May 2017 Placeholder_Cover.jpg
Crazy patient stories and how I deal with themNorman Levine, M.D., believes that acquiring a patient's full history isn't always as helpful as physicians make them out to be, and in fact, can occasionally be harmful.
HS treatment requires multipronged approachEvidence supports combined treatments to target the many factors tied to hidradenitis suppurativa. See one expert's recommendations.
Caregiver education vital for pediatric AD treatmentInstructional handouts help caregivers stick to complicated treatment plans for pediatric AD patients. Historically effective AD treatments are being augmented with new phosphodiesterase inhibitors and biologics. Gentler approaches such as massage, light therapy, and melatonin may also be of value for children with AD.
Several AD products in pipelineDrugs to treat atopic dermatitis are at the top of the FDA’s dermatology list. Biologics and PDE4 inhibitors show promise in the treatment of AD. Approval is still needed for the use of biologics to treat AD in pediatric patients.
PDE inhibitorsPhosphodiesterase (PDE) inhibitors including apremilast and crisaborole ointment may provide safer alternatives than traditional steroid-sparing agents for psoriasis and atopic dermatitis. Side effects of apremilast may include GI symptoms, weight loss and depression, and taking apremilast with anti-seizure drugs or rifampin lowers apremilast blood levels, Apremilast is being studied in inflammatory bowel disease, Behcet's disease and pediatric psoriasis, and may have a place in the treatment of hidradenitis suppurativa (HS).
TNF inhibitor tacticsWith a long history in dermatology and rheumatology, TNF inhibitors can not only improve psoriasis and psoriatic arthritis, but they also may reduce comorbid cardiovascular risks and work better combined with methotrexate. Low doses of cyclosporine may be effective at treating the psoriasis reaction when topicals have proven ineffective. Aggressively managing TNF-induced reactions can help patients stay on drugs that are working for other challenging diseases.
Safety, efficacy data growingLong-term follow-up studies and drug registries continue to deliver reassuring data regarding the safety and efficacy of TNF inhibitors, an expert says.
The feminine mystiqueSurgical and nonsurgical options provide effective treatment for the growing number of women seeking vaginal rejuvenation, experts say.
Psoriasis and skin cancerCyclosporine and PUVA clearly increase the risk of squamous cell carcinomas, and there is evidence that TNF blockers and methotrexate may do so to a lesser degree. UVB phototherapy has not been shown to cause skin cancer. Acitretin offers protection against the development of basal cell and squamous cell carcinomas.
Genetic testing for melanoma riskPatients who carry a high-penetrance melanoma predisposition gene can often benefit from screening for other cancers. Patients who receive a positive genetic test result are more likely to embrace prevention and detection measures. A new “Rules of Three” proposes a point-based guideline to help determine who should be referred for genetic counseling and testing.
New vistas in skin cancer careGenetic profiling is valuable in both diagnosis and prognosis of skin cancer. Hedgehog inhibitors and (superficial radiation therapy) SRT are strong contenders for treating nonmelanoma skin cancer. Advances in targeted therapies and biologics are part of the new wave of melanoma treatments.
Surgical management of melanomaAll surgical management of melanoma is defined by Breslow thickness. For melanoma less than 1 mm in thickness, typically a SLNB is not required. Future imaging devices may better delineate the extent and depth of the tumor in vivo.
Consolidation: What it looks like in dermatologyConsolidation is occurring throughout healthcare. An expert talks about what it means to practicing dermatologists.
The big squeezeLimited provider networks are cutting more than costs; these narrow networks are cutting dermatologists. One expert shares insight on what derms need to know.
Building a patient education programPatient education can be a powerful tool that complements your expertise and boosts patient engagement.