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Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Ketoconazole is a synthetic derivative of phenylpiperazine and an imidazole-type antifungal with broad fungicidal properties and potential antineoplastic activity. It inhibits sterol 14α-demethylase, a microsomal cytochrome P450- dependent enzyme, thereby disrupting synthesis of ergosterol, an important component of the fungal cell wall. Ketoconazole is indicated for the treatment of superficial fungal infections and the following systemic fungal infections: candidiasis, chronic mucocutaneous candidiasis, oral thrush, candiduria, blastomycosis, coccidioido- mycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis (1).
Therapy For Skin, Hair and Nail Fungal Infections
Published in Raimo E Suhonen, Rodney P R Dawber, David H Ellis, Fungal Infections of the Skin, Hair and Nails, 2020
Raimo E Suhonen, Rodney P R Dawber, David H Ellis
Ketoconazole is an oral or topical synthetic dioxolane imidazole compound that interferes with the biosynthesis of ergosterol. This leads to alterations in a number of membrane-associated cell functions. It has a broad spectrum of activity mat includes bom dermatophytes and yeasts. It was the first available orally active imidazole. Ketoconazole is not absorbed after topical application but it is well absorbed orally under acid conditions. It is poorly absorbed in patients with achlorhydria and in yhose taking antacids or H2-receptor antagonists. The usual adult dose is 200–400 mg/day depending on the infection. When required for children, a dose of 3 mg/kg can be used. The duration of treatment will depend on the nature of the infection. However, liver function must be monitored in patients receiving treatment for more than 30 days. The most common side-effects are nausea, anorexia and vomiting, which occur in about 20% of patients. Adrenal or testicular steroid metabolism may be affected. The coadministration of terfenadine, astemizole or cisapride is potentially fatal and should hence be avoided. Ketoconazole also enhances the effects of warfarin, oral hypoglycaemics and phenytoin. Oral ketoconazole has a high affinity for keratin and it has been used for dermatophytes, although the risk of hepatitis, albeit rare, makes this a secondary choice for therapy, especially now newer agents such as fluconazole, itraconazole and terbinafine are available. Ketoconazole remains, however, as an important adjunct in the treatment of AIDS patients with fluconazole-resistant Candida infections.
Topical Products Applied to the Nail
Published in Heather A.E. Benson, Michael S. Roberts, Vânia Rodrigues Leite-Silva, Kenneth A. Walters, Cosmetic Formulation, 2019
Apoorva Panda, Avadhesh Kushwaha, H.N. Shivakumar, S. Narasimha Murthy
Ketoconazole is fungistatic and effective against dermatophytes and candida species (Kushwaha et al., 2015). The proposed dosage regimen for this drug is 200 mg a day that needs to be taken with food (Kushwaha et al., 2015). Frequent administration of ketoconazole could lead to an increase in the risk of idiosyncrasy in patients with liver diseases and those consuming alcohol. Other common side effects associated with ketoconazole are fever, pruritus, diarrhea, nausea and vomiting (Kushwaha et al., 2015; (Markinson et al., 1997). However, the drug is no longer used in the treatment of onychomycosis due to its fungistatic nature.
Systemic ketoconazole continues to be prescribed despite an FDA warning
Published in Journal of Dermatological Treatment, 2022
Suraj Muddasani, Gabrielle Peck, Alan B. Fleischer
Oral ketoconazole is not recommended as an antifungal medication for skin infections due to its poor efficacy and its potential for significant side effects (1–3). In July of 2013, the United States Food and Drug Administration (FDA) issued a safety communication that warns against the prescription of oral ketoconazole for treating skin and nail fungal infections (4). As there are preferred agents that can be used for fungal diseases (2), any continued prescription of oral ketoconazole is concerning. The current extent of oral ketoconazole prescription is poorly characterized. An FDA safety review found that oral ketoconazole continues to be prescribed, and at least one death has occurred from its use after the safety communication (1). It is unknown how the safety communication affected oral ketoconazole prescription. This information could identify practice gaps among physicians who continue to prescribe the drug.
Adrenal disorders in pregnancy, labour and postpartum – an overview
Published in Journal of Obstetrics and Gynaecology, 2020
Madhavi Manoharan, Prabha Sinha, Shabnum Sibtain
Medical treatment with anticortisolic drugs remains a second line of treatment (Lim et al. 2013; Touiti and Mghari 2015; Zieleniewski and Michalak 2017). The drugs commonly used are Metyrapone, Ketoconazole, Cyproheptidine, Amino-glutethemide, Mitotane and Cabergoline. They act by inhibiting steroid synthesis. Metyrapone is the most commonly used treatment with no side effects on maternal liver function or foetal development. This has been used in 69% of cases with good control of hyper cortisolism, in most of the cases (Lindsay et al. 2005; Blanco et al. 2006). However, Metyrapone can exacerbate high blood pressure and preeclampsia. Ketoconazole is not advisable in pregnancy because of risk of transplacental passage and its teratogenic and antiandrogenic effects on the fetus. (Berwaerts et al. 1999; Lindsay et al. 2005; Boronat et al. 2011). Mitotane and aminoglutethimide are also contraindicated during pregnancy because of risk of foetal masculinisation and teratogenicity (McClamrock and Adashi 1992). Cabergoline is not commonly used in pregnancy, unless the condition is persistent and recurrent (Woo and Ehsanipoor 2013; Nakhleh et al. 2016; Sek et al. 2017). Medical treatment with anticortisolic drugs could be reserved for special cases, with Metyrapone being the safest option. These drugs should be used with extreme caution in view of the low number of patients reported and limited experience with its use (Brue et al. 2018).
Retroperitoneal laparoscopic resection of adrenal tumor in pregnant woman with cushing’s syndrome
Published in Gynecological Endocrinology, 2020
Zhenquan Lu, Bingfeng Luo, Yuan Yuan, Xiang Yi, Tuo Liang, Lin Xiong, Yi Jiang, Richard Lo
Therapeutic options of CS include surgical treatment, conservative management, medical treatment, and delay of surgery after delivery [6,9]. Active management of patients with CS in gestation can reduce the maternal and fetal complications. Surgical treatment is reported to be the mainstay of treatment in pregnancy with CS. Some authors [15–19] demonstrated that adrenalectomy for this patients with adrenal tumor is the most successful treatment option, and live birth rate after surgery is up to 87%. In our case, the decision about the patient’s treatment was made by a multidisciplinary team, consisting of urologists, perinatologists, obstetricians, endocrinologists, cardiologist, anesthesiologists and other relevant clinical specialists. Retroperitoneal laparoscopic resection of left adrenal tumor was recommended as the first choice for this patient in her second trimester, with medical treatment as a second choice. When surgical treatment is contraindicated, medical therapy can be used to treat these pregnant patients [8], including metyrapone, ketoconazole, cyproheptadine and aminoglutethimide. However, there are risks for the fetal and maternal adverse effects.