29 Years Factory Dextran iron B12 injection 10%*100ml Jamaica Manufacturers

Composition
Contains per ml.: 
Iron (as iron dextran)  100 mg. 
Vitamin B12, cyanocobalamin  100 μg. 
Solvents ad.  1 ml.

Description
Iron dextran is used for prophylaxis and treatment of by iron deficiency caused anaemia in piglets and calves. Parenteral administration of iron has the advantage that the necessary amount of iron can be administered in one single dosage. Cyanocobalamin is used for prophylaxis and treatment of by cyanocobalamin deficiency caused anaemia.

Indications
Prophylaxis and treatment of anaemia in calves and piglets. 
Contra indications
Administration to animals with vitamin E?deficiency. 
Administration to animals with diarrhoea. 
Administration in combination with tetracyclines, because of the interaction of iron with tetracyclines.

Side effects
Muscle tissue is coloured temporarily by this preparation. 
Leaking of injection fluid can cause a persistent discoloration of skin.

Dosage
For intramuscular or subcutaneous administration:  
 
Calves  : 4 – 8 ml. subcutaneous, in the first week after birth. 
Piglets : 2 ml. intramuscular, 3 days after birth.

Withdrawal times
None. 
Warning
Keep out of reach of children. 
Packing
Vial of 100 ml.

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Rosacea is a frustrating chronic skin condition affecting the face. It is most commonly diagnosed between the ages of 30 and 50. However, it can be diagnosed in teenagers and the elderly. It relapses and remits and is characterised by its symmetrical appearance on the convex surfaces of the face, such as the nose, cheeks, forehead and chin. Commonly it presents as facial flushing, telangiectasias, papules and pustules. In the severe late stage patients may develop chronic facial lymphedema and rhinophyma. Blepharitis, conjunctivits and keratitis are common associations. Rosacea is made worse by corticosteroid treatment, often in the form of prolonged topical therapy but brief topical therapy or oral prednisone can also cause exacerbations.

Avoidance of triggers
Photoprotection can have a dramatic effect on the symptoms of Rosacea for most cases, but maintenance is difficult. A broad spectrum sunscreen combined with physical protection is recommended. Avoidance of alcohol and hot or spicy foods may be of benefit for some. Oily or irritating topical preparations should be avoided. In Brisbane where I practice, the UV index is high and is the number one flare factor for rosacea, facial redness and broken capillaries.

Topical Therapy
Topical Metronidaxzole, Azelaic acid 15% and sulphur preparations can be used once or twice daily, as monotherapy or in combination. They should be combined with a gentle cleanser. These may be adequate for mild to moderate cases. Off-lable use of many other commonly used topical acne preparations have be trialled with varied success eg erythromycin, benzyl peroxide, clindamycin and retinoids. Topical erythromycin is often used first line in pregnancy.

Oral therapy
Minocycline or Doxycycline 50-100mg twice daily can be very effective, but the phototoxic effects limits their use for these patients. The patient could be reviewed in 6-12 weeks with the view to ceasing or continuing at a lower dose, such as 50mg daily. Oral isotretinoin can play a role in severe disease.

Laser and Light therapy
Vascular and intense pulsed light systems are useful as adjunctive therapy. They can achieve faster and more complete symptom resolution. The treatment would have to be individually tailored because of potential side effects, including transient worsening of the patient’s symptoms. My lasers of choice include the V Beam pulse dye laser, IPL, and the Cutera laser using the laser genesis method. For rhinophyma, the use of Co2 laser resurfacing can make the biggest difference.

Usually in medicine we try to follow the rule, ‘keep it simple’ and therefore we look for one over-arching diagnosis. However, Rosacea management is challenging because it is not uncommon that the condition will present as part of a mixed diagnosis. For example, rosacea is not usually seen on the concave surfaces of the face (eg nasolabial folds) where you would typically see seborrhoeic dermatitis. However, these conditions can co-exist and the treatment of one of these diseases can exacerbate or even trigger the other. Classically, steroid preparations, whether they be topical or oral, worsen rosacea and drying products will irritate dermatitis. Also, comodones are not seen in rosacea. However, they may be present because the patient has co-existent acne or solar comodones. In this situation, both you and/or the patient may not be satisfied with treatment results. This may simply be because a second or even third diagnosis needs to be addressed before you can achieve optimal management. Furthermore, there are many conditions that may present with red rashes on the face. They are most commonly thought of as connective tissue diseases, infections or other inflammatory conditions but can be rarer presentations of many systemic conditions and these will warrant further investigation. Co-existent rosacea could easily complicate the diagnosis of these conditions, because it is common and seen in all age groups. As a result, clinical assessment and re-assessment can be equally important as therapeutic trials in the management of rosacea.

Rosacea is a chronic condition and requires ongoing monitoring, but with appropriate consideration can be well managed.

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Dr Davin Lim
Laser and aesthetic dermatologist
BRISBANE, Australia.