Family Practice

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

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.

A Simple Algorithm for the Treatment of Dermatophyte Toenail Onychomycosis

There has been much discussion about the optimal treatment for onychomycosis. We propose a simple algorithmic approach to aid in the selection of therapy for dermatophyte toenail onychomycosis and present a balance between efficacy and risk of therapy.

Topical Antipsoriatic Treatments in 2007

Advancements in topical antipsoriatic therapies have provided safer and more effective treatment options, especially when used in combination. Consequently, much research is underway to investigate novel treatment combinations for psoriasis in the hope that it will provide further enhancements in efficacy.

Cosmeceuticals: A Panel Discussion About Educating the Public

The panelists for cosmeceuticals at Dermatology Update 2008 included 4 dermatologists: Jeffrey Dover, MD, Charles Lynde, MD, Catherine Zip, MD, and Jason Rivers, MD, who discussed cosmeceuticals and the role they play in current dermatology practice.

External Genital Warts

Most HPV infections are asymptomatic and can spontaneously clear on their own. However if treatment is required, there are a number of antiproliferative, destructive, immunomodulatory modalities available. Combination therapies have been shown to be advantageous.

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.

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.

Treatment Options for Excessive Sweating and Hyperhidrosis

For most patients, antiperspirants containing aluminium salts are the first-line treatments. Other therapeutic options, especially for those with hyperhidrosis, include botulinum toxin injection, systemic anticholinergics, iontophoresis and surgery.

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.
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.

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.
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.
Malassezia Infections of the Skin

Malassezia Infections of the Skin

Malassezia are lipophilic yeasts that are normal commensals on the skin surface. There are seven species of these yeasts, which were previously called Pityrosporum. The conditions described in this article are either caused by the Malassezia itself or from some kind of immunological or toxic reaction to the organism.

Tips for Maximizing the Effectiveness of Topical Acne Therapy

Successful treatment of acne with topical therapy can be achieved with patient education, patient engagement in treatment selection, and counseling on aggravating factors.

Update on Broad-Spectrum Sunscreens

The new generation of sunscreens serve an important role in overall skin protection from the sun. However, they should be used in conjunction with other sun protection measures such as sun protective clothing, hats, and sunglasses.

A Summary of Approved Topical Treatments for Rosacea

Today, diagnosing and treating rosacea remains a challenge. More studies are necessary to provide additional insight on drugs currently available as well as possible future agents. The ultimate goal is to provide each patient with a treatment regimen best suited for his or her individual needs.

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 for Acne: A Case Study

Since patient compliance is a concern, a great deal of attention must be given to the methods available to minimize the chance of irritation. In the opinion of the author, this may be the single most important factor influencing the success of topical therapy in acne.

New Evidence for the Treatment and Management of Actinic Keratoses

Cutaneous concerns continue to be a significant part of family and specialty practices, as increasingly, patients are seeking medical consultation for the management of photodamage, actinic keratoses, and nonmelanoma skin cancer (NMSC), which is now a global epidemic.

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.
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.

New Developments in Hormonal Therapy for Acne (FP Edition)

The proven therapeutic benefits of OCs offer a valuable option to physicians for the treatment of acne. The accumulating evidence on the efficacy and safety of recently available drospirenone-containing hormonal preparations provides dermatologists with a new option for the treatment of acne and other hyperandrogenic disorders.
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.

Skin Barrier Repair in the Management of Atopic Dermatitis

The term “atopy” was first coined by Cooke and Coca in 1923, derived from the Greek word atopos, which means out of place and denotes an immune reaction that is “strange or eccentric”. Atopic dermatitis (AD) is a chronic, waxing and waning, often symmetric inflammatory eruption that is characterized by pruritus and xerosis.

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.

Topical Management of Recalcitrant Psoriasis and Eczema

Psoriasis and eczema, especially atopic eczema, are two of the most common cutaneous conditions seen by family physicians and dermatologists. This article discusses the etiology of psoriasis and eczema, immunologic abnormalities, and the role of immune mediators.

Excessive Facial Hair

Hirsutism can cause embarrassment and lead to anxiety and depression. There are a limited number of treatments available that vary in efficacy, degree of discomfort and cost. It is very important to make sure that the patient is aware of all the available treatment modalities, since no one method is effective for all patients or body locations, and results from therapy may not always be satisfactory.

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.

Therapeutic Update on External Genital Warts

External genital warts (EGW) are a common infection caused primarily by human papillomavirus (HPV) types 6 and 11. This article discusses the impact of EGW on the patient, co-factors for other STIs, and therapies for EGW.

Topical Management of Recalcitrant Psoriasis & Eczema

Psoriasis and eczema can at times be recalcitrant to conservative topical treatment. This article focuses on corticosteroid strength and their appropriate uses for various presentations.
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.
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).
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.

Hormonal Agents Approved for Treatment of Acne

Hormonal agents are important, effective therapeutic options for women across the spectrum of acne severity. The three preparations approved in Canada for this indication have safety profiles similar to conventional oral contraceptives.
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.
Update on Drugs and Drug News

Modifying the Course of Atopic Dermatitis

Atopic dermatitis is a chronic inflammatory skin condition. It has a relapsing course characterized by flare-ups of acute eczema on a background of chronically dry skin. The association of atopic dermatitis (AD) with asthma and allergic rhinitis is referred to as the atopic triad.

Atopic Dermatitis: The Skin Barrier and the Role of Ceramides

This paper examines the pathogenesis of atopic dermatitis, the skin barrier, and the role that ceramides can play in therapy.

Topical Management of Psoriasis and the Role of Vitamin D3 Analogues

Psoriasis is a chronic, recurrent, immune-mediated, papulosquamous skin condition characterized by rapid proliferation of keratinocytes. This article focuses on the role of vitamin D analogues in the treatment of psoriasis.

Mild Acne: Treating & Diagnosing the First Pimple

Almost everyone at some point in his or her life will be troubled with mild acne. It can be related to athletic activities, travel, cosmetics, or hormonal changes. Various treatment options are discussed.

Combination Therapy for Acne Vulgaris

Acne vulgaris remains a therapeutic challenge, in large part due to its multifactorial pathophysiology. Evidence for improved and quicker efficacy with safety and longer remission has been noted with combination therapies.

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