The DermEdOnline FAQ is a quick, easy resource for treatments (generic, package insert label, off-label or combination) and differential diagnosis for a specific disease already diagnosed by a medical professional. It is a resource designed expressly for medical professionals with the following designations: M.D., D.O., PA-C or CRNP.
1. What are the “in’s” of taking a drug history?
Answer: There are 6 “in’s” of taking a drug history. Over the last 30 years + of practice I developed what I call the “in’s” of taking a drug history. It is a way to remember all the ways that an offending agent can enter the body to produce an adverse event. There are 5 primary physical ways and there is a 6th that is not physical, but just as important. The 5 primary physical routes are:
– into the eye
Inhaled – up the nose
Ingested – through the mouth
Injected - through the skin, and
Inserted – into an orifice
The 6th is in secret, either intentionally or unintentionally. Recreational or illicit drug use will often be deliberately hidden, but, remember there are things that we do each day, that although not illicit, may be embarrassing or just a matter of personal privacy, such as the use of a friends antibiotic pill or intermittent use of a drug for erectile dysfunction.
So inquire in general about prescription, and non-prescription drugs, (both the patient’s or a friends) – and ask specifically about: vitamins, laxatives, eye drops, nose sprays, inhalers, rectal/vaginal suppositories, nutritional supplements, herbal remedies, chewing gum, mints, menthol cigarettes…and recreations drugs, marijuana, cocaine, methamphetamine
2. What is demodex dermatitis?
Answer: Demodex dermatitis is a red, scaly rash of the face that is frequently mis-diagnoses as rosacea, seborrheic dermatitis or a combination of both. On examination there is erythema and palpable scaling of the forehead, cheeks and chin. There are rarely papules or pustules. If not suspected initially it should certainly be thought of in any patient who has been diagnosed with either rosacea or seborrheic dermatitis and not responded to conventional therapy. Appropriate therapy is permethrin or crotamiton crème bid for 2-4 weeks. Patients with disease with clear and usually stay clear for months without further therapy.
3. Is there any suggestion to help diagnose tinea infections?
Answer: Yes there is: “If it scales, scrape it.” Any scaling eruption should have a KOH preparation performed on scrapings from the periphery of a lesion. In addition the other suggestion is simply: “There are only two time in which a KOH preparation should be performed – when you are absolutely sure that it is tinea and when you are absolutely sure that it is not.”
4. Is there a pathognomonic sign in the diagnosis of scabies?
Answer: There is one pathognomonic clinical sign that is quite helpful in making the diagnosis of scabies, especially if it difficult to isolate a mite. Pruritic, erythematous, 3-5 mm in diameter papules of the penis and/or scrotum. If present in a male with total body itch, these are pathognomonic of infestation with Sarcoptes scabiei.
5. What is unique about Acanya Gel that sets it apart from similar products?
Answer: It contains 2.5% benzoyl peroxide (studies show 2.5% BPO is equal in efficacy to 10% BPO) in an equal efficacy for both types of acne lesions – non-inflammatory and inoptimized formulation that contains no preservative, surfactants, parabens or alcohol. So with a lower concentration of BPO in an essentially non-irritating vehicle and once a day dosing there may be a lower chance of irritation and an increase in patient adherence. (This formulation was developed by Gordon Dow, PhD., one of the foremost formulating chemist in the world.)
As a side note, comparison of the efficacy results from the clinical trials in the package inserts of the three combo BPO/clindamycin products on the market – Benzaclin, Duac, and Acanya – shows essentially flammatory.
6. What is new or different about Atralin Gel that would make it preferable to the tretinoin products already on the market?
Answer: There may be increased efficacy and decreased irritation. Atralin (tretinoin 0.05%) is micronized tretinoin in a moisturizing/hydrating vehicle containing collagen, glycerin and hyaluronic acid. 85% of the tretinoin particles are less than 10 microns in diameter, increasing efficacy by allowing more active ingredient to enter the follicle and minimizing potential for irritation by leaving fewer particles on the skin surface.
7. What is unique about Epiceram that sets it apart from other “devices” on the market?
Answer: EpiCeram Skin Barrier Emulsion is a prescription product that is formulated with an optimal 3:1:1 ratio of ceramides, cholesterol and free fatty acids to help repair the defective skin barrier of atopic patients. In a clinical study, EpiCeram Emulsion demonstrated comparable efficacy to Cutivate Cream after 28 days of treatment of BID treatment in mild to moderate atopic patients. To date, EpiCeram Emulsion is the only prescription device product that has ceramides and the only atopic product with an optimal 3:1:1 ratio of ceramides, cholesterol and free fatty acids. This ratio is important because studies have shown that other ratios are not as effective at repairing an atopic skin barrier.