Brad A. Yentzer

Pyoderma gangrenosum: a review and update on new therapies.

Pyoderma gangrenosum is a rare and often painful skin disease that can be unpredictable in its response to treatment. There is currently no gold standard of treatment or published algorithm for choice of therapy. The majority of data comes from case studies that lack a standard protocol not only for treatment administration but also for the objective assessment of lesion response to a specific therapy. This review provides an update to the treatment of pyoderma gangrenosum with a particular focus on new systemic therapies.

A review of phototherapy protocols for psoriasis treatment

Phototherapy is a mainstay in the treatment of psoriasis and is available as psoralen plus UVA (PUVA), broadband UVB (BB-UVB), and narrowband UVB (NB-UVB). Phototherapy can be administered in the hospital, outpatient clinic, or in the patients home. The purpose of this review is to provide some practical guidance to general dermatologists and residents on the specifics of using phototherapy, which, despite its decreasing use, remains one of our most safe and effective treatment strategies for psoriasis care. We conducted a literature review of home phototherapy, BB-UVB, NB-UVB, and PUVA phototherapy using PubMed, MD Consult, and reference lists. A variety of protocols for BB-UVB, NB-UVB, and PUVA have been used in clinical trials. NB-UVB is more effective than BB-UVB and safer than PUVA. Typical regimens for NB-UVB involve dosing 3 times per week for at least 3 months. Treatment must be independently developed to suit each participants needs. Ultraviolet light is an effective, relatively safe modality that is a valuable tool in the treatment of psoriasis. NB-UVB phototherapy is considered the first-line treatment for extensive plaque type psoriasis.

Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris

Background: Owing to the use of topical and systemic antibiotics for acne vulgaris, the incidence of antibiotic-resistant Propionibacterium acnes is increasing worldwide. Topical benzoyl peroxide (BPO) is an alternative to antibiotics in the treatment of acne vulgaris. Objective: This review describes and evaluates recent clinical literature regarding the efficacy and tolerability of BPO. Methods: A PubMed literature search was conducted using the keywords benzoyl peroxide, acne, and combination therapy. Results: BPO is equally effective at concentrations of 2.5, 5.0 and 10%. However, a concentration-dependent irritant dermatitis can occur with higher concentrations. The efficacy of BPO can be enhanced when used in combination with topical retinoids, antibiotics and tertiary amines. BPO-containing combinations do not induce bacterial resistance and are important first-line treatments for mild to moderate acne vulgaris.

Acne vulgaris and depression: a retrospective examination.

Background  Acne vulgaris is a common skin disease that affects patients both physically and mentally.

Topical Clobetasol Propionate in the Treatment of Psoriasis A Review of Newer Formulations

Ultrapotent topical corticosteroids are the mainstay of psoriasis treatment, used either alone or in combination with a topical vitamin D analog. Traditionally used in an ointment vehicle for psoriasis, clobetasol propionate 0.05% is also available in spray, foam, lotion, and shampoo formulations, which may provide for improved convenience and acceptance in many patients with similar efficacy, safety, and tolerability as the traditional ointment and cream formulations. To compare newer formulations with traditional ointment and cream formulations, we performed a systematic review of the literature. Search terms included ‘clobetasol propionate,’ in combination with ‘psoriasis,’ ‘vasoconstriction,’ ‘vasoconstrictor,’ or ‘absorption’ for each of the four vehicles (‘spray,’ ‘foam,’ ‘lotion,’ and ‘shampoo’).While there are very few direct comparison studies between clobetasol propionate in different vehicles, the efficacy rates (with success defined as clear or almost clear of psoriasis) for more recent formulations are high, with most patients achieving success after 2–4 weeks of treatment in well controlled clinical trials, with response rates that are similar to those with the traditional clobetasol propionate ointment. Small differences in vasoconstrictor potency or cutaneous absorption have been noted among the formulations, but the clinical significance of these observations is difficult to discern. Recent research has emphasized the importance of treatment adherence in the management of psoriasis. Adherence to treatment is likely to be a far more important determinant of success than are small differences in drug delivery, especially in actual clinical use as opposed to the well controlled environment of clinical trials. For patients who prefer a less messy vehicle, adherence and outcomes are likely to be better with the more recent formulations compared with the traditionally recommended ointment.

How good are US dermatologists at discriminating skin cancers? A number-needed-to-treat analysis

Abstract Background: Identification of skin cancer requires discrimination of malignant lesions from benign lesions. The number of biopsies performed to yield one cancer diagnosis can be presented as a number needed to treat (NNT), and provides an assessment of the efficiency of skin cancer detection. Objective: To assess the clinical accuracy of US dermatologists screening for skin cancer, the NNT for both melanoma and non-melanoma skin cancer was examined. Methods: Pathology reports from 2021 biopsies performed at the Wake Forest University Department of Dermatology were reviewed, including the physicians differential diagnosis and final pathological diagnosis. The NNT was calculated for melanoma, non-melanoma skin cancer, and all skin cancer diagnosed. Results: Of 1240 biopsies suspicious for skin cancer, 559 cancers were diagnosed, yielding a NNT of 2.22 for any cancer. The NNT specifically for non-melanoma skin cancer was 1.6, while the NNT for melanoma was 15. Patient age, anatomical location, sex and physician all significantly impacted on NNT values. Conclusions: The NNT for melanoma in our study was lower compared to recently published values obtained from general practitioners in Australian skin cancer clinics (NNT of 30). Variability amongst institutions, practice settings and physicians supports the need to establish a benchmark NNT.

Assessing adherence to dermatology treatments: a review of self‐report and electronic measures

Background: Nonadherence to prescribed medications is a common problem in dermatology, and assessing adherence can be difficult. Electronic monitors are not always practical, but self‐report measures may be less reliable.

Calcitriol ointment: A review of a topical vitamin D analog for psoriasis

Topical vitamin D analogs are a safe and effective treatment for psoriasis vulgaris. This is a brief review of calcitriol 3 µg/g ointment in the treatment of psoriasis. Calcitriol has been safely used outside the USA in Europe under the trade name Silkis Ointment® for almost a decade in the treatment of psoriasis, and it is currently FDA-approved as Vectical™ Ointment. Calcitriol 3 µg/g ointment is a synthetic topical vitamin D analog considered to be as effective as other vitamin D analogs but with a better tolerability in sensitive areas.

Adherence to acitretin and home narrowband ultraviolet B phototherapy in patients with psoriasis

BACKGROUND In the treatment of psoriasis, patient adherence to oral medications is poor and even worse for topical therapy. However, few data exist about adherence rates to home phototherapy, adding to concerns about the appropriateness of home phototherapy as a psoriasis treatment option. OBJECTIVE We sought to assess adherence to both oral acitretin and home ultraviolet B phototherapy for the treatment of psoriasis. METHODS In all, 27 patients with moderate to severe psoriasis were treated with 10 to 25 mg of acitretin daily, combined with narrowband ultraviolet B, 3 times weekly at home, for 12 weeks. Adherence to acitretin was monitored by an electronic monitoring medication bottle cap, and to phototherapy by a light-sensing data logger. RESULTS Adherence data were collected on 22 patients for acitretin and 16 patients for adherence to ultraviolet B. Mean adherence to acitretin decreased steadily during the 12-week trial (slope -0.24), whereas mean adherence to home phototherapy remained steady at 2 to 3 d/wk. Adherence was similar between patients who reported side effects and those who did not. LIMITATIONS Small sample size and lack of follow-up on some patients were limitations of this study. CONCLUSIONS Adherence rates to home phototherapy were very good and higher than adherence rates for the oral medication. Side effects of treatment were well tolerated in this small group and did not affect use of the treatment. Home phototherapy with acitretin may be an appropriate option for some patients with extensive psoriasis.

A randomized controlled pilot study of strategies to increase adherence in teenagers with acne vulgaris

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