Skin Therapy Letter

It's important to know the correct dose when taking Accutane® (Isotretinoin) at different stages of treatment. Here you will find information on the initial dose as well as maintenance and total dosage allowed.

Isotretinion is a powerful drug, and sometimes the only treatment option for severe acne. The most common side-effects such as dry skin, dry eyes, and hair problems, and headaches, and other side-effects are discussed.

Treatment of PIH and melasma is challenging. There are no singular therapies that are efficacious on its own. Management, sun protection, topical lightening therapy and other treatment modalities are considered in this discussion on these growing concerns.

Platelet-rich plasma (PRP) is an autologous serum containing high concentrations of platelets and growth factors. PRP continues to evolve as an important treatment modality with many applications in dermatology, particularly in the areas of hair restoration, skin rejuvenation, acne scars, dermal augmentation, and striae distensae.

An increasing body of research indicates that dietary change may serve as a component of therapy for certain skin conditions. This includes conditions such as acne, atopic dermatitis, aging skin, psoriasis, and rosacea. This article takes a high level overview of the role that diet may play in these conditions.

Herbs have been used in clinical medicine for thousands of years. However, it is only in recent times that we have been able to employ scientific methods to prove the efficacy of many of these herbs and to give us a better understanding of their mechanisms of action.

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.

Moisturizers are widely used in various dermatologic and cosmetic skin therapies. Different classes of moisturizers are based on their mechanism of action, including occlusives, humectants, emollients and protein rejuvenators.

Learn about cannabinoids influence on skin growth control, homeostasis, melanoma, acne, pruritus, inflammation, atopic dermatitis, and other skin conditions.

Chronic urticaria is defined as hives, typically occurring daily, for greater than 6 weeks duration. The associations between chronic urticaria, thyroid disease, and other autoimmune disorders, as well as the implications that this holds for therapeutic intervention are reviewed.

Increased accumulation of AGEs in human tissue has been associated with serious medical concerns including end stage renal disease, chronic obstructive pulmonary disease, and, recently, skin aging. In this review, we summarize the evidence supporting the role of glycation in skin aging.

A comprehensive review of Fabry Disease. Typical presentations, other signs and symptoms, differential diagnosis, as well as treatment options are discussed.

The formation of free radicals is a widely accepted pivotal mechanism leading to skin aging. Topical antioxidants are available in multivariate combinations through over-the-counter skin care products that are aimed at preventing the clinical signs of photoaging.

A triad approach to the treatment of acne and rosacea has been recommended. This integrated management approach includes patient education, selection of therapeutic agents, and initiation of an appropriate skin care regime. Appropriate skin care recommendations for patients with acne and rosacea will be discussed.

Moisturizers are widely used products that are important in many dermatologic and cosmetic skin therapies. They contain varying combinations of emollients, occlusives, and humectants to achieve their beneficial effects, and there is an overwhelming number of formulations available.

Squamous Cell Carcinoma (SCC) is the second most common skin cancer. This article focuses on the various available treatments for SCC.

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.

Propylene glycol (PG) is considered to be a ubiquitous formulary ingredient used in many personal care products and pharmaceutical preparations. This review guides clinicians in selecting suitable topical corticosteroids.

Dermatology supplements, often marketed as “skin, hair, and nail” supplements, are becoming increasingly popular. However, many consumers lack an understanding of the science of dietary supplements or the specifics of the supplement industry.

Androgenetic alopecia (AGA) may affect up to 70% of men and 40% of women at some point in their lifetime. Here we briefly review current therapeutic options and treatments under active investigation.

Topical metronidazole has been used for the treatment of rosacea for over 30 years. Several placebo-controlled trials have demonstrated its effectiveness in the treatment of moderate-to-severe rosacea.

Although the developing fetus was once considered protected from the outside world, we now know that it can potentially be affected by any medication given to the mother. Therapeutic options available for these patients will be discussed.

Vitiligo is a psychosocially debilitating disease requiring a multidisciplinary approach to treatment. Patients should be made aware of all of the options available geared at repigmentation and depigmentation prior to formulating a treatment plan.

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.

Given our current options for the treatment of Seborrheic Keratoses include only more invasive, non-topical therapies, Hydrogen Peroxide Topical Solution (40%) fills a void in our therapeutic repertoire as the first FDA-approved topical therapy for SKs.

A number of research studies have documented the link between diet and skin aging. These results may be used to develop dietary recommendations that combat the forces of oxidation, inflammation, and glycation.

A review of studies, reviewing association between a high-glycemic-load diet, hormonal mediators, and acne risk.

The class of medications known as Janus kinase inhibitors block cytokine-mediated signaling via the Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway, which plays an important role in immunoregulation and normal cell growth.

Minoxidil is a Health Canada and US FDA-approved medication for hair loss in men and women. This article review recent Phase III clinical trials on Minoxidil efficacy for the treatment of female patter hair loss.

The elderly in North America is the fastest growing segment of the population and their most common skin complaint is pruritus. This article outlines the therapeutic challenges with this population.

Emotional stress may influence the development and exacerbation of psoriasis. This article review the evidence for stress and its effects, the challenges in accurate measurements, as well as management strategies.

Current treatments for vitiligo are largely unsatisfactory. Topical corticosteroids and phototherapy (narrow-band UVB and psoralen+UVA) are the most prescribed, however, these therapies are often not effective and have important side-effect, especially when used for a long time.

Shingrix®, a new recombinant subunit vaccine, has shown a great deal of promise in the prevention of HZ in adults over the age of 50. The combination of zoster viral glycoprotein E and the AS01B adjuvant system make it a safe, efficacious option for the elderly as well as immunosuppressed individuals.

Seborrheic dermatitis is a recurrent, usually mild, skin disorder with typical clinical manifestations. This article will review the available treatments for this common dermatologic problem.

Use of azelaic acid was associated with a significant reduction in inflammatory lesions, which persisted beyond the active treatment phase. Overall, azelaic acid 15% gel is an appropriate initial topical therapy for the treatment of moderate facial rosacea.

In this article storage guidelines for common dermatology drugs are provided. We suspect that drug degradation is common due to improper storage and that improved patient instruction regarding storage will reduce degradation and alleviate some of the danger associated with improper storage and usage patterns.

Alcohol is a serious cause of morbidity and mortality in our society and is implicated in multiple health conditions, including hepatic failure, neurological damage, and hematological disorders. Herein, we review the evidence concerning the influences of alcohol in skin conditions.

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.

Urticaria is a common, mast-cell-driven disease, characterized clinically by the development of wheals, angioedema, or both. A large body of data has demonstrated that omalizumab, a biologic agent, is safe and effective in the treatment of H1- antihistamine refractory urticaria and should be considered as a third-line agent, with cyclosporin A reserved for fourth-line therapy.

Oral nicotinamide is an affordable over-the-counter supplement with demonstrated benefit in the treatment of a range of skin conditions, most notably AK and NMSC.

It is hypothesized that the estrogenic properties of parabens may play a role in breast cancer development. At this point, there is an insufficient amount of data suggesting serious consequences from paraben use and exposure to warrant drastic avoidance measures or government regulations.

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.

Primary focal hyperhidrosis afflicts a significant number of patients in the United States and greatly impacts their quality of life. Treatment decisions should take into consideration disease location, severity and patient preference.

Topical corticosteroids have been a mainstay of eczema therapy. This article is a comprehensive list of various indications, contraindications, combination therapies, and differing strengths of steroids.

Pruritus, or itch, is a common sensation that causes a person to want to scratch. It is a complex process that may negatively impact quality of life. This overview provides information regarding the various management and treatment options for pruritus.

Molluscum contagiosum is a poxvirus infection of the skin that is commonly observed in children. This articles discusses the molluscum contagiosum virus (MCV), its pathogenesis, mechanism, and treatment modalities.

Vulvovaginal candidiasis is a common occurrence among women over 25 years of age. The likelihood of developing infection increases with pregnancy, the use of oral contraceptives or antibiotics, or immune disorders. However, in many cases, the etiology of the disorder is unknown.

The etiology of papulopustular rosacea (PPR) is not well understood yet appears to involve both the innate and adaptive immune response in addition to possible infestation with Demodex mites. This article reviews data on Ivermectin cream 1%, a new topical treatment for PPR.

Recent studies have demonstrated the role of Vitamin B Derivative (Nicotinamide), in both topical and oral forms, as a chemopreventive agent against skin cancer.

External genital warts resulting from HPV are a common sexually transmitted infection. This article reviews data on Sinecatechins 10% ointment (a Green Tea extract), a new botanically based patient-administered therapy for external genital warts.

Secukinumab demonstrates rapid and robust clinical improvement accompanied by a favorable short- term safety profile. The results of the phase III trials continue to reinforce the theory that the IL-17 pathway is an essential target in psoriasis and psoriatic arthritis treatment.

Disorders of hyperpigmentation are difficult to treat, particularly in dark-skinned individuals. The goal is to reduce the hyperpigmentation without causing undesirable hypopigmentation or irritation in the surrounding normally pigmented skin. The psychosocial impact caused by these disorders must be considered.

There is a growing demand for the removal of unwanted facial and body hair in both men and women. This article reviews chemical depilatories and other modalities, their method of action, characteristics, advantages and disadvantages.

Biofilms are diverse communities of microorganisms embedded within a self-produced matrix of extracellular polymeric substance which are firmly attached to biotic or abiotic surfaces. Approximately 80% of all human infections are associated with biofilms.

Despite a rising prevalence, effective and safe therapeutics for patients with moderate-to-severe AD are limited due to toxicity and side effects. Dupilumab, an interleukin (IL)-4 and IL-13 antagonist that limits type 2 T helper (Th2) driven inflammatory activity, is a promising therapeutic option.

Pyrethrin and Permethrin are two important classes of lice treatments that are available. Their mechanism of action as well as potential side-effects are discussed in this article.

This article reviews topical corticosteroids (TCS) and topical calcineurin inhibitors (TCIs) to manage inflammatory conditions, its risks with long-term use, and the role of moisturizing as important therapeutic adjuncts.

The scalp is involved in up to 80% of individuals with psoriasis. Topical treatment with corticosteroids with or without vitamin D3 analogues is the mainstay of treatment, but other therapies such as light treatment and systemic drugs including biologics are discussed.

This paper focuses on a comprehensive and practical approach to classifying and managing scars in terms of colour and texture, and discusses topical treatments accessible to family physicians in more detail.

Many options exist for the treatment of rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life.

Ichthyosis management requires a multimodal approach, including topical and oral agents in addition to lifestyle modifications.

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.

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.

As baby boomers get older, they have shown an increasing interest in maintaining a youthful appearance. This paper reviews the more common cosmeceutical ingredients.

Vulvovaginal diseases commonly are inadequately diagnosed and treated. This article discusses the important role dermatologists play in identifying irregular presentations, recognizing skin problems, and addressing itch, pain, and inflammation.

The choice of facial cleanser is important for people with normal skin, as well as for those people with sensitive skin and skin diseases such as atopic dermatitis and acne. Read this overview of all cleanser types for helpful recommendations.

Most people with mild-to-moderate psoriasis manage their disease with topical therapies. However, adherence to topical treatment remains a challenge.. Read about new topical therapeutic options.

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.

Crisaborole represents a novel and efficacious therapeutic approach for the treatment of mild to moderate Atopic Dermatitis and demonstrates early and continued decrease in pruritus, which improves quality of life and reduces the potential risk of infection and scarring.

Twenty-two percent of women in North America have unwanted facial hair, which can cause embarrassment and result in a significant emotional burden. Eflornithine 13.9% cream can be used in combination with other treatments such as lasers and IPL to give the patient the best chance for successful hair removal.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive aged women. This article will review the treatments for acne due to androgen excess in PCOS women.

The forehead flap is a useful technique to reconstruct deep and large nasal defects. It can safely be performed under local anesthesia in an outpatient setting. Advantages of this flap include the fact that it provides an excellent color and texture match to the missing nasal skin.

Hyperpigmentation disorders of the skin are common and can be the source of significant psychosocial distress for patients. Topical applications are the mainstay of treatment and include phenols, retinoids, corticosteroids, and their combinations.

Antidepressant drugs can be an important component of the dermatologist’s armamentarium. Specific guidelines, side effect profile, drug-drug interactions, and the current indications should always be obtained for any particular antidepressant agent before it is prescribed.

In this review, we summarize the most common immunosuppressant medications currently used in dermatology, and provide recommendations for infection screening prior to initiating treatment.

Plasma skin regeneration technology uses energy delivered from plasma rather than light or radiofrequency. Plasma skin regeneration technology can be used at varying energies for different depths of effect, from superficial epidermal sloughing to deeper dermal heating.

Benzoyl peroxide is one of the most widely used topical agents for acne. This article discusses the anti-inflammatory and comedolytic effects of benzoyl peroxide.

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.

Seborrheic dermatitis is a common superficial dermatosis, characterized by red, flaking areas of the skin, which may in some cases be covered with yellowish flakes. The most commonly affected areas are the nasolabial folds, ears, eyebrows, scalp and chest.

Chronic pruritus remains a difficult condition to treat with many non-specific therapeutic options. Recent scientific discoveries have elucidated the physiology associated with pruritus.

Recent advances in the treatment of hereditary angioedema, particularly in the last decade has been promising. This paper reviews the mechanisms, efficacy, and adverse reactions associated with these new treatment medications. 

Use of medications by breast-feeding mothers is not uncommon. Information regarding the safety of common dermatological medications during lactation will be reviewed. Based on this information, treatment recommendations will be made.

This article is a general overview of hair removal practices, which have evolved from utilizing waxes and blades, to advanced lasers and electrolysis, with further advancements still being studied

Methotrexate has been used for over half a century to treat a wide spectrum of skin conditions. This article delves into research on the pharmacogenetic properties of the drug as well as the variety of skin conditions that Methotrexate is used to treat.

The discussed cases reflect the panels’ real-world clinical experience with crisaborole for the treatment of patients with AD and the off-label treatment of irritant 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.

Novel therapeutics are currently being explored for the treatment of Prurigo Nodularis. Nemolizumab and dupilumab both demonstrate promise in inhibiting specific central nervous system pathways responsible for transmission of the pruritic sensation.

Currently, JAK inhibitors are only FDA approved for dermatologic, rheumatologic, and hematologic conditions. Recent studies show the utility of JAK inhibitors in treating atopic dermatitis, psoriasis, psoriatic arthritis, vitiligo, and alopecia areata.

Interleukin (IL)-17 is important in the pathophysiology of psoriasis and has proven to be an effective therapeutic target. As brodalumab enters the marketplace, a review of this important biologic, its safety profile, and discussion of possible adverse effects is in order.

Psoriasis is a common chronic inflammatory skin disease that is mediated, in part by the body’s T-cell inflammatory response mechanisms. Current data regarding the efficacy of these agents show they may have the potential to become the new clinical gold standard for biologic therapy to treat psoriasis.

Propionibacterium acnes (P. acnes) is an anaerobic bacteria implicated in the pathogenesis of acne. Current treatment guidelines offer strategies to limit the potential for resistance while achieving optimal outcome in the management of inflammatory and non-inflammatory acne.

This review details the rosacea phenotype approach to diagnosis and classification, and summarizes current evidence-based treatment recommendations for individual features.

Psoriasis is a chronic condition that affects the well-being and quality of life of patients. The disease is associated with an increased risk of depression and suicidality, which may not be fully understood by the general population.

Parabens have been under scrutiny for some time with the very limited reports of paraben-induced allergic contact dermatitis. This article discusses the controversy, the data, and how the facts may not match up with the concern.

Scabies is a common contagious parasitic dermatosis. This article discusses transmission vectors like direct contact, as well as fomites like infected bedding or clothing, and management strategies.

Seborrheic dermatitis is a common inflammatory skin disease, affecting between 1% and 3% of immunocompetent adults. While its cause is unknown, a number of predisposing factors have been reported, including the implications of Malassezia yeasts.

Atopic dermatitis is a chronic inflammatory skin disease affecting children and adolescents worldwide. This articles reviews the potential relationship of atopic dermatitis to diet and the effectiveness of elimination diets and diet supplementation in the management of AD.

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.

A topical formulation combining 0.5% 5-fluorouracil with 10% salicylic acid (5-FU-SA) was introduced in Europe under the trade name Actikerall™ for the treatment of AKs. Now commercially available in Canada, 5-FU-SA represents a patient applied therapeutic option. Clinical trial data is considered.

Chronic kidney disease-associated pruritus is a significant clinical symptom affecting more than 50% of patients on hemodialysis. Treatment of Chronic kidney disease-associated pruritus should be undertaken according to individual benefit-risk ratio assessments.