Dermatology

Apremilast in Psoriasis

⬅️هو عباره عن ايه وايه Mech of action بتاعه ؟
بطريقه مبسطه : هو عباره عن
(PDE4) inhibitor

⬇️  بيقلل من تحويل
cAMP >> AMP
وبالتالي
⬇️ Production of inf mediators such as
IL2 , IL8, TNF-α and IFN-γ ...
وبالتالي
⬇️ Inflammatory process

➡️ FDA approval  in adult in :
1- Psoraitic  arthritis
2- Plaque psoriasis
3- Oral ulcers of Behcet disease
وعليه studies مبشره كمان ف
Genital, Nail , Scalp and Palmoplantar ps

⬅️نعمل ايه Investigation عشان نديه ؟!

No nessacery lab monitoring
بس هو
metabolized by liver و excreted by kideny
عشان كده بنعمل liver , kideny function 
عشان  ن modify dose فقط لكنه
Not contraindicated  ف liver و kideny disease
⬅️بيتاخد ازاي بأه ؟!
Available in tablet form فبيتاخد Oral
ودي ميزته ✨️

The standard dosing 30 mg twice daily
مفروض بنبدا ب ١٠ ونزود  بالتدريج ع مدار ٥ ايام
ليه بنعمل كده ؟ 🤔
عشان ن control  ال  GIT upset 
وححطلكم صوره dosing schedul مع البوست
بس هو مش متوفر حاليا غير تركيز ال ٣٠ 

فاحنا ممكن نتعامل بتقسيم القرص ال ٣٠
او نديه يوم بعد يوم 
عشان نزود الجرعه تدريجياً ودي حتبقي اجتهادات شخصيه

⬅️ ايه هي Side Effects بتاعته ؟
Apremilast has a relatively Good safety profile
انما اشهر مشاكله ايه هي
1- GIT upset (Nausea and diarrhoea)
و مشاكل GIT دي
بتتحسن مع الوقت بعد اسابيع من العلاج 
2-Weight loss

انما مفيش adverse effect خطيره منه ولا حاجه

⬅️طيب هي فكرته ايه باه؟!
In recent months, apremilast also emerged
as one of a few systemic medications recommended for the treatment of psoriasis and other dermatologic conditions during the COVID-19 pandemic
طيب ليه بردو عشان بالمقارنه مع
cyclosporine, methotrexate, and tofacitinib, apremilast lacks the strong immunosuppressive activity that can be associated with increased risk for malignancy or infection.
ضيف علي كده كمان انو هو مميز بأنه
>> Low Toxicity
>> Simple storage
>> Oral form
>> Minimal monitoring requirements

اعتقد حيبقي خيار معقول الفتره الجايه
عشان كده ومشاكله بالمقارنه
مع باقي ال competitors اقل بكتير
حيتبقي مشكله سعره ودي ان شاء الله تتحل
لما يبدأ يتوفر ف نفقه الدوله والتأمين الصحي

بس حاليا هو اتوفر ف الماركت من شركه Penta

2598 EGP for pack 28 Tab

Dr. Emy Ahmed

///////////

A 44-year-old man presented with a 5-year history of heat intolerance and burning pain in his hands and feet. He had periumbilical angiokeratomas and nonnephrotic proteinuria. A kidney biopsy was performed.

📌 4 طرق لعلاج فرط تعرق اليدين والقدمين..أول 3 طرق مؤقتين طالما بنواظب عليهم وآخر طريقة هي الحل شبه الدائم:

1-العلاج الطبي بالاقراص والتركيبات: بننتظم عليه باستمرار لكن بنقلل الجرعة أو عدد الايام بعد ما بيحصل تحسن.

2-حقن البوتوكس: مؤلمة شوية و بنحتاج تكررها كل 3-7 شهور والتكلفة عالية.

3- جلسات جهاز Iontophoresis : ١_٣ جلسات أسبوعيا بيحصل معاها تحسن بيمتد لبعض الوقتي لكن بعد التوقف بيحصل انتكاسة تاني.

4- الجراحة:الحل شبه الدائم
Endoscopic thoracic sympathectomy (ETS)

📌أحد حالات العيادة قبل وبعد العلاج الطبي ب20 يوم .

✍️For Doctors:

👉 Oxybutinin (Uripan): 2.5_15mg daily.

👉 20 percent aluminum chloride hexahydrate in absolute anhydrous ethyl alcohol (Drysol).

⭕ Revise the Adverse Effects of Oxybutinin & ETS before prescription or recommendation.

#Cosmoderm_Shots
أ.د هاني أبو الوفا

https://www.facebook.com/100024027590297/posts/1450551309089108/?mibextid=rS40aB7S9Ucbxw6v

A 59-year-old veterinarian presented to the dermatology clinic with a 1-year history of a painful rash on his right hand. He had no other symptoms. On physical examination, verrucous plaques with overlying thick yellow-brown crusting were seen on the dorsum of the right hand (Panel A) and the medial aspect of the right index finger (Panel B). Biopsy of the lesion on the dorsum of the hand revealed pseudoepitheliomatous hyperplasia and tuberculoid granulomas in the dermis (Panel C, arrow; hematoxylin and eosin stain). Tissue cultures were negative, but metagenomic next-generation sequencing of the tissue identified Mycobacterium tuberculosis. An interferon-γ release assay was positive, and a computed tomographic scan of the chest was normal. A diagnosis of tuberculosis verrucosa cutis was made.

Cutaneous myiasis occurs on exposed skin,often the face, scalp, arms or legs.
In the furuncular form, boil-like lesions develop gradually over a few days. Each lesion has a central punctum, which discharges sero-sanguinous fluid. The posterior end of the larva, equipped with a group of spiracles, is usually visible in the punctum. The lesions are often extremely painful. Lymphangitis, regional lymphadenopathy, systemic symptoms or secondary  bacterial infection may occur.
Lesions rapidly resolve once the larva emerges/is removed.
Some larvae can be expressed by firm pressure around the edges of the lesion. Others require surgical management. Ivermectin isused if surgery is unsuccessful. Infected wounds require surgical debridement andirrigation to remove larvae, plus treatment ofsecondary infection.
د. ياسر الهبيط
أخصائي الأمراض الجلدية والتناسلية والتجميل
https://www.facebook.com/100024027590297/posts/

بالضبط 👌🏻 .
وما أكثرهم في : 🫥الجلدية والتناسلية 🫥 ، والتجميل 🫥 .

Case of impetigo
https://www.facebook.com/100024027590297/posts/

Urticaria + Psoriasis
https://www.facebook.com/100024027590297/posts/

https://www.facebook.com/100024027590297/posts/

https://t.me/dermatology_Y/4662

Cutaneous myiasis occurs on exposed skin,often the face, scalp, arms or legs.
In the furuncular form, boil-like lesions develop gradually over a few days. Each lesion has a central punctum, which discharges sero-sanguinous fluid. The posterior end of the larva, equipped with a group of spiracles, is usually visible in the punctum. The lesions are often extremely painful. Lymphangitis, regional lymphadenopathy, systemic symptoms or secondary bacterial infection may occur.
Lesions rapidly resolve once the larva emerges/is removed.
Some larvae can be expressed by firm pressure around the edges of the lesion. Others require surgical management. Ivermectin isused if surgery is unsuccessful. Infected wounds require surgical debridement andirrigation to remove larvae, plus treatment ofsecondary infection.
د. ياسر الهبيط
أخصائي الأمراض الجلدية والتناسلية والتجميل
https://www.facebook.com/100024027590297/posts/