Clinical Solutions

The Evolving Management of Actinic Keratoses

Dermatologists agree that due to the risk of progression to non-melanoma skin cancer, the treatment of actinic keratoses is warranted, however no consensus exists on a preferred treatment modality. The pathophysiology and treatment of actinic keratoses (AK), from lesion-directed to field-directed, was expertly discussed in two continuing education webinars, which are summarized in the November JDD Clinical Solutions.

Tetracyclines are the most commonly prescribed oral antibiotics for acne vulgaris and are often utilized for longer than the American Academy of Dermatology recommendation of 3–4 months due to patient preference for effective and persistent acne control. The importance of provider responsibility when prescribing these agents, the structural foundation for their efficacy, and the emergence of sarecycline were all important concepts discussed in a series of podcasts: Oral Antibiotics for Acne: Basic Concepts & Practical Considerations hosted by Drs. Adam Friedman, Emmy Graber, and Mahmoud Ghannoum, and New Developments in Tetracycline-Class Antibiotics hosted by Drs. Adam Friedman and Chris Bunick. Practitioners must take great care to responsibly utilize this multifaceted class of agents, which have both antibiotic and anti-inflammatory properties conferred by structural modifications to their naphthacene core foundation.
Hair loss is a complex problem that affects millions of men and women of all ages and ethnicities, impacting appearance, social interactions, and psychoemotional well-being. Patients seeking medical treatment for hair loss have limited options that are difficult to incorporate into their daily routine and may carry risks of potential side effects. To complicate matters even further, other treatment options can be invasive with frequently required repetition. There is increasing patient interest in natural treatments for hair thinning, however, basic nutritional vitamin supplements lack standardization, regulation, and clinical efficacy. Recent research has identified that hair loss is the result of multiple causative factors that include inflammation, oxidative damage, environmental assaults, aging, psycho-emotional stress, and hormonal imbalances that span beyond the previously studied and known factors like androgens and nutrition. Based on this current understanding of the pathogenesis of hair loss, a multi-modal solution is required and therapies targeting only singular mechanisms or pathways may be less than ideal or result in less than optimal effectiveness. While supplements addressing one factor of hair loss and thinning, like nutrition, have been popular in the dermatologic community, a clinically studied nutraceutical that is able to target multiple pathways tied to hair growth may be the key to providing an effective intervention. Several key publications have highlighted Nutrafol® (Nutraceutical Wellness Inc, New York, NY), a nutraceutical containing a blend of highly purified, standardized, bio-optimized, and bioavailable extracts with clinical efficacy in targeting key pathways that compromise hair growth.

Hyperhidrosis: An Under-Recognized, Under-Diagnosed, and Under-Treated Dermatologic Condition

Hyperhidrosis, a medical condition in which excessive sweating occurs beyond what is needed to maintain normal body temperature, impacts millions of people worldwide. Aside from the physical burden of the condition, the psychological effects of the condition also have a negative impact on quality of life. By recognizing both these physical and emotional symptoms, dermatologists can help people with hyperhidrosis learn more about the condition, ways to manage it, and available treatment options.

New Insights into Gentle Cleansing: Hydrophobically-Modified Polymers Demonstrate Improved Mildness and Skin Barrier Integrity

While soap has been known to exist as far back as 2500 B.C., it was not until the second century that it is known to have been used as a body surface cleanser.1 Since the process of saponification was a tightly guarded secret until the 1770s, the use of a soap as a cleanser was limited.

Triamcinolone in a Spray Vehicle: A Clinical Perspective on Its Importance in Dermatology

Much research has been spent and continues to be spent to produce topical vehicles that can better deliver active ingredients to the dermatology patient. The multibillion dollars per year cosmeceutical industry is at the forefront of this research. This is driven by the expectations of our patients to be given products that are cosmetically pleasing and minimally irritating.

Halcinonide: A Review of its Clinical Merits

Glucocorticosteroids act on a wide range of cells and have a wide range of mechanisms of action. They have been successfully applied in many inflammatory skin diseases and are one of the most frequently used drugs in dermatology. Some inflammatory skin diseases such as a acute eczema and seborrheic dermatitis are more responsive to corticosteroids than are chronic hyperkeratotic or lichenified eczema, psoriasis, lichen planus, discoid lupus erythematosus, vitigligo, or alopecia areata.

Spotlight on Clocortolone Pivalate: Discussion and Case Reports

In the 1930s, Edward Kendall first isolated six compounds from the adrenal glands at the Mayo Clinic (Rochester, MN). In 1948, his friend and his colleague, Dr. Phillip Hench, and his team injected compound E into severe rheumatoid arthritis patients at St Marys Hospital and showed marked improvement in the symptoms of these patients.