RESUMO
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.
Assuntos
Mordeduras Humanas/diagnóstico , Queimaduras/etiologia , Maus-Tratos Infantis/diagnóstico , Contusões/etiologia , Pele/lesões , Adolescente , Adulto , Fatores Etários , Queimaduras/diagnóstico , Criança , Maus-Tratos Infantis/legislação & jurisprudência , Pré-Escolar , Contusões/diagnóstico , Humanos , Lactente , Recém-Nascido , Notificação de Abuso , Anamnese , Exame FísicoAssuntos
Dermatologia/ética , Relações Interprofissionais/ética , Cirurgia de Mohs/normas , Prática Associada/ética , Padrões de Prática Médica/ética , Competência Clínica , Dermatologia/métodos , Humanos , Masculino , Cirurgia de Mohs/estatística & dados numéricos , Narração , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgiaAssuntos
Biópsia/estatística & dados numéricos , Dermatologia/ética , Relações Interprofissionais/ética , Imperícia/legislação & jurisprudência , Nevo/diagnóstico , Assistência ao Paciente/ética , Papel do Médico , Neoplasias Cutâneas/diagnóstico , Procedimentos Desnecessários/ética , Humanos , Nevo/patologia , Direitos do Paciente , Neoplasias Cutâneas/patologiaRESUMO
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.
Assuntos
Interleucina-17/antagonistas & inibidores , Psoríase/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Ensaios Clínicos Fase III como Assunto , HumanosRESUMO
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.
Assuntos
Antibacterianos/uso terapêutico , Eritema Infeccioso/diagnóstico , Doença de Lyme/diagnóstico , Staphylococcus aureus Resistente à Meticilina , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Acrodermatite/epidemiologia , Acrodermatite/virologia , Adolescente , Adulto , Antibacterianos/farmacologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Humanos , Lactente , Doença de Lyme/complicações , Doença de Lyme/tratamento farmacológico , Molusco Contagioso/complicações , Molusco Contagioso/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/microbiologia , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Tinha do Couro Cabeludo/epidemiologiaRESUMO
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.
Assuntos
Antifúngicos/uso terapêutico , Compostos de Boro/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Onicomicose/tratamento farmacológico , Administração Tópica , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Compostos de Boro/administração & dosagem , Compostos de Boro/efeitos adversos , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/efeitos adversos , Aprovação de Drogas , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Humanos , Estados Unidos , United States Food and Drug AdministrationRESUMO
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.