Dermatologic therapy
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Dermatologic therapy · Mar 2008
ReviewFrom conventional to cutting edge: the new era of biologics in treatment of psoriasis.
Psoriasis is a chronic T-cell-mediated inflammatory disease of the skin and joints that affects 1-3% of the world population. Conventional treatments for moderate to severe psoriasis are associated with broadband immunosuppression and/or organ toxicities that can be problematic when used long term. Advances in the understanding of psoriasis pathogenesis have led to targeted therapy in the form of biologics. ⋯ This review will focus on the five main biologics used in the treatment of moderate to severe plaque psoriasis: efalizumab, alefacept, etanercept, infliximab and adalimumab. Mechanisms of action, guidelines for usage, efficacy data, and safety concerns will be discussed for each biologic. In addition, the new Th17 biologics and their role in psoriasis pathogenesis will also be examined.
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Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. Even though it is a psychiatric disorder, these patients usually present to a dermatologist because they are convinced that they have a dermatologic problem. Patients with delusions of parasitosis generally reject psychiatric referral. ⋯ The use of pimozide has been limited by its adverse effects, most notably extrapyramidal adverse effects. There is now an emerging role for atypical antipsychotics with a safer adverse effect profile in the treatment of delusions of parasitosis. However, the most challenging aspect of managing these patients may be the challenge of establishing rapport in the face of unshakable delusional ideation.
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Dermatologic therapy · Sep 2007
ReviewSkin lightening preparations and the hydroquinone controversy.
Skin lightening preparations are widely used in dermatology by persons of all Fitzpatrick skin types. Fitzpatrick skin types I-III require local pigment lightening for the treatment of hormonally induced melasma and postinflammatory hyperpigmentation caused by acne and trauma. ⋯ This has encouraged research into alternative agents to inhibit skin pigmentation such as retinoids, mequinol, azelaic acid, arbutin, kojic acid, aleosin, licorice extract, ascorbic acid, soy proteins, and N-acetyl glucosamine. The efficacy and safety of each of these ingredients is examined as possible topical alternatives to hydroquinone.
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Dermatologic therapy · Jan 2007
ReviewDermoscopy provides useful information for the management of melanonychia striata.
The diagnosis of melanonychia striata is often difficult, and a biopsy of the nail matrix is required in doubtful cases. However, dermoscopic examination of the nail plate offers interesting information in order to better select the cases in which pathologic examination is indicated. In the case of brown longitudinal pigmentation with parallel regular lines, the diagnosis of nail apparatus melanocytic nevus could be made. ⋯ Gray homogeneous lines are observed in case of lentigo, lentiginoses, ethnic or drug-induced pigmentations, and in post-traumatic pigmentations. Blood spots are characterized by their round-shaped proximal edge and their filamentous distal edge and are highly suggestive of subungual hemorrhages. Dermoscopic examination of the free edge of the nail plate gives information on the lesion location; pigmentation of the dorsum of the nail plate is in favor of a proximal nail matrix lesion, whereas pigmentation the lower part of the nail edge is in favor of a lesion of the distal matrix.
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Acne is a ubiquitous affliction that can leave physical and emotional scars that can persist throughout the life of the affected individual. Recent studies have substantiated the psychological impact and support a causal, and at times reciprocal, link between acne and the emotional and functional status of the patient. ⋯ Criteria to identify high-risk patients are provided. High-risk patients are those at increased risk for psychological and functional impairment or self-injurious behavior.