Seminars in cutaneous medicine and surgery
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Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. ⋯ Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.
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Geriatric patients are frequently afflicted by pruritic dermatoses. Most pruritic elderly patients present with a skin eruption. ⋯ These consequences of aging may all afflict the same patient, explaining why elderly people often have multiple overlapping skin conditions. The following article outlines the pathogenesis of the most common forms of pruritic skin disease in elderly patients and the hallmarks that allow the dermatologist to establish an accurate diagnosis and also suggests a management strategy for each common type of pruritic skin disease in the elderly patient.
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Semin Cutan Med Surg · Mar 2011
New agents for prevention of ultraviolet-induced nonmelanoma skin cancer.
With the incidence of nonmelanoma skin cancer on the rise, current prevention methods, such as the use of sunscreens, have yet to prove adequate to reverse this trend. There has been considerable interest in identifying compounds that will inhibit or reverse the biochemical changes required for skin cancers to develop, either by pharmacologic intervention or by dietary manipulation. By targeting different pathways identified as important in the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple agents or the addition of chemopreventative agents to topical sunscreens may offer the potential for novel and synergistic therapies in treating nonmelanoma skin cancer.
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Semin Cutan Med Surg · Mar 2010
ReviewThe treatment of moderate-to-severe psoriasis: prescreening and monitoring psoriatic patients on biologics.
The development of biologics has dramatically altered the treatment of moderate-to-severe psoriasis while also introducing new standards of care for therapeutic monitoring. Currently, the biologics approved by the US Food and Drug Administration are divided into 3 classes: T-cell modulators, tumor necrosis factor-alpha inhibitors, and interleukin-12/23 inhibitors. ⋯ Instead of following a blanket algorithm, providers must understand the evidence as it relates to each medication to determine which tests are appropriate for any specific patient. This chapter summarizes the current body of evidence and recommends a practical approach for monitoring psoriasis patients who are receiving biologic therapies.
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Vitiligo is an acquired dyschromia of the skin in which there is a loss of epidermal melanocytes. The prevalence of vitiligo is approximately 1% in the United States and 0.1-2% worldwide. ⋯ After completing this update, participants should be able to discuss the epidemiology of vitiligo and summarize the proposed mechanisms for development of this disease. In addition, they should be able to discuss physical findings, approach to the patient, and some of the therapeutic modalities for this disorder.