Semin Cutan Med Surg
· 2016 Jun · PMID 27416312
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Rosacea is an inflammatory condition of the skin, primarily affecting the central convexities of the face. Various topical and oral therapeutic approaches exist. Most have been developed to treat the papulopustular subty...Rosacea is an inflammatory condition of the skin, primarily affecting the central convexities of the face. Various topical and oral therapeutic approaches exist. Most have been developed to treat the papulopustular subtype of rosacea; however, other approaches can be used to treat the erythematotelangiectatic, ocular, and phymatous subtypes. This review provides a summary of available topical and oral approaches for the treatment of rosacea.
Semin Cutan Med Surg
· 2016 Jun · PMID 27416311
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Hormones and androgens play an important role in the pathogenesis of acne. Multiple hormonal modulators are now available for the treatment of acne. The efficacies and side effects of currently available hormonal agents...Hormones and androgens play an important role in the pathogenesis of acne. Multiple hormonal modulators are now available for the treatment of acne. The efficacies and side effects of currently available hormonal agents are reviewed here including the use of oral contraceptives, spironolactone, flutamide, cyproterone acetate, finasteride, and cortexolone 17α-propionate. Hormonal therapies are an efficacious treatment option for acne among females. With the growing need to reduce antibiotic exposures, hormonal therapies should be more widely studied and incorporated into acne treatment strategies.
Sinha M, Sadhasivam S, Bhattacharyya A
… +5 more, Jain S, Ghosh S, Arndt KA, Dover JS, Sengupta S
Semin Cutan Med Surg
· 2016 Jun · PMID 27416310
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Propionibacterium acnes is a key pathogenic factor in the development of acne. Antibiotics are the first choice of treatment for mild-to-moderate, mixed, papular/pustular, and moderate nodular acne, and an alternative ch...Propionibacterium acnes is a key pathogenic factor in the development of acne. Antibiotics are the first choice of treatment for mild-to-moderate, mixed, papular/pustular, and moderate nodular acne, and an alternative choice in severe, nodular/conglobate acne. The emergence of resistance to the currently available antibiotics poses a serious set-back to this algorithm, and the reduced arsenal can diminish efficacy of treatment. This emerging situation should catalyze innovations in dermatology; for example, newer drugs and technologies such as next-generation antibiotics with excellent potency and low propensity to develop resistance, rapid diagnostic platforms to select responders and nonresponders, and delivery technologies that target the bacteria. Such innovations can dramatically expand the arsenal for dermatologists in the management of acne.
Semin Cutan Med Surg
· 2016 Jun · PMID 27416309
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Antibiotics, both oral and topical, have been an integral component of the management of acne vulgaris (AV) for approximately 6 decades. Originally thought to be effective for AV due to their ability to inhibit prolifera...Antibiotics, both oral and topical, have been an integral component of the management of acne vulgaris (AV) for approximately 6 decades. Originally thought to be effective for AV due to their ability to inhibit proliferation of Propionibacterium acnes, it is now believed that at least some antibiotics also exert anti-inflammatory effects that provide additional therapeutic benefit. To add, an increase in strains of P acnes and other exposed bacteria that are less sensitive to antibiotics used to treat AV have emerged, with resistance directly correlated geographically with the magnitude of antibiotic use. Although antibiotics still remain part of the therapeutic armamentarium for AV treatment, current recommendations support the following when used to treat AV: 1) monotherapy use should be avoided; 2) use benzoyl peroxide concomitantly to reduce emergence of resistant P acnes strains; 3) oral antibiotics should be used in combination with a topical regimen for moderate-to-severe inflammatory AV; and 4) use oral antibiotics over a limited duration to achieve control of inflammatory AV with an exit plan in place to discontinue their use as soon as possible. When selecting an oral antibiotic to treat AV, potential adverse effects are important to consider.
Semin Cutan Med Surg
· 2016 Jun · PMID 27416308
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Topical retinoids are currently approved by the US Food and Drug Administration for the treatment of acne vulgaris in nonpregnant, nonlactating patients 12 years of age and older. Their efficacy, safety, and tolerability...Topical retinoids are currently approved by the US Food and Drug Administration for the treatment of acne vulgaris in nonpregnant, nonlactating patients 12 years of age and older. Their efficacy, safety, and tolerability are well documented for inflammatory and noninflammatory acne with studies repeatedly demonstrating a decrease in the number of lesions, significant improvement in acne severity, improvement in the cosmetic appearance of acne, and the prevention of acne lesions through microcomedone formation. There is some variability between prescription retinoid products regarding efficacy, safety, and tolerability; with erythema, peeling, and dryness being common, potential side effects. Due to their efficacious and safe profile, topical retinoids remain the first-line treatment for acne vulgaris.
Semin Cutan Med Surg
· 2016 Jun · PMID 29850661
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The anti-tumor necrosis factor (TNF)-α agents represent the second generation of psoriasis therapy. Research has produced a third generation of biologic treatments, some of which offer greater efficacy than the TNF-α inh...The anti-tumor necrosis factor (TNF)-α agents represent the second generation of psoriasis therapy. Research has produced a third generation of biologic treatments, some of which offer greater efficacy than the TNF-α inhibitors. This article reviews the data documenting the efficacy and safety of three types of biologics. Semin Cutan Med Surg 35(supp4):S74-S77.
Semin Cutan Med Surg
· 2016 Jun · PMID 29850660
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Among the newer medications for treating psoriasis are the interleukin-17A inhibitor secukinumab and the phosphodiesterase 4 inhibitor apremilast. Secukinumab offers a level of efficacy greater than that of the tumor nec...Among the newer medications for treating psoriasis are the interleukin-17A inhibitor secukinumab and the phosphodiesterase 4 inhibitor apremilast. Secukinumab offers a level of efficacy greater than that of the tumor necrosis factor-α inhibitor adalimumab. Apremilast is associated with lower levels of efficacy than the biologic therapies for psoriasis. Apremilast may cause diarrhea and nausea and is associated with weight loss and rare instances of depression. Semin Cutan Med Surg 35(supp4):S71-S73.
Semin Cutan Med Surg
· 2016 Jun · PMID 29850659
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Acitretin is an older, oral, non-immunosuppressive medication for the treatment of psoriasis. Tofacitinib is an oral Janus kinase inhibitor that has been studied for use in psoriasis. Each offers efficacy in certain sett...Acitretin is an older, oral, non-immunosuppressive medication for the treatment of psoriasis. Tofacitinib is an oral Janus kinase inhibitor that has been studied for use in psoriasis. Each offers efficacy in certain settings and patient types but carries substantial safety risks. Semin Cutan Med Surg 35(supp4):S65-S66.
Semin Cutan Med Surg
· 2016 Mar · PMID 27074701
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In considering therapy for onychomycosis, the most important factor to take into account is patient selection rather than treatment selection. Patients should be screened and evaluated for the extent of nail involvement,...In considering therapy for onychomycosis, the most important factor to take into account is patient selection rather than treatment selection. Patients should be screened and evaluated for the extent of nail involvement, the amount of subungual debris, the degree of dystrophy, their ability and willingness to follow the regimen, and whether comorbidities are present that may affect the efficacy and/or safety of one or more therapies. Onychomycosis is a chronic disease with a high recurrence rate. Commonsense measures to reduce the risk for reinfection include patient education and a clinician-patient team approach to long-term management.
Semin Cutan Med Surg
· 2016 Mar · PMID 27074700
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In 1996, oral terbinafine joined itraconazole and fluconazole on the short list of systemic medications that could be used to treat onychomycosis (although fluconazole was not approved for this indication by the US Food...In 1996, oral terbinafine joined itraconazole and fluconazole on the short list of systemic medications that could be used to treat onychomycosis (although fluconazole was not approved for this indication by the US Food and Drug Administration [FDA], it was commonly used for this purpose). In 1999, ciclopirox was the first topical treatment to be FDA approved. The addition of the topical antifungal agents efinaconazole and tavaborole in 2014 expanded the roster of medications available to more effectively manage onychomycosis in a wide range of patients, including those for whom comorbid conditions, concomitant medications, or patient preference limited the use of systemic antifungals.
Semin Cutan Med Surg
· 2016 Mar · PMID 27074698
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No scientifically rigorous, large, prospective studies have been done to document the true prevalence of onychomycosis; the reported rates vary mainly by climate and by population, but the overall prevalence in the Unite...No scientifically rigorous, large, prospective studies have been done to document the true prevalence of onychomycosis; the reported rates vary mainly by climate and by population, but the overall prevalence in the United States is estimated to be at least 10%. Advanced age and diabetes are the most commonly reported risk factors for onychomycosis. The differential diagnosis of onychomycosis is lengthy, and visual inspection alone is not sufficient for a definitive diagnosis-direct microscopic examination of a wet-mount preparation with 10% to 20% potassium hydroxide is the first-line diagnostic test.
Semin Cutan Med Surg
· 2016 Mar · PMID 27074696
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Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene...Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes.
Semin Cutan Med Surg
· 2016 Mar · PMID 26963116
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Radiographic imaging is important for the full evaluation of high-risk cutaneous tumors. The correct modality should be chosen based on tumor subtype and clinical question. Locally advanced tumors may require imaging to...Radiographic imaging is important for the full evaluation of high-risk cutaneous tumors. The correct modality should be chosen based on tumor subtype and clinical question. Locally advanced tumors may require imaging to evaluate the extent of disease, such as bony involvement, orbital infiltration, or perineural invasion. Tumors at high risk for regional and distant metastasis require imaging to identify local and distant tumor burden.
Semin Cutan Med Surg
· 2016 Mar · PMID 26963115
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The development of noninvasive optical technologies is revolutionizing the diagnosis of skin tumors. Nonmelanoma skin cancer, the most frequent neoplasm, has become an important health and economic issue, and proper mana...The development of noninvasive optical technologies is revolutionizing the diagnosis of skin tumors. Nonmelanoma skin cancer, the most frequent neoplasm, has become an important health and economic issue, and proper management can avoid unnecessary morbidity and mutilating treatment or relapses. Noninvasive treatment modalities and the recently approved systemic therapies for advanced basal cell carcinoma cases make noninvasive monitoring techniques necessary. Current knowledge, applications, and limitations of the tools most clinically implemented, such as dermoscopy, reflectance confocal microscopy, high frequency ultrasonography, and optical coherence tomography will be reviewed in this article. In addition to the improvement of diagnostic accuracy of skin cancer, using these tools individually or in combination facilitates better management of certain patients and tumors.
Fuller C, Cellura AP, Hibler BP
… +1 more, Burris K
Semin Cutan Med Surg
· 2016 Mar · PMID 26963114
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The computer-assisted diagnosis of melanoma is an exciting area of research where imaging techniques are combined with diagnostic algorithms in an attempt to improve detection and outcomes for patients with skin lesions...The computer-assisted diagnosis of melanoma is an exciting area of research where imaging techniques are combined with diagnostic algorithms in an attempt to improve detection and outcomes for patients with skin lesions suspicious for malignancy. Once an image has been acquired, it undergoes a processing pathway which includes preprocessing, enhancement, segmentation, feature extraction, feature selection, change detection, and ultimately classification. Practicality for everyday clinical use remains a vital question. A successful model must obtain results that are on par or outperform experienced dermatologists, keep costs at a minimum, be user-friendly, and be time efficient with high sensitivity and specificity.