Family Practice

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.

Condylomata acuminata (genital or venereal warts) pose a significant health concern, especially amongst young adults. External genital warts (EGWs) are caused by infection with the human papillomavirus (HPV), the same virus that causes the majority of cervical cancers.

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.

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.

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.

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.

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.

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.

The multifactorial nature of acne vulgaris often requires a combination of topical and/or oral agents for successful management. Common challenges of this multipronged approach include the potential development of skin irritation, which results in nonadherence, as well as concern over bacterial resistance.

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.

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.

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.

Adopting a comprehensive approach that takes into account individual preferences, properties of available treatments, and disease severity can encourage patient adherence and lead to improved treatment outcomes. The key to gaining adherence, is the attention devoted by physicians to establishing effective communication with the patient.

Personal care in Canada is a $5 billion industry that offers thousands of competing products, many of which make skin care-related claims. Advertisers inundate us with messages about what their products can do for us, but how can we be sure that the products we buy will actually live up to their claims?

As baby boomers get older, they have shown an increasing interest in maintaining a youthful appearance. As a result, there has been a corresponding increase in topical antiaging formulations, which are commonly referred to as cosmeceuticals.

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.

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.

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

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.

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.

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.

Topical retinoids are the cornerstone of acne therapy and they can be used across the entire spectrum of acne severity. Selecting the most suitable retinoid formulation, as well as dispensing proper advice in terms of drug application, can improve patient compliance.

TCIs have an important place in the therapeutic armamentarium for AD. They are approved as second line agents for individuals >2 years of age, and have a good safety profile when used short-term or intermittently long-term.

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.

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.

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.

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.

Lice have developed resistance to some pediculicides and it is expected that with ongoing use, these pediculicides will probably become less effective.

Biologics are one of the more effective and relatively safe options for long-term control of psoriasis. They have reduced the time needed to clear the signs of chronic disease, and are effective in maintaining a disease-free state for longer durations. Biologics can safely be used with other treatment modalities (i.e., methotrexate, cyclosporine, acitretin and hydroxyurea).

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.

Post-inflammatory hyperpigmentation, and melasma are common problems that dermatologists see. Various bleaching options are considered.

Seborrheic dermatitis is a common cutaneous disorder occurring in at least 3%–5% of the population. We discuss new treatment formulations and protocols.

Novel uses of old medications and new formulations of systemic medications have broadened the therapeutic armamentarium for treating rosacea patients. It is of primary importance to offer patients safe and effective therapies for this chronic and incurable condition, improving both the clinical and psychosocial consequences of rosacea.

HPV is a very common sexually transmitted disease that is associated with a number of benign, premalignant, and frankly malignant lesions of the anogenital tract. The majority of HPV infections are asymptomatic and are spontaneously cleared by a predominantly cell-mediated immune response.

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.

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.

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.

This article will deal with the diagnosis and treatment of common eruptions on the feet.

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.

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.