Dermatology Case No 40.Hand Eczema.

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Dermatology Case No 40.Hand Eczema.

গ্রীক word, Ekzein অর্থ হচ্ছে Boil over / Break out.

Eczema তে স্কিন এর Epidermis and dermis layer এ itching and scaly লেশন তৈরি হয়, এবং দেখতে মনে হয় স্কিন লেয়ার break out হয়েছে, তাই skin break out এর মিনিং মাথায় রেখে গ্রীক শব্দ Eczein থেকে eczema নামকরণ করা হয়, সাধারণত Eczema কে Dermatitis ও বলা হয়,

Derm শব্দের অর্থ স্কিন, itis =inflammation

Dermatitis =inflammation on skin.

একজিমা একটা Broad Term, skin এর redness, dryness, itchiness, and scaly lesion থাকলে এই কন্ডিশন কে eczema বলে, একজিমার বিভিন্ন প্রকার রয়েছে,

একজিমার সবচেয়ে কমন প্রকার হচ্ছে Atopic Dermatitis.

যাদের atopic disease আছে, তারা সাধারণত Atopic dermatitis এ বেশি আক্রান্ত হয়,

atopic disease = Asthma, allergy, Hay fever

অর্থাৎ যাদের এলার্জি আছে, কিংবা অ্যাজমা আছে,

তাদের একজিমা হবার প্রবণতা অন্যদের থেকে অনেক বেশি,

According to American dermatology Association.

একজিমার সঠিক কোনো কারণ জানা যায়নি,

তবে ফেমিলি হিস্ট্রি, জেনেটিক ফ্যাক্টর, অতিরিক্ত stress কে একটা risk factor for eczema হিসাবে চিহ্নিত করা হয়েছে,,,সাথে increased level of Serum IgE,

অর্থাৎ যাদের serum IgE level বেশি, তাদের একজিমার ঝুঁকি বেশি, আবার একজিমা হলেও serum IgE চেক করলে তা নরমাল লেভেল থেকে বেশি থাকবে,

increased igE level provide diagnostic clue for atopic dermatitis /Atopic eczema.

একজিমা সাধারণত Redness of skin with severe itching দিয়ে শুরু হয়>>>তারপর চুলকাতে চুলকাতে skin থেকে oozing of clear fluid অথবা bleeding হতে পারে,

রোগী বলবে, প্রচুর চুলকায়, চুলকাতে চুলকাতে রক্ত পানি বের হয়ে যায়, এইভাবে কিছুদিন পর দেখা যায়, জায়গা জায়গা লাল হয়ে আছে, Crusting হয়ে থাকে, আবার শুকিয়ে যায়, একসময় scaly বা আঁশের মত শুকনা হয়ে যায়,. Skin surface elevated হয়ে plaque তৈরি করে।

সাধারণত inside of elbow.. হাঁটুর পিছনে, নেক এর সামনে Atopic dermatitis এর র‍্যাশ সমুহ দেখা যায়, এবং infront of Ankle.. ২-৭ বছরের বাচ্চাদের ক্ষেত্রে face, lateral aspect of both upper and Lower limb হতে পারে।

Investigation : CBC করলে eosinophil count বাড়বে)

Serum IgE = বাড়বে

চিকিৎসা —

যেহেতু এনার্জির সাথে একজিমার একটা সমপর্ক আছে, তাই চিকিৎসা করার সময় এই বিষয় খেয়াল রাখবে-

১… Anti histamine

২.. Topical steroid

৩. Emolent

৪… Precaution

Anti histamine কোন টা দিবেন?

itching বেশি থাকলে sedative Antihistamine or 1st Generation antihistamine দিবে যদি কোনো অসুবিধা না থাকে, (students +driver দের কে 2nd Generation anti histamine দিবে)

Tab- Xyril 10 mg

0+0+1 (21 days) (1st Generation)

Tab- Alcet 5 mg

0+0+1 (21 days) 2nd G

Tablet 1- Alcet 5 mg (AS A Levocetirizine Dihydrochloride AS A 2nd Generation AS A Non-sedating antihistamines).

0+0+1 (21 days) 2nd G

Emolent lotion দিনে ২-৩ বার করে ১ -২ মাস

Topical steroid (Betamethasone, Halobet etc)

Cream 1.Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Indications of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Betameson cream and ointment is
indicated for the relief of the inflammatory and pruritic manifestations of resistant or severe corticosteroid-responsive dermatoses. These include-

Atopic eczema
Nummular eczema
Contact dermatitis
Neurodermatitis
Anogenital and senile pruritus
Lichen planus
Psoriasis

Pharmacology of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Betamethasone Dipropionate is a topical corticosteroid with anti-inflammatory, antipruritic and vasoconstrictive properties. Betamethasone Dipropionate induces peptides called lipocortins. Lipocortins antagonize phospholipase A2, an enzyme that causes the breakdown of leukocyte lysosomal membranes to release arachidonic acid. This action decreases the subsequent formation and release of endogenous inflammatory mediators including prostaglandins, kinins, histamine.

Pharmacokinetics: Betamethasone Dipropionate can be absorbed from normal intact skin. Corticosteroids are bound to plasma proteins in varying degrees. Corticosteroids are metabolized primarily in the liver.lt excreted by the kidneys.

Dosage & Administration of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Apply a thin film once or twice daily to cover completely the affected area. Patients with chronic psoriasis who have achieved at least a marked improvement in their psoriatic lesion (i.e., approximately 80% improvement) with Betamethasone Dipropionate may be maintained in remission with a pulse dosing regimen consisting of three consecutive applications of up to 3.5 g each of Betamethasone Dipropionate cream and ointment, twelve hours apart (e.g., morning, evening, following morning) to the previously affected areas once each week. For this purpose, Betamethasone Dipropionate cream and ointment should be applied to the lesion sites previously affected and treated. Patients on this pulse dose regimen who relapse should be reverted back to the conventional dosing regimen.

Interaction of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

There is no evidence of any kind of interaction.

Contraindications of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Hypersensitivity to Betamethasone Dipropionate, other corticosteroids or any components in this preparation. Like other topical corticosteroids, Betamethasone Dipropionate is contraindicated in viral infections of the skin, such as vaccinia, varicella and Herpes simplex, also tuberculosis, acne rosacea, fungal skin infections (moniliasis), perioral dermatitis and ulcerative conditions.

Side Effects of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

The most frequent side effects reported with Betameson are mild to moderate transient burning/stinging, dry skin, pruritus, irritation and folliculitis. Rarely reported adverse effects include tingling, prickly skin/tightening or cracking of skin, warm feeling,laminar scaling and perilesional scaling,follicular rash, skin atrophy, erythema, urticaria, vesiculation, telangiectasia, acneiform papules and hyperaesthesia.

Adverse reactions reported with the use of the Betameson ointment pulse dose regimen were mild intermittent hypertension and paraesthesia. Other local adverse reactions that have been reported with the use of topical corticosteroids include: itching, hypertrichosis, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, striae, miliaria and exacerbation of untreated infections

Precautions & Warnings of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Betameson should not be used in or near the eyes, as there is a potential risk of developing glaucoma and cataract. If irritation or sensitisation develops with the use of Betameson, treatment should be discontinued and appropriate therapy instituted. In the presence of an infection, an appropriate antifungal or antibacterial agent should be administered. If a favourable response does not occur promptly, Betameson should be discontinued until the infection has been controlled adequately.

Corticosteroids are known to be absorbed percutaneously, therefore in patients under prolonged and extensive topical treatment, the possibility of systemic effects should be kept in mind. Betameson is not intended for use under occlusive dressings since this will also increase systemic absorption of the corticosteroid. In infants the napkin may act as an occlusive dressing and increase absorption. Suitable precautions should be taken when using topical corticosteroids in patients with stasis dermatitis and other skin diseases with impaired circulation. Prolonged use of topical corticosteroid preparations may produce striae or atrophy of the skin or subcutaneous tissue. If this occurs, treatment should be discontinued.

Overdose Effects of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Acute overdose with the ointment is unlikely and would not be expected to lead to a life-threatening situation. The ointment should not be used for longer than the prescribed time period.

Therapeutic Class of Cream:-Betameson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Corticosteroid

Or Cream 2. Halobet:-

Cream 2.Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Indications of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Halobet 0.05% is a super-high potent corticosteroid indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Treatment beyond two consecutive weeks is not recommended, and the total dosage should not exceed 50 gm/week because of the potential for the drug to suppress the Hypothalamic-Pituitary-Adrenal (HPA) axis.

Pharmacology of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Like other topical corticosteroids, halobetasol propionate has anti-inflammatory, antipruritic and vasoconstrictive actions. The mechanism of the anti-inflammatory activity of the topical corticosteroids, in general, is unclear. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2 .

Dosage & Administration of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Apply a thin layer of Halobetasol Cream or Ointment to the affected skin once or twice daily, as directed by the physician, and rub in gently and completely. Halobetasol 0.05% is a super-high potency corticosteroid; therefore, treatment should be limited to two weeks, and amounts greater than 50 gm/week should not be used. As with other highly active corticosteroids, therapy should be discontinued when control has been achieved. If no improvement is seen within 2 weeks, reassessment of the diagnosis may be necessary. Halobetasol should not be used with occlusive dressings.

Contraindications of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Halobetasol Propionate Cream/Ointment is contraindicated in those patients with a history of hypersensitivity to any of the components of the preparation.

Side Effects of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

The following adverse effects have been reported infrequently with topical corticosteroids. These reactions include burning, itching, dryness, folliculitis acne, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin atrophy, secondary infections, striae and miliaria.

Pregnancy & Lactation

Topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in breast milk. Therefore caution should be exercised when topical corticosteroids are administered to a nursing woman.

Precautions & Warnings of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Systemic absorption of topical corticosteroids may cause reversible Hypothalamic-Pituitary-Adrenal (HPA) axis suppression, manifestations of cushing’s syndrome, hyperglycemia, and glucosuria. Patients receiving large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid.

Use in Special Populations

Use in children under 12 years of age is not recommended. Safety and effectiveness of Halobet cream & ointment in paediatric patients have not been established. Paediatric patients are at greater risk than adults of HPA axis suppression when they are treated with topical corticosteroids.

Therapeutic Class of Cream:-Halobet 0.05% 20gm Tube (AS A Halobetasol Propionate AS A Other Topical corticosteroids).

Indications of Cream:-Emolent [15%+6% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

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

Pharmacology of Cream:-Emolent [15%+6% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

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% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

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% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

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

Pregnancy & Lactation

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

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% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

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% ] (As A White Soft Paraffin + Liquid Paraffin As A Emollients & combined preparations) 25gm Tube

Emollients & combined preparations

দিনে ১-২ বার, (১ মাস)

চুলকানি কমানোর জন্য আর লোকালি irritation কমানোর জন্য Topical steroid দিবে,

অনেক প্রকার স্টেরয়েড আছে, কখন কোনটা দিবে, তা আমাদের ক্লাসে বিস্তারিত আলোচনা করা হবে,

সাধারণত Hydrocortisone (Topicort cream) দেওয়া হয়,

Cream 2.Topicort 1% daily 2 bar (As A Hydrocortisone Acetate As A Other Topical corticosteroids).

Topicort:-

Cream2: Topicort 1% 20gm tube (AS A Hydrocortisone Acetate AS A Other Topical corticosteroids).

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).

একজিমা যাদের একবার হয়, তাদের এইটা স্থায়ী ভাবে ভালো হয়না, তাই কাউন্সেলিং করা অনেক গুরুত্বপূর্ণ,

এইসব ঔষধ ব্যবহার করলে সাধারণত ৩-৪ মাস ভালো থাকবে, আবার হতে পারে, হলে আবার এই চিকিৎসা চালিয়ে নেবে,

Raiyyan Tahsan. Date:-05-02-2025 Wednesday Time:-8-49-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan