Aars Hot Topics Member Newsletter
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Proper Preop Makes for Easier Toenail Surgery
April 15, 2007 • www.familypracticenews.com Skin Disorders 25 Proper Preop Makes for Easier Toenail Surgery BY JEFF EVANS sia using a digital block or a distal approach to take ef- Senior Writer fect. Premedication with NSAIDs, codeine, or dextro- propoxyphene also may be appropriate, he said. WASHINGTON — Proper early management of in- To cut away the offending section of nail, an English grown toenails may help to decrease the risk of recur- anvil nail splitter is inserted under the nail plate and the rence whether or not surgery is necessary, Dr. C. Ralph cut is made all the way to the proximal nail fold. The hy- Daniel III said at the annual meeting of the American pertrophic, granulated tissue should be cut away as well. Academy of Dermatology. Many ingrown toenails are recurrent, so Dr. Daniel per- “An ingrown nail is primarily acting as a foreign-body forms a chemical matricectomy in nearly all patients after reaction. That rigid spicule penetrates soft surrounding tis- making sure that the surgical field is dry and bloodless. sue” and produces swelling, granulation tissue, and some- The proximal nail fold can be flared back to expose more times a secondary infection, said Dr. Daniel of the de- of the proximal matrix if necessary. Dr. Daniel inserts a Cal- partments of dermatology at the University of Mississippi, giswab coated with 88% phenol or 10% sodium hydroxide Jackson, and the University of Alabama, Birmingham. and applies the chemical for 30 seconds to the portion of For the early management of stage I ingrown toenails the nail matrix that needs to be destroyed. -
Aars Hot Topics Member Newsletter
AARS HOT TOPICS MEMBER NEWSLETTER American Acne and Rosacea Society 201 Claremont Avenue • Montclair, NJ 07042 (888) 744-DERM (3376) • [email protected] www.acneandrosacea.org Like Our YouTube Page Visit acneandrosacea.org to Become an AARS Member and TABLE OF CONTENTS Donate Now on acneandrosacea.org/donate AARS News Register Now for the AARS 9th Annual Scientific Symposium .................................... 2 Our Officers AARS BoD Member Emmy Graber invites you to earn free CME! ............................. 3 J. Mark Jackson, MD AARS President New Medical Research The effect of 577-nm pro-yellow laser on demodex density in patients with rosacea 4 Andrea Zaenglein, MD Aspirin alleviates skin inflammation and angiogenesis in rosacea ............................. 4 AARS President-Elect Efficacy and safety of intense pulsed light using a dual-band filter ............................ 4 Split-face comparative study of fractional Er:YAG laser ............................................. 5 Joshua Zeichner, MD Evaluation of biophysical skin parameters and hair changes ..................................... 5 AARS Treasurer Dermal delivery and follicular targeting of adapalene using PAMAM dendrimers ...... 6 Therapeutic effects of a new invasive pulsed-type bipolar radiofrequency ................ 6 Bethanee Schlosser, MD Efficacy and safety of a novel water-soluble herbal patch for acne vulgaris .............. 6 AARS Secretary A clinical study evaluating the efficacy of topical bakuchiol ........................................ 7 Tolerability and efficacy of clindamycin/tretinoin versus adapalene/benzoyl peroxide7 James Del Rosso, DO Photothermal therapy using gold nanoparticles for acne in Asian patients ................ 8 Director Development of a novel freeze-dried mulberry leaf extract-based transfersome gel . 8 The efficacy and safety of dual-frequency ultrasound for improving skin hydration ... 9 Emmy Graber, MD Director Clinical Reviews Jonathan Weiss, MD What the pediatric and adolescent gynecology clinician needs to know about acne . -
Dermatology Gp Booklet
These guidelines are provided by the Departments of Dermatology of County Durham and Darlington Acute Hospitals NHS Trust and South Tees NHS Foundation Trust, April 2010. More detailed information and patient handouts on some of the conditions may be obtained from the British Association of Dermatologists’ website www.bad.org.uk Contents Acne Alopecia Atopic Eczema Hand Eczema Intertrigo Molluscum Contagiosum Psoriasis Generalised Pruritus Pruritus Ani Pityriasis Versicolor Paronychia - Chronic Rosacea Scabies Skin Cancers Tinea Unguium Urticaria Venous Leg Ulcers Warts Topical Treatment Cryosurgery Acne Assess severity of acne by noting presence of comedones, papules, pustules, cysts and scars on face, back and chest. Emphasise to patient that acne may continue for several years from teens and treatment may need to be prolonged. Treatment depends on the severity and morphology of the acne lesions. Mild acne Comedonal (Non-inflammatory blackheads or whiteheads) • Benzoyl peroxide 5-10% for mild cases • Topical tretinoin (Retin-A) 0.01% - 0.025% or isotretinoin (Isotrex) Use o.d. but increase to b.d. if tolerated. Warn the patient that the creams will cause the skin to become dry and initially may cause irritation. Stop if the patient becomes pregnant- although there is no evidence of harmful effects • Adapalene 0.1% or azelaic acid 20% may be useful alternatives Inflammatory (Papules and pustules) • Any of the above • Topical antibiotics – Benzoyl peroxide + clindamycin (Duac), Erythromycin + zinc (Zineryt) Erythromycin + benzoyl peroxide (Benzamycin gel) Clindamycin (Dalacin T) • Continue treatment for at least 6 months • In patients with more ‘stubborn’ acne consider a combination of topical antibiotics o.d with adapalene, retinoic acid or isotretinoin od. -
An Update on the Treatment of Rosacea
VOLUME 41 : NUMBER 1 : FEBRUARY 2018 ARTICLE An update on the treatment of rosacea Alexis Lara Rivero Clinical research fellow SUMMARY St George Specialist Centre Sydney Rosacea is a common inflammatory skin disorder that can seriously impair quality of life. Margot Whitfeld Treatment starts with general measures which include gentle skin cleansing, photoprotection and Visiting dermatologist avoidance of exacerbating factors such as changes in temperature, ultraviolet light, stress, alcohol St Vincent’s Hospital Sydney and some foods. Senior lecturer For patients with the erythematotelangiectatic form, specific topical treatments include UNSW Sydney metronidazole, azelaic acid, and brimonidine as monotherapy or in combination. Laser therapies may also be beneficial. Keywords For the papulopustular form, consider a combination of topical therapies and oral antibiotics. flushing, rosacea Antibiotics are primarily used for their anti-inflammatory effects. Aust Prescr 2018;41:20-4 For severe or refractory forms, referral to a dermatologist should be considered. Additional https://doi.org/10.18773/ treatment options may include oral isotretinoin, laser therapies or surgery. austprescr.2018.004 Patients should be checked after the first 6–8 weeks of treatment to assess effectiveness and potential adverse effects. Introduction • papules Rosacea is a common chronic relapsing inflammatory • pustules skin condition which mostly affects the central face, • telangiectases. 1 with women being more affected than men. The In addition, at least one of the secondary features pathophysiology is not completely understood, but of burning or stinging, a dry appearance, plaque dysregulation of the immune system, as well as formation, oedema, central facial location, ocular changes in the nervous and the vascular system have manifestations and phymatous changes are been identified. -
Rosacea and Personality
76 Letters to the Editor Rosacea and Personality Erik Karlsson1, Mats Berg2 and Bengt B. Arnetz3 1Department of Social Sciences, Va¨xjo¨ University, 2Section of Dermatology, Department of Medical Science and 3Section for Social Medicine/CEOS, Department of Public Health, Uppsala University, Uppsala, Sweden. E-mail: [email protected] Accepted August 24, 2003. Sir, dermatological patients at the Karolinska Hospital in Stock- Rosacea is a common facial disease (1). Research on holm and were all examined by the same dermatologist. Their symptoms varied from moderate to severe. The mean possible psychosomatic causes of the origin of rosacea duration of disease was 9.5 years. The psoriasis patients is relatively scant and in general fairly old. Guilt and were also consecutive patients at the Swedish Psoriasis shame, mostly concerning sexual problems and social Organization in Enskede outside Stockholm, and their anxiety, were previously thought to play a considerable symptoms varied from mild to more serious. Mean duration part in the aetiology of rosacea, and it was asserted that of disease was 24.5 years. The office employees with healthy skin had jobs in medical administration in a county council, patients with rosacea had homosexual fantasies and and they were randomly chosen from the employment list. A signs of paranoia (2, 3). Suggestions have been made modified version of Schalling’s (10) Karolinska Scales of that rosacea patients show signs of immaturity, strongly Personality (KSP) was used. The factors studied from the test inhibited affective responses, shyness, lack of self- were inhibition of aggression, verbal aggression, indirect confidence and feelings of inadequacy (4). -
Rosacea with Extensive Extrafacial Lesions Teresa M
CORE Metadata, citation and similar papers at core.ac.uk Provided by Repositório Comum CaseBlackwellOxford,IJDInternational0011-9059©XXX 2007 TheUK Publishing International Journal Ltdof Dermatology Society of Dermatology report RosaceaExtrafacialPereiraCase report et al. rosacea; Rosacea with extensive extrafacial lesions Teresa M. Pereira, Ana Paula Vieira, and A. Sousa Basto From the Department of Dermatology and Abstract Venereology, Hospital de São Marcos, Braga, Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex Portugal areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the Correspondence Teresa M. Pereira, MD diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea Department of Dermatology and Venereology with very exuberant extrafacial lesions, when compared with the limited involvement of the face. Hospital de São Marcos Apartado 2242 4701-965 Braga Portugal E-mail: [email protected] Bacteriological and mycological tests of the contents of Introduction the pustules were negative. Baseline investigations, including Rosacea is a skin disorder frequently observed in the clinical complete blood count, liver and renal functions, autoimmune practice. It is characterized by the primary involvement of screen, serology for human immunodeficiency virus, and urine convex areas of the face.1 However, a wide spectrum of clin- bromides and iodides levels were negative or normal. Photo- ical findings is often observed.2 We describe an unusual case testing with ultraviolet A (100 J/cm2 daily) and ultraviolet B of rosacea with exuberant extrafacial involvement. -
Extrafacial and Generalized Granulomatous Periorificial Dermatitis
OBSERVATION Extrafacial and Generalized Granulomatous Periorificial Dermatitis Amy J. Urbatsch, MD; Ilona Frieden, MD; Mary L. Williams, MD; Boni E. Elewski, MD; Anthony J. Mancini, MD; Amy S. Paller, MD Background: Granulomatous periorificial dermatitis is limiting, and were not associated with systemic involve- a well-recognized entity presenting most commonly in ment. Resolution seemed to be hastened with the use of prepubertal children as yellow-brown papules limited to systemic antibiotic therapy in 4 of the 5 patients. the perioral, perinasal, and periocular regions. The con- dition is self-limiting and is not associated with sys- Conclusions: Extrafacial lesions can occur in granulo- temic involvement. matous periorificial dermatitis and do not appear to ad- versely affect the duration, response to therapy, or risk Observations: We reviewed the medical charts of 5 of extracutaneous manifestations. Overly aggressive evalu- healthy children presenting with extrafacial granuloma- ation and inappropriate systemic therapy should be tous papules in addition to the typical periorificial avoided. papules. These extrafacial lesions were clinically and histologically identical to the facial lesions, were self- Arch Dermatol. 2002;138:1354-1358 1 N 1970, Gianotti et al described REPORT OF CASES 5 children with monomorphic perioral papules that showed a CASE 1 granulomatous pattern when le- sional biopsy sections were ex- A 23-month-old white boy with no history Iamined. Since then, several additional pa- of skin disease developed lesions -
Acne and Rosacea in Skin of Color Heather Woolery-Lloyd, MD; Erica Good, BA
Editorial Acne and Rosacea in Skin of Color Heather Woolery-Lloyd, MD; Erica Good, BA reatment of acne in skin of color poses unique of ethnicities, including African Americans, Asians, challenges. Postinflammatory hyperpigmentation Hispanics/Latinos, Pacific Islanders, Middle Easterners, T is a common complaint and must be addressed in and Native Americans, patients with skin of color cur- this patient population. Although less common in skin rently represent 34% of the US population. As it is of color, rosacea can often be more severe in this patient estimated that this figure will rise to 47% by 2050, it is population. We will review acne and rosacea in patients important to have a thorough understanding of how acne with skin of color and will focus on management of the presents in this patient population in order to optimize concerns unique to this patient population. their treatment.3 Regardless of skin color, acne remains the most com- monly diagnosed dermatologic condition. Studies have Clinical Characteristics reported an overall incidence as high as 29% in black Papules are the most frequent presentation of acne in patients, with similar figures for white patients in com- skin of color, occurring in 70.7% of African American parative studies.1 In adult women alone, the prevalence patients and 74.5% of Hispanics/Latinos. Acne hyperpig- may exceedCOS 50%.2 DERMmented maculae are also a common presenting feature, Postinflammatory hyperpigmentation presents a occurring in 65% of African Americans and in 48% of unique but common challenge when treating acne in skin Hispanic/Latino women with acne, according to a recent of color, and can often become a greater source of distress study (Figure 1).4,5 Among African Americans, other com- to the patient than the acne itself. -
Rosacea: Seeing Red in Primary Care
Rosacea: seeing red in primary care Rosacea is an inflammatory facial skin disease that 22% depending on the population and the definition used.2, 3 can cause patients embarrassment and reduce their Rosacea is often encountered in people of Celtic descent with quality of life. There are several different subtypes of blue eyes and fair skin,1 leading to the expression “the curse of rosacea and multiple treatments may be required the Celts”. Rosacea may also occur in Māori, Pacific and Asian to achieve satisfactory symptom relief. Topical people. A study in the United States suggests that people with treatments are first-line with oral treatments reserved white skin are twice as likely to present to a health provider and for patients with persistent and severe rosacea. It be diagnosed with rosacea as people of Pacific Island or Asian should be noted that there is a lack of subsidised ethnicity.4 Rosacea is most frequently diagnosed in people topical treatments and oral treatments that are aged 40 – 59 years and is rare in people aged under 30 years.3 subsidised are “off-label”. There are four subtypes of rosacea (see: “The subtypes of rosacea”) which may respond differently to treatment. Patients with rosacea often have more than one subtype and may Rosacea is often encountered but is poorly require multiple treatments.5 understood Rosacea is an inflammatory facial skin disease characterised The pathophysiology of rosacea by flushing, redness, papules, pustules and telangiectasia Multiple factors are known to contribute to the development (permanent dilation of small blood vessels).1, 2 A person’s of rosacea. -
Acne and Related Conditions
Rosanne Paul, DO Madeline Tarrillion, DO Miesha Merati, DO Gregory Delost, DO Emily Shelley, DO Jenifer R. Lloyd, DO, FAAD American Osteopathic College of Dermatology Disclosures • We do not have any relevant disclosures. Cleveland before June 2016 Cleveland after June 2016 Overview • Acne Vulgaris • Folliculitis & other – Pathogenesis follicular disorders – Clinical Features • Variants – Treatments • Rosacea – Pathogenesis – Classification & clinical features • Rosacea-like disorders – Treatment Acne vulgaris • Pathogenesis • Multifactorial • Genetics – role remains uncertain • Sebum – hormonal stimulation • Comedo • Inflammatory response • Propionibacterium acnes • Hormonal influences • Diet Bolognia et al. Dermatology. 2012. Acne vulgaris • Clinical Features • Face & upper trunk • Non-inflammatory lesions • Open & closed comedones • Inflammatory lesions • Pustules, nodules & cysts • Post-inflammatory hyperpigmentation • Scarring • Pitted or hypertrophic Bolognia et al. Dermatology. 2012. Bolognia et al. Dermatology. 2012. Acne variants • Acne fulminans • Acne conglobata • PAPA syndrome • Solid facial edema • Acne mechanica • Acne excoriée • Drug-induced Bolognia et al. Dermatology. 2012. Bolognia et al. Dermatology. 2012. Bolognia et al. Dermatology. 2012. Bolognia et al. Dermatology. 2012. Acne variants • Occupational • Chloracne • Neonatal acne (neonatal cephalic pustulosis) • Infantile acne • Endocrinological abnormalities • Apert syndrome Bolognia et al. Dermatology. 2012. Bolognia et al. Dermatology. 2012. Acne variants • Acneiform -
The Great Mimickers of Rosacea
The Great Mimickers of Rosacea Jeannette Olazagasti, BS; Peter Lynch, MD; Nasim Fazel, MD, DDS Practice Points Rosacea is characterized by frequent flushing; persistent erythema (ie, lasting for at least 3 months); telangiectasia; and interspersed episodes of inflammation with swelling, papules, and pustules. Rosacea is most commonly seen in adults older than 30 years and is considered to have a strong hereditary component, as it is more commonly seen in individuals of Celtic and Northern European descent as well as those with fair skin. Although rosacea is one of the most common Rosacea Characteristics conditions treated by dermatologists, it also is Rosacea is a chroniccopy disorder affecting the central one of the most misunderstood. It is a chronic dis- parts of the face that is characterized by frequent order affecting the central parts of the face and flushing; persistent erythema (ie, lasting for at least is characterized by frequent flushing; persistent 3 months); telangiectasia; and interspersed epi- erythema (ie, lasting for at least 3 months); tel- sodes of inflammation with swelling, papules, and angiectasia; and interspersed episodes of inflam- pustules.not2 It is most commonly seen in adults older mation with swelling, papules, and pustules. than 30 years and is considered to have a strong Understanding the clinical variants and disease hereditary component, as it is more commonly seen course of rosacea is important to differentiateDo in individuals of Celtic and Northern European this entity from other conditions that can mimic descent as well as those with fair skin. Furthermore, rosacea. Herein we present several mimickers of approximately 30% to 40% of patients report a fam- rosacea that physicians should consider when ily member with the condition.2 diagnosing this condition. -
Rosacea and Skin Care Zoe Diana Draelos, MD
COSMETIC CCONSULTATIONONSULTATION Optimizing Redness Reduction, Part 1: Rosacea and Skin Care Zoe Diana Draelos, MD osacea patients form a subset of individuals with sebum and intercellular lipids; therefore, products that sensitive skin, which makes the process of select- clean too well may be problematic. This discussion R ing skin care products and cosmetics problematic. focuses on the use of cleansers in rosacea patients with Ingredients that typically cause little difficulty in the various skin types, including oily, normal, dry, and sensi- average patient can cause severe stinging and burning tive skin (Table 1). in rosacea patients. Sometimes the adverse reaction can be invisible; however, it is typically characterized by the Cleansers for Oily Skin rapid onset of facial flushing. For this reason, developing Many rosacea patients with highly sebaceous skin pro- a methodology for product recommendations for rosa- duce abundant sebum. Even though the skin is oily, over- cea patients becomes important. This article is part of a cleansing will result in shiny, flaky skin. This is due to the 2-part series discussing methods of optimizing redness barrier disruption created by the removal of intercellular reduction through the use of skin care products, cos- lipids, causing premature corneocyte desquamation, fol- metics, and cosmeceuticals. Whereas it is clear that pre- lowed by the subsequent accumulation of sebum. The scription therapy is necessaryCOS to reduce inflammation asDERM face is overdry immediately after cleansing, but oily again well as inflammatory papules and pustules, the onset of 2 to 4 hours after cleansing. This is a challenging situation facial redness can be minimized by carefully counseling because cleansing does not reduce sebum production; it patients on product selection.