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Procedures in primary care dermatology.

BACKGROUND: General practitioners can provide a range of diagnostic and treatment procedures for patients with dermatological problems. OBJECTIVE: This article reviews the use of Wood's light, diascopy, skin scrapings for microscopy, skin biopsy, cauterisation, doppler measurement of ankle-brachial pressure index, and multi-layer compression bandages for venous ulcers. DISCUSSION: Adequate training and proper equipment is essential for commonly neglected areas including informed written consent, good communication with the histopathologist, a system for handling specimens and reports, action plans for laboratory results, and adequate training and protection for auxiliary staff.

Bandages↗

Tumor necrosis factor alpha inhibitors for the treatment of dermatologic diseases.

Tumor necrosis factor alpha (TNFalpha) is involved in cell differentiation, mitogenesis, cytotoxic responses, inflammation, immunomodulation, and wound healing. Because of its numerous roles, it was thought that inhibition of TNF may aid in the treatment of certain dermatologic diseases such as psoriasis, hidradentitis suppurativa, pyoderma gangrenosum, Behcet 's syndrome, and graft versus host disease. The efficacy of these agents has proven impressive and short-term side effects have been few and relatively benign.

Antibodies, Monoclonal↗

Topical anesthetics for cosmetic and laser dermatology.

Many effective and simple topical anesthetic products are available today and commonly used in medical and non-medical settings. The increased use of topical anesthetics, especially by non-physicians in the medical and non-medical settings, has resulted in increased rates of complications including ineffective anesthesia, allergy, and even potential fatalities. This review focuses on various techniques and formulations for topical anesthesia and their appropriate applications in cosmetic and laser dermatology. In addition, the history, pharmacology, and clinical complications of topical anesthetics are discussed.

Administration, Topical↗

Case reports: suicidal ideation in the dermatology clinic.

Many dermatology patients have significant psychiatric comorbidities, including depression and suicidal ideation. In light of the isotretinoin controversy, the relevance of this subject has never been greater. Therefore, it is imperative for dermatologists to understand the appropriate actions to take when faced with a potentially suicidal patient. We present a case of a clinic patient who expressed suicidal intent and discuss necessary steps to take in such a situation.

Adult↗

Safety update on commonly used psychotropic medications in dermatology.

It is the experience of dermatologists worldwide that a significant proportion of their patient population has underlying psychological components to their dermatologic complaints. Since these patients are often reluctant to see a mental health professional, the effective management of the underlying psychopathology may require the use of psychotropic medications by the dermatologists. This paper aims to update dermatologists on recent safety information on some of the most commonly prescribed psychotropic medications in psychodermatology. In the process it will also address the implications of these recent safety updates for prescribing clinicians.

Contraindications↗

A practical guide to dermatological drug use in pregnancy.

Although the developing fetus was once considered protected from the outside world, we now know that it can potentially be affected by any medication given to the mother. Despite this knowledge, use of medications during pregnancy is common and pregnant women often present for treatment of dermatological disease. Therapeutic options available for these patients will be discussed.

Abnormalities, Drug-Induced↗

Recommendation of moisturizers and cleansers: a study of unmet needs among dermatology patients.

In a survey commissioned by Core-Create, Inc, and conducted by Harris Interactive, 422 subjects in the United States with chronic dermatologic diseases provided feedback regarding information and recommendations provided to them by their dermatologist on the use of moisturizers and cleansers. In particular, the survey results revealed that there is widespread underuse of these products in patients with common cutaneous disorders. The vast majority of patients wish that their dermatologist would provide more information about moisturizers and cleansers; additionally, they would like their dermatologist to recommend a specific product for them to use. What's more, patients want to know if a moisturizer or cleanser will do more than merely provide symptomatic relief. Patient education was confirmed as a critical factor in promoting patient compliance as evidenced by the fact that subjects were 4 times more likely to follow their physician's direction when the role of the products was explained to them than when no explanation was provided. In addition, it was found that overall patient satisfaction with the care received from their dermatologist is driven by communication.

Adult↗

Impaired skin barrier function in dermatologic disease and repair with moisturization.

There is a substantial body of data demonstrating that atopic dermatitis and various other skin diseases are associated with disturbances of skin barrier function as evidenced by an increase in transepidermal water loss (TEWL), a decrease in water-binding properties, and a reduction in skin surface lipids, specifically levels of ceramides. The results of clinical studies suggest that these deficits can be addressed through the judicious use of appropriate moisturizers, which have been shown to improve skin hydration, reduce susceptibility to irritation, and restore the integrity of the stratum corneum. Some emollients also supply the compromised stratum corneum with vital lipids and accelerate barrier recovery. Moisturizers serve as an important first-line therapeutic option for patients with atopic dermatitis and other chronic skin diseases and can be highly beneficial in improving the clinical signs and symptoms of these challenging dermatologic conditions.

Ceramides↗

Improved clinical outcomes with moisturization in dermatologic disease.

Controlled clinical studies have provided strong evidence that moisturizers not only enhance the efficacy of topical corticosteroids in patients with atopic dermatitis but also may prevent disease reexacerbation. Furthermore, moisturizers have been shown to have a steroid-sparing effect both in patients with atopic dermatitis and in those with psoriasis. In particular, certain lipid-dominant moisturizers have been shown to significantly (P<.05) improve the condition of the skin based on objectively assessed changes in clinical parameters when used by patients with various dermatoses. Although further research is warranted, moisturizers represent a valuable first-line treatment option for many dermatologic diseases and confer a number of important therapeutic benefits beyond mere cosmetic effects.

Administration, Topical↗

Dermatological drug dosage in the elderly.

The elderly population is increasing and drug dosing requires special considerations for efficacy and decreasing toxicity. This overview provides algorithms for adjusting drug and dosage based on current evidence-based knowledge with emphasis on drugs prescribed in dermatological practice.

Age Factors↗

[Clinical trials in dermatology. Statistical support].

To determine the efficacy or safety of new topical treatments, more or less standardized studies must be performed. This article presents several examples of statistical analyses of the data currently seen in the dermatology area, and some guidelines for study sample size determination. More importantly, it indicates, for as soon as phase I studies, the need for preliminary informations such as development strategy, historical data, literature references or pilot studies, to determine or adapt appropriate designs and sample sizes. This need can be filled by close collaboration among clinicians, statisticians and sponsor.

Clinical Trials as Topic↗

[Clinical trials in dermatology. Evaluation of the tolerability and efficacy of a topical anti-acne].

Acne is a frequent dermatologic disease of the teenagers. Methodology of antiacne preparations clinical trials has evolved recently, leading to better comprehension of acne treatment on acne lesions. The main rules for good clinical evaluation of acne treatments are: an objective counting of each individual lesions on a defined area (face, back), a global acne assessment, a therapy duration from 1 to 3 months or more, a skin safety evaluation for erythema, desquamation, dryness, itching, burning and oiliness with a 0 to 3 scoring system.

Acne Vulgaris↗

Producing a dermatology newsletter.

The marketing concepts, benefits and drawbacks, topics, and basic elements of a Dermatology practice newsletter are discussed in this article. The methods and production mechanics for such a newsletter are then presented.

Dermatology↗

New health practitioners and dermatology manpower planning.

To assess the need for dermatologists in the United States, the potential role of new health practitioners in this specialty is considered. Available data on physician extenders in general and informed opinion on dermatologist extenders in particular suggest that specially trained, nonphysician personnel could substantially augment the supply of dermatological services. At present, however, widespread adoption of new staffing patterns appears unlikely. A long-run trend toward greater use of all categories of ancillary personnel in this specialty is expected, and the profession is urged to play an early and active role in this trend's development.

Allied Health Personnel↗

Nursing research and dermatology: where to start.

Nursing research can provide the professional growth necessary to ensure the future and credibility of dermatology nursing. This article explains common research definitions, controls, instrumentation, blinding, analysis, and where to seek help for your research project.

Data Collection↗

[An improvement in occupational medical expertise in dermatology and venereology].

Poor organization of medical expert evaluation results in unjustified labor time loss and waste of social insurance money. Test controls and check-ups of the activities of outpatient prophylactic centers have revealed inadequate theoretical knowledge of the basic aspects of medical expert evaluation of the working capacity and poor practical skills of physicians in keeping files and records. Analysis of the status of medical expert evaluation of the working capacity of dermatological and venereological patients and analysis of physicians' scope of knowledge in this field help outline a comprehensive program for elimination of the shortcomings in this work.

Absenteeism↗

Dermatologic surgery--its scope and some practical aspects.

Dermatologic surgery is of increasing interest to both dermatologists and other medical practitioners. It includes procedure like biopsy, excisional surgery, laser surgery, electrosurgery, curettage surgery, nail surgery, cryosurgery, minigrafting, sclerotherapy, collagen implant, punch grafting, Moh's micrographic surgery, dermabrasion and hair transplant. This article highlights the important aspects of the various procedures and some of the more important practical points.

Dermatologic Surgical Procedures↗