Dermatology Case No 29.Scaly Papular Rash.

Hello I'm Raiyyan Tahsan

Brand Model and Executive

Dermatology Case No 29.Scaly Papular Rash.

সিনারিও- মাহি ১৭ বছর বয়স, Lip এর চারপাশে এমন scaly papular rash নিয়ে আসছে, এখানে Burning Sensation হয়, pain and discomfort হয়, কোনো itching নাই—

Dx and Rx…….

Dx… perioral dermatitis. এইটাকে Lip licking Dermatitis ও বলা হয়–

এইটা শুধু excessive Lip licking এর কারণেই হয়, বিষয় টা এমন না–

Lip licking একটা কারণ, অন্যান্য কারণের মধ্যে রয়েছে smoking, food Allergy, less water intake. Dry /Cold weather….

অতিরিক্ত salivation এর কারণেও এমন হতে পারে–

উপসর্গের মধ্যে mouth এর চার পাশে, নাকের চারপাশে কিংবা চোখের চারপাশে blister Like rash হয়, Burning হয়,

চিকিৎসা – Treatment Management :-

যে কোন Eczema তে steroid ব্যবহার করা হয়, কিন্ত Perioral dermatitis এ steroid ব্যবহার করা যাবেনা,

AAD (American Academy of dermatology) steroid ব্যবহার করা Contraindicated বলেছে–

steroid এ প্রথম ৫-৭ দিনে symptoms দ্রুত improve হলেও পরবর্তীতে এইটা severely exacerbated হবে–

তাই steroid দেওয়া হবেনা–

তা ছাড়া এইটা Atopic dermatitis না যে, এখানে steroid দিতে হবে–

steroid যেহেতু দেওয়া যাবেনা, তাই চিকিৎসা কি?

চিকিৎসা —

নিয়মিত ভেসলিন দিবে-

Tacrolimus cream:-

Ointment 1.Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Remus ointment is indicated for short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis in whom the use of alternative, conventional therapies are deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant of alternative, conventional therapies. Remus ointment is also indicated in other skin conditions such as chronic cutaneous graft-vs-host disease, hand and foot eczema, allergic contact dermatitis, vitiligo, psoriasis, lichen planus, facial lichen, vulvar lichen sclerosus, pyoderma gangrenosum, leg ulcers in rheumatoid arthritis, steroid-induced rosacea & alopecia areata, annular erythema, chronic actinic dermatitis and recalcitrant facial erythema.

Pharmacology Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Tacrolimus is a macroiide immunomodulator produced by fungus, Streptomyces tsukubaensis. It has been demonstrated that Tacrolimus inhibits T-lymphocyte activation by first binding to an intracellular protein, FKBP-12. A complex of Tacrolimus-FKBP-12, calcium, calmodulin, and calcineurin is then formed and the phosphatase activity of calcineurin is inhibited. This leads to a general decrease in the entire inflammatory cascade.

Dosage & Administration Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Use in adults: Apply a thin layer of Tacrolimus ointment onto the affected skin areas twice daily and rub in gently and completely. Treatment should be continued for one week after clearing of signs and symptoms of atopic dermatitis. The safety of Tacrolim ointment under occlusion which may promote systemic exposure has not been evaluated. Tacrolimus ointment should not be used with occlusive dressings.

Use in Children:

Tacrolimus 0.03% ointment can be used in pediatric patients 2 years of age and older.
Tacrolimus 0.1% ointment can be used in children 16 years of age and older.

Use in Elderly Patients: Patients >65 years old received Tacrolimus ointment in phase 3 studies. The adverse event profile for these patients was consistent with that for other adult patients.

Interaction Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Formal topical drug interaction studies with Remus ointment have not been conducted. The concomitant administration of known CYP3A4 inhibitors in patients with widespread and/or erythrodermic disease should be done with caution. Some examples of such drugs are erythromycin, itraconazole, ketoconazole, fluconazole, calcium channel blockers and cimetidine.

Contraindications Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Tacrolimus ointment is contraindicated in patients with a history of hypersensitivity to Tacrolimus or any other component of the preparation.

Side Effects Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Topically applied Remus ointment have very few and rare type of side-effects including skin burning, pruritus, flu-like symptoms, allergic reactions, skin erythema, skin infections, headache, etc.

Pregnancy & Lactation Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Pregnancy Category C. There are no adequate and well-controlled studies of topically administered Tacrolimus in pregnant women. Although systemic absorption of Tacrolimus following topical applications of Tacrolimus ointment is minimal relative to systemic administration, it is known that Tacrolimus is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Tacrolimus, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings

Cautions should be exercised while treatment with Remus ointment in patients with atopic dermatitis predisposed to superficial skin infections. The safety of Remus ointment has not been established in patients with generalized erythroderma.

Overdose Effects Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Remus ointment is not for oral use. Accidental oral ingestion of Remus ointment may lead to adverse effects associated with systemic administration of Remus. If oral ingestion occurs, medical advice should be sought.

Therapeutic Class Indications of Ointment:-Remus 0.03% 10gm tube (AS A Tacrolimus Monohydrate AS A Drugs affecting the immune response).

Drugs affecting the immune response

Remus ( দিনে ২ বার করে ১ মাস)

Remus দিয়ে improve না হলে Azelec acid add করবে–

বেশি বেশি পানি পান করবে,

Cream 2.Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Indications of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Azelec cream is indicated for the topical treatment of mild to moderate inflammatory acne vulgaris.

Pharmacology of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Azelaic acid has been shown to possess antimicrobial activity against Propionibacterium acnes and Staphylococcus epidennidis. The antimicrobial action may be attributable to the inhibition of microbial cellular protein synthesis. A normalization of keratinization leading to an anticomedonal effect of Azelaic acid may also contribute to its clinical activity.

Dosage & Administration of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

After the skin is thoroughly washed and patted dry, a thin film of Azelaic Acid should be gently but thoroughly massaged into the affected areas twice daily, in the morning and evening. The hands should be washed following application. Safety and effectiveness in pediatric patients under 12 years of age have not been established. Or as directed by the physician.

Contraindications of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Azelaic acid is contraindicated in individuals who have shown hypersensitivity to any of its components.

Side Effects of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Local skin irritation (e.g. erythema, scaling, itching or burning) occurs in occasional cases, usually at the start of treatment. However, in the majority of cases the irritation is mild and regresses as treatment continues.

Pregnancy & Lactation

FDA Pregnancy Category B. This drug should be used during pregnancy only if clearly needed. Caution should be exercised when Azelaic acid is administered to a nursing mother.

Precautions & Warnings of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

For external use only. If Azelec comes into contact with the eyes they should immediately be thoroughly rinsed with copious amounts of water. The patients should consult a physician if eye irritation persists.

Therapeutic Class of Cream:-Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

Acne treatment preparations

avoid triggering substance.

Smoking, lip licking…increase water intake..

General Queries:

1: Can I use any topical Antibiotic?

Answer is:-dewa jabe..

Topical erytromycin, Metronidazole, azelec acid je kono ekta dewa jabe.

2.Azelac cream ta koidin continue korbe r dose sathe ki Remus cholbe??

Answer is:yes duitai cholbe for 6 week.

Raiyyan Tahsan Date:28-01-2025 Tuesday Time:- 1-12-45 PM

Raiyyan Tahsan

Raiyyan Tahsan