effects of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

The most frequent adverse events reported with Tazoskin cream were limited to the skin. Those occurring in 10 to 23% of patients, in descending order, included pruritus, erythema and burning. For acne treatment, in 10 to 30% patients, it is reported desquamation, dry skin, face pain, irritation and stinging sensation.

Pregnancy & Lactation of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Pregnancy: Tazarotene is not recommended during pregnancy. It has been shown to cause serious birth defects and problems in animals. Be sure you have discussed this with your doctor.

Nursing Mothers: It is not known whether tazarotene passes into breast milk. However, Tazarotene is not recommended during breast-feeding because it may cause unwanted effects in nursing babies.

Precautions & Warnings of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Tazoskin cream should be applied only to the affected areas. For external use only. Avoid contact with eyes, eyelids and mouth. If contact with eyes occurs, rinse thoroughly with water. Retinoids should not be used on eczematous skin, as they may cause severe irritation. Patients must be warned to use sunscreens and protective clothing when using Tazoskin cream. Some individuals may experience excessive pruritus, burning, skin redness or peeling. If these effects occur, the medication should either be discontinued until the integrity of the skin is restored, or the dosing should be reduced

Use in Special Populations of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Pediatric Use: Studies of this medicine have been done only in adult patients, and there is no specific information comparing use of Tazoskin in children up to 12 years of age (gel) and up to 18 years of age (cream) with use in other age groups.

Elderly Use (Over 65 year): There is no specific information comparing the use of Tazoskin in the elderly with use in other age groups.

Overdose Effects of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Excessive topical use cause marked redness, peeling or discomfort. Accidental oral ingestion produces similar adverse effects as those associated with excessive oral intake of Vitamin A or other retinoids. Monitor and take supportive measures as necessary.

Therapeutic Class of Cream :Tazoskin 0.1% use Korte pari.(As a Tazarotene As A

Topical retinoid and related preparations).

Topical retinoid and related preparations

Coal Tar: Slows skin cell growth and reduces inflammation, itching, and scaling.

Cream 4:- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Indications of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Soritar Cream is indicated for psoriasis. Soritar Cream has a keratoplastic and antipruritic effect in psoriasis.

Pharmacology of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Coal tar has antipruritic, keratoplastic and keratolytic properties. It slows down excessive epidermal cell turnover and is often used topically either alone or in combination with other drugs (e.g. salicyclic acid, sulfur) in conditions such as dandruff, seborrheic dermatitis or psoriasis.

Dosage of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Adults and children over 12 years of age: Ensure that the lesions are clean. Apply a thin layer of Coal Tar Cream two or three times a day on to the affected areas massage in gently and leave to dry.

For young children under 12 years of age and the elderly: The emulsion may be diluted by mixing it with a few drops of cooled freshly boiled in the palm of the hand.

Administration

For topical application only.

Contraindications

Coal Tar should not be used when a patient has known sensitivity to Coal Tar or any of the other ingredients. If you have folliculitis and acne vulgaris. Coal Tar Cream should not be used on patients who have disease characterised by photosensitivity such as lupus erythematosus or allergy to sunlight. Coal Tar Cream should not be applied to inflamed or broken skin. Warnings and precautions: For topical administration only. Coal Tar Cream may cause skin irritation, should this occur the treatment should be reviewed and if necessary discontinued. Coal Tar enhances photosensitivity of the skin after applying Coal Tar Cream exposure to direct sunlight should be avoided. Use with care near the eyes and mucous membranes. If any emulsion should accidentally enter the eye, flush with normal saline solution or water. Do not apply to genital and rectal areas. Apply with caution to the face do not get in the eyes. Hydrogenated polyoxyl castor oil may cause skin reactions. Methyl and propyl hydroxybenzoates may cause allergic reactions that might be cause a delayed reaction.

Side Effects of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Skin and subcutaneous tissue disorders: Skin irritation, photosensitivity of the skin, Soritar Cream may cause acne-like eruptions of the skin. There is an increased risk of skin cancer in psoriatic patients treated with a combination of Soritar Cream and UVB radiation has been reported. However epidemiological studies of patients treated with Soritar Cream on its own are inconclusive. The risk of toxicity should be taken into account when considering the prescribing Soritar for the patient.

Pregnancy & Lactation of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

There is no direct evidence of the safety in pregnant and lactating mother. Coal tar preparations have been in use for many years without apparent ill-consequence. No harmful effects on the health of the child is anticipated with the proper use of coal tar. However it is recommended that the use of coal tar in pregnancy and lactation is restricted to intermittent use in low concentrations on a small percentage of body’s surface, use during the first trimester be avoided.

Overdose Effects of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

There is no evidence that an overdose of topical Soritar Cream would be harmful other than a hypersensitivity to Soritar. Ingestion of Soritar Cream may require gastric lavage depending on the quantity taken and should be treated symptomatically.

Therapeutic Class of Cream :- Soritar 10% 50gm tube (As a coal tar As a Coal-tar preparations)

Coal-tar preparations

Salicylic Acid: Helps remove scales and smooth the skin, often used in shampoos for scalp psoriasis.

Cream 5:-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

Indications of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

6% Kerasol: This topical preparations treat the following common scaly conditions:

• Chronic atopic dermatitis
• Lichen simplex
• Psoriasis 
• Seborrhoeic dermatitis
• Ichthiosis

12% Kerasol: This topical preparations treat the following common scaly conditions:

• Warts (small excessive growths of skin caused by a type of virus. Warts often occur on the fingers or on the back of the hands).
• Verruca (occurs only on the sole of the feet and can be painful. It often looks like a small white ring of skin with a black dot in the centre).
• Corns and Calluses (are hard, thick pads of skin caused by pressure and friction. They usually occur on the feet due to poorly fitting shoes and can occur on the hands).

2% Kerasol: This topical preparation is indicated in-

• Mild to moderate acne
• Blackheads and whiteheads
• Redness & swelling of face
• Pimples
• To prevent future acne breakouts

Description of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

Kerasol is available by prescription only as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris, keratosis pilaris, pityriasis rubra pilaris and psoriasis (including body, scalp, palms and soles).

Pharmacology of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

Salicylic Acid has a potent keratolytic & a slight antiseptic action when applied topically to the skin. In low concentrations, the drug has keratoplastic activity (correction of abnormal keratinization) & in higher concentrations, the drug has keratolytic activity (causes peeling of skin). Salicylic Acid softens & destroys the stratum corneum by increasing endogenous hydration (water concentration), probably because of decreased pH, which causes the cornified epithelium (horny layer of the skin) to swell, soften, & then desquamate. Necrosis of normal skin has been associated with overuse of the drug. At high concentrations, Salicylic Acid has a caustic effect. Moisture is essential for Salicylic Acid to exert its action on the skin and for maceration and desquamation of epidermal tissue to occur. The drug has weak antifungal & antibacterial activity.

Dosage & Administration of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

6% & 12% Salicylic Acid: Apply to affected area once daily. Hydrate area for 5 minutes prior to application if possible. Occlude the area at night. Wash off in morning. Salicylic Acid is used in children over 2 years.

2% Salicylic Acid: Apply enough medicine to cover the affected area once daily in 1st week then 2 to 3 times daily from 2nd week and rub gently. After 3-5 minutes rinse face with cool water. Salicylic Acid is used in children over 2 years.

Interaction

Do not use other topical preparations on the treated area unless otherwise directed by your healthcare provider. They may interfere with treatment or increase skin irritation.

Contraindications of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

It should not be used in any patient known to be sensitive to Salicylic Acid or any other listed ingredients.

Side Effects of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

An allergic reaction (shortness of breath, closing of the throat, swelling of the lips, face or tongue or hives) or severe skin irritation.

Pregnancy & Lactation

Pregnancy Category C. If used by nursing mothers, it should not be used on the chest area to avoid accidental contamination of the child.

Precautions & Warnings

For external use only. Avoid contact with eyes and other mucous membranes.

Overdose Effects

An overdose of Kerasol topical is unlikely to occur. If the medication has been ingested or an overdose is suspected, the patient needs to be hospitalized immediately.

Therapeutic Class of Cream :-Kerasol 12%  30gm tube (As a salicylic acid As A Topical salicylic preparation).

 

Topical salicylic preparation

Oral Medications:

Methotrexate :-

Tablet 1: Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

Indications of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

Neoplastic Diseases:

• Treatment of gestational choriocarcinoma, chorioadenoma destruens and hydatidiform mole
• In acute lymphoblastic leukemia
• Used in combination with other chemotherapeutic agents in the treatment of advanced stage non-Hodgkin’s lymphomas
• Treatment of breast cancer, epidermoid cancers of the head and neck, advanced mycosis fungoides (cutaneous T-cell lymphoma) and lung cancer, particularly squamous cell and small cell types.

Rheumatoid Arthritis including Polyarticular-Course Juvenile Rheumatoid Arthritis: Indicated in the management of selected adults with severe, active rheumatoid arthritis, or children with active polyarticular-course juvenile rheumatoid arthritis, who have had an insufficient therapeutic response to, or are intolerant of, an adequate trial of first-line therapy including full dose non-steroidal anti-inflammatory agents (NSAIDs)

Psoriasis: Indicated in the symptomatic control of severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy.

Pharmacology of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

Methotrexate inhibits dihydrofolic acid reductase. Dihydrofolates must be reduced to tetrahydrofolates by this
enzyme before they can be utilized as carriers of one-carbon groups in the synthesis of purine nucleotides and thymidylate. Therefore, methotrexate interferes with DNA synthesis, repair, and cellular replication. Actively proliferating tissues such as malignant cells, bone marrow, fetal cells, buccal and intestinal mucosa, and cells of the urinary bladder are in general more sensitive to this effect of methotrexate. When cellular proliferation in malignant tissues is greater than in most normal tissues, methotrexate may impair malignant growth without irreversible damage to normal tissues. In psoriasis, the rate of production of epithelial cells in the skin is greatly increased over normal skin. This difference in proliferation rates is the basis for the use of methotrexate to control the psoriatic process.

Dosage of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

Neoplastic Diseases–

Choriocarcinoma and similar trophoblastic diseases: Orally or intramuscularly in doses of 15 to 30 mg daily for a five-day course. The courses are usually repeated for 3 to 5 times as required, with rest periods of one or more weeks interposed between courses, until any manifesting toxic symptoms subside. Since hydatidiform mole may precede choriocarcinoma, prophylactic chemotherapy with methotrexate has been recommended. Chorioadenoma destruens is considered to be an invasive form of hydatidiform mole. Methotrexate is administered in these disease states in doses similar to those recommended for choriocarcinoma

Acute Lymphoblastic Leukemia

• Induction dose: 3.3 mg/m2 in combination with prednisone 60 mg/m2 daily for 4 to 6 weeks
• Maintenance dose: Orally or IM administration 2 times a week in total weekly doses of 30 mg/m2
• Alternate maintenance dose: 2.5 mg/kg IV every 14 days. If and when relapse does occur, reinduction of remission can again usually be obtained by repeating the initial induction regimen

Lymphoma

• Burkitt’s tumor Stages I to II: 10 to 25 mg once a day for 4 to 8 days
• Burkitt’s tumor Stage III: Methotrexate is commonly given concomitantly with other antitumor agents
• Duration of therapy: All stages usually require several courses of therapy interposed with 7 to 10 day rest periods
• Lymphosarcoma Stage III: 0.625 to 2.5 mg/kg daily as a part of combination chemotherapy

Mycosis Fungoides: Early stage dosing: 5 to 50 mg once a week; alternatively, 15 to 37.5 mg 2 times a week may be used in patients who have responded poorly to weekly therapy

Breast Cancer: 40 mg/m 2 intravenously on the 1 st and 8 th day every 4 weeks in combination with cyclophosphamide and fluoracil for 6-12 cycles

Head and Neck Cancer: 40 mg/m2 IV weekly until disease progression or unacceptable toxicity (3 weeks equals one cycle; goal is to complete at least six cycles).

Adult Rheumatoid Arthritis: Single doses of 7.5 mg once per week, Maximum dose: 20 mg/week in adults

Polyarticular-Course Juvenile Rheumatoid Arthritis: 10 mg/m2 once weekly

Psoriasis: Single dose: 10 to 25 mg once per week, maximum dose: 30 mg/week

Administration

Should be taken on an empty stomach. Best taken on an empty stomach. May be taken with meals to reduce GI discomfort. Avoid taking with milk-rich products.

Interaction of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

• NSAIDs: Should not be administered prior to or concomitantly with high doses of Trexall, such as used in the treatment of osteosarcoma
• Salicylates, Phenylbutazone, Phenytoin and Sulfonamides: Toxicity may be increased Penicillin, Theophylline, Probenecid, Azathioprine, Retinoids,
• Sulfasalazine: Should be closely monitored for possible increased risk of hepatotoxicity
• Cisplatin: Caution must be exercised if high-dose Trexall is administered in combination
• Mercaptopurine: Trexall increases the plasma levels of mercaptopurine
• Tetracycline, Chloramphenicol and Nonabsorbable Broad Spectrum Antibiotics: May decrease intestinal absorption of Trexall
• Vitamin preparations containing folic acid or its derivatives: Decreases responses to systemically administered Trexall
• Trimethoprim/Sulfamethoxazole: Rarely increases bone marrow suppression

Contraindications of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

• Alcoholism, alcoholic liver disease or other chronic liver disease
• Immunodeficiency syndromes
• Pre-existing blood dyscrasias, such as bone marrow hypoplasia, leukopenia, thrombocytopenia, or significant anemia
• Hypersensitivity to methotrexate
• Pregnant women with psoriasis or rheumatoid arthritis
• Women of childbearing potential
• Nursing mothers
• Pregnancy should be avoided if either partner is receiving methotrexate; during and for a minimum of three months after therapy for male patients, and during and for at least one ovulatory cycle after therapy for female patients

Side Effects of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

 

• The most frequently reported adverse reactions include ulcerative stomatitis, leukopenia, nausea and abdominal distress
• Other frequently reported adverse effects are malaise, undue fatigue, chills and fever, dizziness and decreased resistance to infection
• Trexall has been reported to cause impairment of fertility, oligospermia and menstrual dysfunction in humans, during and for a short period after cessation of therapy

Pregnancy & Lactation

US FDA Pregnancy Category X. Methotrexate should be used in the treatment of neoplastic diseases only when the potential benefit outweighs the risk to the fetus. It is contraindicated in nursing mothers.

Therapeutic Class of Tablet : Trexall 10 mg (As A Methotrexate Antidote preparations, Immunosuppressant).

Antidote preparations, Immunosuppressant

Special Note: কিছু রিসার্চে দেখা গিয়েছে, oral vitamine D supplementary 2-6 month নিলে সোরিয়াসিস কন্ট্রোলে চলে আসে…

তাই উপরের চিকিৎসার সাথে

cap- D-Rise (20000 unit)

প্রতি সপ্তাহে একটা করে ৬ মাস।

General Queries:-

1.Scalp psoriasis এর চিকিৎসা কেমন হবে?

Answer is:-

steroid scalp solution use Korte hobe.

1:Betamesal Scalp Lotion 0.05%+2%

(As A Betamethasone Dipropionate + Salicylic Acid AS A Topical anti-inflammatory preparations BEST USED for his Scalp preparation is used to treat inflammatory, dry and scaly skin disorders, such as Eczema, Psoriasis.)

2.Assalamu Alaikum sir.

Dermasol cream r dyvon cream 2ta shokal ar shondhay use korte hole to 2ta cream akshathe mixed hoye jabe. Tokhon kono problem hobe ki?

Answer is:-

6 am 6pm steroid

8 am and 8 pm others.

More note the point:

for maintenance therapy this is not the right protocol to follow. don’t use dermasol for too long & in case of generalised psoriasis if you give dermasol then it’ll absorb through skin & psoriasis will flare up. Psoriasis তখন বেড়ে যেতে পারে.

another thing don’t give systemic steroid, terbinafine, beta blocker, NSAID in psoriasis pt.generalised psoriasis must reffer a Dermatologist specialist Dr.

PSORIASIS

DEFINITION:

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin.These areas are red, pink, or purple, dry, itchy, and scaly.Psoriasis varies in severity from small localized patches to complete body coverage.Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

CAUSES:

Psoriasis is caused by a combination of genetic, immune system, and environmental factors. Here’s a breakdown of the key causes:

1. Genetics

Psoriasis often runs in families. Specific genes are linked to the condition, and if one or both parents have psoriasis, their children have a higher chance of developing it.

2. Immune System Dysfunction

Psoriasis is an autoimmune disease. In psoriasis, the immune system mistakenly attacks healthy skin cells, accelerating skin cell turnover, which leads to the buildup of thick, scaly patches (plaques) on the skin.

3. Environmental Triggers

People with a genetic predisposition for psoriasis may experience flare-ups triggered by environmental factors. Common triggers include:

Stress: Emotional stress can trigger or worsen psoriasis.

Infections: Bacterial or viral infections, such as strep throat, can initiate or aggravate psoriasis.

Injury to the Skin: Cuts, scrapes, insect bites, or sunburn can trigger psoriasis, a phenomenon called the Koebner response.

Medications: Certain drugs, such as beta-blockers, lithium, and antimalarial medications, can trigger or worsen the condition.

Weather: Cold, dry weather can aggravate psoriasis, while sunlight and humidity can sometimes improve symptoms.

4. Lifestyle Factors

Smoking: Smoking increases the risk of developing psoriasis and can worsen the severity of the condition.

Alcohol Consumption: Excessive alcohol use is linked to more severe psoriasis and can interfere with treatments.

Obesity: Being overweight or obese can increase the risk and severity of psoriasis, particularly in areas where skin rubs together.

5. Hormonal Changes

Hormonal shifts, such as during puberty, pregnancy, or menopause, can trigger psoriasis flare-ups.

6. Other Medical Conditions

Psoriasis is often associated with other autoimmune conditions, such as Crohn’s disease or rheumatoid arthritis. It may also coexist with metabolic syndrome, cardiovascular disease, or type 2 diabetes.

These factors interact in complex ways, and psoriasis manifests differently in different individuals based on these underlying causes and triggers.

COMPLICATIONS:

Psoriasis can lead to a range of complications, both physical and emotional. Some of the key complications include:

1. Psoriatic Arthritis (PsA)

Up to 30% of people with psoriasis develop psoriatic arthritis, an inflammatory form of arthritis that causes joint pain, stiffness, and swelling. If untreated, it can lead to joint damage and permanent disability.

2. Cardiovascular Disease

People with psoriasis, especially severe forms, have a higher risk of developing cardiovascular conditions such as heart disease, stroke, and high blood pressure. The chronic inflammation associated with psoriasis may contribute to this increased risk.

3. Metabolic Syndrome

Psoriasis is linked to an increased risk of metabolic syndrome, a group of conditions that include obesity, high blood pressure, high cholesterol, and insulin resistance. These conditions can lead to type 2 diabetes and heart disease.

4. Type 2 Diabetes

Chronic inflammation in psoriasis patients is associated with an increased risk of type 2 diabetes. The risk is higher in people with severe psoriasis.

5. Mental Health Issues

Psoriasis can have a significant impact on mental health, leading to:

Depression: The emotional toll of living with a visible and chronic skin condition can lead to depression.

Anxiety: Concerns about appearance, social interactions, and disease management can cause anxiety.

Low Self-Esteem: The appearance of psoriasis plaques, particularly in visible areas, can lower self-esteem and affect quality of life.

6. Obesity

There is a strong association between psoriasis and obesity. Obesity can exacerbate psoriasis symptoms, and psoriasis itself can increase the risk of becoming overweight due to reduced physical activity or the effects of certain medications.

7. Inflammatory Bowel Disease (IBD)

People with psoriasis have an increased risk of developing inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, which also involve an overactive immune system.

8. Liver Disease

Psoriasis is associated with an increased risk of nonalcoholic fatty liver disease (NAFLD), especially in those with obesity, metabolic syndrome, or heavy alcohol use.

9. Eye Conditions

Psoriasis, especially in the form of psoriatic arthritis, can lead to eye conditions such as uveitis, conjunctivitis, and blepharitis, which can cause discomfort and vision problems if not treated.

10. Skin Infections

The damaged and inflamed skin from psoriasis is more vulnerable to skin infections. Open or cracked skin can allow bacteria to enter, increasing the risk of bacterial infections.

11. Kidney Disease

Severe psoriasis is linked to an increased risk of chronic kidney disease, especially in people who also have metabolic syndrome or cardiovascular disease.

These complications emphasize the importance of managing psoriasis not only to control skin symptoms but also to reduce the risk of related health issues.

SYMPTOMS:

Symptoms of psoriasis vary from person to person, but some common ones are:

1~Patches of thick,

2 ~red skin with silvery-

3~white scales that itch or burn, typically on the

elbows,

knees,

scalp,

trunk,

palms, and soles of the feet.

4~Dry, cracked skin that itches or bleeds.

5~ Thick, ridged, pitted nails.

TYPES :

There are several types of psoriasis, each of which varies in its signs and symptoms:

1.Plaque psoriasis. …

2.Nail psoriasis. …

3.Guttate psoriasis. …

4.Inverse psoriasis. …

5.Pustular psoriasis. …

6.Erythrodermic psoriasis.

DIAGNOSIS:

The diagnosis of psoriasis is primarily based on a physical examination and medical history. In some cases, additional tests may be required to confirm the diagnosis or rule out other conditions. The diagnostic process typically involves the following steps:

1. Physical Examination

A healthcare provider will examine the skin, scalp, and nails for signs of psoriasis. The characteristic symptoms include red, scaly, thickened patches of skin (plaques), often with silvery scales, particularly on the elbows, knees, scalp, and lower back. Nail changes, such as pitting, discoloration, and thickening, may also be present.

2. Medical History

The doctor will ask about symptoms, when they started, and if there are any known triggers (such as stress or infection). A family history of psoriasis or autoimmune diseases is also important, as psoriasis can have a genetic component.

3. Skin Biopsy

In some cases, the doctor may perform a skin biopsy to confirm the diagnosis. A small sample of skin is taken and examined under a microscope. This can help differentiate psoriasis from other skin conditions, such as eczema, fungal infections, or lichen planus.

4. Blood Tests

Blood tests are not usually necessary to diagnose psoriasis, but they may be done to rule out other conditions that can mimic psoriasis symptoms, such as lupus or rheumatoid arthritis. Blood tests may also be used to monitor inflammation or to check for conditions related to psoriasis, such as psoriatic arthritis.

5. Imaging Tests (for Psoriatic Arthritis)

If psoriatic arthritis is suspected, imaging tests like X-rays or MRI may be performed to check for joint damage or inflammation.

Types of Psoriasis to Diagnose:

Plaque Psoriasis: The most common form, with raised, red patches covered by silvery scales.

Guttate Psoriasis: Small, drop-shaped spots, often triggered by infections.

Inverse Psoriasis: Red lesions that occur in skin folds, such as under the breasts or in the groin.

Pustular Psoriasis: White pustules surrounded by red skin.

Erythrodermic Psoriasis: Severe, widespread redness of the skin, which can be life-threatening and requires immediate medical attention.

Differential Diagnosis

Psoriasis can sometimes resemble other skin conditions like eczema, seborrheic dermatitis, contact dermatitis, or fungal infections. A thorough assessment helps rule out these conditions.

An accurate diagnosis of psoriasis allows for proper management and treatment to help control symptoms and prevent complications.

TREATMENT:

Treatment of psoriasis focuses on reducing symptoms, controlling flare-ups, and improving the quality of life. While there is no cure for psoriasis, several treatment options are available, depending on the severity of the condition. The treatment is often individualized and may involve a combination of therapies.

1. Topical Treatments

These are applied directly to the skin and are commonly used for mild to moderate psoriasis.

Corticosteroids: Anti-inflammatory creams or ointments that reduce swelling and redness. These are often the first line of treatment.

Vitamin D Analogues: Such as calcipotriene and calcitriol, these slow down skin cell growth and reduce scaling.

Topical Retinoids: Derived from vitamin A, these help normalize skin cell turnover (e.g., tazarotene).

Salicylic Acid: Helps remove scales and smooth the skin, often used in shampoos for scalp psoriasis.

Coal Tar: Slows skin cell growth and reduces inflammation, itching, and scaling.

Moisturizers: Help to reduce dryness and itching by maintaining skin hydration.

2. Phototherapy (Light Therapy)

For moderate to severe psoriasis, phototherapy may be recommended.

UVB Phototherapy: Exposure to controlled doses of ultraviolet B (UVB) light can slow the growth of skin cells. This can be done at home or in a clinical setting.

PUVA Therapy: Combines a drug called psoralen with UVA light exposure. This makes the skin more sensitive to light and enhances the effects of UVA light.

Excimer Laser: Targets specific areas of skin affected by psoriasis, delivering high-intensity UVB light to small patches.

3. Systemic Medications

For moderate to severe psoriasis, especially if it affects large areas or involves psoriatic arthritis, systemic treatments may be prescribed. These medications work throughout the body and can have significant effects.

Oral Medications:

Methotrexate: Suppresses the immune system and slows skin cell turnover. It is often used for severe psoriasis or psoriatic arthritis.

Cyclosporine: Another immunosuppressant that is effective for severe psoriasis but has potential side effects, including kidney damage.

Acitretin: A retinoid (vitamin A derivative) that is used for severe psoriasis, especially pustular forms.

Apremilast (Otezla): A newer drug that inhibits an enzyme involved in inflammation, helping to reduce symptoms.

Biologic Medications: Biologics are injected or infused drugs that target specific parts of the immune system. They are used for moderate to severe psoriasis and psoriatic arthritis.

TNF-alpha inhibitors: Such as etanercept, adalimumab, and infliximab, these block a specific protein involved in inflammation.

IL-17 inhibitors: Such as secukinumab and ixekizumab, which block interleukin-17, a molecule involved in psoriasis inflammation.

IL-23 inhibitors: Such as guselkumab and tildrakizumab, targeting interleukin-23, another protein involved in the inflammatory process.

IL-12/IL-23 inhibitors: Ustekinumab targets both IL-12 and IL-23 proteins, involved in the immune response in psoriasis.

4. Lifestyle and Home Remedies

Moisturizing Regularly: Helps reduce itching and scaling.

Baths: Warm baths with added Epsom salts, dead sea salts, or oatmeal can soothe the skin.

Avoiding Triggers: Managing stress, quitting smoking, reducing alcohol intake, and avoiding skin injuries can help prevent flare-ups.

Dietary Changes: Maintaining a healthy weight, eating an anti-inflammatory diet (rich in fruits, vegetables, and omega-3 fatty acids), and avoiding processed foods can potentially help manage symptoms.

5. Stress Management

Since stress can trigger psoriasis flare-ups, stress-relief practices like meditation, yoga, or therapy may help manage the condition.

6. Treatment of Psoriatic Arthritis

Psoriatic arthritis, a common complication of psoriasis, is treated with many of the same systemic medications as psoriasis, including biologics and disease-modifying antirheumatic drugs (DMARDs).

Combination Therapy

Many individuals may need a combination of treatments for better results. Physicians will adjust treatments based on the patient’s response and any side effects.

Ongoing Monitoring

Regular follow-ups with a dermatologist are important to monitor treatment effectiveness, side effects, and potential complications associated with long-term therapies.

Each treatment plan is individualized based on the severity of the condition, the areas affected, and the patient’s overall health.

Psoriasis treatment medicines

Methotrexate

Cyclosporine

Acitretin

Alternative

medicine

Etanercept

Adalimumab

Infliximab

Ustekinumab

Biologics

Raiyyan Tahsan Date:23-01-2025 Thursday Time:12-10-45 PM

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• TC(1486).(02). Dermatology Department Case No 107:- Suspected Superficial Dermatophytosis with Possible Coexisting Allergic Rhinitis: Clinical Diagnosis, Prescription Analysis and Evidence-Based Management (1PR+0RE+0IMG)4433
• TC(1485).(02). Dermatology Department Case No (106): Undifferentiated Genital Ulcer Disease with Associated Skin Rash and Generalized Weakness Suspected Syphilis versus Genital Herpes; Possible Secondary Bacterial Infection (1 PR+ 0RE + 0Img)7799
• TC(1484).(09).Obstetrics & Gynecology Case No 60:-High-Risk Pregnancy with History of Two Preterm Deliveries and Two Neonatal Deaths: Diagnosis, Drug Safety and Evidence-Based Management(1PR+0RE+0IMG)8090
• TC(1483).(09). Gynecology Department Case No. (59): Physician-Documented Mastitis with Fever — Possible Inflammatory or Bacterial Mastitis; Breast Abscess and Dengue Fever to Be Excluded (1Prescription + 0Reports + 0Images)0909

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