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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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Topical Methoxsalen (Uvadex, Oxsoralen) lotion for Vitiligo

Topical Methoxsalen (Oxsoralen, Uvadex) is used in combination with ultraviolet light therapy for the treatment of hypopigmented skin patches.

Topical Methoxsalen (Uvadex, Oxsoralen) Uses:

It is used for the repigmentation of idiopathic vitiligo.

Read the details of oral methoxsalen here: Methoxsalen (Oxsoralen) Tablets & Capsules - Uses, Dosage, Side effects.

Topical Methoxsalen (Uvadex, Oxsoralen) Dose in Adults:

Note: Oxsoralen has been discontinued for more than a year in the US.

Note: For recommendations on UVA exposure, consult the therapy regimens.

Topical Methoxsalen (Uvadex, Oxsoralen) Dose in the treatment of Vitiligo:

The lotion is applied by a healthcare provider before UVA light exposure, not exceeding more than once a week
The frequency of application is determined by the erythema response.

Topical Methoxsalen (Uvadex, Oxsoralen) Dose in Children:

Note: Oxsoralen has been discontinued for more than a year in the US.

Topical Methoxsalen (Uvadex, Oxsoralen) Dose in the treatment of Vitiligo:

Children 12 years and older:
- Refer to adult dosing.

Uvadex Pregnancy Risk Factor C

It has not yet been tested in pregnant human females or animals.

Use during breastfeeding:

It is unknown if the drug will be excreted into breastmilk.
The manufacturer recommends that lactating women use topical methoxsalen.

Topical Methoxsalen Dose in Renal Disease:

No dosage adjustment is recommended when used topically.

Dose in Liver disease:

No dosage adjustment is recommended when used topically.

Side effects of Methoxsalen (Uvadex, Oxsoralen):

Dermatologic:
- Burning sensation of skin
- Erythema
- Skin blister
- Skin irritation

Contraindications to Methoxsalen (Uvadex, Oxsoralen):

Allergy to methoxsalen or any component of formulation
Patients suffering from photosensitive skin conditions such as albinism and porphyriacutanea tarda, erythropoietic or variegate porphyria and systemic lupus-erythematosus and xeroderma pigmentosum.
Skin cancers that are aggressive
History of Melanoma and Melanoma
Children younger than 12 years old

Uvadex Warnings & Precautions

Burns
- Patients can sustain serious burn injuries from exposure to ultraviolet radiation.
- Patients who don't wear sunscreen or protective clothing and who expose to sunlight for longer periods of time are more at risk for sunburns.
Cataracts
- To prevent cataract formation, methoxsalen concentrations in the lenses.
- Patients should protect their eyes from direct and indirect sunlight for at least 24 hours following the use of the drug.
- The risks associated with topical application are minimal, as systemic exposure is very low.
Photosensitivity
- Avoid sun exposure and use of sunlamps for at least eight hours after the use.
- After receiving combined methoxsalen/UVA therapy, patients should wear protective clothing and eyewear. Sunscreens should not apply to areas with psoriasis.
- It is best to not use it on sunburnt skin until you are completely healed.
- Avoid sunbathing for at least 24 hours prior to the treatment, and several days afterwards.
- Patients who are exposed to the sun a lot due to their occupation should avoid it.
Skin cancer:
- Systemic therapy can increase the risk of skin cancers, including basal cells, melanoma and squamous cells.
- Patients at high risk for developing cancers should use it with caution, especially those who have had previous exposure to coal tar, ultraviolet radiation, ionizing radiation or arsenic.
Basal cell carcinoma
- Patients who have had basal cell carcinoma in the past shouldn't use it.
- Patients at high risk for basal cell carcinoma should be closely monitored.

Monitoring Parameters:

Monitor the response to therapy and sunburn.

How to administer Topical Methoxsalen (Oxsoralen, Uvadex)?

Before applying the medicine over hypopigmented areas, wear protective gloves.
Avoid burns and photosensitization of the unaffected areas.

Mechanism of action of Methoxsalen (Oxsoralen, Uvadex):

It causes cellular replication to be inhibited by covalent bonds with DNA nucleotide bases pyrimidine nucleotide.
This results in inhibition of DNA synthesis.
It results in thickening the stratum corneum, increased pigmentation and an increase in melanocyte production.
The methoxsalen molecular is stimulated by sunburn and ultraviolet rays to create a "triplet electronic condition" in the skin.
The skin's reaction to this excited molecule is photosensitization, and an inflammatory reaction.
Following the erythematous reaction, skin repair takes place over several days or weeks.
This results in melanocyte production as well as hardening of skin (stratum corneum).