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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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Alphaderm cream (Urea and hydrocortisone)

Urea is a natural substance found in our bodies that helps moisturize the skin. It's often used in skincare products to hydrate dry skin and to treat conditions like eczema and psoriasis.

Hydrocortisone is a type of medicine called a corticosteroid. It helps reduce inflammation and itching in the skin. It's commonly used to treat conditions like eczema, dermatitis, and insect bites.

Alphaderm is a combination of urea and hydrocortisone. It is available for topical application for the therapy of:

Corticosteroid-responsive dermatoses

Urea and hydrocortisone dose in Adults

Urea and hydrocortisone dose in the treatment of Steroid-responsive dermatoses:

Topical application:

Apply a thin layer and gently rub it into the affected area 2-4 times a day.
Make sure it's well spread out and absorbed into the skin.
It's important to stop the treatment once the condition is under control.
If there's no improvement, it might be necessary to reevaluate the diagnosis and consider alternative treatments.

Urea and hydrocortisone Dose in Children

Refer to adult dosing.

Pregnancy Risk Factor C

Using strong corticosteroid creams during pregnancy can be risky for the baby's development.
Studies on animals have shown that these creams can cause birth defects.
It's best for pregnant women to avoid using topical corticosteroids extensively, in large amounts, or for long durations to minimize any potential harm to the baby.

Use of hydrocortisone and urea during lactation:

It's uncertain whether using topical medications will lead to noticeable amounts in breast milk.

Urea and hydrocortisone Dose in Renal Disease:

No dose adjustment is required.

Urea and hydrocortisone Dose in Liver Disease:

No dose adjustment is required.

Side Effects of Alphaderm

Side effects are mentioned for the individual medicine.
Topical side effects may include skin irritation and photosensitivity.
The risk of infection is increased. When applied to a greater skin area, the risk of systemic absorption may result in adrenal suppression.

Contraindications to Alphaderm (Urea and hydrocortisone) Include:

If you're allergic to urea, hydrocortisone, or any ingredients in the product, you should avoid using it.

Warnings and precaution

Suppression of the adrenals:

When topical corticosteroids are absorbed into the body, especially in young children or individuals using high doses for a long time, it can lead to adrenal suppression.
This means the body might produce too much cortisol or stop producing it altogether, affecting the hypothalamic-pituitary-adrenal (HPA) axis.
Adrenal suppression could potentially result in a serious condition called adrenal crisis.

Systemic effects

When you apply topical corticosteroids to your skin, they can sometimes get absorbed into your body.
This absorption might lead to symptoms like those seen in Cushing's syndrome, which include weight gain, high blood sugar levels (hyperglycemia), or sugar in the urine (glycosuria).
Using occlusive dressings, applying the medication to broken or irritated skin, or covering large areas of the body can increase absorption.

Immunosuppression:

Using topical corticosteroids for a long time can weaken the immune system, making you more susceptible to fungal or bacterial infections.
If you continue to have a skin infection even after using proper antimicrobial treatment.

Sensitization:

Using topical corticosteroids can sometimes cause irritation or redness in the area where it's applied.
If you notice any signs of sensitivity, like redness or irritation, it's best to stop using the product.

Urea and hydrocortisone: Drug Interaction

Risk Factor C (Monitor therapy)
Calcipotriene	Calcipotriene's medicinal effects may be diminished by topical hydrocortisone. Management: If using hydrocortisone valerate in combination with calcipotriene, watch for diminished potency. To reduce the danger of this possible interaction, think about administering these drugs 10 to 12 hours apart.
Corticorelin	The therapeutic benefit of corticorelin may be reduced by corticosteroids. In particular, recent or ongoing corticosteroid medication may reduce the plasma ACTH response to corticorelin.
Deferasirox	Corticosteroids may intensify Deferasirox's negative/toxic effects. Particularly, there may be a higher risk of GI bleeding or ulcers.
Ritodrine	Corticosteroids may intensify Ritodrine's harmful or hazardous effects.
Risk Factor D (Consider therapy modification)
Hyaluronidase	The therapeutic benefit of hyaluronidase may be reduced by corticosteroids. Treatment: Standard dosages of hyaluronidase may not provide the expected clinical response in patients using corticosteroids (especially at higher doses). Hyaluronidase may be needed at higher dosages.
Risk Factor X (Avoid combination)
Aldesleukin:	The anti-cancer effects of corticosteroids may be diminished by aldesleukin.

How to administer Alphaderm (Urea and hydrocortisone)?

Occlusive dressings, which are bandages or wraps that create a seal over the skin, can sometimes be helpful during treatment for conditions like psoriasis or stubborn skin issues.
However, if you notice signs of infection, it's important to stop using occlusive dressings and seek medical advice.

International Brands of Urea and hydrocortisone: