Dermatology Case No 32. Pregnency time Mild Acne.

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Dermatology Case No 32. Pregnency time Mild Acne.

প্রেগন্যান্সিতে Acne Mx এর জন্য Oral কিংবা Topical Tretinoin / Isotretinoin দেওয়া যাবেনা– এইটা absolutely contraindicated — Long term কোনো ওরাল Antibiotics ও দেওয়ার ও কোনো সুযোগ নাই-

Retigel, Reticap, Doxicap এইগুলি সব Contraindicated..

Cream- Adapalen ও দেওয়া যাবেনা-

Cream 1.Cosmotrin 0.025% 10gm Tube (AS A Tretinoin AS A Topical retinoid and related preparations).

Indications of Cream:-Cosmotrin 0.025% 10gm Tube (AS A Tretinoin AS A Topical retinoid and related preparations).

Cosmotrin 0.1% cream is indicated for the treatment of Pregnancy-Related Abdominal Striae (Stretch Marks). It is also indicated for the topical treatment of acne vulgaris, mottled hyperpigmentation, photo damaged skin, flat warts and other skin conditions eg. icthyosis vulgaris, keratosis follicularis.

Cosmotrin 0.025% cream is indicated for topical application in the treatment of acne vulgaris in which comedones, papules and pustules predominate.

Pharmacology of Cream:-Cosmotrin 0.025% 10gm Tube (AS A Tretinoin AS A Topical retinoid and related preparations).

Although the exact mode of action of Tretinoin is unknown, current evidence suggests that topical Tretinoin decreases cohesiveness of follicular epithelial cells with decreased microcomedo formation. Additionally Tretinoin stimulates mitotic activity and increases turnover of follicular epithelial cells, causing extrusion of the comedones, papules and pustules.

Dosage & Administration

This cream should be applied sparingly to the whole affected area once or twice daily. The skin should be thoroughly cleaned and dried before application. Patient should be advised that 6 to 8 weeks of treatment may be required before a therapeutic effect is observed. Moisturizers and cosmetics may be used during treatment with Tretinoin cream but should not be applied to the skin at the same time. Astringent toiletries should be avoided.

Interaction

Other topical acne treatments should be used with caution during treatment with Cosmotrin. Particular caution should be exercised when using preparation containing a peeling agent for example benzoyl peroxide. It is also possible to apply Cosmotrin and benzoyl peroxide alternately. The suggested regimens are either Cosmotrin in the morning and benzoyl peroxide in the evening or the preparations should be used on alternate days.

Contraindications

Tretinoin is contraindicated to those who are highly sensitive to any of the ingredients. This cream should not be used in patients with a personal or family history of cutaneous epithelioma (skin cancer).

Side Effects

Initial external application of Cosmotrin generally may cause burning or slight irritation, erythema and peeling at the site of application may also occur. If irritation becomes severe and persists, discontinue application and consult your physicians, if necessary.

Pregnancy & Lactation

There is an inadequate evidence of the safety of topically applied Tretinoin in human pregnancy. Tretinoin has been associated with teratogenicity in human when administered systemically. So the cream should not be used during pregnancy and lactation.

Precautions & Warnings

Avoid contact of Cosmotrin with lips, mouth, eyes, eyelids, nostrils or another mucous membrane. If contact in these areas occurs, careful washing with water is recommended. Apply the cream to sensitive areas of skin, such as the neck, with caution. Do not use it on broken, eczematous or sun burned skin.

Therapeutic Class of Cream:-Cosmotrin 0.025% 10gm Tube (AS A Tretinoin AS A Topical retinoid and related preparations).

Topical retinoid and related preparations

Cream 2.Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Indications of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Retigel topical gel is indicated for the treatment of mild to moderate inflammatory and non-inflammatory acne vulgaris.

Pharmacology of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Isotretinoin produces its effects through altering progress through the cell cycle, cell differentiation, survival, and apoptosis. These actions reduce sebum production, preventing the blockage of pores, and growth of acne causing bacteria. Isotretinoin and 4-oxo-isotretinoin both significantly reduce the production of sebum. Isotretinoin has little to no affinity for retinol binding proteins (RBPs) and retinoic acid nuclear receptors (RARs). Tretinoin and 4-oxo-tretinion bind to the RAR-γ receptor, which is suspected to be part of the action of acne treatment by isotretinoin. Isotretinoin induces apoptosis in sebocytes, leading to a decrease in sebum production. Isotretinoin also reduces the formation of comedones by reducing hyperkeratinization through an unknown mechanism. Isotretinoin does not directly kill bacteria but it does reduce the size of sebum ducts and makes the microenvironment less hospitable to acne causing bacteria. It may also increase immune mechanisms and alter chemotaxis of monocytes to reduce inflammation.

Dosage & Administration of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Apply Isotretinoin 0.05% gel cautiously over the affected area once or twice daily. Patients should be advised that 6-8 weeks of treatment may be required before a therapeutic effect is observed. The safety and efficacy of Isotretinoin have not been established in children since acne vulgaris rarely present in this age group. There are no specific recommendations for use in the elderly. Acne vulgaris does not present in the elderly.

Interaction

Concomitant topical medication should be used with caution during therapy with Retigel. Particular caution should be exercised when using preparations containing a peeling agent (for example Benzoyl Peroxide) or abrasive cleansers.

Contraindications

Isotretinoin 0.05% gel is contra-indicated in patients with known hypersensitivity to Isotretinoin.

Side Effects of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

In normal use, Retigel may cause stinging, burning or irritation; erythema and peeling at the site of application may occur. If undue irritation occurs, treatment should be interrupted temporarily and resumed once the reaction subsides. If irritation persists, treatment should be discontinued. Reactions will normally resolve on discontinuation of therapy.

Pregnancy & Lactation of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Pregnancy Category B. There is inadequate evidence of the safety of topically applied Isotretinoin in human pregnancy. Isotretinoin has been associated with teratogenicity in humans when administered systemically. Reproduction studies conducted in rabbits using Isotretinoin applied topically at up to 60 times the human dose have, however, revealed no harm to the foetus. The use of Isotretinoin should be avoided during pregnancy. Percutaneous absorption of Isotretinoin from Isotretinoin 0.05% gel is negligible. It is not known, however, whether Isotretinoin is excreted in human milk. Isotretinoin should not be used during lactation.

Precautions & Warnings

Contact with the mouth, eyes and mucous membranes and with abraded or eczematous skin should be avoided. Care should be taken not to let the medication accumulate in skin fold areas and in the angles of the nose. Application to sensitive areas of skin, such as the neck, should be made with caution. Although Tretinoin has not been shown to initiate or promote carcinogenesis in humans, Tretinoin applied topically to albino hairless mice had resulted in a dose-related acceleration in ultraviolet-B radiation induced cutaneous tumours. The same author also observed the opposite effect in another study of low, non-irritating concentrations of Tretinoin. The significance of these findings as related to man is unknown; however, caution should be observed in patients with a personal or family history of cutaneous epithelioma. Exposure to sunlight of areas treated with Retigel should be avoided or minimised. When exposure to strong sunlight cannot be avoided a sunscreen product and protective clothing should be used. Patients with sunburn should not use Retigel due to the possibility of increased sensitivity to sunlight. The use of sunlamps should be avoided during treatment.

Overdose Effects

Acute overdosage of Retigel has not been reported to date. Accidental ingestion of Retigel resulting in overdosage of Retigel could be expected to induce symptoms of hypervitaminosis A. These include severe headaches, nausea or vomiting, drowsiness, irritability and pruritus.

Therapeutic Class of Cream:-Retigel 0.05% 20gm tube (AS A Isotretinoin AS A Topical retinoid and related preparations.).

Topical retinoid and related preparations

Cream 3. Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Indications of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Fona cream or gel is indicated for topical treatment of acne vulgaris.

Pharmacology of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Adapalene acts on retinoid receptors that are commonly found in the skin of face, back and chest. Biochemical and pharmacological studies have demonstrated that Adapalene is a modulator of cellular differentiation, keratinization, and inflammatory processes, all of that represent important features in the pathology of acne vulgaris. Adapalene binds with specific retinoic acid nuclear receptors that normalize the differentiation of follicular epithelial cells resulting in decreased microcomedone formation. Absorption of Adapalene through human skin is low.

Dosage of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Adapalene 0.1%: It should be applied to the affected areas of skin, once daily at night-time.
Adapalene 0.3%: It should be applied to the entire face and any other affected areas of the skin, once daily in the evening.

Children below 12 years of age: Safety and effectiveness in children below 12 years of age have not been established.

Administration

A thin film of gel or cream should be applied to the skin areas where lesions present, using enough to cover the entire affected areas lightly.

Interaction

Concomitant use of other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, products with high concentrations of alcohol, astringents, spices or lime) should be approached with caution. Exercise particular caution in using preparations containing sulfur, resorcinol or salicylic acid in combination with Fona. If any of these preparations have been used, it is advisable not to start therapy with Fona until the effects of such preparations in skin have subsided. If combined use of both medications is important, it is better to use in two different times.

Contraindications

Adapalene should not be administered to individuals who are hypersensitive to Adapalene or any of its components.

Side Effects of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Erythema, scaling, dryness, pruritus, burning sensation, skin irritation, stinging unburn, acne flares, etc. are commonly seen during the first month of therapy but usually lessen with continued use of the medication.

Pregnancy & Lactation of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Use Adapalene during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in breast milk. Exercise caution when administering Adapalene to a nursing mother.

Precautions & Warnings

Fona should not be applied to cuts, abrasions, eczematous or sunburned skin.

Therapeutic Class of Cream :- Fona 0.1% 10gm tube (AS A Adapalene AS A Topical retinoid and related preparations).

Topical retinoid and related preparations

Cream 4. 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 of Cream:- Azelec 20% 10gm tube (AS A Azelaic Acid AS A Acne treatment preparations).

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

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

Lotion 5.Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Indications of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Clindacin lotion is indicated in the treatment of acne vulgaris. Other uses of topical Clindacin lotion are:

Skin infections such as erythrasma caused by Corynebacterium minutissimum; rosacea, periorificial dermatitis, folliculitis, stasis, chronic lymphaedema and familial pemphigus.
Dermal ulcers.

Pharmacology of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Clindamycin is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. Clindamycin is a semisynthetic antibiotic derived from lincomycin. It has antiacne and antibacterial activity. It binds with the 50s subunit of the bacterial ribosome and inhibits the early stage of protein synthesis. It is highly potent against gram positive and anaerobic bacteria.

Microbiology: Aerobic gram-positive cocci, including: Staphylococcus aureus, Staphylococcus epidermidis (penicillinase and non-penicillinase producing strains), Streptococci, Pneumococci. Anaerobic gram-negative bacilli, including: Bacteroides species, Fusobacterium species. Anaerobic gram-positive non-spore forming bacilli, including: Propionibacterium species, Eubacterium species, Actinomyces species. Anaerobic and microaerophilic gram-positive cocci, including: Peptococcus species, Peptostreptococcus species, Microaerophilic streptococci, C. perfringes

Dosage & Administration of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

At first, wash the face or affected area gently with warm water or soap. When the skin is completely dried (about 30 minutes later) apply a thin film of Clindamycin lotion to the entire affected area twice daily. The Applied area should not be washed within 3 hours. Noticeable improvement is usually seen after about 6 weeks. However, 8 to 12 weeks of treatment may be required for maximum benefit. Eye, lip or nose contact should be avoided while applying Clindamycin lotion.

Interaction of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Clindacin enhances the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between Clindacin and erythromycin in vitro. Because of possible clinical significance, these two drugs should not be administered concurrently.

Side Effects of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Side effects are usually rare. Possible side-effects may includes skin rash, itching, oily skin, dryness, erythema, burning, change in skin color, diarrhea, colitis, GI disturbance etc.

Pregnancy & Lactation of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

There is no adequate data for safe use in pregnancy. Animal studies showed no adverse effects on the fetus. It is not known that whether Clindamycin is excreted through breast milk following topical administration. However, Clindamycin lotion can be used during lactation with caution.

Precautions & Warnings of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Clindacin lotion is not for oral, ophthalmic, or Intravaginal use. Avoid exposure to sunlight and sunlamps. Wear sunscreen daily.

Overdose Effects

Intravaginal overdose is not possible. Accidental ingestion of the product could be accompanied by effects related to therapeutic levels of oral Clindacin.

Therapeutic Class of Lotion :- Clindacin 1% 25ml Bottle (AS A Clindamycin AS A Macrolides).

Macrolides

এইটাও Category -C

এখন কেউ যদি প্রেগন্যান্সিতে Acne চিকিৎসার জন্য আসে- তাহলে Mild acne তে তাকে কেবল Azelec Acid দিবেন,

Cream- Azelec 20% – সকালে ও রাতে লাগাবেন, ৩ মাস

আর কারো যদি Moderate acne থাকে, কিংবা pustular/Nodular Acne থাকে, সে ক্ষেত্রে Azelec এর ক্ষেত্রে Topical antibiotics Clindamycin দেওয়া হবে–

Clindamycin Lotion দিনে ২ বার– দুইটা একটু আলাদা সময়ে দিবে, যেনো ১ ঘন্টার প্রার্থক্য থাকে মিনিমাম-

এর সাথে পেশেন্ট কে কাউন্সেলিং করে দিবেন- যেনো উল্টাপাল্টা কোনো ঔষধ ব্যবহার না করে-

Raiyyan Tahsan Date:29-01-2025 Wednesday Time:2-57-45 PM

Raiyyan Tahsan

Raiyyan Tahsan