Yearly STL Archives: 2016

Recent advances in our understanding of the innate and adaptive immune systems have led to the identification of interleukin (IL)-17 as a key pro-inflammatory mediator in psoriasis. We review phase 1-3 clinical trials of ixekizumab, for treatment of moderate-to-severe plaque psoriasis.

Update and discussion on onychomycosis (nail fungus) and Efinaconazole 10%. Recent clinical trial results, and discussion about patient safety profile, special cases like diabetic patients, and cure rates.

Update on drugs, approval dates, and comments. Brodalumab for SC injection (Lumicef®), Etanercept-szzs for SC injection (Amjevita™), Propranolol hydrochloride oral solution 3.75 mg/ml (Hemangiol®), Calcipotriol 50 mcg/g + betamethasone dipropionate 0.5 mg/g foam (Enstilar®) are covered.

Actinic keratosis, a common cutaneous lesion with the potential to transform into squamous cell carcinoma. Recently, a topical formulation Actikerall, combining 0.5% 5-fluorouracil with 10% salicylic acid (5-FU-SA) has been made commercially available in Canada. We discuss their merits.

Phosphodiesterase 4 (PDE4) is a key enzyme in the regulation of immune responses of inflammatory diseases through degradation of the second messenger, cyclic adenosine 3',5'-monophosphate (cAMP). Apremilast (APR), a selective PDE4 inhibitor, has been shown to reduce the production of pro-inflammatory cytokines.

Hand Dermatitis can have a significant impact on quality of life. It may interfere with activities both at work and in the home and can be associated with social and psychological distress. This article provides helpful practical guidance for the general practitioner in the management of patients with Hand Dermatitis.

This update covers Pembrolizumab IV injection (Keytruda®), Hyaluronic acid gel filler (Juvéderm Volbella® XC), Biosimilar of infliximab (Flixabi®), Ceftaroline fosamil for IV infusion (Teflaro®), Dermal filler with calcium hydroxylapatite (CaHA) + integral 0.3% lidocaine (Radiesse® + Lidocaine), Ixekizumab SC injection (Talz®), Adapalene gel 0.1% (Differin® Gel), C1 esterase inhibitor(human) for IV infusion (Berinert®)

Rituximab is an anti-CD20 monoclonal antibody with considerable potential in dermatology due to an increase in off-label indications. Off-label use of rituximab, indications, side-effects, and dosing are some of the topics discussed.

Sodium Deoxycholate for contouring the jawlines are discussed. With recent approval in Canada (Belkyra™), and the US (Kybella®) for the treatment of submental fat, this is a timely review of this injectable. Clinical trial results, indications, safety and efficacy are discussed.

Update on Bilastine tablet (Blexten™), Ixekizumab SC injection (Talz®), Wound care gel (Lasercyn™ gel), Ceftaroline fosamil (Teflaro®), Nivolumab + ipilimumab (Opdivo® + Yervoy®), PDT for actinic keratosis (Ameluz® gel + BF-RhodoLED®)

Frontal fibrosing alopecia has become one of the most frequently seen causes of scarring alopecia at many specialist hair clinics. It has distinctive features and associations which distinguish it from LPP. Discussion includes familial or genetic factors, etiology, and trials.

Adalimumab (Humira®) is a novel therapy approved by the US Food and Drug Administration, Health Canada, and the European Commission for the treatment of hidradenitis suppurativa (HS). Discussion includes, safety and efficacy in clinical trials.

Update on Betamethasone dipropionate 0.05% spray (Sernivo™), Dapsone 7.5% gel (Aczone®), Cobimetinib + vemurafenib (Cotellic™ + Zelboraf®), Botulinum toxin type A for injection (Bocouture®), Calcipotriol + betamethasone dipropionate foam (Enstilar®), (Talz®), (Inflectra™), (Pruridexin™), and (Dermadexin™)

This update summarizes current concepts, relevance, and therapeutics in psychodermatology, including aspects pertinent to depression, anxiety, obsessive-compulsive, impulse-control, and delusional disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

A topical formulation combining 0.5% 5-fluorouracil with 10% salicylic acid (5-FU-SA) was introduced in Europe under the trade name Actikerall™ for the treatment of AKs. Now commercially available in Canada, 5-FU-SA represents a patient applied therapeutic option. Clinical trial data is considered.

Update on (Beteflam™), Human papillomavirus (HPV) 9-valent vaccine, recombinant (Gardasil®9), (Imlygic®), Pembrolizumab IV injection (Keytruda®), Adalimumab SC injection (Humira®), Secukinumab SC injection (Cosentyx®), Ustekinumab SC injection (Stelara®), and Nivolumab + ipilimumab (Opdivo® + Yervoy®).

An overview and update of skin treatments introduced in 2015: Quick overview of drug name, indications and regulatory status. Deoxycholic acid injection, 5-fluorouracil 0.5% + salicylic acid 10% solution, Adapalene 0.3% + benzoyl peroxide 2.5% gel, and more are covered.

Melanoma is an aggressive skin cancer with a generally poor prognosis at Stage III-IV disease. Discussion centres around clinical trial data from phase I-III studies of Nivolumab (Opdivo®), a human monoclonal antibody which prevents immune inhibition by interacting with PD-1 on tumor cells.

Standard therapies for atopic dermatitis have fallen short, prompting efforts to discover novel therapeutics for this disease. Dupilumab, a fully human monoclonal antibody that inhibits the actions of both IL-4 and IL-13, has shown promise.

January and February 2016: Update on drugs, approval dates, and comments. Autologous cell suspension (ReCell® ReGenerCell® ReNovaCell®), Calcipotriene 0.005% + betamethasone dipropionate 0.064% foam (Enstilar®), Ipilimumab (Yervoy®), Talimogene laherparepvec (T-Vec) oncolytic virus therapy (Imlygic™), Cobimetinib + vemurafenib (Cotellic™ + Zelboraf®), Dabrafenib + trametinib (Tafinlar® + Mekinist®), Nivolumab injection (Opdivo®) are covered.

Topical calcineurin inhibitors (TCIs) have been proposed as an alternative, long-term treatment option to topical corticosteroids. Currently, TCIs are only approved for treatment of atopic dermatitis in patients 2 years of age or older. This article reviews the off-label uses of TCIs and their efficacy in the treatment of cutaneous diseases.

Treatment of PIH and melasma is challenging. There are no singular therapies that are efficacious on its own. Management, sun protection, topical lightening therapy and other treatment modalities are considered in this discussion on these growing concerns.

Mohs surgery is an advanced technique for removing skin cancers that combines histological analysis under a microscope at real-time with surgical excision.

Why is Mohs Surgery considered the world's gold standard treatment for BCC and SCCs? Dr. Bryce Cowan explains the types of cancers that are typically treated with Mohs surgery, and why the procedure has such as high cure rate.

In the third video of the Mohs Surgery series, plastic surgeon Dr. Bryce Cowan explains in further detail the combined process of surgical excision and real-time histological analysis of the excised tissue.

Patients often wonder why Mohs is not the standard treatment for invasive melanoma, the most dangerous of skin cancers. Dr. Cowan explains why the use of Mohs surgery is considered controversial for treating invasive melanomas.

In this video Dr. Cowan explains common scenarios where a doctor might not recommend Mohs Micrographic surgery, and might opt for another treatment modality instead.

Dr. Cowan explains when Mohs Micrographic Surgery is recommended, from a physician perspective. At the same time, he emphasizes the importance and necessity of patients doing their own research.

Mohs micrographic surgery is often used to treat recurrent skin cancers. In this video, we ask Dr. Bryce Cowan whether previous attempts to remove skin cancer can affect the prognosis of Mohs surgery.

A very common question from patients concerning Mohs Surgery is “Will I need reconstruction surgery?” Dr. Bryce Cowan explains why reconstruction surgery is necessary to optimize the final outcome, and outlines the process and importance of this with some examples.

Reconstruction surgery is required after any Mohs Surgery procedure. Typically the wounds will take over a year to completely heal after the surgery. 10% per month is a typical rate of healing, with the peak at around 2 months.

What's the difference between true risks and expectations of surgery? Dr. Cowan explains the difference.

Patients need to take some important steps prior to surgery to maximize the outcome of their procedure. The first step for a patient is to ensure that their surgeon is a qualified Mohs surgeon...

In Canada, there are only a very limited number of qualified Mohs surgeons at this stage, but that number is growing. The health care system in Canada is run at the provincial level, and currently there are only a limited number of facilities where Mohs surgeons can practice at.

If a patient has skin cancer removed with Mohs Surgery, will they see another cancer, or a recurrence of the same cancer again? Unfortunately, the answer is that yes it's highly likely.

Patients often ask whether they are likely to have skin cancer if their mother or father had this problem. Being a genetic combination of your parents, what you do inherent is the same skin types.

What is fat grafting? Plastic surgeon Dr. Bryce Cowan explains this important rejuvenating options that is used both in restorative surgery (after a trauma) and for cosmetic purposes.

At what age do we start losing volume in the face, and in what areas? Plastic surgeon Dr. Bryce Cowan explains the process of volume loss with age, and how it affects the overall appearance of the face, and how fat grafting can help combat these changes.

Grafted fat is transferred as whole cells which are believed to contain stem cells that release cytokines and growth factors. This promotes a rejuvenative process in the surrounding skin.

We ask plastic surgeon Dr. Bryce Cowan about what patients should expect on the day of the surgical procedure.