Dermatology Case No.34 Paederus Dermatitis.

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Dermatology Case No.34 Paederus Dermatitis.

রফিক, বাগানে কাজ করতে গেলো, কিছু জংগল পরিষ্কার করে বাসায় আসলো- কিছুক্ষণ পর তার গলার এক পাশ চুলকাতে চুলকাতে লাল হয়ে গেলো- সে ভাবলো, হয়তো গাছ পালা পরিষ্কার করায় এলার্জিক রিয়েকশন হয়ে এমন চুলকাচ্ছে– রাত পর্যন্ত চুলকিয়ে একটু ফুলে গেলো, রফিক কিছুই করলোনা, সকালে ঘুম থেকে উঠে দেখে একটা লিনিয়ার প্যাটার্ণ ব্লিস্টারিং র‍্যাশ- ছোট ছোট কিছু blister দেখা যায়, আর কিছুটা ব্যাথাও হচ্ছে- করণীয় ক?

Dx- Paederus Dermatitis -(প্যাডেরাস ডার্মাটাটিস)

এইটা একধরনের স্কিন রোগ, যা বিভিন্ন কীটপতঙ্গের সংস্পর্শে আসলে হয়ে থাকে, কিট পতঙ্গের সংস্পর্শ দুই ধরনের হতে পারে, এক- কামড়ের মাধ্যমে, যাকে insect bite বলে, insect bite এর পরে পেইন + swelling হতে পারে– পোকামাকড়ের কামড় ছাড়াও যদি কোনো insect শরীরে বসে, তার সেখানে কিছু Toxin juice ছেড়ে দেয়-

অর্থাৎ পোকামাকড়ের শরীরে থাকা বিষাক্ত রস যখন মানুষের স্কিনে আসে, সেখানে একটা abnormal reaction হয়, প্রথমে redish হয়, পরে সেখানে itching হয়, 24-48 hours এর মধ্যে ব্লিস্টার দেখা যায়, ব্লিস্টার একটু লিনিয়ার টাইপের হয়, সাথে margin গুলি লাল থাকে- পেইন+ চুলকানি থাকে- দেখতে কিছুটা herpes এর মত লাগতে পারে– কৃষক, বন কর্মকর্তা, বন জঙ্গলে ট্রাভেল, কিংবা শস্যক্ষেতে যারা কাজ করে, তাদের এইসব হতে পারে-

তাই এইসব কাজ করার সময় শরীর ডেকে রাখবে-

চিকিৎসা-

এখানে potent topical steroid দেওয়া হয়-

সাথে৷ Emolent,

Antihistamine.

Secondary bacterial infection সাসপেক্ট করলে একটা Antibiotics (first G cephalosporin) দেওয়া হবে-

Rx- Treatment Management:-

topical steroid (clobetasol ointment/Cream)

Cream 1.Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Indications of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Dermasol is indicated for adults, elderly and children over 1 year in following dermatoses.

Psoriasis (excluding widespread plaque psoriasis)
Recalcitrant dermatoses
Lichen planus
Discoid lupus erythematosus
Other skin conditions which do not respond satisfactorily to less potent steroids.

Composition of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate Cream: Each gram cream contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Ointment: Each gram ointment contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Scalp Application: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Shampoo: Each gram shampoo contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Lotion: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Spray: Each gram spray contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Pharmacology of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate is a very potent topical corticosteroid. It has anti-inflammatory, antipruritic and vasoconstrictive properties. It shows anti-inflammatory activity via multiple mechanisms to inhibit late phase allergic reactions. It decreases the density of mast cells, chemotaxis and activation of eosinophils. It also reduces cytokine production and inhibits the metabolism of arachidonic acid.

Dosage of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Cream, Ointment: Adults, elderly and children over 1 year: Apply a thin layer of Clobetasol Propionate Cream or Ointment to the affected skin areas twice daily and rub in gently and completely. Repeated short courses of Clobetasol Propionate may be used to control exacerbations. In more resistant lesions, especially where there is hyperkeratosis, the effect of Clobetasol can be enhanced, if necessary, by occluding the treatment area with polythene film. Overnight occlusion only is usually adequate to bring about a satisfactory response.

Clobetasol Propionate is super-high potency topical corticosteroids; therefore, treatment should be limited to 2 consecutive weeks. The maximum weekly dose should not be exceeded 50 gm/week. In case of children, courses should be limited if possible to five days and reviewed weekly.

Spray: Apply required quantity of spray of once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Propionate scalp solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Propionate scalp solution for brief periods only.

Shampoo: It should be applied to the dry (not wet) scalp once a day to the affected areas only. It should be massaged gently into the lesions and left in place for 15 minutes before lathering and rinsing. Treatment should be limited to 4 consecutive weeks. Total dosage of shampoo should not exceed 50 g per week. Under 18 years this preparation is not recommended.

Scalp Solution: Apply required quantity of spray of Clobetasol Scalp Solution once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Scalp Solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Scalp Solution for brief periods only.

Administration of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Route of administration: Cutaneous. Creams are especially appropriate for moist or weeping surfaces. Ointments are especially appropriate for dry, lichenified or scaly lesions.

Interaction of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Co-administered drugs that can inhibit CYP3A4 (eg ritonavir, itraconazole) have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.

Contraindications

Rosacea, acne vulgaris and perioral dermatitis. Primary cutaneous viral infections (e.g. herpes simplex, chickenpox).
Hypersensitivity to the preparation.
The use of Clobetasol Propionate skin preparations is not indicated in the treatment of primarily infected skin lesions caused by infection with fungi (e.g. candidiasis, tinea), or bacteria (e.g.impetigo): perianal and genital pruritus.
Dermatoses in children under one year of age, including dermatitis and napkin eruptions.

Side Effects of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

As with other topical corticosteroids prolonged use of large amounts, or treatment of extensive areas can result in sufficient systemic absorption to produce the features of hypercorticism.
Prolonged and intensive treatment with a highly active corticosteroid preparation may cause local atrophic changes in the skin such as thinning, striae and dilatation of the superficial blood vessels, particularly when occlusive dressings are used or when skin folds are involved.
In rare instances, treatment of psoriasis with corticosteroids (or its withdrawal) is thought to have provoked the pustular form of the disease.
There are reports of pigmentation changes and hypertrichosis with topical steroids. Dermasol is usually well tolerated, but if signs of hypersensitivity appear, application should be stopped immediately. Exacerbation of symptoms may occur.

Pregnancy & Lactation

There are limited data from the use of Clobetasol Propionate cream in pregnant women. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. The relevance of this finding to humans has not been established. However, the administration of Clobetasol Propionate Cream during pregnancy and lactation should only be considered if the expected benefit to the mother outweighs the possible risks of treatment.

It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Clobetasol Propionate Cream is administered to a nursing woman.

Precautions & Warnings

Long-term continuous topical therapy should be avoided where possible, particularly in infants and children, as adrenal suppression can occur readily even without occlusion. If used in childhood or on the face, courses should be limited if possible to five days and occlusion should not be used.

The face, more than other areas of the body, may exhibit atrophic changes after prolonged treatment with potent topical corticosteroids. This must be borne in mind when treating such conditions as psoriasis, discoid lupus erythematosus and severe eczema.

If applied to the eye lids, care is needed to ensure that the preparation does not enter the eye, as glaucoma or cataract might result.

Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses, development of tolerance, risk of generalised pustular psoriasis and development of local or systemic toxicity due to impaired barrier function of the skin. If used in psoriasis careful patient supervision is important.

Appropriate anti-microbial therapy should be used whenever treating inflammatory lesions which have become infected. Any spread of infection requires withdrawal of topical corticosteroid therapy and systemic administration of anti-microbial agents. Bacterial infection is encouraged by the warm, moist conditions induced by occlusive dressings, and so the skin should be cleansed before a fresh dressing is applied.

Use in Special Populations of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

In infants and children under 12 years of age, long-term continuous topical corticosteroid therapy should be avoided where possible, as adrenal suppression can occur. Children are more susceptible to the use of topical corticosteroids which develops atrophic changes.

Overdose Effects of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Acute overdosage is very unlikely to occur, however, in the case of chronic over-dosage or misuse the features of hypercortisolism may occur and in this situation topical steroid should be discontinued.

Therapeutic Class of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

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

Secondary bacterial infection সাসপেক্ট করলে একটা Antibiotics (first G cephalosporin) দেওয়া হবে-

Capsule 5.Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Indications of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Adora is indicated in the treatment of the following infections.

Streptococcal pharyngitis and tonsillitis
Bronchopneumonia, bacterial pneumonia
Uncomplicated urinary tract infections: pyelonephritis, cystitis
Skin and soft tissue infections: abscesses, furunculosis, impetigo, erysipelas, pyoderma, lymphadenitis.

Pharmacology of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Cefadroxil inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Dosage & Administration of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

The dosage of Cefadroxil depends on the susceptibility of the pathogens, the severity of the disease and on the clinical status of the patient (renal and hepatic function).

Streptococcal pharyngitis and tonsillitis–

Adult and adolescents >40 kg with normal renal function: 1000 mg once a day over at least 10 days. Dosage may be decreased.
Children <40 kg with normal renal function: 30 mg/kg/day once a day over at least 10 days.

Bronchopneumonia, bacterial pneumonia, Urinary tract infections, Skin & soft tissue infections–

Adult and adolescents >40 kg with normal renal function: 1000 mg twice a day.
Children <40 kg with normal renal function: 30-35 mg/kg/day divided into two daily doses.

Children may benefit of increased posology up to 100 mg/kg/day. Depending on the severity of the infection, adults may require increased posology. The dosage maximum is 4 g per day. Chronic urinary tract infection may require a prolonged and intensive treatment with continued testing of susceptibility and clinical monitoring. Cefadroxil 500 mg is not recommended for infants and children under 6 years. For younger children and children with a body weight <40 kg, liquid dosage oral form is recommended.

Renal impairment patients: In patients with renal impairment, the dose should be adjusted according to creatinine clearance rates to prevent accumulation of cefadroxil. In patients with creatinine clearance of 50 ml/min or less, the following reduced dosage schedule is recommended as a guideline.

Creatinine clearance 50-25 ml/min/1.73 m2: 500 mg-1000 mg every 12 hours
Creatinine clearance 25-10 ml/min/1.73 m2: 500 mg-1000 mg every 24 hours
Creatinine clearance 10-0 ml/min/1.73 m2: 500 mg-1000 mg every 36 hours
Children (<40 kg) with renal impairment: Cefadroxil is not indicated in children suffering from renal insufficiency and children requiring haemodialysis.
Dosage for haemodialysis patients: Haemodialysis eliminates 63% of 1000 mg of cephalosporin after 6 to 8 hours of haemodialysis. Elimination half-time of cephalosporin is about 3 hours during dialysis. Patients with haemodialysis receive one additional dose ofcefadroxil 500 mg-1000 mg at the end of the haemodialysis.

Hepatic impairment: No adjustment of posology is necessary.

Elderly: As cefadroxil is excreted by renal route, the dosage should be adjusted if necessary as described under impaired renal function.

Mode of administration: Bioavailability is not affected by food and cefadroxil may be taken with meals or on an empty stomach. In case of gastro-intestinal disturbances, it may be administered with food.

Duration of therapy: Treatment should be applied for 2 to 3 further days after regression of the acute clinical symptoms or evidence of bacterial eradication has been obtained. In infections caused by Streptococcus pyogenes up to 10 days treatment may be considered.

Interaction of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Prothrombin time will be prolonged; bleeding may occur when taken with anticoagulants. Decreased elimination with Probenecid is also reported.

Contraindications of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Cefadroxil is contraindicated in patients with a history of hypersensitivity to any of the Cephalosporins. It is also contraindicated in patients with a history of severe reactions to penicillins or to any other beta lactam drugs.Cefadroxil should not be combined with bacteriostatic antibiotics (e.g. tetracycline, erythromycin, sulfonamides, chloramphenicol) since an antagonistic effect is possible.Treatment with cefadroxil in combination with aminoglycoside antibiotics, polymyxin B, colistin or high-dose loop diuretics should be avoided since such combinations can potentiate nephrotoxic effects.

Cefadroxil does not penetrate in the CSF and is not indicated for the treatment of meningitis. Penicillin is the first drug of choice for the treatment of the Streptococcus pyogenes and for the prevention of rheumatic fever. Data for cefadroxil are not Sufficiently substantial for prophylaxis therapy. Special caution should be exercised in patients with history of severe allergies or asthma. In patients with a history of non severehypersensitity to penicillins, or other non-cephalosporin beta-lactam drugs, cefadroxil should be used with special caution. Caution is necessary in patients with renal impairment; the dosage must be adjusted according to the grade of renal impairment. Cefadroxil should be used with caution in patients with a history of gastro-intestinal disturbances, particularly colitis. The occurrence of diarrhoea may impair the resorption of other medicaments and therefore lead to an impairment of their efficacy. Treatment must be discontinued at once if allergic reactions occur (urticaria, exanthema, pruritus, fall of blood pressure and increased heart rate, respiratory disturbances, collapse, etc.) and suitable countermeasures should be taken (sympathomimetics, corticosteroids and/or antihistaminics). Particularly on prolonged use frequent checks on the blood count and regular hepatic and renal function tests are advisable.Superinfections with fungi (e.g. candida) can occur on prolonged treatment with cefadroxil. In case of severe and persistent diarrhoea, an antibiotic-associated pseudomembranous colitis should be considered. In that case Cefadroxil must be discontinued immediately and a suitable therapy should be started. The result of the Coombs’ test can be transiently positive during or after treatment with cefadroxil. This also applies to Coombs’ tests carried out in newborns whose mothers received treatment with cephalosporins before delivery. Urinary sugar should be determined enzymatically (e.g. with test strips) during treatment with cefadroxil since reduction tests can furnish falsely elevated values.

Side Effects of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Infections and infestations: Uncommon side effects are Vaginal mycoses, thrush. Blood and lymphatic system disorders: Rare side effects are eosinophilia, thrombocytopenia, leucopenia, neutropenia, agranulocytosis and very rarely occurs haemolytic anemia.

Immune system disorders: Rarely occur serum sickness-like reactions, Very rarely occur immediate allergic reaction (anaphylactic shock).

Nervous system disorders: Very rare side effects are Headache, sleeplessness, dizziness, nervousness.

Gastrointestinal disorders: Common side effects are nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, glossitis and very rarely occurs Pseudomenbranous colitis.

Hepatobiliary disorders: Rarely occurs cholestase and idiosyncratic hepatic failure.

Skin and subcutaneous tissue disorders: Pruritus, rash, allergic exanthema, urticaria are common side effects. Very rarely occurs stevens Johnson syndrom and erythema multiforma.

Musculoskeletal and connective tissue disorders: Rarely occur arthralgia. Renal and urinary disorders: Rarely occurInterstitial nephritis.

General disorders: Fever is rare and fatigue is very rare.

Pregnancy & Lactation of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

Although animal studies and clinical experience have not shown any evidence of teratogenicity, the safe use during pregnancy has not been established. Cefadroxil is present in low concentrations in breast milk; sensitization, diarrhoea or colonization of the infants’ mucosa with fungi are possible. The use of cefadroxil during pregnancy and in lactating mothers should therefore be handled very strictly.

Precautions & Warnings

Adora binds to cholestyramine which may lead to reduced bioavailability of cefadroxil. The concomitant administration of probenecid reduces the renal elimination of cefadroxil; therefore, plasma concentrations of cefadroxil may be increased when given in combination with probenecid.

Overdose Effects

No clinical reports are as yet available on cefadroxil in this respect. However in view of experience gained with other cephalosporins the following symptoms are possible: nausea, hallucinations, hyperreflexia, extrapyramidal symptoms, clouded consciousness, or even coma and renal functional impairment.

Therapeutic Class of Capsule :-Adora 500 mg (AS A Cefadroxil Monohydrate AS A First generation Cephalosporins).

First generation Cephalosporins

Cream1- Topiclo/Halobet (apply locally BD for 7-10 days weeks)

infection suspect করলে Mild topical steroid + Antibiotics এর কম্বিনেশন দিবে- Cream:fusicort

বাচ্চাদের ক্ষেত্রে Betson/Topicort

Cream 6.Betson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

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

Betson 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:-Betson 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:-Betson 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

There is no evidence of any kind of interaction.

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

The most frequent side effects reported with Betson 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 Betson 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:-Betson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Betson 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 Betson, 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, Betson 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. Betson 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

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:-Betson 0.05% 20gm tube (AS A Betamethasone Dipropionate AS A Corticosteroid).

Corticosteroid

Emolent cream (3-4 times Daily)

Tab- Deslor 5 mg once Daily

Cap – Adora 500 mg BD for 7 days (if needed)

এইটা র‍্যাশ সহ পরিপূর্ণ ভালো হতে ২-৪ সপ্তাহ লাগে-

Raiyyan Tahsan Date:- 29-01-2025 Wednesday Time:-4-38-55 PM

Raiyyan Tahsan

Raiyyan Tahsan