Therapeutic dermatologic and aesthetic updates

HSV Eraser Protocol
Rated 4.8/5 based on 1500 reviews

Tips therapeutic. Common in children and adults mild and tolerable itch limiting Auto The best treatment is Watchful antibiotics Some studies suggest that erythromycin may shorten the course of the rash and relieve itching, though oreos have found no significant differences versus placebo. In a nonrandomized study it has reported a cure rate of 73%, but with poor intestinal tolerance in 12%. Nor they have noted significant differences between placebo and azitromcina. Clarithromycin 250 mg twice daily for two weeks has been obtained healing in 50/52 cases in the 1st week. antivirals The indication would be justified by the frequent presence of herpes virus 6 and 7 in pink rosea. One study randomized, open-label, has shown good results with a dose of 800 mg 5 times daily.

The authors suggest that the effectiveness of antiviral maximum serious if treatment is indicated in the 1st week of disease onset. Phototherapy In a nonrandomized study exposure to UVB doses eritematogénicas for 10 days resulted in a decrease in severity of lesions in 15/17 patients. systemic treatment The oral methylprednisolone at a rate of 16 mg / day is indicated in children with severe itching, suberitrodérmicas scattered shapes and forms. But it should be given with caution because in some cases it can exacerbate itching. Acyclovir can be used in disseminated forms during pregnancy to prevent abortion or premature birth, with the warning that has not yet been confirmed the safety and efficacy of this treatment. conclusions Watchful waiting is the most common Topical remedies often induce itching The evidence from the accumulated experience is not enough to sustain prescription topical therapies: emollients, antihistamines, corticosteroids Nor it has established the efficacy of exposure to sunlight, artificial UV, antihistamines or systemic corticosteroids, antiviral Systemic therapy has limited indications.

Bibliography:  Drago F, Rebora A. Treatments for pityriasis rosea. Skin Therapy Letter 2009; 14 (3). . . . . . . . . .

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. . . . Keywords: pink rosea. Click image to enlarge

Therapeutic dermatologic and aesthetic updates

HSV Eraser Protocol
Rated 4.8/5 based on 1500 reviews

Herpes zoster and post-herpetic neuralgia PHN develops in 20% of patients affected by acute herpes zoster, the prevalence being 15-27 times higher in those over 50 years. complications skin infections PHN ophthalmic Damage: Dendriform keratopathy, stromal keratitis, anterior uveitis, iridocyclitis, glaucoma, ptosis Encephalitis, myelitis, paralysis of cranial and peripheral nerves Contralateral hemiparesis syndrome acute retinal necrosis Objectives of early treatment with antivirals (72 hours) Ease the pain Lessen the severity of the eruption Accelerate healing

Reduce the risk of complications Management of PHN Gabapentin, pregabalin opioids TCAs Lidocaine patch 5% capsaicin cream nonpharmacological The choice of therapy should consider comorbidities, tolerance and safety profile of drugs, patient preference and evolution of neuralgia antivirals Antivirals are effective, safe and well tolerated.

While it is proposed that indicate treatment with antivirals in the first 24 to 72 hours into the rash is the best strategy to prevent complications, other studies indicate that even exceeded this time it is possible to turn a profit. Antivirals reduce the duration and severity of acute episode but not in 100% prevent the development of postherpetic neuralgia. Antiviral therapy reduces the duration of acute episode and the risk of complications in patients immunocompetent and immunocompromised Acyclovir is the gold standard. The meta-analysis 4 double-blind studies, randomized, placebo comparison, about 6691 patients, indicate that acyclovir reduced by 50% the duration and prevalence of pain More recently incorporated valacyclovir a prodrug of acyclovir achieved similar to the intravenous use concentrations, and famciclovir with a longer half-life. Some studies indicate efficacy for both drugs and superior to acyclovir with faster pain relief and reducing the duration of PHN tolerance While oral treatment is highly effective, in many cases antivirals are administered intravenously Dosage in immunocompetent adults with normal renal function acyclovir

valaciclovir famciclovir Dose 800 mg 1000 mg 500 mg range shots Every 4 hours 8 hours 8 hours Total days 7 to 10 days 7 days

7 days Antiviral therapy is essential for the prevention of acute ophthalmic complications in ocular herpes. comparative clinical trials show that these three agents have similar efficacy to treat ophthalmic herpes with decreased incidence of complications and long-term favorable developments. Antiviral therapy is essential to prevent complications in acute ophthalmic herpes corticosteroids Corticosteroid administration associated with antiviral aims to quickly relieve pain but with the risk of severe adverse effects. A comparative trial versus acyclovir acyclovir + prednisolone demonstrated superiority for the latter association between weeks 1 and 2 with no significant differences in the assessment in the 3rd week. As for tolerance and safety incidence of adverse effects and changes in biochemical tests it was higher in the group receiving the combination of prednisolone. The addition of corticosteroids to antiviral therapy also reduces the incidence of post-herpetic neuralgia. Also, the use of corticosteroids intrathecal offers long-term benefits with regard to the development of neuralgia. Corticosteroids help relieve pain but they increase the risk of complications, particularly in elderly

anticonvulsants The association of gabapentin to antivirals, in the acute phase of treatment reduces the risk of post-herpetic neuralgia. Randomized clinical trials, controlled, double-blind, indicate that between 30 and 60% of those treated with gabapentin or pregabalin unrelieved pain (scale of Mc Gill) and improve scores on scales of sleep and welfare (Short-Form 36 Health Survey). Adverse effects somnolence, and peripheral edema of mild to moderate intensity are included. Pregabalin dose used is between 300 and 600 mg / day, depending on creatinine clearance. The gabapentin is between 1800 and 2400 mg / day, up to 3600 mg / day. topical anesthetics Lidocaine patches 5% are effective in 50% of cases short term (4 to 12 hours). Lack of systemic adverse effects and, locally, produce erythema and eruptions Capsaicin cream relieves pain significantly versus placebo. But the burning in the initial phase of implementation is intolerable in a third of patients. Gabapentin and lidocaine patch 5% are 1st line therapy for PHN.

They are FDA approved and They have a higher tolerance profile of tricyclic antidepressants TCAs The rate of patients reporting pain relief with tricyclic antidepressants reaches 67%. According to the results of comparative studies, randomized controlled trials, the agent with better tolerance profile it is nortriptyline and desipramine second is located. They have long been considered the first line treatment of PHN but on issues related to safety and tolerability have been replaced by gabapentin and lidocaine patches. Among its adverse effects postural hypotension, confusion, urinary retention, dry mouth and arrhythmias are listed. In addition they should be used with caution in patients with history of cardiovascular disease, glaucoma, urinary retention, autonomic neuropathy and coadministration with selective inhibitors of serotonin reuptake. In older than 40 years should be requested prior ECG to rule out conduction defects. opioids Its effectiveness is demonstrated in randomized controlled trials but adverse effects limit its indication to refractory cases. Some of the agents used are oxycodone 45 mg / day morphine controlled release 91 mg / day; Methadone 15 mg / day. In comparative studies they have proven more effective than tricyclic antidepressants.

Adverse effects include constipation, nausea and sedation. Administered in the first 72 hours, antiviral reduce the duration and severity of acute herpes zoster Corticosteroids provide additional pain relief but its adverse effects limit their use in elderly patients Neither antivirals or corticosteroids consistently prevent the development of postherpetic neuralgia Anticonvulsants, opioids, tricyclic antidepressants and topical lidocaine are treatment options with proven efficacy in PHN. . . . . . . . .

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. . . . . . Stephen K. Tyring. Management of postherpetic neuralgia and herpes zoster J. Am. Acad. Dermatol.

57; 2007: Area 1: S136-S142. Keywords: herpes zoster, neuralgia, acyclovir, antiviral, lidocaine, capsaicin, antidepressants, opioids.