Ulticort Plus

• Approved Indications:
• Treatment of moderate to severe plaque psoriasis in adults who require potent topical corticosteroid and retinoid combination therapy.
• Used to reduce inflammation, scaling, and plaque thickness associated with chronic plaque psoriasis.
• Important Off-Label (Clinically Accepted) Uses:
• Treatment of corticosteroid-responsive dermatoses with resistant plaques where combined anti-inflammatory and keratolytic effects are desired.
• Adjunctive therapy in difficult-to-treat psoriatic lesions requires both anti-proliferative and anti-inflammatory effects.

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

• Adults:
• Apply a thin layer of the combination topical gel or cream once daily to affected areas.
• Treatment duration is generally limited to 4 weeks to reduce risk of corticosteroid-related side effects.
• Avoid exceeding 50 grams per week to minimize systemic absorption risks.
• Pediatrics (<18 years):
• Safety and efficacy have not been established; use is generally not recommended.
• Elderly:
• Use standard adult dosing with careful monitoring for skin thinning or irritation.
• Special Populations:
• No specific dosing adjustments are necessary for renal or hepatic impairment due to topical application and minimal systemic absorption.
• Administration Instructions:
• Apply to clean, dry skin once daily.
• Avoid application on face, groin, or intertriginous areas unless directed.
• Avoid contact with eyes, lips, and mucous membranes.
• Wash hands thoroughly after application.
• Do not use occlusive dressings unless prescribed.
• Limit treatment duration to minimize adverse effects.

রেজিস্টার্ড চিকিৎসকের নির্দেশনা অনুযায়ী ঔষধ সেবন করুন।

This combination therapy pairs halobetasol propionate, a super-high potency corticosteroid, with tazarotene, a third-generation topical retinoid. Halobetasol propionate binds intracellular glucocorticoid receptors, modulating gene expression to suppress inflammatory cytokines, inhibit leukocyte migration, and reduce vasodilation and edema, resulting in anti-inflammatory and immunosuppressive effects. Tazarotene is converted in the skin to its active metabolite tazarotenic acid, which selectively binds retinoic acid receptors (RAR-β and RAR-γ), regulating gene transcription involved in cell proliferation and differentiation. This retinoid effect normalizes keratinocyte differentiation and reduces epidermal hyperproliferation. Together, the combination reduces inflammation, plaque formation, scaling, and hyperkeratosis characteristic of psoriasis.

• Absorption: Both agents exhibit minimal systemic absorption when applied topically to intact skin. Absorption may increase if applied to broken skin or under occlusion.
• Distribution: Remain primarily localized in epidermal and dermal layers.
• Metabolism:
• Halobetasol propionate is metabolized in the skin and liver to inactive metabolites.
• Tazarotene is rapidly converted in the skin to tazarotenic acid, which undergoes hepatic metabolism.
• Elimination: Metabolites are excreted mainly via renal pathways.
• Onset of Action: Improvement in psoriasis plaques may be seen within 1 to 2 weeks; maximal effects typically by 4 weeks.
• Half-life: Not well defined due to topical use and low systemic levels.

• Pregnancy: Classified as FDA Pregnancy Category C. Animal studies have shown potential teratogenicity with retinoids and fetal risk with systemic corticosteroids at high doses. The combination should be used during pregnancy only if the potential benefits outweigh risks. Topical use limits systemic exposure but caution is warranted.
• Lactation: It is unknown if either drug is excreted in human milk. Due to minimal systemic absorption, the risk to nursing infants is likely low, but use caution and avoid applying to breast area during breastfeeding.
• Data: Limited human data available; use only if clearly needed and under medical supervision.

• Primary Classes:
• Halobetasol propionate: Topical corticosteroid, super-high potency (Class I)
• Tazarotene: Topical retinoid, third-generation
• Combination Class: Potent anti-inflammatory and keratolytic topical therapy for psoriasis

• Known hypersensitivity to halobetasol propionate, tazarotene, or any formulation components
• Untreated skin infections including bacterial, viral (e.g., herpes simplex), fungal, or parasitic infections
• Patients with rosacea, perioral dermatitis, or eczema affecting areas intended for treatment
• Pregnancy and breastfeeding unless clearly justified by physician
• Use on mucous membranes or open wounds

• Limit use to 4 weeks to minimize risk of skin atrophy, telangiectasia, striae, and systemic corticosteroid effects.
• Avoid use on thin or sensitive skin areas unless directed.
• Risk of hypothalamic-pituitary-adrenal (HPA) axis suppression with prolonged or extensive use.
• Tazarotene may cause photosensitivity; advise patients to avoid excessive sunlight and use sunscreen.
• Monitor for signs of skin irritation or allergic contact dermatitis; discontinue if severe.
• Not recommended in pediatric patients due to safety concerns.
• Avoid occlusive dressings unless prescribed.
• Use with caution in elderly patients due to increased risk of skin thinning.

• Common:
• Application site burning, itching, irritation, or dryness
• Erythema and peeling
• Photosensitivity reactions (due to tazarotene)
• Less Common/Rare:
• Skin atrophy, telangiectasia, striae from corticosteroid component
• Allergic contact dermatitis or sensitization reactions
• Hyperpigmentation or hypopigmentation
• Secondary infections due to immunosuppression
• Systemic corticosteroid effects (rare, with extensive use), including HPA axis suppression

• Minimal systemic absorption limits major drug-drug interactions.
• Avoid concomitant use with other topical agents that cause irritation or increase absorption.
• No significant drug-food or drug-alcohol interactions reported.
• CYP450 enzymes are not significantly involved due to topical use.

• Current dermatology guidelines recommend limiting duration of therapy to 4 weeks for combination topical corticosteroid-retinoid treatments.
• Emphasis on patient education regarding photosensitivity and sun protection with tazarotene-containing products.
• Guidelines advise against use in pediatric populations and caution in elderly.
• Monitoring for systemic corticosteroid adverse effects reinforced in recent safety updates.

• Store at controlled room temperature between 20°C and 25°C (68°F to 77°F).
• Protect from light, moisture, and heat.
• Keep container tightly closed when not in use.
• Avoid freezing.
• Do not use if product changes color or consistency.
• No reconstitution or refrigeration needed.