Family Practice

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).

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.

Management of the patients’ expectations and compliance are crucial aspects of acne treatment. Disease chronicity and long-term treatment should be discussed at length during the initial consultation.

The goal of this novel publication is to improve both diagnostic and therapeutic skills among primary care practitioners with regard to diseases and disorders of the skin, hair, and nails. The Editor and publishers feel that this is a critical educational endeavor, and one designed to improve overall patient care.

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.

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.

Psoriasis remains a therapeutic challenge. Involvement of the scalp can be minimal (“dandruff”) or more significant and difficult to manage. Gentle treatment, reducing trauma, and treating the inflammation and pruritus will improve therapeutic results.

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.

Cold sores can be an embarrassment. They can provide a source of herpes that can autoinoculate into the eye as well as infect others. In atopic dermatitis it can be become very widespread and can also produce erythema multiforme.

Educate and counsel. Most patients with acne are teenagers who are very self-conscious about their looks and expect immediate treatment results. However, adult acne is becoming more common, and can be very distressing as well.

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.

Since multiple factors are involved in the pathophysiology of acne, treatment that counteracts the majority of them can be expected to achieve the best results. When considering the options for reducing the P. acnes population, it is best to choose those that do not encourage resistance patterns.

Psoriasis has a greater mental and physical impact than myocardial infarction, hypertension, diabetes mellitus, arthritis, and cancer; only depression had a greater mental impact, and congestive heart failure a greater physical impact.

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.

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).

Eczema diagnosis, treatments, and management techniques are discussed. Diagnostic features, treatments both topical and oral, infection control, and a note on calcineurin inhibitors.