Drug and therapeutics bulletin
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Hidradenitis suppurativa is a recurring chronic inflammatory debilitating skin disease of the hair follicle that usually presents with painful, deep-seated and inflamed lesions in the apocrine gland-bearing areas of the body. The lesions often progress to become chronic with purulent discharge, sinus formation and scarring. ⋯ However, there is a lack of good quality evidence and a paucity of authoritative guidance on treatment strategies. In this article, we review the diagnosis and management of hidradenitis suppurativa and discuss some new developments, including the use of cytokine modulators.
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Multimorbidity and associated polypharmacy present a significant and increasing challenge to patients, carers and healthcare professionals.(1,2) While it is recognised that polypharmacy can be beneficial, there is considerable potential for harm, particularly through drug interactions, adverse drug events and non-adherence.(1) Such harms are amplified in people who are frail and who may require interventions to be tailored to their individual needs rather than strictly following guidance designed to manage single diseases. It is important to develop an approach that allows patients to make informed decisions and prioritise medicines for continuation or discontinuation, in order to maximise benefit and minimise harm.(1)The term 'deprescribing' has been suggested in recognition that the skills utilised in stopping medicines need to be as sophisticated as those used when initiating drug treatment.(3) Key to deprescribing, as with all medical interventions, is the active participation of the patient to ensure that their preferences and choices are taken into account. Particular care is needed when end-of-life considerations apply, so that treatment is optimised and the burden of taking medicines is minimised.(4) Although evidence is sparse, this article provides some practical observations on deprescribing.
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Idiopathic restless legs syndrome (RLS)--also known as Willis-Ekbom disease--is a neurological condition characterised by an overwhelming urge to move the legs, occurring during rest or inactivity, especially at night. Symptoms are highly variable in frequency and severity, and can affect sleep and quality of life. ⋯ Drug therapy (e.g. a dopamine agonist) is used for patients with more severe symptoms. In December 2014, the marketing authorisation for a modified-release preparation containing oxycodone and naloxone (Targinact-Napp Pharmaceuticals) was expanded to include use in the treatment of severe to very severe RLS after failure of dopaminergic therapy.(10)Here we review the management of adults with RLS, including the place of oxycodone/naloxone.