DOCSLIB.ORG

Pediatric Dermatology Updates & Common Curbsides

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pediatric Dermatology Updates & Common Curbsides Pediatric Dermatology Updates & Common Curbsides EMILY CROCE, MSN, APRN, CPNP-PC, PHD STUDENT PEDIATRIC & ADOLESCENT DERMATOLOGY DELL CHILDREN’S MEDICAL CENTER, AUSTIN, TEXAS THE UNIVERSITY OF TEXAS AT AUSTIN No relevant conflict of interest DISCLOSURES: Some off-label discussion, but commonly used indications Case 1: 5 y/o male with few month hx molluscum contagiosum. In the last week they have become red, tender, and “angry.” Do we: A. Begin mupirocin B. Begin oral antibiotic with staph coverage C. I&D D. Reassurance B.O.T.E. Sign Beginning of the end Inflammation is a sign that there is an immune response and, often, impending resolution Comfort measures such as warm compresses Discuss signs infection and reasons to return Reassurance Warts & Molluscum Update: No definitive therapy…nothing new about this! Tretinoin or OTC Differin gel may be useful every 1-2 nights Wart Stick - strongest OTC salicylic acid product Efudex every 2 nights x 12 wks Compounded topical such as Wart Peel Cimetidine 2—40 mg/kg/day x 2-3 months (or longer if helping) Molluscum dermatitis – treat like eczema Liquid nitrogen, cantharidin, candida antigen injections all still work…but only about 40% of the time Case 2: Parents of 2 y/o female with atopic dermatitis are worried about steroid s/e and black box warning on topical calcineurin inhibitors, but Eucrisa is not helping and patient is miserable. How we will treat and reassure: A. Steroid s/e and how to use B. Topical calcineurin inhibitor discussion C. To Eucrisa or not to Eucrisa D. Reinforce skin care routine How we will treat and reassure: A. Steroid s/e and how to use B. Topical calcineurin inhibitor discussion C. To Eucrisa or not to Eucrisa D. Reinforce skin care routine Topical Steroid Potency Chart • Low potency for face • Medium to high for extremities/torso depending on thickness of plaques, response to steroids, age • BID x 1-2 wks for flare then 2-3x/wk when needed on “hot spots” to maintain Topical steroid safety profile: Tacrolimus (Protopic) & Pimecrolimus (Elidel) Black box warning: animals in trials developed lymphomas PEER – long-term Pimecrolimus registry has not documented increased risk malignancy in normal topical use in children Crisabarole (Eucrisa) Benefits: do not cause atrophy, okay on thin-skinned areas, good for maintenance, Eucrisa approved to 3 mos, Protopic/Elidel approved to 2 yrs (but studied down to 3 mos) Cons: $$$, insurance coverage Topical calcineurin inhibitors & Eucrisa: Tacrolimus (Protopic) & Pimecrolimus (Elidel) Black box warning: animals in trials developed lymphomas PEER – long-term Pimecrolimus registry has not documented increased risk malignancy in normal topical use in children Crisabarole (Eucrisa) Benefits: do not cause atrophy, okay on thin-skinned areas, good for maintenance, Eucrisa approved to 3 mos, Protopic/Elidel approved to 2 yrs (but studied down to 3 mos) Cons: $$$, insurance coverage Case 3: 7 y/o male with few month hx scaly plaques and hair loss on scalp. No significant medical history, topical terbinafine is not helping. Tinea capitis treatment tips: Palpate for lymph nodes Culture (but probably okay to start treatment) to confirm dx and determine microsporum vs trichophyton Affected family members and fomites should be addressed Griseofulvin or terbinafine…but give enough med for long enough duration! 20 mg/kg/day x 6-8 wks griseofulvin or weight-based dosing terbinafine po x 4-6 wks Risk is low in otherwise healthy child, labs studies not indicated unless prolonged course If kerion, may need oral antibiotic and or oral/topical steroid Case 4: 14 y/o female with few year hx acne on face and back. No improvement with OTC products or rx benzoyl peroxide-clindamycin gel Acne plan of attack: Type Comedonal needs a retinoid Inflammatory probably needs benzoyl peroxide +/- antibiotic Most need both! Distribution Chest/back may require wash and/or PO Beard distribution in girls – ask about menstrual hx, consider PCOS Severity Scarring Response to therapy Impact on patient Cost Complexity of treatment regimen Acne treatment: Topical retinoid Tretinoin, adapalene, tazorac Start slow, advance as tolerated, moisturize, educate Topical antibiotic and/or antimicrobial Clindamycin Benzoyl peroxide Combo clinda/bpo Oral antibiotic Doxycycline minocycline Isotretinoin (Accutane) OCP, spironolactone Clascoterone Case 5: 6 wk old male with small red papules on back and arm. Started to appear around 2 weeks of age. Baby is otherwise healthy. What is your workup, if any? Hemangiomas: Benign vascular growths with some potential complications Cosmetic Glabella, eyelid, nose, lip, areola genitalia Ulceration Especially if friction such as diaper area, axilla or fast growing Syndromic or signifying underlying issues Superficial & plaque-like on face, midline spine, beard distribution 5+ hemangiomas = hemangiomatosis, obtain liver u/s early Functional If in doubt, refer early to dermatology Case 6: 9 month-old male with itchy red papules and nodules scattered on torso and extremities, concentrated on axillae. He has been treated x 1 with permethrin without improvement. No affected family members. Scabies: The main reason we see treatment failure in our clinic is inadequate treatment of household members and close contacts. All household members must be treated, even if they are not symptomatic Ask, ask, ask again if they all treated Standard of care is permethrin 5% cream applied (neck down if over 1 year or head to toes if under 1 year) at bedtime, rinse in morning, repeat in 14 days The itch may persist for up to a month due to hypersensitivity but new burrows/pustules should not be appearing after 2nd treatment Consider PO ivermectin for difficult cases or crusted scabies References BUTALA, N., SIEGFRIED, E., & WEISSLER, A. (2013). MOLLUSCUM BOTE SIGN: A PREDICTOR OF IMMINENT RESOLUTION. PEDIATRICS, 131(5), E1650-E1653; DOI: 10.1542/PEDS.2012-2933 DIAMANTIS, S. A., MORRELL, D. S., & BURKHART, C. N. (2009). PEDIATRIC INFESTATIONS. PEDIATRIC ANNALS, 38(6), 326–332. HTTPS://DOI-ORG.EZPROXY.LIB.UTEXAS.EDU/10.3928/00904481-20090521-05 EICHENFIELD, L. ET AL. (2013). EVIDENCE-BASED RECOMMENDATIONS FOR THE DIAGNOSIS AND TREATMENT OF PEDIATRIC ACNE. PEDIATRICS, 131(SUPPL3), S163-S186. MARGOLIS, D. J., ABUABARA, K., HOFFSTAD, O. J., WAN, J., RAIMONDO, D., & BILKER, W. B. (2015). ASSOCIATION BETWEEN MALIGNANCY AND TOPICAL USE OF PIMECROLIMUS. JAMA DERMATOLOGY, 151(6), 594–599. HTTPS://DOI-ORG.EZPROXY.LIB.UTEXAS.EDU/10.1001/JAMADERMATOL.2014.4305 PAPIER, A., & STROWD, L. C. (2018). ATOPIC DERMATITIS: A REVIEW OF TOPICAL NONSTEROID THERAPY. DRUGS IN CONTEXT, 7, 212521. HTTPS://DOI-ORG.EZPROXY.LIB.UTEXAS.EDU/10.7573/DIC.212521 SIEGFRIED, E. C., JAWORSKI, J. C., KAISER, J. D., & HEBERT, A. A. (2016). SYSTEMATIC REVIEW OF PUBLISHED TRIALS: LONG-TERM SAFETY OF TOPICAL CORTICOSTEROIDS AND TOPICAL CALCINEURIN INHIBITORS IN PEDIATRIC PATIENTS WITH ATOPIC DERMATITIS. BMC PEDIATRICS, 16, 75. HTTPS://DOI-ORG.EZPROXY.LIB.UTEXAS.EDU/10.1186/S12887-016- 0607-9 SMITH, C., FRIEDLANDER, S. F., GUMA, M., KAVANAUGH, A., & CHAMBERS, C. D. (2017). INFANTILE HEMANGIOMAS: AN UPDATED REVIEW ON RISK FACTORS, PATHOGENESIS, AND TREATMENT. BIRTH DEFECTS RESEARCH, 109(11), 809– 815. HTTPS://DOI-ORG.EZPROXY.LIB.UTEXAS.EDU/10.1002/BDR2.1023.
Load more

Recommended publications
  • Experience with Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice the Bump That Rashes
    STUDY ONLINE FIRST Experience With Molluscum Contagiosum and Associated Inflammatory Reactions in a Pediatric Dermatology Practice The Bump That Rashes Emily M. Berger, MD; Seth J. Orlow, MD, PhD; Rishi R. Patel, MD; Julie V. Schaffer, MD Objective: To investigate the frequency, epidemiol- (50.6% vs 31.8%; PϽ.001). In patients with molluscum ogy, clinical features, and prognostic significance of in- dermatitis, numbers of MC lesions increased during the flamed molluscum contagiosum (MC) lesions, mollus- next 3 months in 23.4% of those treated with a topical cum dermatitis, reactive papular eruptions resembling corticosteroid and 33.3% of those not treated with a topi- Gianotti-Crosti syndrome, and atopic dermatitis in pa- cal corticosteroid, compared with 16.8% of patients with- tients with MC. out dermatitis. Patients with inflamed MC lesions were less likely to have an increased number of MC lesions Design: Retrospective medical chart review. over the next 3 months than patients without inflamed MC lesions or dermatitis (5.2% vs 18.4%; PϽ.03). The Setting: University-based pediatric dermatology practice. GCLRs were associated with inflamed MC lesion (PϽ.001), favored the elbows and knees, tended to be Patients: A total of 696 patients (mean age, 5.5 years) pruritic, and often heralded resolution of MC. Two pa- with molluscum. tients developed unilateral laterothoracic exanthem– like eruptions. Main Outcome Measures: Frequencies, characteris- tics, and associated features of inflammatory reactions Conclusions: Inflammatory reactions to MC, including to MC in patients with and without atopic dermatitis. the previously underrecognized GCLR, are common. Treat- ment of molluscum dermatitis can reduce spread of MC Results: Molluscum dermatitis, inflamed MC lesions, and via autoinoculation from scratching, whereas inflamed MC Gianotti-Crosti syndrome–like reactions (GCLRs) oc- lesions and GCLRs reflect cell-mediated immune re- curred in 270 (38.8%), 155 (22.3%), and 34 (4.9%) of sponses that may lead to viral clearance.
    [Show full text]
  • Updates in Pediatric Dermatology
    Peds Derm Updates ELIZABETH ( LISA) SWANSON , M D ADVANCED DERMATOLOGY COLORADO ROCKY MOUNTAIN HOSPITAL FOR CHILDREN [email protected] Disclosures Speaker Sanofi Regeneron Amgen Almirall Pfizer Advisory Board Janssen Powerpoints are the peacocks of the business world; all show, no meat. — Dwight Schrute, The Office What’s New In Atopic Dermatitis? Impact of Atopic Dermatitis Eczema causes stress, sleeplessness, discomfort and worry for the entire family Treating one patient with eczema is an example of “trickle down” healthcare Patients with eczema have increased risk of: ADHD Anxiety and Depression Suicidal Ideation Parental depression Osteoporosis and osteopenia (due to steroids, decreased exercise, and chronic inflammation) Impact of Atopic Dermatitis Sleep disturbances are a really big deal Parents of kids with atopic dermatitis lose an average of 1-1.5 hours of sleep a night Even when they sleep, kids with atopic dermatitis don’t get good sleep Don’t enter REM as much or as long Growth hormone is secreted in REM (JAAD Feb 2018) Atopic Dermatitis and Food Allergies Growing evidence that food allergies might actually be caused by atopic dermatitis Impaired barrier allows food proteins to abnormally enter the body and stimulate allergy Avoiding foods can be harmful Proper nutrition is important Avoidance now linked to increased risk for allergy and anaphylaxis Refer severe eczema patients to Allergist before 4-6 mos of age to talk about food introduction Pathogenesis of Atopic Dermatitis Skin barrier
    [Show full text]
  • Pimecrolimus for the Treatment of Adults with Atopic Dermatitis, Seborrheic Dermatitis, Or Psoriasis: a Review of Clinical and Cost- Effectiveness
    CADTH RAPID RESPONSE REPORT: SUMMARY WITH CRITICAL APPRAISAL Pimecrolimus for the Treatment of Adults with Atopic Dermatitis, Seborrheic Dermatitis, or Psoriasis: A Review of Clinical and Cost- Effectiveness Service Line: Rapid Response Service Version: 1.0 Publication Date: September 25, 2017 Report Length: 19 Pages Authors: Raywat Deonandan, Melissa Severn Cite As: Pimecrolimus for the treatment of adults with atopic dermatitis, seborrheic dermatitis, or psoriasis: a review of clinical and cost- effectiveness. Ottawa: CADTH; 2017 Sep. (CADTH rapid response report: summary with critical appraisal). Acknowledgments: ISSN: 1922-8147 (online) Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. The information in this document should not be used as a substitute for professional medical advice or as a substitute for the application of clinical judgment in respect of the care of a particular patient or other professional judgment in any decision-making process. The Canadian Agency for Drugs and Technologies in Health (CADTH) does not endorse any information, drugs, therapies, treatments, products, processes, or services. While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect.
    [Show full text]
  • Aetna Formulary Exclusions Drug List
    Covered and non-covered drugs Drugs not covered – and their covered alternatives 2020 Advanced Control Plan – Aetna Formulary Exclusions Drug List 05.03.525.1B (7/20) Below is a list of medications that will not be covered without a Key prior authorization for medical necessity. If you continue using one of these drugs without prior approval, you may be required UPPERCASE Brand-name medicine to pay the full cost. Ask your doctor to choose one of the generic lowercase italics Generic medicine or brand formulary options listed below. Preferred Options For Excluded Medications1 Excluded drug name(s) Preferred option(s) ABILIFY aripiprazole, clozapine, olanzapine, quetiapine, quetiapine ext-rel, risperidone, ziprasidone, VRAYLAR ABSORICA isotretinoin ACANYA adapalene, benzoyl peroxide, clindamycin gel (except NDC^ 68682046275), clindamycin solution, clindamycin-benzoyl peroxide, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, EPIDUO, ONEXTON, TAZORAC ACIPHEX, esomeprazole, lansoprazole, omeprazole, pantoprazole, DEXILANT ACIPHEX SPRINKLE ACTICLATE doxycycline hyclate capsule, doxycycline hyclate tablet (except doxycycline hyclate tablet 50 mg [NDC^ 72143021160 only], 75 mg, 150 mg), minocycline, tetracycline ACTOS pioglitazone ACUVAIL bromfenac, diclofenac, ketorolac, PROLENSA acyclovir cream acyclovir (except acyclovir cream), valacyclovir ADCIRCA sildenafil, tadalafil ADZENYS XR-ODT amphetamine-dextroamphetamine mixed salts ext-rel†, dexmethylphenidate ext-rel, dextroamphetamine ext-rel, methylphenidate ext-rel†, MYDAYIS,
    [Show full text]
  • Pimecrolimus Cream 1% PI
    Mat# 238328-01 Filename: 238328-01_PimecroCrm30gPi_5_18.indd Proof# 1 Artist Name/Date: Mike Aspinall 9/10/18 AMT Version: 10 Sep 2018 Vault# VV-141752 Approvals:* NDA/ANDA# 209345 Black Approval: Date: Approval: Date: ” n/a Rev: * Applicable when approver is not able to apply electronic signature to PDF in Veeva Vault or Acrobat® Electronic and scanned proxy approval signatures appear on separate pages following the proof pages within this PDF Iss. 5/2018 n/a Created by: Outsert Configuration: Regulatory Affairs US Artwork Management Team Flat: 10” x 27” 1070 Horsham Road, North Wales, PA, 19454 Phone 215-591-3000 Fold: 5” x 2.25” Die Line - No Print 10” 10.00 1/8” 5” 5” 2.25” .25” 238328-01 238328-01 Pimecrolimus Cream Pimecrolimus Cream Rx only Rx only 238328-01 238328-01 Iss. 5/2018 Iss. 5/2018 HIGHLIGHTS OF PRESCRIBING INFORMATION • If signs and symptoms persist beyond 6 weeks, patients should be 8 USE IN SPECIFIC POPULATIONS These highlights do not include all the information needed to use re-examined. (2) 8.1 Pregnancy PIMECROLIMUS CREAM safely and effectively. See full prescribing • Continuous long-term use of pimecrolimus cream, 1% should be Pregnancy Category C information for PIMECROLIMUS CREAM. avoided. (2) There are no adequate and well-controlled studies with pimecrolimus cream, 1% in pregnant women. Therefore, pimecrolimus cream, 1% should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. PIMECROLIMUS cream, 1% for topical use • Avoid use with occlusive dressings. (2) Initial U.S. Approval: 2001 In dermal embryofetal developmental studies, no maternal or fetal toxicity was observed up to the highest practicable doses tested, 10 mg/kg/day DOSAGE FORMS AND STRENGTHS ”2 (1% pimecrolimus cream) in rats (0.14X MRHD based on body surface area) and 10 mg/kg/day (1% pimecrolimus cream) in rabbits (0.65X MRHD WARNING: LONG-TERM SAFETY OF TOPICAL CALCINEURIN Cream, 1%.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • Patent Application Publication ( 10 ) Pub . No . : US 2019 / 0192440 A1
    US 20190192440A1 (19 ) United States (12 ) Patent Application Publication ( 10) Pub . No. : US 2019 /0192440 A1 LI (43 ) Pub . Date : Jun . 27 , 2019 ( 54 ) ORAL DRUG DOSAGE FORM COMPRISING Publication Classification DRUG IN THE FORM OF NANOPARTICLES (51 ) Int . CI. A61K 9 / 20 (2006 .01 ) ( 71 ) Applicant: Triastek , Inc. , Nanjing ( CN ) A61K 9 /00 ( 2006 . 01) A61K 31/ 192 ( 2006 .01 ) (72 ) Inventor : Xiaoling LI , Dublin , CA (US ) A61K 9 / 24 ( 2006 .01 ) ( 52 ) U . S . CI. ( 21 ) Appl. No. : 16 /289 ,499 CPC . .. .. A61K 9 /2031 (2013 . 01 ) ; A61K 9 /0065 ( 22 ) Filed : Feb . 28 , 2019 (2013 .01 ) ; A61K 9 / 209 ( 2013 .01 ) ; A61K 9 /2027 ( 2013 .01 ) ; A61K 31/ 192 ( 2013. 01 ) ; Related U . S . Application Data A61K 9 /2072 ( 2013 .01 ) (63 ) Continuation of application No. 16 /028 ,305 , filed on Jul. 5 , 2018 , now Pat . No . 10 , 258 ,575 , which is a (57 ) ABSTRACT continuation of application No . 15 / 173 ,596 , filed on The present disclosure provides a stable solid pharmaceuti Jun . 3 , 2016 . cal dosage form for oral administration . The dosage form (60 ) Provisional application No . 62 /313 ,092 , filed on Mar. includes a substrate that forms at least one compartment and 24 , 2016 , provisional application No . 62 / 296 , 087 , a drug content loaded into the compartment. The dosage filed on Feb . 17 , 2016 , provisional application No . form is so designed that the active pharmaceutical ingredient 62 / 170, 645 , filed on Jun . 3 , 2015 . of the drug content is released in a controlled manner. Patent Application Publication Jun . 27 , 2019 Sheet 1 of 20 US 2019 /0192440 A1 FIG .
    [Show full text]
  • Atopic Dermatitis (Eczema) •Chronic Inflammatory Skin Disease That Begins During Infancy Or Early Childhood
    9/18/2019 Pediatric Dermatology Jennifer Abrahams, MD, FAAD, DTM&H Collaborators: Kate Oberlin, MD; Nayoung Lee MD September 27th, 2019 1 Disclosures • Nothing to disclose 2 1 9/18/2019 Disclaimer *Pediatric dermatology is taught over 3 years of derm-specific residency training and there is an additional year of subspecialized fellowship! *We won’t cover all of pediatric derm in an hour but I hope to give you some common highlights 3 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 4 2 9/18/2019 A 9 month old infant presents with the following skin lesions. Which of the following is most likely true of this disease? A.) Asthma generally precedes skin findings B.) The majority of affected children will outgrow the skin disease C.) There is no way to avoid or decrease risk of progression of the disease D.) Genetic factors account for approx 1% of susceptibility to early onset of this disease 5 6 3 9/18/2019 Atopic Dermatitis (Eczema) •Chronic inflammatory skin disease that begins during infancy or early childhood •Often associated with other “atopic” disorders • Asthma • Allergic rhinitis (seasonal allergies) • Food allergies •Characterized by intense itch and a chronic relapsing course •Prevalence almost 30% in developed countries 7 Table courtesy of Bolognia, et al.
    [Show full text]
  • Evidence-Based Danish Guidelines for the Treatment of Malassezia- Related Skin Diseases
    Acta Derm Venereol 2015; 95: 12–19 SPECIAL REPORT Evidence-based Danish Guidelines for the Treatment of Malassezia- related Skin Diseases Marianne HALD1, Maiken C. ARENDRUP2, Else L. SVEJGAARD1, Rune LINDSKOV3, Erik K. FOGED4 and Ditte Marie L. SAUNTE5; On behalf of the Danish Society of Dermatology 1Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2 Unit for Mycology, Statens Serum Institut, 3The Dermatology Clinic, Copen- hagen, 4The Dermatology Clinic, Holstebro, and 5Department of Dermatology, Roskilde Hospital, University of Copenhagen, Denmark Internationally approved guidelines for the diagnosis including those involving Malassezia (2), guidelines and management of Malassezia-related skin diseases concerning the far more common skin diseases are are lacking. Therefore, a panel of experts consisting of lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspi- dermatologists and a microbiologist appointed by the ces of the Danish Society of Dermatology undertook a Danish Society of Dermatology undertook a data review data review and compiled guidelines for the diagnostic and compiled guidelines on the diagnostic procedures procedures and management of pityriasis versicolor, se- and management of Malassezia-related skin diseases. borrhoeic dermatitis and Malassezia folliculitis. Main The ’head and neck dermatitis’, in which hypersensi- recommendations in most cases of pityriasis versicolor tivity to Malassezia is considered to be of pathogenic and seborrhoeic dermatitis include topical treatment importance, is not included in this review as it is restric- which has been shown to be sufficient. As first choice, ted to a small group of patients with atopic dermatitis. treatment should be based on topical antifungal medica- tion.
    [Show full text]
  • The Rx Consultant Index to Volume XVIII (2009 Issues)
    The Rx Consultant Index to Volume XVIII (2009 Issues) January Number 1 - Prostate Cancer, An Update on Disease Pathogenesis and Drug Therapy An overview of prostate cancer including risk factors, screening recommendations, symptoms, and diagnosis. Sum- marizes treatment options for early and advanced stages. Focuses on the hormonal therapies (luteinizing hormone- hormone-releasing hormone [LHRH] agonists and antiandrogens) that are typically used for both localized prostate cancer and more advanced cancer. The role of bisphosphonate therapy for bone loss or fracture prevention is discussed. Drugs included in this issue: LHRH Agonists Antiandrogens Bisphosphonates leuprolide acetate (Lupron®, Lupron® Depot, Eligard®) bicalutamide (Casodex®) alendronate (Fosamax®, generic) leuprolide acetate implant (Viadur®) flutamide (Eulexin®) zoledronic acid (Zometa®) ® ® goserelin acetate implant (Zoladex ) nilutamide (Nilandron ) Chemotherapy ( ®) ® histrelin acetate implant Vantas docetaxol (Taxotere ) ® ® triptorelin pamoate (Trelstar Depot, Trelstar LA ) mitoxantrone (Novantrone®) February Number 2 - Adult Immunizations The benefits of a pharmacy-based adult immunization program are discussed along with key steps for implementation. Recommended adult vaccines are reviewed with a focus on those commonly administered by pharmacists. Topics cov- ered include the rationale for vaccination, current indications, side effects, precautions, administration schedules, and vaccine questions commonly asked by patients. Vaccines reviewed in this issue: Influenza
    [Show full text]
  • Estonian Statistics on Medicines 2013 1/44
    Estonian Statistics on Medicines 2013 DDD/1000/ ATC code ATC group / INN (rout of admin.) Quantity sold Unit DDD Unit day A ALIMENTARY TRACT AND METABOLISM 146,8152 A01 STOMATOLOGICAL PREPARATIONS 0,0760 A01A STOMATOLOGICAL PREPARATIONS 0,0760 A01AB Antiinfectives and antiseptics for local oral treatment 0,0760 A01AB09 Miconazole(O) 7139,2 g 0,2 g 0,0760 A01AB12 Hexetidine(O) 1541120 ml A01AB81 Neomycin+Benzocaine(C) 23900 pieces A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+Thymol(dental) 2639 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+Cetylpyridinium chloride(gingival) 179340 g A01AD81 Lidocaine+Cetrimide(O) 23565 g A01AD82 Choline salicylate(O) 824240 pieces A01AD83 Lidocaine+Chamomille extract(O) 317140 g A01AD86 Lidocaine+Eugenol(gingival) 1128 g A02 DRUGS FOR ACID RELATED DISORDERS 35,6598 A02A ANTACIDS 0,9596 Combinations and complexes of aluminium, calcium and A02AD 0,9596 magnesium compounds A02AD81 Aluminium hydroxide+Magnesium hydroxide(O) 591680 pieces 10 pieces 0,1261 A02AD81 Aluminium hydroxide+Magnesium hydroxide(O) 1998558 ml 50 ml 0,0852 A02AD82 Aluminium aminoacetate+Magnesium oxide(O) 463540 pieces 10 pieces 0,0988 A02AD83 Calcium carbonate+Magnesium carbonate(O) 3049560 pieces 10 pieces 0,6497 A02AF Antacids with antiflatulents Aluminium hydroxide+Magnesium A02AF80 1000790 ml hydroxide+Simeticone(O) DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 34,7001 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 3,5364 A02BA02 Ranitidine(O) 494352,3 g 0,3 g 3,5106 A02BA02 Ranitidine(P)
    [Show full text]
  • An Open, Randomized, Comparative Clinical and Histological Study Of
    Ann Dermatol Vol. 22, No. 2, 2010 DOI: 10.5021/ad.2010.22.2.156 ORIGINAL ARTICLE An Open, Randomized, Comparative Clinical and Histological Study of Imiquimod 5% Cream Versus 10% Potassium Hydroxide Solution in the Treatment of Molluscum Contagiosum Sang-Hee Seo, M.D., Hyun-Woo Chin, M.D., Dong-Wook Jeong, M.D.1, Hyun-Woo Sung, M.D.2 Departments of Dermatology and 1Family Medicine, Yansan Pusan National University Hospital, School of Medicine, Pusan National University, Yangsan, 2Department of Orthopaedics, School of Medicine, Dong-a University Medical Center, Busan, Korea Background: Although molluscum contagiosum (MC) re- -Keywords- solves spontaneously, there are several reasons to treat this Imiquimod, Molluscum contagiosum, Potassium hydrox- dermatological disorder. Objective: To evaluate the safety ide and efficacy of 5% imiquimod cream versus 10% potassium hydroxide (KOH) solution in treating MC, and to propose the mechanism of cure by observing the histological findings. INTRODUCTION Methods: Imiquimod or KOH were applied by the patient or a parent 3 days per week until all lesions cleared. The Molluscum contagiosum (MC), the most common viral number of MC lesions was counted and side effects were skin infections (2∼8%) in children, is a self-limiting evaluated at 5 points during the treatment (the initial visit, epidermal papular condition caused by the Molluscipox week 2, week 4, week 8, and week 12). Histological changes virus1. Although spontaneous resolution of the lesions were compared between 2 patients of each group, before occurs, there are several reasons to treat them2. Firstly, the and after the 2 weeks of application. Results: In both group, lesions are cosmetically unattractive.
    [Show full text]