Dermatology

Evaluation and Management of Nail Diseases

Nail disease is a common presentation in general practice. The most frequent conditions presenting to general practice include onychomycosis, psoriasis, trauma and melanonychia. Recognising the clinical features of the various nail diseases can ensure that patient referrals to a dermatologist are prompt and that diagnosis and treatment are not delayed. Nail disease can be difficult to treat given the anatomy and associated poor penetrance of treatments, and results may take time to occur; thus, having realistic expectations of treatment outcomes and knowing when to refer in treatment failure is important. Patients with longitudinal melanonychia and other features demonstrating dystrophy in the absence of trauma should be promptly referred to a dermatology service.

Modern Medicine – Issue 1, 2025

Psoriasis – Presentation, Types and Management

Psoriasis is an autoimmune disease occurs as a result of a combination of genetic, immune and environmental factors. Psoriasis ranges from mild to severe, and acute to chronic. Chronic psoriasis is associated with numerous comorbidities, including psoriatic arthritis, inflammatory bowel disease, metabolic syndromes, and issues related to cardiovascular, respiratory and mental health. Optimal management includes correct early diagnosis and treatment that considers chronic comorbidities. A range of systemic and biologic therapies are available for the treatment of psoriasis.

Modern Medicine – Issue 1 2024

Actinic Keratosis: An Update on Management

Actinic keratoses (AKs) are potentially premalignant cutaneous lesions that occur on chronically sunexposed regions of the body. Left untreated, a small proportion of AKs will transform into invasive squamous cell carcinomas. Treatment for AKs is broadly classified as lesion-directed therapy, and includes cryotherapy or curettage and cautery, or field treatment, which includes topical (eg 5-fluorouracil and imiquimod) and light-directed therapies. Photodynamic therapy involves application of either methyl aminolevulinate or 5-aminolevulinic acid, followed by light activation, either by red light for seven to nine minutes or continuous daylight for two hours. Ingenol mebutate is no longer considered a therapeutic option.

Modern Medicine – Issue 5 2023

Tailor Eczema Treatment to the Individual Patient

Although emollients can be sufficient to manage mild atopic dermatitis, acute flares resulting in moderate- to-severe symptoms require treatment with anti- inflammatory agents, such as topical corticosteroids. Different formulations of methylprednisolone aceponate have been shown to provide rapid, reliable and highly effective treatment of eczematous disorders, with excellent local and systemic tolerability.

Modern Medicine – Issue 6 2022

Patient Preference is Key when Choosing Psoriasis Topical Treatments

Fixed combination calcipotriol (50μg/g) plus betamethasone (50μg/g); as dipropionate), available in gel and ointment formulations, is a recommended first-line treatment for mild-to- moderate psoriasis vulgaris. Patients with psoriasis have diverse needs and different preferences for topical treatment. This knowledge may help prescribers to choose the right formulation for the right patient.

Modern Medicine – Issue 6 2022

Scalp Pruritus Scratching for answers

Scalp itch is common in people of all ages. Treatment depends on an accurate diagnosis. Causes range from everyday skin conditions such as seborrhoeic dermatitis, psoriasis and head lice to rare disorders such as dermatitis herpetiformis andtrigeminal trophic syndrome.

Modern Medicine – Issue 6 2022

Stop the Cycle of Acne Formation

Acne vulgaris is an inflammatory disorder of the pilosebaceous unit, with a generally self-limiting chronic course. It is a very common skin disorder which can present with inflammatory and non-inflammatory lesions, chiefly on the face, but can also occur on the upper arms, trunk, and back. Azelaic acid is a naturally occurring dicarboxylic acid analogue with antimicrobial and keratinisation-normalising properties that interfere with acne formation.

Modern Medicine – Issue 5 2022

Summer is Coming – and so is Impetigo

Bacterial impetigo is one of the most common paediatric skin infections around the world, in particular among children aged 2–5 years, with a peak in tropical areas and low-income settings. Poor hygiene, high humidity, maceration, skin lesions with disruption of the epidermis barrier (eg, scabies, atopic dermatitis, insect bites), comorbidities and adverse reactions (rash, itch) associated with drug administration are well-established risk factors for impetigo.

Modern Medicine – Issue 5 2022

Treating Teenage Acne Early Builds Better Self-esteem

Acne vulgaris is a common skin condition which affects most adolescents. It has a major impact on quality of life and psychosocial well-being. Azelaic acid is a non-antibiotic topical acne treatment that is available as a 20% cream and a 15% gel, and it is often used as an adjuvant acne treatment. Azelaic acid has comedolytic, antimicrobial and anti – inflammatory properties.

Modern Medicine – Issue 4 2022