This slide is about Oral Griseofulvin, its pharmacology, adverse effects, dosage and administration, interactions and its role in management of dermatophytosis such as tinea corporis, tinea cruris, tinea capitis,
Anthelmintics | B.Pharm 3rd year 2nd Sem | Medicinal Chemistry-III | History, Classification, Structures & Synthesis of anthelmintics, Synthesis of Diethylcarbamazine citrate, Synthesis of Mebendazole
Anthelmintics | B.Pharm 3rd year 2nd Sem | Medicinal Chemistry-III | History, Classification, Structures & Synthesis of anthelmintics, Synthesis of Diethylcarbamazine citrate, Synthesis of Mebendazole
This ppt deals with the sulfonamide group of drugs with classification, mechanism, spectrum, resistance, uses and adverse effects discussed in detail. It also discusses in detail about Cotrimoxazole
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
Sulfonamide (also called sulphonamide, sulfa drugs or sulpha drugs) is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group.
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
This ppt deals with the sulfonamide group of drugs with classification, mechanism, spectrum, resistance, uses and adverse effects discussed in detail. It also discusses in detail about Cotrimoxazole
Tetracyclines slide contains full information about uses, adverse effect, marketed preparation, precaution, route of drug administration, antimicrobial spectrum, mechanism of action, pharmacokineticks and pharmacodynamics of tetracyclines. This slide is very helpful for pharmacy and pharmacology student for the study about tetracyclines.
Sulfonamide (also called sulphonamide, sulfa drugs or sulpha drugs) is the basis of several groups of drugs. The original antibacterial sulfonamides are synthetic antimicrobial agents that contain the sulfonamide group.
Basic principles of chemotherapy/ AMAs covers definition, history of AMAs development, principles of AMAs, problems associated with AMAs, failure of therapy with examples.
history of TB,epidemiology, clinical features, lab diagnosis, treatment, MDR TB, XDR TB, TDR TB, and mechanism of drug resistant, methods of identification of resistant drugs
Fungal infection of the skin, most common on the exposed surfaces of the body, namely the face, arms and shoulders.
Most common fungal diseases ; Ringworm. A common fungal skin infection that often looks like a circular rash.
This is a presentation on cutaneous manifestations of tuberculosis. tuberculosis is a very important disease especially in the sub-Saharan region.
The pictures are not mine( from internet sites) and the study material majorly used was Fitzpatrick dermatology and extrapulmonary TB by Alper Senner. If anyone feels like some of the information is from their site and has been wrongly used do contact me via : lilacpreton12@gmail.com . This information is only for educational purposes.
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
Fungal infection of animals.
By Mycosa /Mycotic organisms.
Fungi like aspergillus, histoplasma / pathogenic forms.
Inhaling spores/ colonization on skin may initiate persistent infections.
People being treated with antibiotics are more prone to it.
This seminar consisits of description of various bacterial diseases along with their oral manifestations,diagnosis and treatment.an addition of suitable case reports for better understanding and associated disorders
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. DERMATOPHYTOSIS
Tinea capitis
Based on
inflammation
Inflammatory
Kerion and
favus
Non
inflammatory
Grey patch,
black dot
types
Based on
spores
Ectothrix
Microsporum
Endothrix
T. tonsurans,
T. violaceum
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Dermatophytic infection of scalp and hair
4. DERMATOPHYTOSIS
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Grey patch
• Circular patches
of hair loss with
broken off hairs
• M. audouinii
Black dot
• Brittle hair shaft
breaks at level of
scalp
• T. verrucosum, T.
mentagrophytes
Kerion
• Inflamed,
indurated, tender,
boggy swelling
with hair, vesicles
and pustules
• T. tonsurans, T.
violaceum, T.
soudanense
Favus
• Scutulum –
Yellow cup
shaped crust
composed of
dense mat of
mycelia and
epithelial debris
• T. schoenleinii, T.
violaceum, M.
gypseum
5. DERMATOPHYTOSIS
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Dermatophytic infection of beard and mustache area
Commonest anthrophilic species – T. rubrum, Commonest zoophilic species – T. verrucosum
Inflammatory type
• Nodular and boggy like a
kerion
• Hair can be easily
epilated
Superficial or
sycosiform type
• Diffuse erythema with
perifollicular papules and
pustules resembling
bacterial folliculitis
• Commonly caused by
anthrophilic species
Circinate or
spreading type
• Identical to tinea of
glabrous skin
• Vesiculopustular lesions
at periphery and central
scaling
6. DERMATOPHYTOSIS
• Dermatophytic infection of
nonbeard regions of face
Definition
• T. mentagrophytes, T.rubrum
Etiology
• Erythematous scaly macule that
extends peripherally and
develops a raised border
• Atypical features are more
common in Tinea faciei than in
other forms of dermatophytosis
Clinical features
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
7. DERMATOPHYTOSIS
• Dermatophyte infection of the skin
of the trunk and extremities,
excluding the hair, nails, palms,
soles and groin
Definition
• T. rubrum, T. mentagrophytes, M.
canis
Etiology
• Typical lesion is annular or polycylic
• Borders are erythematous and
vesicular or scaly, but center is
clear
Clinical features
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
8. DERMATOPHYTOSIS
Introduction
• Variant of Tinea corporis
• Also known as Tokelau
Etiology
• T. concentricum
Clinical features
• Begin as squamous annular
concentric plaques, some with
erythema
• With time, they become lamellar as
they have abundant thick scales that
adhere to one side, giving
appearance of tiles, fish scales or
lace
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
9. DERMATOPHYTOSIS
Definition
• Dermatophytic infection of groin
Etiology
• T. rubrum, T. mentagrophytes, E.
floccosum
Clinical features
• Well marginated raised border,
composed of multiple
erythematous papulovesicles
and a clear center
• Usually bilateral but
asymmetrical
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
10. DERMATOPHYTOSIS
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Dermatophytic infection of feet
Commonly caused by T. rubrum, T. mentagrophytes, E. floccosum
Chronic
intertriginous
•Fissuring, scaling or
maceration in
interdigital area
•May spread to sole but
seldom involve dorsum
Chronic
papulosquamous
•Inflammation and a
patchy or diffuse
moccasin like scaling
over soles
Vesicular or
vesiculobullous
•Small vesicles or
vesiculopustules
•Seen near instep and
on mid-anterior plantar
surface
Acute ulcerative
variant
•Maceration, weeping,
denudation and
ulceration
•Obvious white
hyperkeratosis and
pungent odor if
complicated by
bacterial infection
11. DERMATOPHYTOSIS
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Dermatophytic infection of palmar skin
Commonly caused by T. rubrum and E. floccosum
Non inflammatory squamous
• Diffuse Hyperkeratosis of palms and
fingers
• Accentuation of flexural creases
Inflammatory/vesicular/dyshidrotic
• Clusters of multiloculated vesicles
• Annular or segmental pattern
12. DERMATOPHYTOSIS
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
Dermatophytic infection of nail plate
Commonly caused by T. rubrum, T. mentagrophytes var intedigitale and E. floccosum
Distal and lateral subungual onychomycosis
• Most common type, T. rubrum
• Starts by invasion of stratum corneum of hyponychium of distal nail bed or lateral nail fold
Proximal subungual onychomycosis
• Early indicator of HIV infection, T. rubrum, T. mentagrophytes, T. tonsurans
• Initially whitish or brownish area on proximal part of nail plate, later involves entire nail
White Superficial onychomycosis
• T. mentagrophytes, T. rubrum
• Well circumscribed powdery white patches away from free edge of nail
Endonyx
• T. soudanense, T. violaceum
• Milky white discoloration of nail plate without surface change
Total dystrophic onychomycosis
• In above clinical variants, as infective process continues, invasion of nai plate results in gross
and total destruction of nail
15. GRISEOFULVIN
Robertson DB, Maibach HI. Dermatologic Pharmacology. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and Clinical
Pharmacology. New York: The McGraw-Hills Companies Inc. 1066-7.
• Spiro-benzo[b]furan
• Insoluble in water
• Fungistatic drug
STRUCTURE
16. GRISEOFULVIN
1939
• Isolated from the mold Penicillium
griseofulvum Dierckx by Oxford
1958
• Started using from treatment of dermatophytic
infections (First significant oral agent)
Now
• Use is largely superseded by Terbinafine and
Itraconaze except for Tinea capitis
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
17. GRISEOFULVIN
Absorption
• Poor
• Enhanced by fatty food and smaller particle size
Peak plasma levels
• 2 to 4 hours
Half life
• 9.5 to 22 hours
Protein binding
• 84%
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
18. GRISEOFULVIN
Metabolism
• Hepatic
• Major metabolites: 6-demethyl-griseofulvin
and its glucuronide conjugate
Excretion
• Renal 50%
• 36% in feces
• 1% Excreted unchanged in urine
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
19. GRISEOFULVIN
Micronizing
Ultramicronizing
Solubilizing
• Small particle size
• Standard preparation
• Smallest particle size
• Half the dose of
micronized is enough
• Polyethylene glycol
• Enhances absorption
further
Robertson DB, Maibach HI. Dermatologic Pharmacology. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and Clinical
Pharmacology. New York: The McGraw-Hills Companies Inc. 1066-7.
20. GRISEOFULVIN
Fungistatic action
Thus inhibiting fungal cell division
Causes arrest of mitosis (at metaphase
stage)
Binds to tubulin and prevents formation of
microtubules
Enters the fungal cell (Intracellular action)
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
21. GRISEOFULVIN
Robertson DB, Maibach HI. Dermatologic Pharmacology. In: Katzung BG, Masters SB, Trevor AJ, editors. Basic and Clinical
Pharmacology. New York: The McGraw-Hills Companies Inc. 1066-7.
Binds to keratin & protects skin from
new infection
Binding is not firm unlike itraconazole
Inhibits nucleic acid synthesis
Narrow spectrum of antimycotic
activity
22. GRISEOFULVIN
Tinea capitis*
Tinea unguium
Tinea corporis*
Tinea cruris*
Tinea pedis*
Tinea barbae*
Tinea
imbricata
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
*Not justified for minor or trivial infections which
will respond to topical agents alone
24. GRISEOFULVIN
Candidiasis
Pityriasis versicolor
Deep fungal infections
Bacterial infections
Actinomycosis
Nocardiosis
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
25. GRISEOFULVIN
Availability
• 250 mg tablets
• 500 mg tablets
Dose
• 10 to 20
mg/kg/day
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
26. INDICATIONS
SOURCE DOSE DURATION COMMENT
Rooks 10 mg/kg OD 6 weeks Used particularly for
Microsporum infections (Superior
efficacy than terbinafine)
20 mg/kg is considered in some
T. tonsurans and T. schoenleinii
Fitzpatrick 20-25 mg/kg OD 6-8 weeks
IADVL 5-25 mg/kg OD 8 week Griseofulvin continues to be the
treatment of choice for tinea
capitis where causative agent is
undetected
Continue for 2 weeks beyond
cure
27. GRISEOFULVIN IN TINEA CAPITIS
J Am Acad
Dermatol
2011;64:663-70
• Tinea capitis caused by
Trichophyton species:
Terbinafine > Griseofulvin
• Tinea capitis caused by
Microsporum species:
Griseofulvin > Terbinafine
Tey HL, Tan AS, Chan YC. Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the
treatment of tinea capitis. J Am Acad Dermatol. 2011;64:663–70
29. GRISEOFULVIN vs TERBINAFINE FOR TINEA CAPITIS
Griseofulvin
• Effective for
Microsporum
• Approved for more
than 2 years
Terbinafine
• Effective for
Trichophyton
• Approved for more
than 4 years
Cochrane library: Systemic antifungal therapy for tinea capitis in children (Review) 2016
30. GRISEOFULVIN vs TERBINAFINE FOR TINEA CAPITIS
Treats ectothrix infections
(Microsporum) more effectively
Reach outside hair shaft (ecto)
Griseofulvin and azoles are
secreted in sweat
Treats endothrix infection (Trichophyton)
more effectively
But it incorporates into hair shaft
Terbinafine cannot reach ectothrix infection
Children have little sebum secretion prior to
puberty
Terbinafine is secreted in sebum
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
31. GRISEOFULVIN vs AZOLES FOR TINEA CAPITIS
Cochrane library: Systemic antifungal therapy for tinea capitis in children (Review) 2016
• No evidence that griseofulvin was superior in
efficacy
• Limitation: Small trials
Azoles
• FDA approval only for children more than 12 years
of ageItraconazole
• Recommended as an alternative to terbinafine
• Optimal regimen unclearFluconazole
• Not recommended in children because of severe
hepatotoxicityKetoconazole
33. INDICATIONS
SOURCE DOSE DURATION COMMENT
Rooks 1 g OD 4 weeks Second line treatment for
widespread disease
Much longer treatment required for
extensive disease
Fitzpatrick 500 mg OD 2-4 weeks
IADVL 500 mg OD 4-8 weeks
36. INDICATIONS
SOURCE DOSE DURATION COMMENT
Rooks - - -
Fitzpatrick - - -
IADVL 500 mg BD 4-8 weeks Higher doses for relapse
Chronic moccasin type due to T.
rubrum – 2 to 3 months
Not recommended when infection
is limited to toe cleft
38. GRISEOFULVIN
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
Hepatic impairment
Porphyria
Hypersensitivity to drug
Pregnancy
Lupus Erythematosus
39. SPECIAL POPULATION
Reports
• Several reports of conjoined
twins
Mechanism
• Interferes with chromosomal
distribution during cell division
Contraception
• Women need additional
contraception during and 1
month after use, men should
wait 6 months before fathering
child
Gupta AK. Systemic Antifungal Agents. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd ed. Amsterdam:
Elsevier Inc.; 2013. 98-120.
• Risk cannot be ruled out
– human studies are
lacking
• Animal studies may or
may not show risk
• Potential benefits may
justify potential risk
CATEGORY
40. SPECIAL POPULATION
>2 years
• FDA approved
• Acceptable first
line treatment
<2 years
• Limited data
• In practice,
used frequently
with few side
effects and
high efficacy
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
41. SPECIAL POPULATION
Safety has not been
formally evaluated in
trials
However, studies
including elderly
population did not
show increased
incidence of
adverse effects in
elderly
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
42. GRISEOFULVIN
Gastrointestinal effects
• Most common
• Nausea, vomiting and
dyspepsia
CNS effects
• Most common
• Headache, dizziness, insomnia
Hematological toxicity
• Leukopenia
Hepatotoxicity
Cutaneous effects
• Photosensitivity and
Photolichenoid eruptions
• Precipitate lupus
erythematosus
• Precipitation of acute
intermittent porphyria
• Erythema multiforme
• Steven-Johnson
syndrome
• Urticaria and Angioedema
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
43. GRISEOFULVIN
• Griseofulvin decreases anticoagulant property of
warfarin
• By CYP3A4 induction
Warfarin
• Griseofulvin decreases effectiveness of OCP
• By CYP3A4 induction
Oral Contraceptive
Pills
• Phenobarbitone reduces blood levels of
GriseofulvinPhenobarbitone
• Disulfiram like reaction
• Severe nausea and vomitingAlcohol
Shenoy MM, Shenoy MS. Superficial Fungal Infections. In: Sacchidanand S, Oberai C, Inamadar AC, editors. IADVL Textbook
of Dermatology. 4th ed. Mumbai: Bhalani Publishing House; 2015. 459-516.
44. GRISEOFULVIN
• KOH
• Fungal Culture
• Histology
Documentation of positive
tests
No specific baseline
investigations
Jacob R, Konnikov N. Oral Antifungal Agents. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors.
Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: The McGraw-Hill Companies Inc.; 2012. 2804-5.
46. CONCLUSION
For
• First line therapy for
tinea capitis caused
by Microsporum
species
• Second line therapy
for Tinea corporis
Against
• Limited spectrum of
coverage
• Lengthy courses
Editor's Notes
Fungi are unicellular or multicellular eukaryotic organism that absorb nutrition from other organims
Fungi are broadly classified to moulds and yeasts
Moulds – Made of long nucleated filaments called hyphae. Aggregation of hyphae is mycelium
Yeast – Unicellular ovoid to globose cells that reproduce by budding
Produce harmful effects by producing mycotoxins, by evoking allergic reactions or by direct tissue invasion
Non dermatophytic moulds – Fusarium, cladosporium, cladophilospora, alternaria alternata
Atypical forms are also present. Granuloma annulare like and verrucous granulomatous lesions
Atypical forms are also present. Granuloma annulare like and verrucous granulomatous lesions
Atypical forms are also present. Granuloma annulare like and verrucous granulomatous lesions
Atypical forms are also present. Granuloma annulare like and verrucous granulomatous lesions
Currently, griseofulvin and terbinafine are the only FDA-approved agents for tinea capitis in children
There are no specific monitoring recommendations.
Patients should be warned about potential photosen- sitivity induced by griseofulvin and the possibility of lupus erythematosus or a lupus-like syndrome.