Dermatology Case No 19. Pytriasis rosea

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Dermatology Case No 19. Pytriasis rosea

ছবিটির দিকে লক্ষ করুন-.

১৮ বছর বয়স, পিঠে গত ৭ দিন আগে বড় Circular lesion টা হয়,

একটা lesion ছিলো, পরবর্তী ৩-৪ দিনে আশে পাশে অনেক গুলি ছোট ছোট লেশন তৈরি হয়–

এইটার ডায়াগনোসিস কি হবে? চিকিৎসা কি হবে?

আমরা যদি প্রথমত ছবির দিকে দেখি যে – বড় Circular lesion টা ring shape, Ring shape হলে এখানে Tinea D/D হিসাবে আসে, কিন্ত Tinea তে central clearance থাকে, মানে চার দিকে রিং আকৃতি গোলাকার লেশন হলেও মাঝখানে ক্লিয়ার জোন থাকবে—

ছবির লেশন টাতে মাঝখানে কোনো central clearance নাই– আবার কিছু কিছু কেসের মধ্যে central clear থাকতেও পারে, তবে প্রার্থক্য করার মুল উপায় হলো

Pytiriasis rosea তে একটা বড় oval patch এর চারপাশে

অনেক ছোট ছোট patch থাকবে—

আরেকটা বিষয়, টিনিয়াতে একটা বড় লেশন হয়ে ৩-৪ দিন পর অনেকগুলি ছোট লেশন হওয়াটা অস্বাভাবিক

এবার তাহলে চিন্তা করি,

এই ধরনের oval patch যা mild itchy… যার আশে পাশে অনেক গুলি ছোট ছোট লেশন হয়, এই কন্ডিশন কে Pytriasis rosea বলে-

এইটার কোনো কারণ জানা যায়না, এক প্রকার unknown atiology বলা যায়—

বড় patch টা কে Herald patch বলা হয়–

*Rx-

প্রথমত কাউন্সেলিং করবেন,

এইটা পরিপূর্ণ ভালো হতে ১ -৩ মাস সময় লাগবে-

Treatment Management :-

Tablet 1- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

0+0+1 for 4 weeks,

Indications of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Allergic rhinitis: Fexo is indicated for the relief of symptoms associated with seasonal and perennial allergic rhinitis, in adults and children 12 years of age and over. Symptoms treated effectively include sneezing, rhinorrhea, lacrimation, itchy, red eyes and itchy nose/palate/throat. Fexo improves health-related quality of life and work/activity productivity.

Chronic idiopathic urticaria: Fexo is indicated for the relief of symptoms associated with chronic idiopathic urticaria in adults and children 12 years of age and older. Fexo significantly reduces the signs and symptoms of chronic idiopathic urticaria, the number of wheals, and pruritus. Fexo improves health-related quality of life and work/activity productivity.

Pharmacology of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

The H1 histamine receptor is responsible for mediating hypersensitivity and allergic reactions. Exposure to allergen results in the degranulation of mast cells and basophils, which then release histamine and other inflammatory mediators. Histamine binds to, and activates, H1 receptors, which results in the further release of pro-inflammatory cytokines, such as interleukins, from basophils and mast cells. These downstream effects of histamine binding are responsible for a wide variety of allergic symptoms, such as pruritus, rhinorrhea, and watery eyes.

Fexofenadine is considered an “inverse agonist” of the H1 receptor because it binds to and stabilizes the inactive form of the receptor, preventing its activation and subsequent downstream effects. It has a potent and selective affinity for H1 receptors, and there is no evidence that it carries antidopaminergic, antiserotonergic, anticholinergic, sedative, or adrenergic blocking activity. Fexofenadine does not cross the blood-brain barrier and thus is unlikely to cause significant CNS effects.

Dosage & Administration of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Allergic Rhinitis-

Adults and children 12 years and older:

Tablet: 60 mg twice daily or 120 mg once daily or 180 mg once daily
In case of impaired renal function: 60 mg once daily

Children from 6 to 11 years:

Tablet: 30 mg twice daily or 60 mg once daily
In case of impaired renal function: 30 mg once daily

Children from 2 to 11 years

Suspension: 30 mg or 5 ml twice daily
In case of impaired renal function: 30 mg or 5 ml once daily

Chronic Idiopathic Urticaria-

Adults and children 12 years and older:

Tablet: 60 mg twice daily or 120 mg once daily or 180 mg once daily
In case of impaired renal function: 60 mg once daily

Children from 6 to 11 years:

Tablet: 30 mg twice daily or 60 mg once daily
In case of impaired renal function: 30 mg once daily

Children from 6 months to less than 2 years:

Suspension: 15 mg or 2.5 ml (1/2 tsp) twice daily
In case of impaired renal function: 15 mg or 2.5 ml (1/2 tsp) once daily

Children from 2 to 11 years:

Suspension: 30 mg or 5 ml (1 tsp) twice daily
In case of impaired renal function: 30 mg or 5 ml (1 tsp) once daily

Interaction of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Fexo does not undergo hepatic biotransformation and therefore will not interact with other medicinal products through hepatic mechanisms. Coadministration of Fexo with erythromycin or ketoconazole has been found to result in a 2-3 times increase in the level of fexofenadine in plasma. The changes were not accompanied by any effects on the QT interval and were not associated with any increase in adverse reactions compared to the medicinal products given singly. No interaction between fexofenadine and omeprazole was observed. However, the administration of an antacid containing aluminium and magnesium hydroxide gels 15 minutes prior to Fexo caused a reduction in bioavailability, most likely due to binding in the gastrointestinal tract. It is advisable to leave 2 hours between administration of Fexo and aluminium and magnesium hydroxide containing antacids.

Contraindications of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Contraindicated in patients with known hypersensitivity to Fexofenadine Hydrochloride or any of its ingredients.

Side Effects of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

The following frequency rating has been used, when applicable: Very common ≥1/10; Common ≥1/100 and <1/10; Uncommon ≥1/1,000 and <1/100; Rare ≥1/10,000 and <1/1,000; Very rare <1/10,000 and not known (frequency cannot be estimated from the available data). Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. In adults, the following undesirable effects have been reported in clinical trials, with an incidence similar to that observed with placebo: Nervous system disorders- Common: headache, drowsiness, dizziness; Gastrointestinal disorders- Common: nausea; General disorders and administration site conditions- Uncommon: fatigue. In adults, the following undesirable effects have been reported in post-marketing surveillance. The frequency with which they occur is not known (cannot be estimated from available data): Immune system disorders- hypersensitivity reactions with manifestations such as angioedema, chest tightness, dyspnoea, flushing and systemic anaphylaxis; Psychiatric disorders- insomnia, nervousness, sleep disorders or nightmares/excessive dreaming (paroniria); Cardiac disorders- tachycardia, palpitations; Gastrointestinal disorders- diarrhea; Skin and subcutaneous tissue disorders- rash, urticaria, pruritus

Pregnancy & Lactation of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

There are no adequate data from the use of Fexofenadine hydrochloride in pregnant women. Limited animal studies do not indicate direct or indirect harmful effects with respect to effects on pregnancy, embryonal/foetal development, parturition or postnatal development. Fexofenadine hydrochloride should not be used during pregnancy unless clearly necessary.

There are no data on the content of human milk after administering Fexofenadine hydrochloride. However, when Terfenadine was administered to nursing mothers Fexofenadine was found to cross into human breast milk. Therefore, Fexofenadine hydrochloride is not recommended for mothers breast-feeding their babies. No human data on the effect of Fexofenadine hydrochloride on fertility are available. In mice, there was no effect on fertility with Fexofenadine hydrochloride treatment.

Therapeutic Class of tab- Fexo 120 mg (AS A – Fexofenadin Hydrochloride AS A Non-sedating antihistamines).

Non-sedating antihistamines

Common Questions about Fexo 120 mg Tablet

What is Fexo 120 mg Tablet?

Fexo 120 mg Tablet is an antihistamine. It works by blocking histamine that the body makes during an allergic reaction.

What are the uses of Fexo 120 mg Tablet?

Fexo 120 mg Tablet is used for the treatment of allergic rhinitis and urticaria. It relieves allergy symptoms such as runny nose, itching eyes/nose, sneezing, hives, and itching.

What are the Side Effects of Fexo 120 mg Tablet?

Fexo 120 mg Tablet has some reported side effects such as Vomiting, Headache, Coughing, Diarrhea, Painful menstruation, Pain in the arms and legs, Hives and redness of skin, Swelling of face, lips, eyelids, tongue, hands and feet.

What are the instructions for storage and disposal Fexo 120 mg Tablet?

Fexo 120 mg Tablet should be kept in a cool dry place and in its original pack. Make sure this medication remains unreachable to children and pets.

Can Fexo 120 mg Tablet make you sleepy?

Yes, Fexo 120 mg Tablet can make you feel sleepy, infect sleepiness is a common side effect of this medicine.

Can you overdose on Fexo 120 mg Tablet?

Do not take an overdose of Fexo 120 mg Tablet as this can cause adverse reactions and may increase the risk of side effects like dizziness, drowsiness, fatigue, and dry mouth.

How quickly does Fexo 120 mg Tablet work?

Fexo 120 mg Tablet starts working within 1 hour of consuming it. The peak benefit of Fexo 120 mg Tablet is observed within 6 hours.

Does Fexo 120 mg Tablet relieve symptoms of outdoor and indoor allergies?

Yes, Fexo 120 mg Tablet can help relieve symptoms that may be caused by outdoor and indoor allergens such as upper respiratory allergies, hay fever, watery eyes, runny nose, and sneezing, or itching of the nose or throat.

How to cope with dizziness caused by Fexo 120 mg Tablet?

Take some rest after taking Fexo 120 mg Tablet if you feel dizzy or sleep. Do not use heavy machinery or drive and move very slowly. Exercise caution and if there is extreme dizziness, then consult a doctor as soon as possible.

Can I take antacids while taking Fexo 120 mg Tablet?

Fexo 120 mg Tablet should not be used in combination with antacids as the interaction between them can result in a decreased absorption of Fexo 120 mg Tablet.

How should I take Fexo 120 mg Tablet?

Fexo 120 mg Tablet should be taken in dose and duration as recommended by the doctor. Do not take an overdose as this can affect your health adversely.

Is there any food or drink that I need to avoid while taking Fexo 120 mg Tablet?

Do not consume juices like grapefruit juice, orange juice and apple juice if you are on the course of medication with Fexo 120 mg Tablet.

Can Fexo 120 mg Tablet cause heart problems?

Those who suffer from heart disorders should exercise caution and must look out for some other alternative of this medicine.

Quick Tips

Fexo 120 mg Tablet is an antihistaminic medication. It treats allergy symptoms such as itching, swelling, and rashes by blocking the effects of a chemical messenger (histamine) in the body.
Fexo 120 mg Tablet is less likely to make you feel sleepy than some other similar medicines.
Do not take Fexo 120 mg Tablet with any fruit juices (such as apple, orange, or grapefruit) as they might make the drug less effective.
Fexo 120 mg Tablet may cause nausea. Stick to simple meals, and do not eat rich or spicy food.
Avoid using antacids 30 minutes before or after taking Fexo 120 mg Tablet. It can make it harder for your body to absorb this medication.

3.. Emolent lotion (For 2 month)

Cream 1:Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

Indications of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

For general use as an emollient in the symptomatic relief of dry skin conditions.

Pharmacology of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

White Soft Paraffin and Liquid Paraffin are emollients with occlusive properties for topical application. There is no significant systemic absorption of the active ingredients but has substantial penetration into the stratum corneum.

Dosage & Administration of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

Apply a thin film of the ointment to the affected area of the skin, in the direction of hair growth, as required. Repeat as necessary. Ideally the product should be applied three or four times a day or at least twice a day. In adults, where a large area of the body is affected, up to 500 g a week may be used. For topical administration only.

Side Effects of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

Prolong use may cause folliculitis, should this occur, use of the product should be discontinued.

Pregnancy & Lactation of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

The safety of White Soft Paraffin and Liquid Paraffin during pregnancy and lactation has not been established, but use during this periods is not considered to constitute a hazard.

Precautions & Warnings of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

This topical agent should be applied in the direction of hair growth to reduce the incidence of folliculitis.

Overdose Effects of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

This topical agent has low toxicity and if ingested treatment should be supportive and symptomatic. Gastric lavage should not be attempted following ingestion of paraffin-based products, due to the risk of inhalation or aspiration into the lungs.

Therapeutic Class of Cream :Emolent 15%+6% 25 gm tube.( As A white soft paraffin and Liquid paraffin. As a Emollients & combined preparations).

Emollients & combined preparations

Figure no 2:-

Follow the image2 @everyone

উপরের কেস টা ভালোভাবে দেখুন,

Pytiriasis Rosea Dx করার উপায় হচ্ছে, এখানে একটা বড় লেশন প্রথমত দেখা দিবে, যা Pink scaly lesion.. পরে ৩-৪ দিনের মধ্যে সেই লেশন এর আশেপাশে কিছু ছোট লেশন দেখা দিবে,

মানে একটা Mother lesion + surrounded by some baby lesion….

নীচের কয়েকটা পিক দেখলে এসব ক্লিয়ার হয়ে যাবেন-

*Topicort cream if excessive itching not controlled by Antihistamine*

Cream 4:-Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

The anti-inflammatory activity of Topicort is its main therapeutic property. It also has immunosuppressant and antimitotic actions. Topicort is indicated in:

Primary irritant dermatitis
Contact allergic dermatitis
Eczema: atopic, infantile, discoid, stasis
Seborrheic dermatitis
Lichen simplex and pruritus ani
Flexural psoriasis
Skin irritations, itching and rashes, for example those caused by insect bites, minor thermal burns, sunburn, etc

Pharmacology Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Hydrocortisone binds to the cytosolic glucocorticoid receptor. After binding the receptor the newly formed receptor-ligand complex translocates itself into the cell nucleus, where it binds to many glucocorticoid response elements (GRE) in the promoter region of the target genes. The DNA bound receptor then interacts with basic transcription factors, causing the increase in expression of specific target genes. The anti-inflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. Specifically glucocorticoids induce lipocortin-1 (annexin-1) synthesis, which then binds to cell membranes preventing the phospholipase A2 from coming into contact with its substrate arachidonic acid. This leads to diminished eicosanoid production. The cyclooxygenase (both COX-1 and COX-2) expression is also suppressed, potentiating the effect. In other words, the two main products in inflammation Prostaglandins and Leukotrienes are inhibited by the action of Glucocorticoids. Glucocorticoids also stimulate the lipocortin-1 escaping to the extracellular space, where it binds to the leukocyte membrane receptors and inhibits various inflammatory events: epithelial adhesion, emigration, chemotaxis, phagocytosis, respiratory burst and the release of various inflammatory mediators (lysosomal enzymes, cytokines, tissue plasminogen activator, chemokines etc.) from neutrophils, macrophages and mastocytes. Additionally the immune system is suppressed by corticosteroids due to a decrease in the function of the lymphatic system, a reduction in immunoglobulin and complement concentrations, the precipitation of lymphocytopenia, and interference with antigen-antibody binding.

Dosage & Administration Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Hydrocortisone Acetate should be applied in a small quantity to the affected area 2 or 3 times daily.

Contraindications Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Infections: bacterial, viral, fungal.
Skin ulcers.
Hypersensitivity to the preparation.

Side Effects Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Topicort 1% cream is usually well-tolerated, but if signs of hypersensitivity appear, application should be stopped.

Pregnancy & Lactation Indications of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

There is inadequate evidence for safety in human pregnancy. It is recommended that topical corticosteroids should not be used extensively during pregnancy. It is highly unlikely that sufficiently high blood levels of Hydrocortisone are achieved during topical therapy to reach breast milk.

Therapeutic Class of Cream :Topicort 1% 20gm tube (AS A Topicort Hydrocortisone Acetate AS A Other Topical corticosteroids).

Raiyyan Tahsan Date:24-01-2025 Friday Time:5-31-45 PM

Raiyyan Tahsan

Raiyyan Tahsan