Family Practice

Read articles from the family practice edition, focused on helping family practitioners about various dermatological conditions.

Collage image of Colloidal Oatmeal and woman using cream on her skin

Colloidal Oatmeal use in Dermatology

Patients often seek natural approaches to treating skin disease. Colloidal oatmeal has been used for decades to improve atopic dermatitis and soothe other pruritic and xerotic dermatologic conditions.

Efinaconazole in the Treatment of Onychomycosis: Managing Patient Expectations and Promoting Compliance

Onychomycosis, also known as tinea unguium, is a progressive fungal infection of the nails resulting in discoloration, nail plate thickening, and onycholysis. Efinaconazole 10% solution is an effective and convenient topical antifungal treatment for onychomycosis, with toenail mycological cure rates between 53.4% and 55.2% and complete cure rates between 15.2% and 17.8%.

Diagnosis and Management of Atopic Dermatitis for Family Physicians: A Clinical Review

Atopic dermatitis (AD) is a chronic and pruritic inflammatory disease that affects a wide age range of patients causing significant impact on their quality of life. There has been a recently updated consensus paper on the treatment of mild-to-moderate AD published by an expert panel of dermatologists and pediatricians. Family physicians are well equipped to manage...
How to Create a Great Algorithm

How to Create a Great Algorithm

Medical algorithms are created, yet there is a paucity of information about how such algorithms should be created and the optimal way to develop an excellent algorithm. Well constructed medical algorithms have the potential to improve and standardize medical decisions, enhance adherence to better guidelines and improve patient care.
Adapalene/Benzoyl Peroxide image

Advances in Understanding Atrophic Acne Scarring and the Role of Adapalene/Benzoyl Peroxide

There have been important advances in our understanding of acne scarring. Acne scars can resolve, and their evolution is determined by a balance between matrix repair and degradation. Timely, effective management of acne can minimize risk of subsequent acne scarring.
Fucibet Cream image, doctor applying cream

Fucibet®: What’s Old Is New

Fusidic acid/betamethasone 17-valerate cream (Fucibet®) is a cosmetically acceptable, well tolerated cream which is hydrating and improves the TSS dermatitis score in secondarily infected dermatitis. In addition, it clears bacteria in infected dermatitis better than vehicle suggesting that improving the dermatitis with a steroid might be synergistic, perhaps through a reduction in bacterial load.
Suicidal Ideation and Behaviour in Psoriasis, Brodalumab image

A Closer Look at the Data Regarding Suicidal Ideation and Behaviour in Psoriasis Patients:...

When prescribing brodalumab, or any other biologic agent, physicians should screen patients for psychiatric comorbidities. Assessment of risk versus benefit, and having an honest conversation with patients regarding the label, will help provide better patient care for both physical and mental health.
A Clinician’s Guide to Treating Acne

A Clinician’s Guide to Treating Acne

In this article, we provide a guide to address a growing need by primary care physicians to have a logical and practical approach to treating various forms of acne.
Atopic Dermatitis: Pediatric Use of Crisaborole

Atopic Dermatitis: Pediatric Use of Crisaborole

An overview to AD care and focus our review to topical agents used in AD including topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI) and discuss the newest topical agent accessible in the physician's armamentarium, crisaborole.
Melanoma Gene Expression Testing

Ruling out Melanoma: A Practical Guide to Improving Performance Through Non-Invasive Gene Expression...

In this article, we summarize a large body of literature on such a tool (a non-invasive adhesive patch based gene expression test for LINC and PRAME) and provide a guide to primary care physicians on how to use this tool to improve pigmented lesion management by biopsying less while at the same time reducing the chance of missing melanomas.
Hormonal Treatment of Acne in Canada: Clinical Update

Hormonal Treatment of Acne in Canada: Clinical Update and Case-Based Treatment Approaches

Evolving understanding of the role of hormones in acne, along with a growing body of data from clinical trials, calls for a reappraisal of the role of hormonal therapy for acne.
Topical Formulations in Psoriasis

The Evolution of Topical Formulations in Psoriasis (Family Practice)

Adherence to topical treatment for psoriasis remains a challenge as the daily application creates a significant treatment burden. New topical therapeutic options need to offer a combination of higher efficacy and better patient acceptability, including...
Chronic Urticaria Practice Guidelines

Chronic Urticaria: Following Practice Guidelines (Family Practice)

Recently updated and revised international guidelines suggest a step-wise approach to the management of chronic spontaneous urticaria. These guidelines suggest that first-line therapy should be second-generation non-impairing, non-sedating H1-antihistamines such as bilastine (BLEXTEN®).
Non-melanoma Skin Cancers

Management of Non-melanoma Skin Cancers in Canada

A summary of the most comprehensive and up to date guideline for treating non-melanoma skin cancer in Canada. Background, primary prevention, actinic keratosis, managing basal cell carcinoma, and squamous cell carcinoma, are covered.
Bilastine – A Novel Antihistamine for Allergic Rhinitis and Chronic Spontaneous Urticaria

Bilastine – A Novel Antihistamine for Allergic Rhinitis and Chronic Spontaneous Urticaria

Bilastine has a proven, long-term safety record with use by over 71 million patients in over 104 countries. This article describes the evolution from first generation antihistamines, second generation antihistamines, and where Bilastine comes in.
Acne Clindamycin/Tretinoin Preparation

Management of Acne Using a Fixed Dose Clindamycin/Tretinoin Preparation

The focus of this review is to delve deeper into the use of Biacna® Gel, a fixed-dose clindamycin/tretinoin combination product, for the treatment of acne.
A Physician's Guide to Treating Acne

A Physician’s Guide to Treating Acne

Acne is among the most common dermatological conditions seen in primary care. In this article, we provide a guide to address a growing need by primary care physicians to have a logical and practical approach to treating various forms of acne.

Atopic Dermatitis: A Practical Guide to Management

A group of dermatologists with extensive experience in managing pediatric and adult patients with atopic dermatitis developed practical recommendations for the management of atopic dermatitis based on expert consensus opinion and the best available medical evidence.
Understanding Truncal Acne: A Practical Guide to Diagnosis and Management

Understanding Truncal Acne: A Practical Guide to Diagnosis and Management

Truncal acne refers to AV affecting the chest and/or back, a common presentation in acne patients. This article offers guidance in clinical differentiation of truncal acne from other acneiform diseases and provides management recommendations.

Acne in the Post-Adolescent Patient

For the purposes of this article, the focus will be on the topical treatment of post-adolescent mild to moderate acne. A selection of over-the-counter and prescription based topical treatments are discussed below.

Topical Efinaconazole in the Management of Toenail Onychomycosis

Onychomycosis is a fungal infection of the nail caused by dermatophytes, yeasts, or non-dermatophyte molds. Here we discuss using topical Efinaconazole in the management of toenail onychomycosis.

Chronic Hand Dermatitis: Case-based Approaches to Management

Practical guidelines for the management of Chronic Hand Dermatitis were published in the Skin Therapy Letter, Family Practice Edition (October 2016). This series of cases using Alitretinoin (Toctino®), is a follow on to that publication to put the guidelines into context.
toenail onychomycosis transungal treatment image

Toenail Onychomycosis – A Canadian Approach with a New Transungal Treatment – a Podiatrist...

A recently published clinical pathway for Toe Onychomycosis is used as the basis for the management strategy presented here, and follows a pathway reflective of the therapeutic options available in Canada.
picture for Management of Adult Moderate-to-Severe Atopic Dermatitis

Management of Adult Moderate-to-Severe Atopic Dermatitis: A Practical Guide for Primary Care

Atopic dermatitis (AD) is a chronic, relapsing, pruritic, inflammatory condition involving the skin which can have a significant impact on the quality of life. This article will guide the family practitioner on how to manage adults with moderate-to-severe AD and when to refer for specialist management.
pic for New Canadian Guideline for Acne Treatment

The New Canadian Guideline for Acne Treatment

Physicians will be particularly reassured if the suggested guidelines are supported by scientific evidence. This new Canadian clinical guideline for the treatment of acne was developed taking into account new data published up to March 2015, as well as expert opinion and clinical experience.
image for actikerall actinic keratoses

Actikerall™ (5-Fluorouracil 0.5% and Salicylic Acid 10%) Topical Solution for Patient-directed Treatment of Actinic...

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.

Apremilast in the Treatment of Psoriasis and Psoriatic Arthritis (Family Practice)

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.

Management of Chronic Hand Dermatitis: A Practical Guideline for the General Practitioner

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.

Chronic Idiopathic Urticaria: Treatment with Omalizumab (Family Practice)

Chronic idiopathic urticaria (CIU) is a common autoimmune skin condition characterized by spontaneously recurring hives for six weeks or longer. We review the mechanisms of action of omalizumab, efficacy, cost and potential side effect profile for treating CIU.

New Developments in the Science Behind Anti-Aging Skin Care Products

This article delves into new development and research into cosmeceuticals, their potential role, and the importance of educating patients on realistic expectations. Various potential benefits are discussed using an evidence based vantage.

An Update on Medical Therapies for Chemical Exfoliation

Chemical exfoliation has been used for decades to reverse the signs of aging skin and provide a cosmetic benefit. This article reviews various peeling methods and strengths, and their therapeutic potential.

Onychomycosis Diagnosis and Emerging Therapy

Onychomycosis is a common nail disorder for which successful treatment can be clinically challenging. Diagnosis, treatment, and management using various modalities are discussed.
Skin Treatments

Clinical Management of Recurrent Herpes Labialis

This article reviews HSV infections around the lips (herpes labialis), and clinical trial data of a new formulation of topical 5% acyclovir with 1% hydrocortisone cream (Xerese®).

Rosacea: An Update on Medical Therapies (Family Practice)

Rosacea is a common, chronic cutaneous condition that affects the face. This article reviews a variety of treatments for treatments for rosacea, including topical and systemic therapies.

Clinical Management of External Genital Warts

External genital warts (EGW) is a common sexually transmitted infection (STI) affecting millions of individuals worldwide. It is likely the most frequent STI in both Canada and the US. Treatment options and vaccination is discussed.

Advances in Acne Management and Patient Adherence

Acne vulgaris is a multifactorial disease characterized by different types of lesions at various stages of development. Treatment options, such as light based therapy and systemic therapy, as well as CIS-Isotretinoin (Epuris™) that increases absorption are discussed as well as patient adherence.

New Science to Support 50 Years of Colloidal Oatmeal Use in Dermatological Practice

Colloidal oatmeal has been used for centuries in skin care as a soothing agent to relieve itch and irritation. Its use, efficacy, and mechanism of action are discussed.

Therapeutic Options for Vitiligo

Vitiligo is a disease that presents with depigmented skin and is associated with significant psychosocial effects. Disease progression can be unpredictable and management is challenging. This article discusses etiology, management, and treatment options.

The Health Controversies of Parabens

Parabens are preservatives used in a variety of personal care, cosmetic, pharmaceutical and food products. Discovery of parabens in the breast tissue of patients with breast cancer has raised public concern over their use. This article discusses the controversy, research, regulations, and possible alternatives.
Malassezia Infections of the Skin

Advances in Topical Acne Therapy: New Molecules, Vehicles and Delivery Mechanisms

Acne vulgaris is a multifactorial disease characterized by different types of lesions at various stages of development. The most frequently used therapeutic agents for acne are topical. This article focuses on the role of vehicles and advancements in this area.

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