Rosacea: an update on medical therapies.

Rosacea is a common, chronic cutaneous condition that affects the face. Two topicals and one oral medication are currently approved for the treatment of rosacea, including azelaic acid, metronidazole, and sub-antimicrobial dose of doxycycline. Identification of subtypes can help guide treatment strategies. It is essential for psychosocial implications of rosacea to be considered and conservative management, such as nonpharmacologic routine skin care, must form an important part of the overall care. Recently, new insights into the pathophysiology of rosacea have led to the emergence of etiologically oriented treatments. Ivermectin, an acaricidal agent that has been shown to be effective against rosacea refractory to other therapies, is currently in Phase 3 trials. Brimonidine, which was US FDA approved last year and recently sanctioned by Health Canada, has filled an essential therapeutic void in the targeted treatment of diffuse facial erythema.

A treatment for severe nodular acne: a randomized investigator-blinded, controlled, noninferiority trial comparing fixed-dose adapalene/benzoyl peroxide plus doxycycline vs. oral isotretinoin.

BACKGROUND: Oral isotretinoin (ISO) is the gold standard for severe nodular acne. However, as some patients are unwilling or unable to take, or are intolerant to, ISO, other options are needed. OBJECTIVES: To compare efficacy and safety of oral ISO vs. doxycycline 200 mg plus adapalene 0·1%/benzoyl peroxide 2·5% gel (D+A/BPO) in severe nodular acne over 20 weeks. METHODS: This was a multicentre, randomized, controlled, noninferiority investigator-blinded study involving 266 subjects. RESULTS: D+A/BPO showed a significantly earlier onset of action in reducing nodules, papules/pustules and total lesions at week 2. ISO was superior in reducing nodules (95·6% vs. 88·7%), papules/pustules (95·2% vs. 79·6%) and total lesions (92·9% vs. 78·2%; all P < 0·01) at week 20. Half as many subjects for D+A/BPO compared with ISO had treatment-related, medically relevant adverse events (33 events in 18·0% of subjects vs. 73 in 33·8% of subjects, respectively). D+A/BPO was noninferior to ISO in the intent-to-treat population [95% confidence interval (CI) -2·7 to 20·8 (P = 0·13); 63·9% vs. 54·9% of subjects, respectively] and per-protocol population [95% CI 3·9-28·6 (P = 0·01); 74·3% vs. 58% of subjects, respectively), based on the composite efficacy/safety end point. CONCLUSIONS: D+A/BPO showed a favourable composite efficacy/safety profile compared with ISO. This combination is an alternative to ISO in patients intolerant to, or unable or unwilling to take, oral ISO, and is an option for treatment of severe nodular acne.

[Influence of frozen-dried antlers of Siberian stags on humoral homeostasis in athletes of cyclic sports].

The authors evaluated effects of antlers of Siberian stags on humoral homeostasis parameters in highly qualified athletes during contest period. Medication based on antlers of Siberian stags provides more balanced operation of energy supplying processes, maintains stable lipid metabolism, favors balance in "prooxidants - antioxidants" system.

Current effective topical therapies in the management of psoriasis.

Topical therapy forms the cornerstone of treatment in the management of psoriasis. It plays a significant role as monotherapy in mild to moderate psoriasis, and it is used predominantly as adjunctive therapy in moderate to severe forms of the disease. Over the past decade, the topical treatment of psoriasis has evolved from the age-old applications, such as coal tar, to the more cosmetically acceptable and efficacious options containing topical corticosteroids, vitamin D analogues, and combined agents. With the advent of topical therapies in tailored vehicles and sophisticated delivery modes, the outlook for effectively managing psoriasis with topical approaches appears promising. To ensure therapeutic success, patient education about the disease, treatment options, proper administration, and adverse effects is essential, which will alleviate the common problem of poor patient adherence and promote more optimal clinical outcomes.

One-year followup on the impact of a sun awareness curriculum on medical students' knowledge, attitudes, and behavior.

BACKGROUND: A one-week sun awareness curriculum was developed at the University of Western Ontario to educate first-year medical students on skin cancer risks and prevention. OBJECTIVE: To assess the retention of knowledge, attitudes, and behavioral practices one year after receiving education in sun awareness. METHOD: Three surveys were administered: before, immediately after the sun awareness teaching, and one year later. Actual practiced behavior in the past year was compared with the intended behavior. RESULTS: Half as many sunburns were reported in the year following the sun awareness curriculum compared with the previous year. Medical students demonstrated a good retention of the knowledge learned a year earlier. However, many students still believed that a tanned appearance looks healthy. While there was intent to adopt more healthy behavior after the curriculum, the actual behavior practiced varied. CONCLUSIONS: An undergraduate medical curriculum on sun awareness can be effective in improving the knowledge, attitudes, and behaviors of future physicians.

Effects of a sun protection program targeting elementary school children and their parents.

BACKGROUND: Excessive sun exposure in childhood is considered a risk factor for later development of skin cancer, so sun awareness programs targeting children have been developed. OBJECTIVE: To assess the benefits of involving parents at home in the sun protection program received by their children at school. METHOD: The existing "Sun and the Skin" program was enhanced in two ways. Parents were educated both about their child's program and with supplemental information. Also, sunscreen was distributed to each child. RESULTS: Certain methods of sun protection, particularly the use of sunscreen, are being practiced by the majority of children, while others, such as protective clothing, have not been readily adopted. The enhanced group of students showed improvement over control and standard groups in their attitude toward tanning. There is a need for teachers to remind their students to practice protective measures. CONCLUSIONS: While a sun-awareness curriculum has been shown to be beneficial for elementary school children, the adjunct of parental and school involvement in this process can improve the results and ultimately decrease the risk of skin cancer in the children.

Dermatological manifestations of Down's syndrome.

BACKGROUND: Down's syndrome (DS) is an extensively researched congenital condition characterized by mental retardation and distinct physical features. The cutaneous manifestations of DS are numerous, yet they seldom receive appropriate attention. OBJECTIVE: To review the dermatological conditions associated with DS. METHODS: A review of the medical literature. RESULTS: DS is associated with an increased incidence of numerous dermatological conditions, some of which may be related to an immunological deficiency. CONCLUSION: Along with the importance of understanding the physical and psychosocial aspects of DS, an appreciation of the dermatological manifestations of this condition is integral to comprehensive medical care.