Dermatology Case No 35. Seborrheic Dermatitis.

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Dermatology Case No 35. Seborrheic Dermatitis.

Seborrheic Dermatitis (SD)/ খুশকী/ Dandruff

dermatology

Sehorrheic Dermatitis(SD)_ Skin এর একটি কমন সমস্যা যেটা Malassezia furfur দিয়ে সাধারণত scalp এ হয়ে থাকে। এটা scaly or Crusted patches…এছাড়া Oily Area যেমন_____

•Face

• Eye brow,

•চোখের চারপাশে

•নাকের পাশে

•কানের কাছে Affected হয়ে থাকে

Scalp এর জন্য Management

Head_&_Shoulder shampoo 1st line in case of Sclap*

2nd লাইন Ketoconazole( Shmpoo Dancel)

কিটোকোনাজল কয়েকদিন ব্যবহার করার পর আর কাজ করে না। এক্ষেত্রে সমাধান কি?

Answer is:-

Shmapoo Clopirox* Topical Antifungal preparations:-

Shampoo 2:- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Indications of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Shampoo is indicated in the treatment of Seborrheic dermatitis, Dandruff, Inflammation and Swelling of the scalp.

Pharmacology of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

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

Dosage & Administration of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Wet hair and apply approximately 1 teaspoon (5 ml) of Ciclopirox Olamine Shampoo to the scalp. Up to 2 teaspoons (10 ml) may be used for long hair. Lather and leave on hair and scalp for 3 minutes. A timer may be used. Avoid contact with eyes. Treatment should be repeated twice per week for 4 weeks, with a minimum of 3 days between applications.

Contraindications of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

This Shampoo is contraindicated in individuals who have shown hypersensitivity to any of its components.

Side Effects of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Candela Shampoo is well tolerated with a low incidence of adverse reactions reported in clinical trials.

Pregnancy & Lactation

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

Precautions & Warnings

Candela Shampoo is not for ophthalmic, oral, or intravaginal use.

Use in Special Populations

No clinical trials have been conducted in subjects younger than 16 years.

Therapeutic Class of Shampoo :- Candela 1% 100 ml bottle (AS A Ciclopirox Olamine AS A Topical Antifungal preparations).

Topical Antifungal preparations

If ketoconazole + zinc pyrithione failed or hairfall visualized

Then coal tar + salicylic acid lotion or shampoo is very effective

Coal tar shampoo 3:-Polytar 1% shampoo 150ml Bottle (AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Indications of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Polytar Scalp Shampoo effectively controls dandruff, stubborn dandruff and scalp psoriasis. Polytar has a unique formulation containing: natural tars to clear scales, relieve itching and inflammation, and slow the rate of skin cell growth oils to moisturise the scalp.

Composition

Ingredients:

Crude And Refined Coal Tars
Sodium Laureth Sulfate
Cocamidopropyl Betaine
Disodium Phosphate
Citric Acid
Benzyl Alcohol
Peg-150 Distearate
Hexylene Glycol
Oleyl Alcohol
Polyquaternium-10
Parfum
Water

Pharmacology of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Polytar Scalp Shampoo is a thick, coal-tar based shampoo that soothes irritated skin on the scalp, reducing itchiness, scaling, and inflammation.

These symptoms are often experienced by people with scalp psoriasis or other related skin conditions such as eczema. In these cases, a specially formulated shampoo is required, as standard shampoos often contain irritants that make the condition worse.

Coal tar is proven to provide relief for psoriasis sufferers. It is a thick oil that works on patches of inflamed red skin covered in scales. It moisturises and nourishes the skin to reduce scales and dandruff, and soothes it to make it feel less itchy.

This shampoo can be used by adults and children aged 12 or over.

Dosage & Administration of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Polytar Scalp Shampoo should be used by adults and children over the age of 12, once or twice per week for an initial period of 4 weeks.

First, wet your hair and then massage a small amount of the shampoo into the scalp and any affected areas nearby, using the fingertips. After it has lathered, rinse the scalp well. Repeat this process, ensuring that the shampoo is in contact with scalp for around 3-5 minutes in total over the two applications.

For use for longer than a period of 4 weeks, consult a doctor and use as directed.

Contraindications

Hypersensitivity

Side Effects of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

In rare cases, Polytar Scalp Shampoo is associated with skin reactions due to allergies (rashes, swelling, difficulty breathing). Other possible rare side effects include eye irritation, hair loss, itchy and redskin, change of hair colour or texture, and burning sensations on the skin.

If you are taking other medications, speak to your doctor before using this shampoo, as certain antibiotics and tranquilizers increase sensitivity to sunlight.

Pregnancy & Lactation of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Precautions & Warnings

Keep Polytar Scalp Shampoo away from children, in a cool place. Use eternally only and take care not to get any in the eyes.

Avoid using Polytar if you are allergic to coal tar or any of the listed ingredients. It is not suitable for use by children below the age of 12, and never use on open, damaged, or blistered skin.

In some cases, especially where excessive shampoo is used or it is used more frequently than advised, irritation may occur. This may also occur if the shampoo is in contact with sensitive or inflamed skin. If you experience such a reaction, stop using it.

While using this shampoo, avoid strong sunlight and sunbeds, as some people become extra-sensitive to UV radiation. It’s best to wear protective clothing and sunscreen until you know how you will react. Also, if you are taking other medicines that make you more sensitive to sunlight, seek your doctor’s advice before using this shampoo.

If you are pregnant, avoid using it in the first trimester of pregnancy; consult with your doctor before using while breastfeeding.

Therapeutic Class of shampoo Polytar 1% AS A Coal Tar Solution AS A Coal-tar preparations, Emollients & combined preparations).

Coal-tar preparations, Emollients & combined preparations

Supplement biotin can be given as well

•Tablet 5. Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

1+0+1 (3 month).

Indications of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Floriz is indicated in-

Hair loss
Weak, brittle, splitting or soft nails
Eczema & dermatitis.

Pharmacology of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Biotin is an essential vitamin that is also known as vitamin H. It is involved in vital physiological function like fatty acid synthesis, amino acid catabolism and gluconeogenesis. It acts as a cofactor in the enzymatic carboxylation of pyruvate and acetyl-CoA. Biotin influences the growth and differentiation of epidermal cells and is therefore important for the formation and renewal of the skin, hair and nails. It functions as a coenzyme for mitochondrial carboxylases in hair roots and improves the keratin structure. Biotin deficiency may result in hair loss and a variety of systemic symptoms such as dermatitis, and aciduria. Biotin is one of the most prescribed nutritional supplements for any kind of hair loss.

Dosage & Administration of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Biotin dose varies depending on disease condition and age group.

In adults: Generally 1-3 tablets per day or as advised by the physician.

In children: biotin deficiency affects between 1 week and 2 years of age and usually exhibits seizures, hypotonia, developmental delay, ataxia, hyperventilation, and coma. In this case, 5-10 tablets daily, crushed and mixed with water or any kind of fruit juice or as advised by the physician.

Recommended dietary allowance:

Infants-

0-6 months: 5 mcg/day
7-12 months: 6 mcg/day

Children-

1-3 years: 8 mcg/day
4-8 years: 12 mcg/day

Males and females-

9-13 years: 20 mcg/day
14-18 years: 25 mcg/day
≥19 years: 30 mcg/day

Pregnancy: 30 mcg/day

Lactation: 35 mcg/day

Interaction of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

There are indications that anticonvulsant drugs lower the plasma level of Floriz. Antibiotic use may decrease the Floriz contribution to the body made by the microflora of the large intestine. Excessive consumption of raw egg whites interferes with Floriz absorption.

Contraindications of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Contraindicated in patients with known hypersensitivity to any of the ingredients.

Side Effects of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Well tolerated in the recommended dose. No Floriz toxicity has been reported in individuals supplemented with as much as 200 mg orally or 20mg intravenously per day.

Pregnancy & Lactation of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Sufficient clinical data is not available to use in pregnant women and lactating mother.

Therapeutic Class of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Herbal and Nutraceuticals

Selenium sulphide & topical corticosteroid ও দেয়া যেতে পারে

Body বা Face involved হলে

•Topical Ketoconazol Shampoo 1st line

•Topical Steroid ভালো কাজ করে( Short time এর জন্য )

Cream 1:-Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

Indications of Cream:-Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

The treatment of fungal infections where co-existing symptoms of inflammation e.g. itching, require rapid relief.

All dermatomycoses due to dermatophytes (e.g. Trichophyton species), moulds and other fungi.
All dermatomycoses due to yeasts (Candida species).
Skin diseases showing secondary infection with these fungi
The treatment of nappy rash where infection due to Candida albicans is present.

Pharmacology of Cream. -Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

Clotrimazole is a broad-spectrum antifungal agent active on dermatophytes, yeasts and other fungi. Hydrocortisone is a glucocorticoid with both glucocorticoid and to a lesser extent mineralocorticoid activity. Hydrocortisone is used for replacement therapy in adrenocortical insufficiency.

Dosage & Administration

Apply thinly and evenly to the affected area twice daily.

Contraindications of Cream. -Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

It is contraindicated in patients with known hypersensitivity to any of the components of this preparation.

Side Effects of Cream. -Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

Rarely local mild burning or irritation may be experienced. Hypersensitivity reactions may occur.

Precautions & Warnings

In infants, the napkins may act as an occlusive dressing and increase absorption. Treatment should be for a maximum period of seven days.

Therapeutic Class of Cream. -Neosten Hc 1%+1% 10gm/20gm tube As A (Clotrimazole + Hydrocortisone) As A Hydrocortisone & Combined preparations.

Hydrocortisone & Combined preparations

Recurrence is common

অনেকেই জিজ্ঞেস করেন Shampoo কিভাবে use করবো??

Ketoconazole Shampoo ব্যবহারের নিয়ম____

গোসলের সময় মাথায় ফেনা তৈরী করে 5-10 মিনিট রেখে দিয়ে এর পর ধুয়ে ফেলবেন। ১ দিন পর পর use করতে পারেন___Recurrence এর ক্ষেত্রে প্রয়োজনে বেশি দিন ব্যবহার করা যাবে।

SD & Psoriasis অনেক সময় Confusion করতে পারে___Seborrheic dermatitis Hair line cross করে ! কিন্তু psoriasis কখনো hair line cross করে না।Psoriasis এ history এনেক লম্বা হয়।Extensor surface of limb involve দেখা যায়। স্কিন Dry & Red scale __ Psoriasis এর উপর থেকে Plaque টা অল্প করে তুলে ফেল্লে Bleeding (Red scale) দেখা যাবে। খুব অল্প। যা SD তে হবে না।

Shampoo 2. Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

Indications of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

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

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

Tablet: Treatment of superficial and deep mycoses:

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

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

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

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

Pharmacology of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

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

Dosage & Administration of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

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

Treatment:

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

Prophylaxis:

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

Cream:

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

Tablet:

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

Duration of Treatment-

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

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

Interaction

Shampoo and Cream: No information was found.

Tablet: Reduced absorption with antimuscarinics, antacids, H2-blockers, PPIs and sucralfate. Reduced plasma concentrations with rifampicin, isoniazid, efavirenz, nevirapine, phenytoin. May also reduce concentrations of isoniazid and rifampicin. May reduce efficacy of oral contraceptives. May increase serum levels of CYP3A4 substrates e.g. digoxin, oral anticoagulants, sildenafil, tacrolimus.

Contraindications

Contraindicated in patients with known hypersensitivity to ketoconazole.

Side Effects of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

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

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

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

Pregnancy & Lactation of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

Shampoo: Since ketoconazole is not absorbed through the skin after topical application, pregnancy and lactation are not a contraindication for the use of ketoconazole shampoo 2%.

Cream: There are no adequate and well-controlled studies in pregnant or lactating women. To date, no other relevant epidemiological data are available. Data on a limited number of exposed pregnancies indicate no adverse effects of topical Ketoconazole on pregnancy or on the health of the foetus/newborn child. Animal studies have shown reproductive toxicity following oral administration of Ketoconazole. No effects on the breastfed newborn/infant are anticipated.

Tablet: Pregnancy category C. There is no adequate and well controlled studies in pregnant women. Ketoconazole Tablets should not be used during pregnancy and lactation.

Precautions & Warnings

Shampoo: In patients who have been on prolonged treatment with topical corticosteroids, it is recommended that the steroid therapy be gradually withdrawn over a period of 2 to 3 weeks, while using Dancel shampoo 2%, to prevent any potential rebound effect. Increased hair shedding is often associated with seborrhoeic dermatitis and dandruff, and has been rarely reported with the use of Dancel shampoo 2%. Avoid contact with the eyes. If the shampoo should get into the eyes, they should be bathed with water.

Cream: Not for ophthalmic use. If a potent topical corticosteroid has been used previously in the treatment of seborrhoeic dermatitis, a recovery period of 2 weeks should be allowed before using Dancel 2% w/w cream, as an increased incidence of steroid induced skin sensitisation has been reported when no recovery period is allowed.

Tablet: In patients with a previous history of liver disease, liver enzyme levels should be monitored during treatment. When patients develop symptoms indicative of liver reaction, such as nausea or fatigue, accompanied with pale faeces, dark urine or jaundice, Dancel therapy should be stopped immediately

Overdose Effects

Shampoo: Not expected as Dancel shampoo 2% is intended for external use only. In the event of accidental ingestion, only supportive measures should be carried out. To avoid aspiration, emesis or gastric lavage should not be performed.

Cream: Exaggerated topical application may lead to erythema, oedema and a burning sensation, which will disappear upon discontinuation of the treatment. If accidental ingestion of Dancel 2% w/w cream occurs, no special measures have to be taken.

Therapeutic Class of Shampoo:- Dancel 2% 100ml/120ml Bottle (AS A Ketoconazole AS A Drugs for subcutaneous and mycoses).

Drugs for subcutaneous and mycoses

Raiyyan Tahsan Date:29-01-2025 Wednesday Time:-5-24-45 PM

Raiyyan Tahsan

Raiyyan Tahsan