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Dermatology Case No 36. Pediculosis_capitis( Head lice)

Pediculosis_capitis( Head lice)

Pediculosis capitis বিশেষ করে বাচ্চাদের (4-14) বেশি দেখা যায়।

Risk factor*

• মেয়েদের বেশি হয়

• পরিবারে সন্তানের সংখ্যা বেশি হলে

• বিছানা, পোশাক এবং চুলের ব্রাশ সবাই একটা ব্যবহার করলে

Clinically দেখেই ডায়াগনোসিস করা যায়,

রোগীর ঘাড়ে,কানের পিছনে, মাথায় সব জায়গায় হতে পারে___

Complications

*Dermatitis(Red scaly itchy plaque

*2ndry bacterial infection

Treatment 🚨

  1. Ivermectin ( Tab Scabo)

Tablet 1:-Scabo 12 mg ( AS A Ivermectin AS A Anthelmintic).

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

Scabo tablet is indicated for the treatment of-

  • Strongyloidiasis
  • Onchocerciasis
  • Filariasis
  • Scabies &
  • Head lice.

Strongyloidiasis of the intestinal tract: Scabo 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 Scabo.

Onchocerciasis: Scabo 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 :-Scabo 12 mg ( 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 :-Scabo 12 mg ( 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 :-Scabo 12 mg ( AS A Ivermectin AS A Anthelmintic).

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

Contraindications

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

Side Effects of Tablet :-Scabo 12 mg ( 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 Scabo, the following adverse reactions were reported as possibly, probably, or definitely related to Scabo.

  • 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

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 Scabo 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

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

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

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

Anthelmintic

Single dose*✅

Or Alice lotion

Lotion 2.Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Indications of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Alice is indicated for topical treatment of head lice infestations in patients 6 months of age and older.

Pharmacology of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Ivermectin, a member of the avermectin class, causes death of parasites, primarily through binding selectively and with high affinity to glutamate-gated chloride channels, which occur in invertebrate nerve and muscle cells. This leads to an increase in the permeability of the cell membrane to chloride ions with hyperpolarization of the nerve or muscle cell, resulting in paralysis and death of the parasite. Compounds of this class may also interact with other ligandgated chloride channels, such as those gated by the neurotransmitter gamma-aminobutyric acid (GABA). The selective activity of compounds of this class is attributable to the fact that some mammals do not have glutamate-gated chloride channels, the avermectins have a low affinity for mammalian ligand-gated chloride channels, and Ivermectin does not readily cross the blood-brain barrier in humans.

Dosage of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Only for topical use in scalp & scalp hair. It is not for oral, ophthalmic or intravaginal use. Apply the Lotion to dry hair in an amount sufficient (up to 1 tube) to thoroughly coat the hair and scalp. After 10 minutes, rinse off with water. The tube is intended for single use. Discard any unused portion. Contact with eyes should be avoided

Administration

  • Your hair and scalp must be completely dry before applying Ivermectin Lotion
  • Apply Ivermectin Lotion directly to dry hair and scalp.
  • Completely cover your scalp and hair closest to the scalp first, and then apply outwards towards the ends of your hair.
  • Rub Ivermectin Lotion throughout your hair.
  • It is important to completely cover your entire head so that all lice and eggs are exposed to the lotion. Be sure that each hair is coated from the scalp to the tip.
  • Use sufficient quantities to completely cover hair and scalp.
  • Allow Ivermectin Lotion to stay on your hair and scalp for 10 minutes after it has been applied. Start timing after you have completely covered your hair and scalp with Ivermectin Lotion.
  • After 10 minutes, completely rinse Ivermectin Lotion from your hair and scalp using water only.
  • After application of Ivermectin Lotion, you or anyone who helps you to apply the lotion should wash hands properly

Side Effects of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Common side effects are-

  • Conjunctivitis
  • Ocular hyperemia
  • Eye irritation
  • Dandruff
  • Dry skin
  • Skin burning sensation etc.

Pregnancy & Lactation of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Pregnancy Category C. There are no adequate and well-controlled studies with Ivermectin Lotion in pregnant women. Ivermectin Lotion should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Following oral administration, Ivermectin is excreted in human milk in low concentrations. This has not been evaluated following topical administration. Caution should be exercised when Ivermectin Lotion is administered to a nursing woman.

Precautions & Warnings

Accidental ingestion in pediatric patients may occur administer only under direct adult supervision.

Tips to prevent the spreading of lice:

  • Avoid direct head-to-head contact with anyone known to have live, crawling lice.
  • Do not share combs, brushes, hats, scarves, bandannas, ribbons, hair bands, towels, helmets, or other hair-related personal items with anyone else, whether they have lice or not.
  • After finishing treatment with anti-lice medicine, check everyone in your family for lice after one week. Be sure to talk to your healthcare provider about treatments for those who have lice.

Therapeutic Class of Lotion :-Alice 0.5% 60gm tube (AS A Ivermectin AS A Miscellaneous topical agents).

Miscellaneous topical agents

Raiyyan Tahsan Date:29-01-2025 Wednesday Time:5-42-45 Pm

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