Dermatology Case No 30.Scabies-1.

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Dermatology Case No 30.Scabies-1.

1st line Drug of choice : permethrin 5 %

Cream 1: Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

99% এইটাতেই রেসপন্স করবে,

Indications of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Arotrix cream is indicated for the treatment of scabies and crab lice infestations (Pediculosis). Scabies can affect everyone in the family. If one is infected, all family members must be treated together.

Pharmacology of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Permethrin cream contains Permethrin, a pyrethroid, which is a topical scabicidal agent for the treatment of infestation with Sarcoptes Scabiei (scabies). It acts on the nerve cell membrane to disrupt the sodium channel current by which the polarization of the membrane is regulated. Delayed repolarization & paralysis of the pests are the consequences of this disturbance.

Pharmacokinetics: The only approved route of administration is the topical route and there are few human data available on systemic exposure or kinetics following permethrin application to the skin. Some presystemic metabolism occurs in skin. Less than 0.5% of applied permethrin is absorbed during the first 48 hours. Absorbed permethrin is rapidly metabolized by ester hydrolysis, most likely in the liver and the products are excreted primarily in the urine.

Dosage of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Recommended duration of Treatment:

Adults and children over 12 years: a full tube
Children aged 6-12 years: up to 1⁄2 of a tube
Children aged 1-5 years: up to ¼ of a tube
Children aged 2 months to 1 year: up to ⅛ of a tube
Children Less then 2 month: dose is not established

Administration of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Before application of Permethrin cream the skin should be clean, cool and dry. Do not have a hot shower or bath before applying.

For adults and children over 2 years: Apply the cream to the whole body from the neck down, rubbing lightly into the skin until the cream disappears. It is important to include all skin surfaces, such as between the fingers and toes, under the nails and on the soles of the feet.

For babies under 2 years: Apply to the face, neck, ears and scalp as well, only avoiding the area immediately around the eyes and mouth.

Leave cream on for at least 8 hours, before washing off. Reapply to any area that may be washed during the 8h treatment time (such as after washing the hands). If necessary, permethrin cream should be used again after 7 days as per the advice of the doctor.

Interaction of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

The treatment of eczemodous like reactions with corticosteroids should be withheld prior to treatment with Arotrix, as there is a risk of exacerbating the scabies infestation by reducing the immune response to the mite.

Contraindications of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Permethrin is contraindicated in patients with known hypersensitivity to any component of pyrethroids or permethrin. Nursing staff who routinely apply permethrin may wear globes to avoid any possible irritation to the hands.

Side Effects of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

In Scabies patients, skin discomfort, usually described as burning, stinging or tingling occurs in a few individuals soon after the cream is applied. Others transient signs and symptoms of irritation including enythema, edema, eczema, rash and puritis.

Pregnancy & Lactation of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

In the absence of specific studies in pregnant women, its use in pregnancy should only follow medical advice. It is not known whether permethrin is excreted in human milk so it should not be used in nursing mothers.

Precautions & Warnings of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Scabies infestation is often accompanied by pruritus, edema & erythema. Treatment with Arotrix may temporarily exacerbate these conditions. Patients should be advised to avoid contact with eyes during application & to flash with water immediately if the cream gets in the eyes.

Therapeutic Class of Cream : Arotrix 5% 30gm tube (As A Permethrin As A Parasiticidal preparations).

Parasiticidal preparations

যদি না করে—-

Benzyl benzoate

Benzyl lotion নামে পাওয়া যায়,

Emulation lotion 2:Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

Indications of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

Ascabiol is indicated for-

Scabies
Pediculosis pubis and capitis

Pharmacology of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

Benzyl Benzoate is used in the treatment of ectoparasites such as scabies and pediculosis. Benzyl benzoate in concentrations of 10-20% v/v is toxic to sarcoptes scabiei as well as pediculosis. In vitro, the sarcoptes mite is killed in 5 minutes in benzyl benzoate. It’s mechanism of action is unclear but in view of its effects on vertebrates, it is thought that it may act on the nervous system of the parasite.

Dosage & Administration of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

Scabies: After a hot bath and drying, it is applied to the whole body except the head and face. If the application is thorough, one treatment should suffice, but the possibility of failure is lessened if a second application is made within 5 days of the first. Alternatively, Scabisol can be applied to the whole body, except the head and face, on three occasions at 12 hourly intervals. The patient has a hot both 12 hours after the last application and changes to clean clothes and sheets.

Pediculosis: The affected region is coated with Scabisol followed by a wash 24 hours later with soap and water. In severe cases this procedure may need to be repeated two or three times. An examination should always be made a week after the last treatment to confirm disinfestation.

USE IN CHILDREN: It can be diluted with an equal quantity of water for older children and with three parts of water for babies.

Interaction of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

No hazardous interactions have been reported.

Contraindications of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

It should not be used on the face due to its irritant effect on the risk, and should not be used on broken or irritant skin.

Side Effects of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

It is irritant to the eyes and mucous membrane and it may be irritant to the skin. Hypersensitivity reactions have been reported. Systemic symptoms have been reported following excessive topical use.

Pregnancy & Lactation of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

There is inadequate evidence of the safety of Benzyl benzoate in human pregnancy, but it has been widely used without apparent ill consequence. Nevertheless, it should not be used during pregnancy unless considered essential. Breast feeding should be suspended during treatment with Benzyl benzoate. Feeding may be restarted after the emulsion has been washed off the body.

Precautions & Warnings

It causes little skin irritation, but may cause a transient burning sensation. This is usually mild but can occasionally be severe in sensitive individuals. In the event of a severe skin reaction, the preparation should be washed off using soap and warm water. It is also irritating to the eyes, therefore these should be protected if it is applied to the scalp.

Therapeutic Class of Emulation lotion :Ascabiol 25% 100 ml bottle (As A Benzyl benzoate As A Parasiticidal preparations, Topical Antifungal preparations)

Parasiticidal preparations, Topical Antifungal preparations

অনেক সময় দেখা যায়, যদি permethrin e response না করে,

তখন permethrin +Cortamiton এর কম্ভিনেশনে ভালো কাজ করে।

Lotion 4.Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Indications of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

This lotion is indicated for the treatment of scabies and pruritus. Moreover, it is used for the relief of itching and skin irritation like as sunburn, dry eczema, itchy dermatitis, allergic rashes, hives, nettle rash, chickenpox, insect bite and stings, heat rashes and personal itching.

Pharmacology of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

This Lotion is a topical antipruritic and scabicidal agent. It is effective against Sarcoptes scabiei. It is used in pruritus and other skin infections. This is available as a lotion for topical use.

Permethrin is a pyrethroid pediculocide and scabicide. It causes paralysis and death of the pest by inhibiting sodium ion influx through nerve cell membrane channels delaying repolarisation. Crotamiton has scabicidal and antipruritic action against Sarcoptes scabei. It is an effective pediculocide as well.

Dosage of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Adults (including the elderly): After the patient has taken a warm bath, the skin should be well dried and Crotam Plus rubbed into the entire body surface (excluding the face and scalp) until no traces of the preparation remain visible on the surface. The application should be repeated once daily, preferably in the evening, for a total of 3-5 days. Depending on the response, special attention should be paid to sites that are particularly susceptibly to infestation by the mites (e.g. interdigital spaces, wrists, axillae and genitalia). Areas where there is pus formation should be covered with a dressing impregnated with this lotion. While the treatment is in progress the patient may take a bath shortly before the next application. After completion of the treatment, a cleansing bath should be taken followed by a change of bed linen and underclothing.

Children: Application as described for adults but in children under 2 years of age this lotion should not be applied more than once a day.

Administration of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Treatment procedure: Before application of Crotam Plus lotion the skin should clean, cool and dry.

For adults and children over 2 years: Apply the lotion to the whole body from the neck down, rubbing lightly into the skin until the lotion disappears. It is important to include all skin surfaces, such as between the fingers and toes, under the nails and on the soles of the feet.

For babies under 2 years: Apply to the face, neck, ears and scalp as well, only avoiding the area immediately around the eyes and mouth. Leave lotion on for at least 8 hours, before washing off. Reapply to any area that may be washed during the 8 hours treatment time (such as after washing the hands).

Patients of >2 month of age can use the lotion.

As scabies is highly contagious other members of the family should use this medicine as preventive in the same way.

Interaction of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

The treatment of eczematous-like reactions with corticosteroids should be withheld prior to treatment with Permethrin and Crotamiton lotion, as there is a risk of exacerbating the scabies infestation by reducing the immune response to the mite.

Contraindications of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Permethrin and Crotamiton lotion is contraindicated in individuals with a known allergy to permethrin, its components, other pyrethroids or pyrethrins.

Side Effects of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

In scabies patients, skin discomfort, usually described as burning, stinging or tingling occurs in a few individuals soon after the lotion is applied. Other transient signs and symptoms of irritation including erythema, edema, eczema and rash which may follow the treatment of scabies with Permethrin and Crotamiton lotion are generally considered to be the part of the natural history of scabies.

Pregnancy & Lactation of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

There is no experience to judge the safety of Permethrin and Crotamiton in pregnancy, therefore it is not recommended during pregnancy, especially in the first three months. It is not known whether the active substance passes into breast milk. Nursing mothers should avoid applying it in the area of the nipples.

Precautions & Warnings of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Nursing staff, who routinely apply Permethrin and Crotamiton lotion, may wear gloves to avoid any possible irritation to the hands. Avoid contact with the eyes. The lotion can cause eye irritation. If lotion goes to the eye, rinse with water immediately.

Overdose Effects

There are no reports of over dosage with Permethrin and Crotamiton lotion. It is possible that excessive application of Permethrin and Crotamiton lotion might result in localized adverse reactions or more severe skin reactions.

Therapeutic Class of Lotion:-Lorix Plus (5%+10%) 60ml Bottle AS A (Permethrin +Crotamiton) AS A (Local Antipruritic, Parasiticidal preparations).

Local Antipruritic, Parasiticidal preparations

এইগুলি তে কাজ না করলে

Oral Ivermectin :

Tablet 4.Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Indications of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Alice tablet is indicated for the treatment of-

Strongyloidiasis
Onchocerciasis
Filariasis
Scabies &
Head lice.

Strongyloidiasis of the intestinal tract: Alice is indicated for the treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis. This indication is based on clinical studies of both comparative and open-label designs, in which 64-100% of infected patients were cured following a single 200-mcg/kg dose of Alice.

Onchocerciasis: Alice is indicated for the treatment of onchocerciasis due to the nematode parasite Onchocerca volvulus. This indication is based on randomized, double-blind, placebo-controlled and comparative studies conducted in 1427 patients in onchocerciasis-endemic areas of West Africa. The comparative studies used diethylcarbamazine citrate (DEC-C).

Pharmacology of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Ivermectin selectively binds and with high affinity to glutamate-gated chloride ion channels, which occur in invertebrate nerve and muscle cells leading to an increase in the permeability of cell membranes to chloride ions with hyperpolarization of the nerve or muscle cell and, ultimately, death of the parasite.

Dosage & Administration of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

For Treatment (If COVIO Positive): 2 Tablets of Ivermectin 6 mg once daily for 5 days. (2+0+0 for 5 days).
For Prophylaxis: Single-dose as mentioned below to be taken on Day 1 & same dose on Day 7.

Body Weight 15-24 kg: 1 Tablet of Ivermectin 3 mg
Body Weight 25-35 kg: 1 Tablet of Ivermectin 6 mg
Body Weight 36-50 kg: 1 Tablet of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg
Body Weight 51-65 kg: 2 Tablets of Ivermectin 6 mg
Body Weight 66-79 kg: 2 Tablets of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg
Body Weight >80 kg: 3 Tablets of Ivermectin 6 mg

Strongyloidiasis: The recommended dosage of Ivermectin for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg/kg of body weight. Patients should take tablets on an empty stomach with water. In general, additional doses are not necessary. However, follow-up stool examinations should be performed to verify eradication of infection.

Dosage Guidelines for Ivermectin for Strongyloidiasis:

Body Weight (kg) 15-24: Dose 3 mg/kg
Body Weight (kg) 25-35: Dose 6 mg/kg
Body Weight (kg) 36-50: Dose 9 mg/kg
Body Weight (kg) 51-65: Dose 12 mg/kg
Body Weight (kg) 66-79: Dose 15 mg/kg
Body Weight (kg) >80: Dose 200 mcg/kg

Onchocerciasis: The recommended dosage of Ivermectin is a single oral dose designed to provide approximately 150 mcg of Ivermectin per kg of body weight on an empty stomach with water, the most commonly used dose interval is 12 months. For the treatment of individual patients, retreatment may be considered at intervals as short as 3 months.

Dosage Guidelines for Ivermectin for Onchocerciasis:

Body Weight (kg) 15-25: Dose 3 mg/kg
Body Weight (kg) 26-44: Dose 6 mg/kg
Body Weight (kg) 45-64: Dose 9 mg/kg
Body Weight (kg) 65-84: Dose 12 mg/kg
Body Weight (kg) >85: Dose 150 mcg/kg

Interaction of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Post-marketing reports of increased INR (International Normalized Ratio) have been rarely reported when Alice was co-administered with warfarin.

Contraindications of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

It is contraindicated in patients who are hypersensitive to any component of this product.

Side Effects of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Strongyloidiasis: In four clinical studies involving a total of 109 patients given either one or two doses of 170 to 200 mcg/kg of Alice, the following adverse reactions were reported as possibly, probably, or definitely related to Alice.

Body as a whole: asthenia/fatigue (0.9%), abdominal pain (0.9%)
Gastrointestinal: anorexia (0.9%), constipation (0.9%), diarrhea (1.8%), nausea (1.8%), vomiting (0.9%) Nervous System/Psychiatric: dizziness (2.8%), somnolence (0.9%), vertigo (0.9%), tremor (0.9%)
Skin: pruritus (2.8%), rash (0.9%), and urticaria (0.9%).

Onchocerciasis: arthralgia/synovitis (19.3%), axillary lymph node enlargement and tenderness (11.0% and 4.4%, respectively), cervical lymph node enlargement and tenderness (5.3% and 1.2%, respectively), inguinal lymph node enlargement and tenderness (12.6% and 13.9%, respectively), other lymph node enlargement and tenderness (3.0% and 1.9%, respectively), pruritus (27.5%), skin involvement including edema, papular and pustular or frank urticarial rash (22.7%), and fever (22.6%), abnormal sensation in the eyes, eyelid edema, anterior uveitis, conjunctivitis, limbitis, keratitis, and chorioretinitis or choroiditis. These have rarely been severe or associated with loss of vision and have generally resolved without corticosteroid treatment. The following adverse reactions have been reported since the drug was registered overseas: hypotension (mainly orthostatic hypotension), worsening of bronchial asthma, toxic epidermal necrolysis, and Stevens-Johnson syndrome.

Pregnancy & Lactation of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Pregnancy Category C. Ivermectin does not appear to be selectively fetotoxic to the developing fetus. There are, however, no adequate and well-controlled studies in pregnant women. Ivermectin should not be used during pregnancy since safety in pregnancy has not been established.

Nursing Mothers: Ivermectin is excreted in human milk in low concentrations. Treatment of mothers who intend to breast feed should only be undertaken when the risk of delayed treatment to the mother outweighs the possible risk to the newborn

Precautions & Warnings

Historical data have shown that microfilaricidal drugs, such as diethylcarbamazine citrate (DEC-C), might cause cutaneous and/or systemic reactions of varying severity (the Mazzotti reaction) and ophthalmological reactions in patients with onchocerciasis. These reactions are probably due to allergic and inflammatory responses to the death of microfilariae. Patients treated with Alice for onchocerciasis may experience these reactions in addition to clinical adverse reactions possibly, probably, or definitely related to the drug itself. The treatment of severe Mazzotti reactions has not been subjected to controlled clinical trials. Oral hydration, recumbency, intravenous normal saline, and/or parenteral corticosteroids have been used to treat postural hypotension. Antihistamines and/or aspirin have been used for most mild to moderate cases. After treatment with microfilaricidal drugs, patients with hyperreactive onchodermatitis (sowda) may be more likely than others to experience severe adverse reactions, especially edema and aggravation of onchodermatitis. Rarely, patients with onchocerciasis who are also heavily infected with Loa loa may develop a serious or even fatal encephalopathy either spontaneously or following treatment with an effective microfilaricide. In these patients, the following adverse experiences have also been reported: back pain, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, difficulty in standing/walking, mental status changes, confusion, lethargy, stupor, or coma.

Use in Special Populations of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Pediatric Use: Safety and effectiveness in pediatric patients weighing less than 15 kg have not been established.

Geriatric Use: Clinical studies of Alice did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Therapeutic Class of Tablet:-Alice 12mg (AS A Ivermectin AS A Anthelmintic).

Anthelmintic

Ivermectin ১৫ কেজির উপরের বাচ্চাদের দিবে,

Ivermectin dose:

200 microgram /kg/dose

15 kg হলে 3 mg

প্রতি ৫ কেজির জন্য 1 mg

3 dose দেওয়া হয়,

Day 1.

Day 2

Day 8

ধরুন,

safwana 3 years old baby suffering from scabies, topical permethrin and Benzyl Doesn’t working… Write a prescription for her.

Answer :

Cream: Lorix plus

রাতে লাগাবে, থুতনির নিছ থেকে সারা শরীরে, সকালে ধুয়ে নিবে,

জামা-কাপড় বেড শীট সব ডেটল দিয়ে গরম পানিতে ধুয়ে নিবে,

ফেমিলি মেম্বার কেউ আক্রান্ত থাকলে চিকিৎসা নিবে,

যাদের উপসর্গ নাই, তারাও চিকিৎসা নিবে,

কারণ আক্রান্ত হবার পরে উপসর্গহীন থাকতে পারে

অন্যান্য আক্রান্ত বাচ্চা থেকে দূরে থাকবে।

General Quaries:

1.Baby weight 15 kg er kom hole ivermectin chara ki dibo jodi baki family members ivermectin treatment nei

Answer is:- In that case only topical treatment diben.

2.ivermectin এর ডোজ ২ টা জানতাম ১ সপ্তাহ গ্যাপে। তাতেও বাচ্চাদের অবস্থা খারাপ হয়ে যায়,আর যদি ৫ টা ডোজ দেই তাও কম গ্যাপে তাইলে বাচ্চাদের অবস্থা কি হবে স্যার? এটার টক্সিসিটি তো বেশি

Answer is:-Follow the CDC guidelines.

Tab: Ivera 6 mg

1/2 tab করে

Day 1

DAY 2

Day 8 Raiyyan Tahsan Date:-28-01-2025 Tuesday Time:1-37-55 PM

Raiyyan Tahsan

Raiyyan Tahsan