Dermatology Case No 38. Eczema

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Dermatology Case No 38. 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… Precaution

1.Anti Histamin 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)

Tablet 1.Xyril 10 mg

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

Tablet1.Xyril 10 mg (AS A (1st Generation) ,Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

0+0+1 (21 days)

Indications of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Xyril Hydrochloride is indicated-

For symptomatic relief of anxiety and tension associated with psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.
Management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses, and histamine-mediated pruritus.
As a sedative when used as premedication and following general anesthesia.

The effectiveness of Xyril as an antianxiety agent for long-term use (>4 months) has not been assessed by systematic clinical studies. The physician should reassess periodically the usefulness of the drug for the individual patient.

Pharmacology of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Hydroxyzine Hydrochloride is an anxiolytic antihistamine of the piperazine class which is a H1 receptor antagonist. Hydroxyzine is not a cortical depressant, but its action may be due to a suppression of activity in certain key regions of the subcortical area of the central nervous system. Primary skeletal muscle relaxation has been demonstrated experimentally. Bronchodilator activity and antihistaminic and analgesic effects have been demonstrated experimentally and confirmed clinically. An antiemetic effect, both by the apomorphine test and the veriloid test, has been demonstrated. Hydroxyzine is rapidly absorbed from the gastrointestinal tract and clinical effects are usually noted within 15 to 30 minutes after oral administration.

Dosage & Administration of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

For symptomatic relief of anxiety and tension-

Adults: 50-100 mg 4 times daily.
Children (>6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

Pruritus due to allergic conditions-

Adults: 25 mg 3 to 4 times daily.
Children ( 6 years): 50-100 mg (5-10 teaspoonfuls) daily in divided doses.
Children (<6 years): 50 mg (5 teaspoonfuls) daily in divided doses.

As a sedative (premedication and following general anesthesia)-

Adults: 50-100 mg.
Children: 0.6 mg/kg of body weight.

Interaction

Xyril may potentiate Meperidine and barbiturates, so their use in pre-anesthetic adjunctive therapy should be modified on an individual basis. Atropine and other belladonna alkaloids are not affected by the drug. Xyril is not known to interfere with the action of digitalis in any way and it may be used concurrently with this agent. Simultaneous administration of Xyril with monoamine oxidase inhibitors should be avoided.

Contraindications of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Hydroxyzine is contraindicated in patients with a known hypersensitivity to Hydroxyzine or any of its ingredients.

Side Effects of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Side effects reported with the administration of Xyril Hhydrochloride are usually mild and transitory in nature. More common side effects include drowsiness, headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastrointestinal disturbances. Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.

Pregnancy & Lactation of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Clinical data in human beings are inadequate to establish safety in early pregnancy. Until such data are available, Hydroxyzine is contraindicated in early pregnancy. It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, Hydroxyzine should not be given to nursing mothers.

Precautions & Warnings

The potentiating action of Xyril must be considered when the drug is used in conjunction with central nervous system depressants such as narcotics, non-narcotic analgesics, and barbiturates. Therefore, when central nervous system depressants are administered concomitantly with Xyril, their dosage should be reduced. Since drowsiness may occur with the use of Xyril, patients should be warned of this possibility and cautioned against driving a car or operating dangerous machinery while taking Xyril. Patients should be advised against the simultaneous use of other CNS depressant drugs and cautioned that the effect of alcohol may be increased.

Use in Special Populations

Use in renal impairment patient: In case of renal impairment, half of the normal dose should be given.

Use in the elderly patient: In the elderly, it is advised to start with half the recommended dose due to the prolonged action.

Overdose Effects of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

The most common manifestation of Xyril overdosage is hypersedation. As in the management of overdosage with any drug, it should be borne in mind that multiple agents may have been taken.

If vomiting has not occurred spontaneously, it should be induced. Immediate gastric lavage is also recommended. General supportive care, including frequent monitoring of the vital signs and close observation of the patient, is indicated. Hypotension, though unlikely, may be controlled with intravenous fluids and Levarterenol or Metaraminol. Epinephrine should not be used as Xyril counteracts its pressor action.

There is no specific antidote. It is doubtful that hemodialysis would be of any value in the treatment of overdosage with Xyril. However, if other agents such as barbiturates have been ingested concomitantly, hemodialysis may be indicated. There is no practical method to quantitate Xyril in body fluids or tissue after its ingestion or administration.

Therapeutic Class of Tab:- Xyril 10 mg (AS A Hydroxyzine Hydrochloride AS A Sedating Anti-histamine)

Sedating Anti-histamine

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

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

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).

[[[সেকেন্ডারি ইনফেকশন হলে চিকিৎসা কিভাবে দিবেন, তা জানতে wait korun )))).

Recurrent eczema or atopic dermatitis er khetre steroid sate calcineurin inhibitor like tacrolimus ointment good option..ate recurrence kome jai

Ointment 2. Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Indications of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Prolimus ointment is indicated for short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis in whom the use of alternative, conventional therapies are deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant of alternative, conventional therapies. Prolimus ointment is also indicated in other skin conditions such as chronic cutaneous graft-vs-host disease, hand and foot eczema, allergic contact dermatitis, vitiligo, psoriasis, lichen planus, facial lichen, vulvar lichen sclerosus, pyoderma gangrenosum, leg ulcers in rheumatoid arthritis, steroid-induced rosacea & alopecia areata, annular erythema, chronic actinic dermatitis and recalcitrant facial erythema.

Pharmacology of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Tacrolimus is a macroiide immunomodulator produced by fungus, Streptomyces tsukubaensis. It has been demonstrated that Tacrolimus inhibits T-lymphocyte activation by first binding to an intracellular protein, FKBP-12. A complex of Tacrolimus-FKBP-12, calcium, calmodulin, and calcineurin is then formed and the phosphatase activity of calcineurin is inhibited. This leads to a general decrease in the entire inflammatory cascade.

Dosage & Administration of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Use in adults: Apply a thin layer of Tacrolimus ointment onto the affected skin areas twice daily and rub in gently and completely. Treatment should be continued for one week after clearing of signs and symptoms of atopic dermatitis. The safety of Tacrolim ointment under occlusion which may promote systemic exposure has not been evaluated. Tacrolimus ointment should not be used with occlusive dressings.

Use in Children:

Tacrolimus 0.03% ointment can be used in pediatric patients 2 years of age and older.
Tacrolimus 0.1% ointment can be used in children 16 years of age and older.

Use in Elderly Patients: Patients >65 years old received Tacrolimus ointment in phase 3 studies. The adverse event profile for these patients was consistent with that for other adult patients.

Interaction of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Formal topical drug interaction studies with Prolimus ointment have not been conducted. The concomitant administration of known CYP3A4 inhibitors in patients with widespread and/or erythrodermic disease should be done with caution. Some examples of such drugs are erythromycin, itraconazole, ketoconazole, fluconazole, calcium channel blockers and cimetidine.

Contraindications

Tacrolimus ointment is contraindicated in patients with a history of hypersensitivity to Tacrolimus or any other component of the preparation.

Side Effects of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Topically applied Prolimus ointment have very few and rare type of side-effects including skin burning, pruritus, flu-like symptoms, allergic reactions, skin erythema, skin infections, headache, etc.

Pregnancy & Lactation of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Pregnancy Category C. There are no adequate and well-controlled studies of topically administered Tacrolimus in pregnant women. Although systemic absorption of Tacrolimus following topical applications of Tacrolimus ointment is minimal relative to systemic administration, it is known that Tacrolimus is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Tacrolimus, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Precautions & Warnings

Cautions should be exercised while treatment with Prolimus ointment in patients with atopic dermatitis predisposed to superficial skin infections. The safety of Prolimus ointment has not been established in patients with generalized erythroderma.

Overdose Effects of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Prolimus ointment is not for oral use. Accidental oral ingestion of Prolimus ointment may lead to adverse effects associated with systemic administration of Prolimus. If oral ingestion occurs, medical advice should be sought.

Therapeutic Class of Ointment:-Prolimus 0.1% 30 gm tube .(As A Tacrolimus Monohydrate (Topical) As A Drugs affecting the immune response).

Drugs affecting the immune response

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,

2^nd dery infection hole ta prevent korar jonhho

Capsule1.Fluclox 500mg (AS A Flucloxacillin Sodium AS A Penicillinase-resistant penicillins)

Capsule 1. Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

1+1+1+1——-5days

Indications of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Fluclox is indicated for the treatment of infections due to Gram-positive organisms, including infections caused by penicillinase producing staphylococci. These indications include:

Skin and soft tissue infections: Boils, abscess, carbuncles, infected skin conditions (e.g. ulcer, eczema, acne, furunculosis, cellulitis, infected wounds, infected burns, otitis media and externa, impetigo).
Respiratory tract infections: Pneumonia, lung abscess, empyema, sinusitis, pharyngitis, tonsillitis, quinsy.
It is also used for the treatment of other infections i.e. osteomyelitis, enteritis, endocarditis, urinary tract infection, meningitis, septicaemia caused by Fluclox-sensitive organisms.
As a prophylactic agent, it is used during major surgical procedures where appropriate; for example, cardiothoracic and orthopedic surgery.

Pharmacology of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Flucloxacillin is active against Gram-positive organisms including penicillinase producing strains. It has little activity against Gram-negative bacilli. Flucloxacillin acts by inhibiting the formation of cell wall of bacteria. Flucloxacillin is isoxazolyl penicillin which combined the properties of resistance to hydrolysis by penicillinase, gastric acid stability and activity against gram-positive bacteria. Flucloxacillin is a bactericidal antibiotic that is particularly useful against penicillinase-producing staphylococci. Flucloxacillin kills bacterial cellwall, thus interfering with peptidoglycan synthesis. Peptidoglycan is a heteropolymeric structure that provides the cell wall with its mechanical stability. The final stage of peptidoglycan synthesis involves the completion of the cross-linking with the terminal glycine residue of the pentaglycin bridge linking to the fourth residue of the pentapeptide (D-alanine). The transpeptidase enzyme that performs this step is inhibited by Flucloxacillin. As a result the bacterial cellwall is weakened, the cell swells and then ruptures. Flucloxacillin resists the action of bacterial penicillinase probably because of the steric hindrance induced by the acyl side chain which prevents the opening of the β- lactam ring.

Dosage of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Oral administration:

Adult: 250 mg four times daily. Dosage may be doubled in severe infections. In osteomyelitis and endocarditis, up to 8 gm daily is used in 6-8 hourly divided doses.
Children (2-10 years): 1/2 of adult dose.
Children (Under 2 years): 1/4 of adult dose.

Parenteral administration:
Adult or Elderly:

Intramuscular Injection: 250 mg four times daily.
Intravenous Injection: 250 mg-1 g four times daily by slow injection over 3 to 4 minutes or by intravenous infusion.
All systemic doses may be doubled in severe infections: doses up to 8 g daily have been suggested for endocarditis or osteomyelitis.

Children:

2-10 years: half of the adult dose.
Under 2 years: a quarter of the adult dose.

Administration of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Oral doses should be administered 1 hour before meal.

Interaction of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Concurrent use of Fluclox and may result in increased level of Fluclox in blood for prolonged period.

Contraindications of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Flucloxacillin is contraindicated in penicillin hypersensitive patients.

Side Effects of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

There have been some common side effects of gastrointestinal tract such as nausea, vomiting, diarrhoea, dyspepsia and other minor gastrointestinal disturbances. Besides these rashes, urticaria, purpura, fever, interstitial nephritis, hepatitis and cholestatic jaundice have been reported.

Pregnancy & Lactation of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

US FDA Pregnancy Category of Flucloxacillin is B. There are, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Flucloxacillin have been shown to be excreted in human milk. So, caution should be exercised when Flucloxacillin is administered to a lactating mother.

Therapeutic Class of cap Fluclox 500mg (AS A (Flucloxacillin Sodium) AS A Penicillinase-resistant penicillins)

Penicillinase-resistant penicillins

Raiyyan Tahsan Date:-30-01-2025 Thursday Time:-12-06-55 Pm

Raiyyan Tahsan

Raiyyan Tahsan