Dermatology

Onychomycosis has a significant impact on the patient. With three new, orally effective, antifungal agents, we have for the first time effective treatment that can provide benefit for a high percentage of patients. This review examines some of the areas of uncertainty and controversy.

Never before have so many people sought our assistance to help get get rid of their wrinkles. Until recently, most biological materials presented shortcomings – resorption within months, allergic reaction, and on occasion, foreign body or granuloma formation at the site of injection.

Update on: Efavirenz Sustiva® Nevirapine Viramune®Famciclovir Famvir®Cetirizine Zyrtec® Rifapentine Priftin® Denileukin diftitox Ontak® Doxorubicin Caelyx® Graftskin Apligraf® Dangers of alternative medicine, Protease inhibitors during pregnancy

Some of the most striking advances in dermatology have followed the off-label use of drugs. This review examines some of the issues surrounding off-label use of drugs by dermatologists, illustrates the need for such use and looks at possible changes in the regulatory system.

Update on: Famciclovir Famvir® Acyclovir sodium Zovirax® Calcipotriol Dovonex® Thalidomide 50 mg Thalomid® Finasteride 1mg tablets Propecia® Aids vaccine Aidsvax® phase III, Indinavir Crixivan® Calcipotriene 0.005% Dovonex®ointment

We review the various controversies surrounding sunscreen use.

Approximately 50% of patients with psoriasis have nail psoriasis but the life time chance of nail changes must be much higher. Nail changes in psoriasis include pitting, thickening, onycholysis, discoloration, oily spots, splinter hemorrhages and paronychia. Treatment of choice depends on the form the psoriasis takes.

Estimates of the percentage of patients with cutaneous lichen planus (LP) who also have oral LP vary from somewhere between a third and a half 1-3, to as high as 70% and even higher when the cutaneous lesions are of long duration.

Update on: Diclofenac sodium Solarase Gel 3% Trovafloxacin (oral) Alatrovafloxacin (IV) Trovan Zidovudine 300 mg/ lamivudine 150 mg Combivir Hydroquinone 4%, glycolic acid & an antioxidant complex. Lustra 10% Docosanol Cream Bleomycin ANDA Leprosy vaccine Minocycline Minocin Protease inhibitor side-effects

On the 26th of February 1998, Hoffmann-LaRoche, on the instructions of the FDA, sent out more than 210,000 Dear Dr. warning letters to health care providers communicating new safety information about the prescribing of isotretinoin for acne, and citing isolated reports of drug-induced depression, psychosis and rarely, suicidal thoughts and action.

Alpha-hydroxy acids (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. Topical formulations incorporating these acids are now frequently used or prescribed by dermatologists.

Update on: Norgestimate / Ethinylestradiol Tri-Cyclen® Lidocaine/Prilocaine Cream Emla®Tretinoin gel 0.025% Avita® Adapalene solution 0.1% Differin®Topical tissue adhesive Dermabond® Atorvastin calcium Lipitor® Isotretinoin Accutane®

Tinea capitis, the most contagious of all the tineas caused by dermatophytes, has been described as a scourge of young children. Children are most susceptible before puberty, and the infection develops less commonly in older age groups.

Finasteride 1 mg (Propecia®, Merck) was approved by the US FDA December, 1997 for the treatment of male pattern hair loss (androgenetic alopecia, AGA) in men only. Safety and efficacy were demonstrated in men between 18 and 41 years of age with mild to moderate hair loss of the vertex and anterior mid-scalp area.

Update on: Mupirocin calcium cream 2% Bactroban Cream® Butenafine cream Mentax®Becaplermin gel 0.01% Regranex®Finasteride 1mg tablets Propecia®Minoxidil 5% Rogaine Extra Strength for Men® Dermagraft® Graftskin® (apligraf) UV light as carcinogen

Clinical rosacea is not a single disease but rather a combination of cutaneous stigmata which include flushing, erythema, telangiectasia, facial edema, papules, pustules, ocular lesions, and rhinophyma. A review of rosacea, treatment, and management.

For Erythema Nodosum Leprosum there are no good alternative treatments to thalidomide. ENL is a severe and painful complication for approximately half of all leprosy patients, affecting about two million people worldwide. A review of thalidomide.

Update on: Amphotericin B Lipid Complex Injection Abelcet® Butenafine HCl Cream 1% Mentax® Itraconazole Sporanox® Acitretin Soriatane® Penciclovir cream 1% Denavir® Valacyclovir  Valtrex® Laser device Sharplan Silktouch laser®Permethrin lotion Nix®Ivermectin Mectizan® (6 mg tablet) 

Antibiotic prophylaxis aims to prevent wound infections and provide adequate antibiotic cover for patients with prostheses or at risk for endocarditis. Most recommendations are based spread of risk factors may not accurately predict the risks for patients. A case for prophylaxis is made.

Imiquimod is an immune response modifier. Studies have shown that it has potent immunomodulatory effects and stimulates human peripheral mononuclear cells to release interferon alpha, sub-types α1,α2, α5, α6, and α8.

Update on: Amphotericin B Lipid Complex Injection Abelcet®Butenafine HCl Cream 1% Mentax® Itraconazole Sporanox® Acitretin Soriatane® Penciclovir cream 1% Denavir® Valacyclovir Valtrex® Laser device Sharplan Silktouch laser® Permethrin lotion Nix® Ivermectin Mectizan® (6 mg tablet)

Although PDT remains an investigational treatment modality in dermatology, several important areas of development may ultimately lead to official and practical acceptance of PDT for the skin. Various uses of PDT are evaluated.

A review of the history surrounding the Skin-Cap controversy as it unfolded.

Update on: Tazarotene Gel 0.05%, 0.1% Tazorac® topical gel Ketoconazole Shampoo 2% Nizoral® Fluticasone proprionate Cutivate® Cream 0.05% Amoxicillin/clavulanic acid Augmentin®Indinavir, Crixivan®Nelfinavir, Viracept®Ritonavir, Norvir®Saquinavir, Invirase® Acitretin Soriatane®, Neotigason®

Scalp conditions such as itchy scalp, dandruff, seborrheic dermatitis, and scalp psoriasis are common. The emotional effect these complaints cause are often ignored or trivialized, but as dermatologists we should appreciate the relief that appropriate advice and treatment will bring to our patients.

Preparation of the wound bed, proper application of Apligraf, and patient compliance with underlying therapy for underlying disease are probably the most important determinants of clinical efficacy. Part 2 of the series.

Penciclovir cream (Vectavir™/Denavir™, SmithKline Beecham) is a novel product, approved in 15 countries including the USA and UK, for the treatment of herpes simplex labialis in immunocompetent adults.

Update on: Tretinoin gel 0.1% Retin-A Micro® Delavirdine Rescriptor® Nelfinavir Viracept®Calcipotriene ointment Dovonex® Valacyclovir tablet Valtrex®Pulsed Er:Yag laser system Derma 20®Human skin equivalent Apligraf®Podofilox gel 0.5% Condylox®

Sunscreens have been in use for nearly 70 years. Originally designed to protect against sunburn, enable longer sun exposure and promote tanning, sunscreens are now often promoted as a method for preventing skin cancer and skin aging.

In this article, we examine the other approaches to PHN management. Claims have been made for products ranging from vitamins to snake venom for patients who develop PHN.

In April 1997, Apligraf® (Novartis), an in vitro construct of human skin (human skin equivalent HSE1), gained approval from the HPB in Canada for use in healing venous leg ulcers. This was the first major regulatory body to approve HSE for this indication.

Update on: Amphotericin B Lipid Complex Injection Abelcet®Butenafine HCl Cream 1% Mentax® Itraconazole Sporanox®Acitretin Soriatane® Penciclovir cream 1% Denavir®Valacyclovir Valtrex®Laser device Sharplan Silktouch laser®Permethrin lotion Nix®Ivermectin Mectizan® (6 mg tablet)

Androgenetic alopecia is a stressful experience for both sexes, but possibly more distressing for women. An overview of the condition, treatments, and considerations surrounding alopecia.

Various treatment modalities for the treatment of scalp psoriasis are considered, as well as their upsides and downsides. A list of practical tips in management are also provided.

Benzoyl peroxide 5% plus erythromycin 3% (Benzamycin. gel, Dermik) will be evaluated. Although it is not known how effective it is compared with benzoyl peroxide and erythromycin prescribed separately, Benzamycin® is simpler to use and likely to improve patient compliance.