ABSTRACT
Skin injury is the most common form of child physical abuse. Although the pattern and visual appearance of skin injury and the treatment needed for the injury is similar in children and adults, characteristics of infant and childhood skin may complicate the diagnosis of injury. A good understanding of normal developmental presentation of accidental injury from infancy to adulthood, locations for injury that should trigger consideration of abuse, and cutaneous mimics of abuse across the lifespan are critical to the identification of suspected abuse. Adults and older children can provide a history directly to providers, though it should be noted that abused adults and children may not always disclose the true cause of their injuries. In infants and very young children, a history from the patient is lacking due to the verbal abilities of the child, and a parent or other caregiver may provide a false or misleading history that can complicate the diagnosis and treatment. The approach to taking the history, when abuse is suspected, is a critical part of the evaluation, and best practice will vary depending on whether your patient is a child or an adult.
Subject(s)
Bites, Human/diagnosis , Burns/etiology , Child Abuse/diagnosis , Contusions/etiology , Skin/injuries , Adolescent , Adult , Age Factors , Burns/diagnosis , Child , Child Abuse/legislation & jurisprudence , Child, Preschool , Contusions/diagnosis , Humans , Infant , Infant, Newborn , Mandatory Reporting , Medical History Taking , Physical ExaminationSubject(s)
Dermatology/ethics , Interprofessional Relations/ethics , Mohs Surgery/standards , Partnership Practice/ethics , Practice Patterns, Physicians'/ethics , Clinical Competence , Dermatology/methods , Humans , Male , Mohs Surgery/statistics & numerical data , Narration , Skin Neoplasms/diagnosis , Skin Neoplasms/surgerySubject(s)
Biopsy/statistics & numerical data , Dermatology/ethics , Interprofessional Relations/ethics , Malpractice/legislation & jurisprudence , Nevus/diagnosis , Patient Care/ethics , Physician's Role , Skin Neoplasms/diagnosis , Unnecessary Procedures/ethics , Humans , Nevus/pathology , Patient Rights , Skin Neoplasms/pathologyABSTRACT
Psoriasis is a chronic, immune-mediated, inflammatory dermatosis, affecting 2-3% of the US population. While first-generation cytokine antagonists targeting tumor necrosis factor alpha (TNF-α)-dependent pathways have produced favorable responses in the treatment of psoriasis, higher levels of efficacy in a greater proportion of patients have been shown in trials with antibodies targeting interleukin (IL)-17A and the IL-17 receptor subunit. This examines the role of IL-17 inhibitors in the treatment of plaque psoriasis. The efficacy and safety results from the phase-3 trials with monoclonal antibodies targeting IL-17RA (brodalumab) and IL-17A (ixekizumab and secukinumab) validate IL-17 as a highly effective therapeutic target for the treatment of plaque psoriasis.
Subject(s)
Interleukin-17/antagonists & inhibitors , Psoriasis/drug therapy , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Clinical Trials, Phase III as Topic , HumansABSTRACT
The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Erythema Infectiosum/diagnosis , Lyme Disease/diagnosis , Methicillin-Resistant Staphylococcus aureus , Skin Diseases, Infectious/diagnosis , Skin Diseases, Infectious/drug therapy , Acrodermatitis/epidemiology , Acrodermatitis/virology , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Humans , Infant , Lyme Disease/complications , Lyme Disease/drug therapy , Molluscum Contagiosum/complications , Molluscum Contagiosum/drug therapy , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Skin Diseases, Infectious/complications , Skin Diseases, Infectious/epidemiology , Skin Diseases, Infectious/microbiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/microbiology , Tinea Capitis/diagnosis , Tinea Capitis/drug therapy , Tinea Capitis/epidemiologyABSTRACT
Onychomycosis is a fungal nail plate infection that has been increasing in prevalence. A variety of oral and topical anti-fungal agents are currently available but their use is limited by their adverse effect profile, drug-drug interactions, and limited efficacy. Therefore, there is a great need for newer anti-fungal agents. Tavaborole is one of these newer agents and was approved by the US Food and Drug Administration in July 2014 for the topical treatment of mild to moderate toenail onychomycosis. Tavaborole is a novel, boron-based anti-fungal agent with greater nail plate penetration than its predecessors, due to its smaller molecular weight. It has proven through several Phase II and III trials that it can be a safe and effective topical agent for the treatment of mild to moderate toenail onychomycosis without the need for debridement. In this paper, we review the landscape of topical and systemic treatment of onychomycosis, with particular attention to the pharmacokinetics, safety, and efficacy of topical tavaborole.
Subject(s)
Antifungal Agents/therapeutic use , Boron Compounds/therapeutic use , Bridged Bicyclo Compounds, Heterocyclic/therapeutic use , Onychomycosis/drug therapy , Administration, Topical , Antifungal Agents/administration & dosage , Antifungal Agents/adverse effects , Boron Compounds/administration & dosage , Boron Compounds/adverse effects , Bridged Bicyclo Compounds, Heterocyclic/administration & dosage , Bridged Bicyclo Compounds, Heterocyclic/adverse effects , Drug Approval , Foot Dermatoses/drug therapy , Foot Dermatoses/microbiology , Humans , United States , United States Food and Drug AdministrationABSTRACT
Ultraviolet (UV) radiation plays a pivotal role in the development of both melanoma and non-melanoma skin cancers. Numerous factors potentially place athletes at high risk for developing these cancers. Various prevention strategies ameliorate this risk, including avoiding sun exposure during peak UV exposure hours, applying sunscreen with a sun protection factor of 30 or above before participating in outdoor sports, wearing hats and sunglasses, and reducing exposure with long pants and long-sleeve shirts. The literature, however, cites several barriers to these prevention approaches, including sports' competition rules, the lack of availability of sunscreen, and the lack of information about sun safety behaviors. Sun safety education programs prove effective in getting athletes to participate in prevention strategies. This article reviews the effect of UV radiation on athletes' skin and provides sports medicine clinicians with suggestions to improve the sun safety behaviors of their athletes.