On the Cover
Genetic testing for melanoma risk April 05, 2017By Bob KronemyerPatients 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.
In this issue
Maximizing the physician-patient relationshipNorman Levine, M.D., notes that being a physician is not easy. A large part of the difficulty centers on the patient-doctor relationship and how one maximizes the benefits that the patient accrues by the care he receives. I didn't ask about natural substance use. Am I liable?Dr. Derm recently performed a fairly simple excision, discussed blood thinners, but failed to ask his patient about “natural” herbal intake. The patient did not take any prescription blood thinners, but did take high daily dosages of garlic and ginkgo. A lawsuit was brought against Dr. Derm. Can he really have liability for all the things people ingest these days?
HS treatment requires multipronged approach February 17, 2017By Bob KronemyerEvidence supports combined treatments to target the many factors tied to hidradenitis suppurativa. Impact of childhood atopic dermatitis April 06, 2017By Bob KronemyerInstructional 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. Atopic dermatitis pipeline April 06, 2017By Bob KronemyerDrugs 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. A new class steps forward April 06, 2017By John JesitusPhosphodiesterase (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 treatment tactics April 06, 2017By John JesitusWith 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. TNF alfpha inhibitor safety, efficacy data grows April 06, 2017By John JesitusLong-term follow-up studies and drug registries continue to deliver reassuring data regarding the safety and efficacy of TNF inhibitors, an expert says.
What does it mean when skin is “well-hydrated?”Skin hydration is an interesting term that has great consumer and scientific meaning. What is an ultra-hydrating and therapeutic moisturizer?The terms ultra-hydrating and therapeutic, as they pertain to moisturizer formulation, are pure marketing gibberish, however they have tremendous consumer appeal. The feminine mystique April 24, 2017By John JesitusSurgical and nonsurgical options provide effective treatment for the growing number of women seeking vaginal rejuvenation, experts say. What are sensates in moisturizers and what is their value?Sensates are substances that induce a certain sensation when applied to the skin.
Psoriasis and skin cancer April 05, 2017By Bob KronemyerCyclosporine 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. Skin cancer advances April 14, 2017By Bob KronemyerGenetic 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. Melanoma surgical management guidelines April 14, 2017By Bob KronemyerAll 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. Lasers in melanoma care May 01, 2017By Bob KronemyerLaser for melanoma in situ (MIS) should generally be reserved for nonsurgical, usually elderly patients. When indicated, MIS may be treated with CO2 laser or with combined Q-switched Nd:YAG and imiquimod. Any atypical-appearing lesion should be biopsied prior to the start of a laser treatment.
Supportive oncodermatologySkin side effects from anticancer treatments can be a special burden for patients already suffering the extreme pressures of a cancer diagnosis. Treatments must be customized for patients based on the type of cancer and treatment, as well as the patient’s personal goals. Close and active relationships with patients are vital to assure the best possible outcome. ECP may prevent mycosis fungoides progressionExtracorporeal photopheresis is underused for early-stage mycosis fungoides. ECP is capable of correcting the cytokine imbalance seen in patients with MF and results in an increase of Th1 cytokines. Clinicians should consider more frequent use in select patients
Consolidation: What it looks like in dermatology April 12, 2017By Lisette HiltonConsolidation is occurring throughout healthcare. An expert talks about what it means to practicing dermatologists. The big squeeze April 12, 2017By Lisette HiltonLimited 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 program April 12, 2017By Cheryl BiseraPatient education can be a powerful tool that complements your expertise and boosts patient engagement.