Family Practice

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

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.

Update on the Management of Chronic Hand Dermatitis

Hand dermatitis (HD) is a common skin disorder affecting individuals of all ages. This article looks into the challenges associated with therapy, side-effects of commonly used treatments, and long-term management plans for HD.

Non-Pharmacologic Management of Atopic Dermatitis

Atopic dermatitis (AD) or eczema is a chronic, relapsing skin condition that can lead to xerosis, pruritus, and patches of dermatitis. Coping with the physical and emotional aspects of AD can significantly impact the quality of life. It is most common in childhood, as many patients seem to outgrow the condition by adulthood.

The Red Face and Its Management

Red face is commonly seen, can be transient and come and go (flushing), or be persistent. Sometimes it can be scaly (dermatitis), or there may be papules and pustules (rosacea) present. Red face is occasionally seen in infants or neonates.

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.
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.

Skin Treatments Introduced in 2012

Skin Treatments Introduced in 2012. Adapalene 0.1% + benzoyl peroxide 2.5% gel (Epiduo®), Adapalene 0.3% gel (Differin®), Tazarotene 0.1% foam (Fabior™), CIP-Isotretinoin capsule Epuris™ (in Canada) Absorica™ (in US), Ingenol mebutate gel (0.015%, 0.05%) Picato®and more are covered.
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.

Hyperhidrosis

Hyperhidrosis is characterized by sweating in excess of the physiological needs to maintain thermal homeostasis. No formal definition exists but for practical purposes any degree of sweating that interferes with activities of daily living, can be viewed as hyperhidrosis. This disease is much more common than once thought and greatly impacts upon quality of life (QOL).

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.

Hair Care

Implementing basic proper hair care is essential to maintaining healthy hair. Furthermore, minimizing exposure to chemical agents, inadvisable grooming techniques, and prolonged exposure to environmental elements, will promote healthier hair and avoid unnecessary hair loss.
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.

Head Lice: A Review of Topical Therapies and Rising Pediculicidal Resistance

Head lice infestations (Pediculosis capitis) are a worldwide problem with prevalence estimates typically ranging between 1-3% in elementary school aged children. Although this obligate parasite is a nuisance, infestation does not pose a health risk.

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.
Tildrakizumab for psoriasis picture

How to Use Halobetasol Propionate and Tazarotene Lotion to Treat Psoriasis

A fixed combination halobetasol propionate and tazarotene lotion (HP/TAZ) was launched in Canada in 2020, to treat moderate to severe plaque psoriasis in adults. With the use of polymeric emulsion technology, there is uniform distribution of HP and TAZ and excipients on the skin and improved skin moisturization.

Update on Topical Approaches for Managing Scalp Psoriasis

Patients suffering from scalp psoriasis frequently seek medical care because of the persistent discomfort and social embarrassment caused by the visible flakes that are shed onto clothing. However, the presence of hair makes it challenging to apply medication to the scalp.

Common Bacterial Skin Infections

Recognition and appropriate treatment of these common bacterial skin infections, while at times challenging, can be very rewarding for both the physician and the patient. Selecting the right therapy from the beginning should help minimize complications, reduce the number of hospitalizations, and may also help reduce the climbing incidence of bacterial resistance.
The Treatment of Cystic Acne

The Treatment of Cystic Acne

Cystic acne is characterized by the formation of cysts enclosing a mixture of keratin and sebum in varying proportions. It is the most severe of the four main types of acne, which are comedonal, papular, pustular, and cystic. Identification and treatment options are discussed.

Skin Conditions and the Sun

The skin has evolved to protect us from the harmful effects of ultraviolet light. Sunscreens were first developed to prevent sunburns by blocking UVB; they allowed us to prolong our time in the sun, but that resulted in increased exposure to UVA.

Management of Recalcitrant Acne

Acne treatment success involves a comprehensive approach that addresses diagnostic confounders, appropriate therapeutic options and patient adherence. Ongoing education and counselling will assist in meeting patient expectations and establishing a favourable rapport that promotes adherence.

Non-Pharmacologic Management of Atopic Dermatitis

Atopic dermatitis (AD) or eczema is a chronic, relapsing skin condition that can lead to xerosis, pruritus, and patches of dermatitis. Coping with the physical and emotional aspects of AD can significantly impact the quality of life. It is most common in childhood, as many patients seem to outgrow the condition by adulthood.

Topical Treatment Adherence for Psoriasis

For many years, clinicians have expressed ongoing concerns about treatment adherence by patients, especially pertaining to those with chronic skin disorders. Although crucial to effective therapeutic outcomes, the issue of patient adherence has been largely ignored in dermatologic disease management until recently.
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.

New Classification of Rosacea and Present Therapy for Family Practitioners

There are currently no laboratory tests to diagnose rosacea; it remains a clinical diagnosis. The actual pathophysiology and etiology of rosacea also remain unclear; however, quite recently the spectrum of rosacea has been classified and standardized.

Actinic Keratoses

The best approach is a pragmatic one. The patient with few AK lesions is most conveniently and cost effectively treated with a destructive technique (cryosurgery or curettage with light desiccation). Those with many AKs are candidates for medical therapy (such as 5-fluorouracil, imiquimod or diclofenac).

Diagnosis and Treatment of Lip Conditions for Family Practitioners

Skin conditions are commonly found on the lips. Surrounding skin and mucosal surfaces may be involved, and hair problems may be present. Lesions can be single or multiple. Conditions can be localized or diffuse, with other features found upon physical examination that help to make a diagnosis.
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®).

Moisturizers: An Essential Component in Eczema Management

Atopic dermatitis (AD) or eczema is a chronic, relapsing form of skin inflammation that is attributable to multiple pathogenic, genetic, and environmental factors, as well as a dysfunctional epidermal barrier. Immune responses involved in AD culminate in dry skin, pruritus, and IgE mediated sensitization to food and environmental allergens.

Dermatological Drug Use in Pregnancy

Medications that are considered safe in pregnancy are available for the treatment of common dermatological disorders. Knowledge of these medications is important when considering treatment options for both pregnant patients, and women of childbearing potential.

HPV Vaccines

The National Advisory Committee on Immunization (NACI) recently released its recommendations for the use of the quadrivalent vaccine, which include: For use in females 9-26 years of age. The recommendations for the use of the bivalent vaccine will be available following its approval in Canada.

Management of Unwanted Facial Hair

Unwanted facial hair is a common, frustrating condition that affects up to 25% of women. This article review impact on patient QOL, treatment options ranging from shaving, waxing, threading, and bleaching to electrolysis, and laser therapy.

Cosmeceuticals: A Practical Approach

The cosmeceutical industry has undergone phenomenal growth over the past decade. Acquiring a basic knowledge of the major classes of active ingredients that are found in cosmeceuticals will enable healthcare professionals to provide accurate and educational information to consumers.

Management of Unwanted Facial Hair (Reprint from FP 7.2)

(Reprint from STL FP 7.2) Facial hair can be a distressing, chronic problem for many women. This article discusses assessment, treatment options, side-effects, and costs. Combination therapy and its benefits are also covered.
Crisaborole in Atopic Dermatitis

Optimal Use of Crisaborole in Atopic Dermatitis – An Expert Guidance Document

Mild to moderate atopic dermatitis (AD) is often controlled by behavioral measures such as skincare and avoidance of triggers in addition to topical treatments such as topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), and crisaborole, a phosphodiesterase-4 inhibitor (PDE4-I).

Androgenetic Alopecia: A Review of Topical Agents for Hair Growth Promotion (Family Practice)

Hair loss is a common dermatological problem that affects a large segment of the population both physically and psychologically. This article focuses on androgenetic alopecia (AGA) or male pattern hair loss, as well as the common treatments, Minoxidil and other topical treatments.

Ceramide-based Moisturizers as Treatment for Pediatric Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory, xerotic and pruritic skin disease of increasing prevalence affecting 15-30% of children and 2-10% of adults. AD and its associated health consequences present significant challenges to patients, particularly children and their families.

Topical Approaches in Combination Therapy for Acne (FP Edition)

Acne vulgaris is a chronic inflammatory cutaneous disease involving the pilosebaceous unit. This article discusses pathophysiology, sebum production, keratinization, and the role of P.acnes in acne formation.

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.
A Review of Brodalumab

Management of Onychomycosis

Diagnosis of onychomycosis can only be established with a positive culture or observation of fungus in the nail clippings. Consideration should be given to cost and possible complications before starting treatment. Recurrent disease is a problem even after a complete cure.

Review of Conventional Systemic Therapies for Severe Psoriasis

Psoriasis is a chronic inflammatory cutaneous disorder that can significantly affect patient quality of life (QoL). This article discusses immunologic abnormalities, immune mediators, and the possible pathogenesis of psoriasis.

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