Clinics in dermatology
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The human commensal bacterium Propionibacterium acnes (P. acnes) resides in the pilosebaceous duct of the skin. It has been long implicated in the pathogenesis of acne, although its exact role in the development of inflammatory acne lesions and in the formation of the microcomedo in the early stages of acne remains controversial. ⋯ Although the relative abundances of P. acnes may be similar among patients with acne and individuals without acne, P. acnes populations and the presence of P. acnes biofilms differ, with different potential virulence properties and antimicrobial resistance patterns. Implications of the use of antibiotics and of antimicrobial resistance in patients with acne include the decreased efficacy of antibiotic treatments for acne, and the possible emergence of other resistant bacterial species via selective pressure by antibiotic use.
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Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules, phymatous changes, and ocular signs and symptoms. Rosacea is generally classified into four subtypes and one variant. ⋯ There is debate whether rosacea progresses from one subtype over time or subtypes represent discreet entities. Defining clinical presentation and improved understanding of pathophysiology has resulted in identification of novel treatment approaches. This contribution outlines a rationale for treatment, highlights an evidence-based approach with approved treatments, and considers novel developments and off-license therapy available.
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Clinics in dermatology · Nov 2016
Comparative StudyPhotodermatoses: Kids are not just little people.
Photodermatoses are a group of skin disorders caused by abnormal reaction to ultraviolet radiation. Photodermatoses are divided into four groups: (1) immunologically mediated photodermatoses; (2) chemical- and drug-induced photodermatoses; (3) photoaggravated dermatoses; and (4) hereditary photodermatoses. This contribution discusses differences in the approach and diagnosis of pediatric and adult patients with suspected photodermatoses, focusing on immunologically mediated photodermatoses and chemical- and drug-induced photodermatoses.
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Phototherapy has been the mainstay of vitiligo therapy for several decades. A variety of wavelengths and modalities are available, but narrowband ultraviolet B remains the safest and most commonly used treatment. ⋯ Achievement of optimal results involves using a combination of appropriate treatment protocols, careful patient selection, and patient education to set expectations. Individual patient characteristics, including disease activity, vitiligo phenotype, lesion location, and skin phototype, should all be considered, along with combination therapies.
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As the use of indoor tanning beds gained popularity in the decades after their appearance in the market in the early 1970s, concerns arose regarding their use. Clinical research has revealed an association between indoor tanning and several health risks, including the subsequent occurrence of melanoma and nonmelanoma skin cancers, the development of psychologic dependence, and a tendency toward other high-risk health behaviors. In the face of mounting evidence, legislation has been passed, which includes the restriction of access to tanning beds by minors in 42 states and the District of Columbia, and the recent reclassification by the Food and Drug Administration, which now categorizes tanning beds as class II devices and worthy of restrictions and oversight. Early evidence suggests that these labors are resulting in cultural change, although continued efforts are necessary to limit further exposure and better inform the public of the dangers associated with indoor tanning use.