Off-label use in dermatology: Hydroxicine for hypertrophic scars

Leal George — Mon, 01 Feb 2010 09:30:15 +0000

The patient after high doses of systemic corticosteroids started to develop a brutal case of acne and folliculitis.

OFF – LABEL USE IN DERMATOLOGY

The Off-Label use of medications in medicine is a progressive techique, that gets more consistent in an ever-growing fashion. An objective translation of the term would be ” Use not referred on the insert that comes with every medication, inside the box” . The FDA defined the medical expression as ” Use for indication, dosage regimen, dosage recomendations, population or other use parameter not mentioned on the approved insert” (circa 1999) . But, at the same time, the FDA recognized that the off-label use by doctors was occasionally accepted and might represent a pattern of a medical practice. And that the prescribers and others could obtain, upon request, information about the off-label use of medicines, to be provided by the pharmaceutical companies. Many pediatric prescriptions were off – label, and in oncology, many of the therapeutic regimens included off-label use, and other entities like CDC (CENTER FOR DISEASES CONTROL) and other subespecialties used this practice. So that the FDA was about to develop some programs with the objective of a normatization of such use.

In our experience, we decide to use the off-label regimen when all other available official ways to deal with a case have failed, and/or when the patient stresses he / she doesn’t want to cope with such approaches. We explain every single detail of the involved aspects, having in mind, as a very basic point, the PRIMUN NON NOCERE concept.

The patient presented below is a good example. He was practicing bodybuilding, and wanted to “speed up” his physical development. He was told to take some substances that would help. Unfortunately, he was given high doses of systemic corticosteroids, and after some weeks he started to develop a brutal case of acne and folliculitis.

He took many systemic antibiotics, after cultures and so on, and at the end the condition subsided, but as a result he developed many lesions compatible with inestetic hypertrophic scars.

There were many lesions to treat, and the classical topical and intralesional corticosteroid was not a very welcome idea. He also didn’t want to go through cryosurgery, due to the amount of lesions. We presented the idea of the systemic and topical hydroxizine with its anti – fibroblastic actions, and after some weeks of treatment he achieved a good result and got very satisfied

after inflamation subsided, but many hypertrophic lesions developed

A few weeks after topical and systemic hydroxizine:

drug: hydroxizine

dosage: 10 mg a day

topically – a 25 mg tablet dissolved in oil-free vehicle

The final results came within a few months, and the patient could affirm this regimen was the key of the success, specially the topical approach

Cordialmente,

George Leal
Dermatologo
Fortaleza, Brazil

Libro di dermatologia e Atlas dermatologico online

Abrusci Vito — Sat, 16 Jan 2010 21:00:40 +0000

1) Hai bisogno di un libro di dermatologia online?
Clicca il link http://telemedicine.org/stamford.htm The Electronic Textbook of Dermatology

2) Hai bisogno di un atlas fotografico di dermatologia online?
Clicca il link http://dermatlas.med.jhmi.edu/derm/ DermAtlas (B Cohen, Johns Hopkins U)

Predicting outcome in Melanoma: where are we now?

Abrusci Vito — Thu, 19 Nov 2009 09:01:37 +0000

PREDICTING OURCOME IN MELANOMA
Medline Oncology, from The British Journal of Dermatology
L. Jennings; G.M. Murphy, Published: 10/22/2009

Per leggere l’articolo cliccare: http://www.medscape.com/viewarticle/710445?src=mp&spon=7&uac=83977BN

Importante aggiornamento sulla Dermatite Atopica

Abramovits William — Thu, 15 Oct 2009 15:05:17 +0000

Hint: A syndrome characterized by pruritus*, erythema (pale to violaceous hues), scaling, thickening (macules to patches, to plaques), fissuring, lichenification, vesiculation (“mini” to bullae), erosion, oozing, crusting and excoriations.

Attachment:
AD_peculiarities_short.pdf

William Abramovits, MD, FAAD
Dermatology Treatment & Research Center
Baylor University Medical Center
University of Texas Southwestern Medical School
Dallas, TX

SKINBLOG-IT.com » g. Altri contributi

Off-label use in dermatology: Hydroxicine for hypertrophic scars

Libro di dermatologia e Atlas dermatologico online

Predicting outcome in Melanoma: where are we now?

Importante aggiornamento sulla Dermatite Atopica