Supplement 1 Vol. 32, No. 2S June 2013 A CME-CERTIFIED SUPPLEMENT TO Seminars in Cutaneous Medicine and Surgery Editors Kenneth A. Arndt, MD Philip E. LeBoit, MD Bruce U. Wintroub, MD UPDATE ON ONYCHOMYCOSIS: EFFECTIVE STRATEGIES FOR DIAGNOSIS AND TREATMENT Guest Editors David Pariser, MD Boni Elewski, MD Phoebe Rich, MD Richard K. Scher, MD Update on Onychomycosis: Effective Strategies for Diagnosis and Treatment Original Release Date: June 2013 Target Audience Most Recent Review Date: June 2013 This continuing medical education activity has been devel- Expiration Date: June 30, 2015 oped for dermatologists, family practice and internal medicine Estimated Time to Complete Activity: 2.5 hours physicians, and other health care providers who treat diseases Medium or Combination of Media Used: Written Supplement of the skin. Method of Physician Participation: Journal Supplement Disclosure Hardware/Software Requirements: As a sponsor accredited by the ACCME, the University of High Speed Internet Connection Louisville School of Medicine must ensure balance, inde- To get instant CME credits online, go to http://uofl.me/onycho13. pendence, objectivity, and scientific rigor in all its sponsored Upon successful completion of the online test and evaluation educational activities. All faculty participating in this CME form, you will be directed to a webpage that will allow you activity were asked to disclose the following: to receive your certificate of credit via e-mail. Please add 1. Names of proprietary entities producing health care goods [email protected] to your e-mail “safe” list. If you have or services—with the exemption of nonprofit or government any questions or difficulties, please contact the University of organizations and non–health-related companies—with Louisville School of Medicine Continuing Medical Education which they or their spouse/partner have, or have had, a (CME & PD) office at [email protected]. relevant financial relationship within the past 12 months. For this purpose, we consider the relevant financial Joint Sponsorship relationships of a spouse/partner of which they are aware This activity has been planned and implemented in accor- to be their financial relationships. dance with the Essential Areas and Policies of the Accreditation 2. Describe what they or their spouse/partner received Council for Continuing Medical Education (ACCME) through (eg, salary, honorarium). the joint sponsorship of the University of Louisville School of Medicine and Global Academy for Medical Education, LLC. 3. Describe their role. The University of Louisville School of Medicine is accredited by 4. No relevant financial relationships. the ACCME to provide continuing education for physicians. CME & PD Advisory Board Members: have no relevant finan- Designation Statement cial relationships with any commercial interests: Lisa J. Pfitzer, The University of Louisville Continuing Medical Education MD; Soon Bahrami, MD; Douglas Coldwell, MD, PhD; W. Daniel designates this enduring material for a maximum of 2.5 AMA Cogan, Ed.D., FAODME; Justin L. Costa, MD; James Creg; Daniel PRA Category 1 Credit(s)™. Physicians should claim only the Da Justa, MD; Adair Heyl, PhD; Christopher Jones, MD;Lucy Juett, credit commensurate with the extent of their participation in MS; Gerald Larson, MD; Rana Latif, MD; Kimberly Moore; Karen the activity. Napolilli; Scott Plantz, MD;Kerri Remmel, MD, PhD; Michael D. Stillman, MD; Uldis Streips, PhD; Kathy M. Vincent, MD; Lori Wagner, Educational Needs MD; Angela Wetherton, MD; and Stephen Wheeler, MD have no Onychomycosis has become recognized as an infection relevant financial relationships with any commercial interests. of clinical importance well beyond its cosmetic effects. This CME REVIEWER: Timothy Brown, MD, Professor, Division of is especially true for elderly individuals, patients who are Dermatology, University of Louisville, School of Medicine has no immunocompromised (eg, because of post-transplant immu- relevant financial relationships with any commercial interests. nosuppressive drug therapy or HIV infection), and those with Boni Elewski, MD, has been an investigator for Anacor and diabetes. The number of patients who present with onychomy- Valeant Pharmaceuticals. cosis has grown substantially as these high-risk populations increase, with increased longevity, greater survival among David Pariser, MD, has been a consultant and/or investigator people with HIV infections, and the growing prevalence of and/or advisory board member with Abbott Laboratories, diabetes mellitus. Clinicians must be prepared to make a Amgen, Astellas Pharma US, Inc, Basilea, Celgene Corporation, clinical diagnosis of onychomycosis based on physical exami- Dow Pharmaceutical Sciences, Inc., DUSA Pharmaceuticals, Inc., nation and personal and family history. The current standard Eli Lily and Company, Galderma Laboratories, L.P., Genentech, Inc., Graceway Pharmaceuticals, LLC, Intendis, Inc., Janssen- of care is definitive diagnosis using recognized laboratory Ortho Inc, Johnson & Johnson Consumer Products Company, methods for identifying the presence of causative organisms. LEO Pharma, US, Medicis Pharmaceutical Corporation, This supplement provides up-to-date information on epide- MelaSciences, Novartis Pharmaceutical Corporation, Novo miology, pathophysiology, and diagnosis of onychomycosis, Nordisk A/S, Ortho Dermatologics, Peplin Inc., Pfizer, Photocure and reviews and provides expert recommendations on the ASA, Proctor & Gamble Company, Stiefel a GSK company, and currently available systemic and topical medications and Valeant Pharmaceuticals International. devices for treating this infection. Phoebe Rich, MD, has been a principal investigator and/or Learning Objectives consultant for Valeant, Dow Pharmaceuticals, Topica, and Tolmar. After participating in this continuing medical educational Richard K. Scher, MD, is an advisor/consultant to Valeant. activity, clinicians should be able to: Joanne Still, BA has no relevant financial relationships with • List and describe the differential diagnosis of onychomycosis any commercial interests. and the expert-recommended methods for establishing the diagnosis of this infection. Sylvia H. Reitman, MBA and Shirley V. Jones, MBA, Global Academy for Medical Education, have no relevant financial Explain the benefits of early diagnosis and treatment of • relationships with any commercial interests. onychomycosis and the potential sequelae if this infection is untreated or is inadequately treated. Acknowledgments • Apply practice protocols for identifying patients with onycho- The authors would like to thank Global Academy for Medical mycosis, particularly the elderly, patients with diabetes mellitus, Education and Joanne Still for assistance with the preparation and other high-risk populations. of this supplement. • Integrate effective, office-based diagnostic tests into the This activity is supported by an educational grant from Medicis, workup of patients with symptoms of onychomycosis. a division of Valeant Pharmaceuticals. • Use currently available oral and topical medications to University of Louisville CME & PD Privacy Policy treat various patient populations. All information provided by course participants is confidential • Evaluate the results of clinical studies on new and emerging and will not be shared with any other parties for any reason treatments for onychomycosis. without permission. Seminars in Cutaneous Medicine and Surgery Editors Kenneth A. Arndt, MD Clinical Professor of Dermatology, Emeritus Harvard Medical School Boston, Massachusetts Adjunct Professor of Surgery Dartmouth Medical School Hanover, New Hampshire Adjunct Professor of Dermatology Brown Medical School Providence, Rhode Island Philip E. LeBoit, MD Professor of Clinical Dermatology University of California San Francisco San Francisco, California Bruce U. Wintroub, MD Associate Dean Professor and Chair of Dermatology School of Medicine University of California San Francisco San Francisco, California Seminars in Cutaneous Medicine and Surgery presents well-rounded and authoritative discussions of Statement important clinical areas, especially those undergoing rapid change in the specialty. Each issue, under the direction of the Editors and Guest Editors selected because of their expertise in the subject area, includes of Purpose the most current information on the diagnosis and management of specific disorders of the skin, as well as the application of the latest scientific findings to patient care. Guest Editors David Pariser, MD, Chair Professor of Dermatology Eastern Virginia Medical School Department of Dermatology Pariser Dermatology Norfolk, Virginia Boni Elewski, MD Vice-Chair for Clinical Affairs Professor of Dermatology University of Alabama School of Medicine Birmingham, Alabama Phoebe Rich, MD Clinical Adjunct Professor of Dermatology Oregon Health Science University Portland, Oregon Richard K. Scher, MD Clinical Professor of Dermatology Weill Cornell Medical College New York, New York The Guest Editors acknowledge the editorial assistance of Global Academy for Medical Education, LLC, and Joanne Still, medical writer, in the development of this supplement. This continuing medical education (CME) supplement was developed from a clinical roundtable. The manuscript was reviewed and approved by the Guest Editors as well as the Editors of Seminars in Cutaneous Medicine and Surgery. The ideas and opinions expressed in this supplement are those of the Guest Editors and do not necessarily