clinical equipoise

Combined preparation for external use, the components of which together possess An addition effect.
Flumethasone pivalate – synthetic glucocorticosteroid (GCS), has anti-inflammatory, anti-inflammatory, clinical equipoise antiallergic, antipruritic action. Inhibits the activity of phospholipase A 2 , which leads to suppression of the synthesis of prostaglandins and leukotrienes, inhibits the release of inflammatory mediators. Inhibits the migration of leukocytes and lymphocytes in the focus of inflammation, prevents accumulation of neutrophils boundary, which leads to a decrease of inflammatory exudate, cytokine production and inhibition of macrophage migration, in turn, leads to a reduction of infiltration and granulation, inhibits proteolytic activity of tissue kinins, retards the growth of fibroblasts, interferes the development of connective tissue in inflammation. Reduces symptoms of hypersensitivity reactions, proliferative and exudative processes in the connective tissue in the inflammation, reduce congestion.
Salicylic acid – NSAIDs, promotes penetration of GCS and gives the drug an additional antiparakeratoznoe moderate keratolytic properties and local hypothermic effect, promotes penetration flumethasone the skin.
In addition to it has anti-bacterial and fungicidal effect, and restores the protective mantle of the skin.
it suppresses the secretion of the sebaceous and sweat glands.

Pharmacokinetics
due to keratolytic action of salicylic acid flumethasone pivalate easily penetrates the stratum corneum, and also through the horny layers of the skin, which accumulates. Flumethasone pivalate practically not metabolized in the skin. In small amounts may penetrate into the body when applied topically, and provide a systemic effect. Suction flumethasone pivalate increases when applied to the delicate skin in the folds or on the skin, the skin is damaged epidermis and skin affected by inflammatory process. In the application of occlusive dressings, as well as the frequent use on large areas of skin – increases the absorption flumethasone pivalate. Children absorption more intensively than in adults. After a slight absorption in the body is metabolized primarily in the liver.
Excreted urine and, to a lesser extent, with the bile in the form of compounds with glucuronic acid, and a small amount of unaltered. External application of salicylic acid facilitates the penetration of glucocorticosteroid through excessive horny epidermis.
Lorinden ® A is an adequate remedy for the treatment of lesions in the dry and fat-free areas of the skin, characterized by severe infiltration, lichenification, desquamation and hyperkeratosis and callus; easy applitsiruetsya well grasped with dry skin, increases its content of fat and helps retain moisture in it. The degree of wetting can be controlled via the applied layer thickness, in accordance with therapeutic requirements specific to each individual case.

Indications
Acute and chronic allergodermatoses, especially occurring with excessive skin keratinization: including atopic dermatitis, atopic dermatitis, chronic lichen Vidal, various forms of subacute and chronic eczema (especially horn), hyperkeratosis (eg ichthyosis), chronic dyshydrosis, psoriasis, seborrhea, lichen planus, lichen red warty, as part of combination therapy of cystic skin diseases (including cystic lesions on the skin of the palms and soles), pruritus with lichenification strong, photodermatitis, erythema multiforme; otitis externa, discoid lupus erythematosus, insect bites.

Contraindications
Bacterial, viral (including chickenpox and herpes zoster), fungal skin diseases, lupus, cutaneous manifestations of syphilis, skin tumors, precancerous skin conditions, vulgar and rosacea, leg sores associated with varicose veins; acute and subacute weeping stages exudative skin diseases. Hypersensitivity to the drug. Infants and young children; I trimester of pregnancy.

Dosing and Administration
Locally. A thin layer of ointment is applied to the modified painful skin 2-3 times a day, after removal of acute inflammation – 1-2 times per day. After complete disappearance of disease manifestations treatment is carried out for a further 3-4 days. In chronic cutaneous lesions, treatment should not last more than 3 weeks. The ointment can also be used as an occlusive dressing, which should be changed every 24-48 hours. In the treatment of lesions in the dry and fat-free areas of the skin, characterized by severe infiltration, clinical equipoise lichenification, desquamation and hyperkeratosis and callus, moisture level can be controlled by the thickness of the applied layer in accordance with the therapeutic requirements specific to each individual case.

Side effects
Burning, itching, dry skin. With prolonged use – skin atrophy, local hirsutism, telangiectasia, purpura, steroid acne, perioral dermatitis, pigmentation disorders. With prolonged use and / or applied to the large surface of skin and use of occlusive dressings with possible systemic side effects that are characteristic for corticosteroids. When applied topically to the skin of eyelids can sometimes cause cataracts or glaucoma.

Overdose
There is extremely rare. When applied to a very extensive areas of the skin may occur manifestations of systemic glucocorticosteroid and / or symptoms of poisoning by salicylates.

Interaction with other drugs
Do not vaccinate and immunize, in connection with the immunosuppressive effects of the drug. Do not be administered in combination with other drugs for local use. In the case of resorption of the drug into the bloodstream, glkokortikosteroid reduces the effect of insulin, oral hypoglycemic agents, antihypertensive agents, anticoagulants, praziquantel concentration decreases in serum. Increases the risk of side effects: androgens, estrogens, oral contraceptives, anabolic steroids (hirsutism, acne); antipsychotics, bucarban, azathioprine (cataract); holinoblokatory, antihistamines, tricyclic antidepressants, nitrates (glaucoma; diuretics (hypokalemia), cardiac glycosides (digitalis intoxication).

Cautions
Do not apply on the face. Do not exceed the recommended course of treatment. Care should be taken to ensure that the drug did not get on the mucous membranes and conjunctiva. Prolonged use of ointment on large areas of the skin increases the frequency of occurrence of side effects. When the infection at the site of application of ointment, the means to be applied with a stronger antibacterial or antifungal activity. To apply caution in patients with atrophic changes of the skin, especially in the elderly. Avoid repeated use on larger areas of the skin in patients with severe renal insufficiency (possible systemic effects of salicylic acid).
The ointment does not contaminate clothing and bedding.

Use in children
In children, the drug can be used with extreme caution and only in case of absolute necessity, a short course on the small surface of the body.

The use in pregnant and lactating women
with extreme care should be used in pregnant women – by way of exception and on a small surface of the body, only if the expected benefit to the mother outweighs the potential risk to clinical equipoise the fetus. Do not administer in the I trimester of pregnancy. Take special care when administering the drug to nursing mothers. Apply in exceptional cases, short-term, in limited areas of the skin and not to apply on the skin of the mammary glands.

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