The Dermatology Practice.

#topicalsteroids #eczema #psoriasis

Topical steroids, also known as topical corticosteroids, are a class of medications widely used to treat various skin conditions. They are available in different potencies and formulations, including creams, ointments, lotions, and gels. In this article, we will discuss the indications, potency, and side effects of topical steroids, as well as alternative treatments like topical calcineurin inhibitors and PDE4 inhibitors.

Indications for Topical Steroids

Topical steroids are commonly used to treat a range of skin conditions, including:

  1. Atopic dermatitis (eczema): Topical steroids are often used to reduce inflammation and itching associated with eczema
  2. Psoriasis: Topical steroids can help reduce inflammation and slow down skin cell growth in psoriasis
  3. Contact dermatitis: Topical steroids can help reduce inflammation and itching caused by skin allergies or irritants
  4. Seborrheic dermatitis: Topical steroids can help reduce inflammation and flaking associated with seborrheic dermatitis. Sometimes, having an added anti fungal coverage may have a synergistic effect
  5. Skin allergies: Topical steroids can help reduce inflammation and itching caused by skin allergies

Potency of Topical Steroids

Topical steroids are classified into seven potency categories, ranging from Class I (superpotent) to Class VII (least potent). The potency of a topical steroid is determined by its ability to suppress inflammation and immune responses. Superpotent and potent steroids should be used under clear direction from healthcare professionals. Do note that the consistency e.g. lotions, ointments do have an effect on the potency of the steroids.

  1. Class I (superpotent): Examples include clobetasol propionate
  2. Class II (potent)
  3. Class III (upper mid-strength)
  4. Class IV (mid-strength): Examples include betamethasone valerate and triamcinolone acetonide
  5. Class V (lower mid-strength)
  6. Class VI (mild): Examples include hydrocortisone acetate and desonide
  7. Class VII (least potent): Examples include hydrocortisone

Side Effects of Topical Steroids

While topical steroids are generally safe and effective, they can cause side effects, especially with prolonged use or high-potency formulations. Common side effects include:

  1. Skin thinning (atrophy)
  2. Stretch marks (striae)
  3. Rosacea-like symptoms
  4. Acne-like symptoms
  5. Folliculitis
  6. Hypopigmentation
  7. Hypertrichosis

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors are a class of medications that can be used as an alternative to topical steroids. They work by inhibiting the activity of calcineurin, a protein that plays a key role in the immune response. Examples of topical calcineurin inhibitors include:

  1. Tacrolimus
  2. Pimecrolimus

Topical calcineurin inhibitors are commonly used to treat atopic dermatitis, psoriasis, and vitiligo. They are generally well-tolerated and can be used for prolonged periods without the risk of skin thinning or other side effects associated with topical steroids.
Nonetheless, they may cause skin irritation on initial use, where patients report a ‘burning’ sensation.

Topical PDE4 Inhibitors

Topical PDE4 inhibitors are a new class of medications that have been approved for the treatment of atopic dermatitis. They work by inhibiting the activity of phosphodiesterase 4 (PDE4), an enzyme that plays a key role in the inflammatory response. Examples of topical PDE4 inhibitors include:

  1. Crisaborole

Topical PDE4 inhibitors have been shown to be effective in reducing inflammation and itching associated with atopic dermatitis. Similar to topical calcineurin inhibitors, they may elicit a skin reaction or sensation on initial use.

Conclusion

Topical steroids are a widely used treatment for various skin conditions, including atopic dermatitis, psoriasis, and contact dermatitis. However, there needs to be a balance in its duration of use and strict monitoring. Other topical anti inflammatories can be useful adjuncts in the appropriate context. Always speak to your healthcare provider and be judicious in their use!

References

  1. National Eczema Association. (2020). Topical Corticosteroids.
  2. British Journal of Dermatology. (2018). Topical corticosteroids: A systematic review.
  3. #skincare #lighttreatment #medicallighttherapy #eczema #psoriasis

    What is Phototherapy?

    Phototherapy involves the use of specific wavelengths of light to target various skin conditions. The light emitted by phototherapy devices can be ultraviolet (UV) A or B, visible, or infrared, depending on the condition being treated. Phototherapy can be administered in various forms, including both targeted (hand held devices focussing on problem areas) or systemic (Full body).
    They are a form of skin directed therapies that can be used for large areas of skin with no internal derangements.


    What is Excimer Laser?

    The excimer laser is a type of phototherapy that uses a specific wavelength of UV light to target various skin conditions. The excimer laser emits a high-intensity beam of UV light that is precisely calibrated to target specific skin cells. This laser is commonly used to treat conditions such as:

    1. Psoriasis: The excimer laser can help reduce psoriatic plaques and inflammation
    2. Vitiligo: The excimer laser can help repigment vitiligo patches
    3. Atopic Dermatitis: The excimer laser can help reduce inflammation and itching associated with atopic dermatitis
    4. How does phototherapy differ from sunlight?

      1. Spectrum/ Specificity:

        Phototherapy typically uses narrowband light (specifically ultraviolet B). This range is more effective in treating skin conditions like psoriasis and vitiligo.

        In contrast, sunlight contains a broader spectrum of UV light, including shorter wavelengths that may cause skin damage or pigmentation

      2. Intensity: Controlled emission of UV light, which can be adjusted to meet individual patient’s needs. This is not seen in sunlight, which varies in intensity throughout the day, season and location
      3. Duration: Phototherapy typically involves short treatment sessions, ranging from a few minutes to 30 minutes. In contrast, sunlight exposure can be prolonged, leading to increased risks of skin damage

    Conditions Treated with Phototherapy and Excimer Laser

    1. Psoriasis: Phototherapy, including excimer laser, can help reduce psoriatic plaques and inflammation
    2. Vitiligo: Phototherapy, including excimer laser, can help repigment vitiligo patches
    3. Atopic Dermatitis: Phototherapy, including excimer laser, can help reduce inflammation and itching associated with atopic dermatitis
    4. Acne: Blue light phototherapy can help reduce acne-causing bacteria and inflammation
    5. Pain and Inflammation: Infrared phototherapy can help reduce pain and inflammation in conditions such as arthritis and fibromyalgia

    Benefits of Phototherapy and Excimer Laser

    1. Non-Invasive: Phototherapy and excimer laser are non-invasive treatments that do not require surgery or injections
    2. Targeted Treatment: Phototherapy and excimer laser can target specific skin cells and conditions, reducing the risk of side effects
    3. Minimally Painful: Phototherapy and excimer laser treatments are generally minimally painful and well-tolerated
    4. Quick Recovery: Phototherapy and excimer laser treatments typically require minimal downtime, allowing patients to resume their daily activities quickly

    Conclusion

    Phototherapy and excimer laser are highly effective treatments for various skin conditions. By understanding the mechanisms and benefits of these treatments, patients can make informed decisions about their skincare options. Whether you’re struggling with psoriasis, vitiligo, or acne, phototherapy and excimer laser can provide a safe and effective solution. Consult with a healthcare professional or dermatologist to determine if phototherapy or excimer laser is right for you.

    References

    1. National Psoriasis Foundation. (2020). Light Therapy.
    2. Mayo Clinic. (2020). Excimer laser for psoriasis.
    3. #skincare #radiantskin #skinglow #skinrejuvenation #exosomes #peptides

      The quest for radiant youthful skin has led to the discovery of innovative skincare ingredients. Among these, exosomes, stem cell factors, and peptides have garnered significant attention for their potential to revolutionize skin regeneration. In this comprehensive guide, we’ll delve into the world of these three skincare powerhouses, exploring their benefits, mechanisms, and applications in skincare.

      Exosomes: The Cellular Messengers

      Exosomes are tiny, membrane-bound vesicles (30-150 nm) released by cells, including stem cells, to communicate with neighboring cells. They are akin to messenger molecules. These nanocarriers contain a cargo of biomolecules, such as proteins, lipids, and nucleic acids, which are essential for intercellular signaling.

      Benefits of Exosomes in Skincare:

      1. Cellular Communication: Exosomes facilitate communication between skin cells, promoting a harmonious and balanced skin environment
      2. Wound Healing: Exosomes have been shown to accelerate wound healing by promoting cell migration, proliferation, and differentiation
      3. Anti-Aging: Exosomes can help reduce fine lines, wrinkles, and age-related skin damage by stimulating collagen production and improving skin elasticity
      4. Skin Barrier Repair: Exosomes can help repair the skin’s natural barrier function, reducing inflammation and improving skin hydration


      Exosome Derivatives

      While exosomes can be derived from stem cells, such as mesenchymal stem cells (MSCs) or adipose-derived stem cells (ADSCs), there are other sources of derived exosomes. These include plant-based, synthetic/ engineered exosomes which are biomimetic in nature, hybrid exosomes. These products can be found in various forms, including serums, creams, and masks.

      Stem Cell Factors: Unlocking Cellular Potential

      Stem cell factors are signaling molecules produced by stem cells to regulate cellular behavior, including proliferation, differentiation, and survival. These factors can be used to stimulate skin cells, promoting regeneration and rejuvenation.

      Benefits of Stem Cell Factors in Skincare:

      1. Cellular Regeneration: Stem cell factors can stimulate skin cells to regenerate and repair damaged tissue
      2. Collagen Production: Stem cell factors can increase collagen production, improving skin elasticity and reducing fine lines and wrinkles
      3. Skin Brightening: Stem cell factors can help reduce melanin production, resulting in a brighter, more even-toned complexion
      4. Wound Healing: Stem cell factors can accelerate wound healing by promoting cell migration, proliferation, and differentiation

      Stem Cell Factor-Based Skincare Products

      Stem cell factor-based skincare products typically contain a combination of growth factors that help in regulation of stem cell behaviour, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF). These products can be found in various forms, including serums, creams, and masks.

      Peptides: The Building Blocks of Skin

      Peptides are short chains of amino acids that play a crucial role in skin health. They can stimulate collagen production, improve skin elasticity, and reduce inflammation.
      Peptides take on different roles in the skin. They can help to regulate certain skin functions by their actions on skin

      1. Neurotransmitter: To reduce wrinkle formation and muscle contraction
      2. Signalling: Stimulate production of collagen, elastin and skin structural proteins
      3. Carrier: Delivering trace elements e.g. copper to the skin

      Benefits of Peptides in Skincare

      1. Collagen Production: Peptides can stimulate collagen production, improving skin elasticity and reducing fine lines and wrinkles
      2. Skin Firming: Peptides can help firm and tighten the skin, reducing the appearance of sagging skin
      3. Inflammation Reduction: Peptides can reduce inflammation, which can contribute to skin conditions like acne, rosacea, and eczema
      4. Wound Healing: Peptides can accelerate wound healing by promoting cell migration, proliferation, and differentiation

      Peptide-Based Skincare Products

      Peptide-based skincare products typically contain a combination of short-chain peptides, such as acetyl hexapeptide-8, palmitoyl pentapeptide-4, and dipeptide diaminobutyroyl benzylamide diacetate. These products can be found in various forms, including serums, creams, and masks.

      Conclusion

      Exosomes, stem cell factors, and peptides are revolutionizing the skincare industry with their potential to promote skin regeneration, rejuvenation, and repair. By understanding the benefits and mechanisms of these ingredients, skincare professionals and enthusiasts can harness their power to achieve healthier, more radiant skin. As research continues to uncover the secrets of these skincare powerhouses, we can expect to see even more innovative products and treatments emerge in the future.

      References

      1. Sreeraj et al. Exosomes for skin treatment: Therapeutic and cosmetic applications. NanoTransMed Dec 2024 .
      2. Shin et al. The use of epidermal growth factor in dermatological practice. Int Wound J. Dec 2022.
      3. #acne #acnescarring #treatmentforacne #laserscartreatment #dermatologist

        Acne scarring can be a distressing and persistent reminder of past breakouts. The good news is that various treatments can help alleviate scarring, restoring smoother, more even-toned skin. This comprehensive guide explores the different types of acne scarring and the most effective treatment options.

        Types of Acne Scarring

        Acne scarring can be broadly categorized into four main types

        1. Ice Pick Scars: Deep, narrow, and V-shaped, these scars are typically caused by severe acne, such as cysts or nodules
        2. Boxcar Scars: Shallow, wide, and U-shaped, these scars are often the result of moderate to severe acne
        3. Rolling Scars: Shallow, wide, and wavy, these scars are typically caused by mild to moderate acne
        4. Hypertrophic Scars: Raised, thick, and often red or pink, these scars are the result of an overactive healing process

        Credits: MS Junayed et al. IEEE. 2021

        Additional Types of Acne Scarring

        1. Atrophic Scars: Depressed scars that can be further divided into ice pick, boxcar, and rolling scars
        2. Keloid Scars: Raised, thick, and often red or pink, these scars are similar to hypertrophic scars but can be larger and more painful
        3. Pigmented Scars: Scars that have changed color due to inflammation or sun exposure, often appearing darker or lighter than the surrounding skin

        Treatment Options for Acne Scarring

        The most effective treatment for acne scarring depends on the type and severity of the scarring. Here are some common treatment options:

        1. Topical Treatments: Creams, gels, and serums containing ingredients like retinoids, vitamin C, and silicone can help improve skin texture and reduce the appearance of scars
        2. Chemical Peels: A solution is applied to the skin to remove the top layers and help reduce scarring
        3. Microdermabrasion: A non-invasive exfoliating treatment that helps improve skin texture and reduce the appearance of scars
        4. Laser Therapy: Various laser treatments can help reduce scarring by promoting collagen production, improving skin texture, and reducing redness
        5. Microneedling: A minimally invasive treatment that uses tiny needles to create micro-injuries, stimulating collagen production and improving skin texture
        6. Surgical Excision: In severe cases, surgical excision may be necessary to remove the scar tissue and promote new collagen growth
        7. Dermabrasion: A surgical procedure that uses a special tool to remove the top layers of skin and help reduce scarring
        8. Fillers: Injecting fillers like hyaluronic acid, calcium hydroxylapatite, or poly-L-lactic acid can help raise depressed scars and improve skin texture

        Combination Therapy

        Often, the most effective treatment plan involves combining multiple therapies. For example:

        1. Laser therapy + microneedling: Enhances collagen production and improves skin texture
        2. Chemical peels + microdermabrasion: Exfoliates the skin and promotes cell turnover
        3. Fillers + laser therapy: Raises depressed scars and reduces redness

        Preventing Acne Scarring

        While treatment options are available, preventing acne scarring is always the best approach. Here are some tips:

        1. Maintain good skincare habits: Cleanse, tone, and moisturize regularly
        2. Use sunscreen daily: Protect your skin from UV damage
        3. Avoid picking or popping pimples: This can lead to further inflammation and scarring
        4. Manage stress: High stress levels can trigger acne breakouts
        5. Eat a balanced diet: Focus on whole foods, fruits, vegetables, and lean proteins

        Conclusion

        Acne scarring can be a frustrating and persistent issue, but various treatment options are available. By understanding the different types of acne scarring and the most effective treatments, you can take the first step towards achieving smoother, more even-toned skin. Remember to always consult a dermatologist or skincare professional for personalized advice and guidance.

        References

        1. American Academy of Dermatology (AAD)
        2. American Society for Dermatologic Surgery (ASDS)
        3. #facialflushing #redface #centrofacial #rosaceatreatment #howtoavoidskinredness

          Rosacea is a chronic inflammatory skin condition characterized by facial redness, flushing, and visible blood vessels. It affects millions worldwide, impacting quality of life and self-esteem. This comprehensive guide explores rosacea’s subtypes, symptoms, causes, and treatment options.

          What is Rosacea?

          Rosacea is a complex condition involving:

          1. 1. Abnormal blood vessel function
          2. 2. Inflammation
          3. Skin barrier disruption

          Subtypes of Rosacea

          The American Academy of Dermatology recognizes four primary subtypes:

          1. Type 1: Erythematotelangiectatic Rosacea (ETR): Persistent redness and visible blood vessels
          2. Type 2: Papulopustular / Inflammatory Rosacea (PPR): Redness, acne-like lesions, and pus-filled bumps
          3. Phymatous Rosacea: Thickened skin, nodules, and enlargement of facial features, especially the nose
          4. Ocular Rosacea: Eye symptoms, including redness, tearing, and burning

          Credit: National Institutes of Health. (2023)

          Symptoms

          Common symptoms include:

          1. Facial redness and flushing
          2. Visible blood vessels (telangiectasias)
          3. Acne-like lesions
          4. Swelling and inflammation
          5. Eye irritation
          6. Skin sensitivity
          7. Caution: Signs and symptoms of rosacea can be often mistaken for eczema/ dermatitis or common acne.

          Causes and Triggers

          Factors contributing to rosacea:

          1. Genetics
          2. Hormonal changes
          3. Environmental factors (sun, wind, temperature)
          4. Skin care products
          5. Certain medications
          6. Food and drink (spicy, hot, or caffeinated)
          7. Stress

          Treatment Options

          A comprehensive treatment plan involves:

          Topicals

          1. Metronidazole (antibacterial and anti-inflammatory)
          2. Ivermectin for inflammation and reduction of demodex mites (a type of skin organism that can contribute to skin irritation and inflammation)
          3. Brimonidine (vascular constriction)
          4. Azelaic acid (anti-inflammatory and antibacterial)

          Oral Medications

          1. Antibiotics (doxycycline, minocycline)
          2. Isotretinoin (severe cases)
          3. Beta-blockers (for flushing)

          Laser and Light Therapy

          1. Pulsed dye laser
          2. Intense pulsed light (IPL)

          Lifestyle Modifications

          1. Sun protection (SPF 50+)
          2. Gentle skin care
          3. Avoid triggers (heat, spicy food) and managing stress

          Surgical Options

          1. Rhinophyma (severe nasal enlargement) correction
          2. Electrosurgery or laser surgery for telangiectasias

          Conclusion

          Rosacea is a complex condition requiring personalized treatment. Understanding the subtypes, symptoms, and triggers enables effective management. A combination of topical treatments, oral medications, lifestyle modifications, and laser therapy can help alleviate symptoms and improve quality of life.

          References

          1. American Academy of Dermatology (AAD)
          2. National Rosacea Society (NRS)
          3. Rosacea Support Group
          4. #pediatricskin #pediatricdermatology #skincareforchildren #dermatologist #dermatology

            The human skin, the body’s largest organ, undergoes significant changes throughout life. Pediatric skin, encompassing newborns to adolescents, exhibits distinct characteristics compared to adult skin. Understanding these differences is crucial for developing effective skin care strategies and products tailored to specific age groups.

            Pediatric Skin (0-18 years)

            There are fundamental physiologic skin differences between adults and children. Pediatric skin have the following characteristics:

            1. Thinner skin: Pediatric skin is approximately 20-30% thinner than adult skin
            2. Higher water content: Increased hydration levels required, hence make pediatric skin more susceptible to dryness in normal everyday conditions
            3. Immature barrier function and increased sensitivity: Pediatric skin’s natural moisture barrier is weaker, hence causing it to react more intensely to irritants and allergens
            4. Faster cell turnover

            (Young) Adult Skin (19+ years)

            1. Thicker skin: Adult skin is more resilient due to increased collagen and elastin. In young adults, they will find their skin being sweatier or greasier, due to the maturation and increased activity of both sweat and oil glands. This can lead to acne or comedone formation as well
            2. Lower water content: Adult skin tends to be drier, especially with aging
            3. Mature barrier function: Adult skin’s natural moisture barrier is stronger, hence are more resistant to irritants
            4. Slower cell turnover: Adult skin regenerates more slowly

            Skin Care Product Differences

            There are many product formulations available. Taking heed of the different characteristics of adult and pediatric skin, there are certain useful ingredients in caring for the skin for either groups.


            Pediatric Skin Care Products

            We would recommend skincare products with the following properties

            1. Gentle, fragrance-free formulations: To minimize irritation and allergic reactions
            2. Hypoallergenic ingredients: To reduce risk of allergic reactions
            3. Moisturizing properties: To combat dryness and support skin hydration
            4. pH balanced: To maintain skin’s natural pH (5.5). Do take note that in actively inflamed or infected skin, the natural skin microbiome and pH can be disrupted. Speak to your dermatologist to see how best to manage acute flares
            5. Avoid harsh chemicals: No artificial dyes, sulfates, or parabens

            Key Ingredients for Pediatric Skin (Non exhaustive list)

            1. Glycerin: Hydrates and protects
            2. Ceramides: Supports skin barrier function
            3. Niacinamide: Soothes and calms
            4. Aloe vera: Soothes and hydrates
            5. Zinc oxide: Protects against sun damage

            Adult Skin Care Products

            1. Anti-aging properties: Address wrinkles, fine lines, and skin discoloration
            2. Gentle Exfoliating ingredients: Remove dead skin cells, promoting cell turnover
            3. Hydrating and moisturizing: Combat dryness, especially in mature skin
            4. Targeted treatments: Address specific concerns (acne, hyperpigmentation)
            5. Active ingredients-specific: Retinol, vitamin C, and alpha-hydroxy acids (AHAs)

            Key Ingredients for Adult Skin (Non exhaustive list)

            With greater maturity, adult skin can safely tolerate different skincare ingredients. This should be tailored to the individual skin needs. Some of more commonly used ingredients include:

            1. Retinol: Stimulates collagen production, reduces fine lines
            2. Hyaluronic acid: Hydrates and plumps
            3. Vitamin C: Antioxidant, brightens complexion
            4. Peptides: Stimulates collagen production
            5. Salicylic acid: Exfoliates, unclogs pores
            6. Conclusion

              Pediatric and adult skin exhibit distinct characteristics, requiring tailored skin care approaches. Understanding these differences enables the development of effective, age-specific skin care products. By choosing products suitable for their skin type and age, individuals can optimize their skin health and address specific concerns

              References

              1. National Eczema Association. (2022). Skin Care for Children with Eczema.
              2. Journal of Clinical and Aesthetic Dermatology. (2020). Pediatric Skin Care.
              3. Skin Cancer Foundation. (2022). Sun Protection for Children.
              4. #wart #warttreatment #surgeryforwart #dermatologist #dermatology

                Skin warts are common, benign growths caused by the human papillomavirus (HPV). They can appear anywhere on the body, affecting people of all ages. This comprehensive article explores the types, causes, symptoms, treatment options, and preventive measures for skin warts.

                Types of Skin Warts

                1. Common Warts (Verruca Vulgaris): Small, rough, and flesh-colored, often on hands and feet
                2. Plantar Warts (Verruca Plantaris): Painful, flat warts on the soles of the feet
                3. Flat Warts (Verruca Plana): Smooth, flat warts, often on face, hands, and arms
                4. Genital Warts (Condyloma Acuminatum): Often taking on a cauliflower-shaped appearance- these warts are found in genital areas
                5. Filiform Warts: Long, thin, and thread-like warts, often on face and neck
                6. Periungual Warts: These are warts occurring at nail margins. In view of the functional nature of our hands and feet, they may be somewhat rough, thick and/or abraded. Should the nail plate be involved, they may alter the shape of the involved nail. Periungal warts have a propensity for recurring, due to the nailplate forming a barrier which may encumber direct treatment of the wart

                7. (Left: Common wart, Right: Palmar wart)


                  (Left: Verrucous wart, Right: Periungal wart)


                  (Left: Facial wart in a child, Right: Plantar wart)

                  Credit: American Family Physician (2003).

                Causes and Risk Factors

                The main etiological agent is a skin virus known as Human Papillomavirus (HPV). There are over 100 strains, with some causing skin warts.

                1. Skin-to-Skin Contact: Direct contact with infected person or contaminated surfaces
                2. Weakened Immune System: Chemotherapy, and immunosuppressive medications
                3. Age: Children and teenagers are more susceptible owing to a maturing immune system/ response
                4. Skin Damage: Cuts, scratches, or bites provide entry points for HPV. After initial infection, warts frequently are spread by autoinoculation from scratching or shaving

                Symptoms

                1. Small, Rough Growths: Typically 1-10mm in diameter
                2. Flesh-Colored or Pigmented: May be pink, brown, or gray
                3. Pain or Discomfort: Especially plantar warts
                4. Itching or Bleeding: Rarely, but possible

                Treatment Options

                All treatments are hampered by wart persistence and recurrence. Sometimes, field treatment may b be offered (treating a larger area surrounding the wart).

                Topical Medications

                They are locally exfoliative and abrasive- helping to remove the wart burden from the top layers of skin.

                1. Salicylic Acid: Over-the-counter (OTC) products
                2. Cryotherapy: Liquid nitrogen to freeze warts. This is a clinic administered procedure requiring regular sessions
                3. Cantharidin: Blistering agent derived from beetles
                4. Imiquimod: Prescription cream stimulating immune response
                5. Podophyllin: Prescription solution for genital warts

                Surgical Options

                1. Curettage: Scraping off warts with a curette.
                2. Electrocautery: Burning off warts with electrical current.
                3. Laser Therapy: Targeted heat to destroy warts.
                4. Surgical Excision: Removing warts surgically.

                Vaccination
                HPV vaccinations, whilst useful in the prevention management of cervical cancer, is also effective in preventing skin wart occurrence from certain HPV strains.

                Home Prevention Strategies

                1. Keep Skin Healthy: Moisturize and protect
                2. Avoid Sharing Personal Items: Towels, razors, and clothing
                3. Avoid Skin-to-Skin Contact: Especially over active lesions
                4. Conclusion

                  Skin warts are common and usually harmless, but can be unsightly and uncomfortable. Understanding the types, causes, symptoms, and treatment options can help manage and prevent skin warts. Consult a healthcare professional for proper diagnosis and a tailored treatment programme.

                  References

                  1. American Academy of Dermatology. (2023). Warts: Diagnosis and Treatment.
                  2. American Family Physician. (2003). Molluscum Contagiosum and Warts
                  3. #ringworm #fungal treatment #nailfungus #dermatology #dermatologist

                    Fungal infections, also known as mycoses, are caused by fungi that invade and colonize various tissues in the human body. These infections can range from mild and superficial to severe and life-threatening. This comprehensive overview will explore the different types of fungal infections, their symptoms, and management strategies.

                    Types of Fungal Infections

                    More commonly, patients tend to experience superficial fungal infections. This is in part contributed by the warm and humid tropical climate locally. Certain lifestyle and hobbies involving heavy physical exertion or medical conditions e.g. diabetes, may also contribute to fungal infections.

                    Superficial Fungal Infections (And its close mimics)

                    1. Tinea Pedis (Athlete’s Foot): Affects the feet, causing itching, cracking, and scaling. N.B. This can be commonly mistaken for feet eczema. Ancillary testing may be required to differentiate the two conditions.
                    2. Tinea Corporis (Ringworm): Circular, itchy lesions on the body. N.B. Psoriasis can sometimes be a close consideration. Topical steroidal treatments, while beneficial for psoriasis treatment, may lead to a worsening of the rash.
                    3. Tinea Capitis (Scalp Ringworm): Scalp infection causing hair loss and itching. N.B. This form of superficial fungal infection can be mistaken for both other infective causes (e.g. lice) or non inflammatory causes (e.g. Seborrhoeic dermatitis (a form of eczema affecting oilier parts of the body).
                    4. Tinea Cruris (Jock Itch): Groin infection causing itching and redness. N.B. There are subset of inflammatory conditions e.g. psoriasis which can affect the folds. These subsets have an ‘inverse’ prefix e.g. inverse psoriasis, signifying its location over folds.
                    5. Tinea Unguium (Onychomycosis): Fungal infection of the nails. N.B. There are different species of fungus, which one showing up as different appearances of nails. Fungal culture for proper identification and treatments are usually warranted for more targeted treatment.

                    Credit: American Family Physician (2013).

                    Subcutaneous Fungal Infections

                    As the name suggests, these are more deep seated fungal infections affecting the deeper parts of the skin (subcutis) and lymph hodes. A history of inoculation or cuts can sometimes preceded the development of fungal infection. Examples of such conditions are: Sporotrichosis (Infection caused by Sporothrix schenckii, affecting skin and lymph nodes.) and Chromoblastomycosis (Chronic infection affecting skin and subcutaneous tissue.)

                    Systemic Fungal Infections

                    1. Candidemia: Bloodstream infection caused by Candida species
                    2. Aspergillosis: Infection caused by Aspergillus species, affecting lungs and other organs
                    3. Cryptococcosis: Infection caused by Cryptococcus neoformans, affecting lungs and central nervous system
                    4. Histoplasmosis: Infection caused by Histoplasma capsulatum, affecting lungs and other organs

                    Management of Fungal Infections

                    Preventive Measures

                    1. Good hygiene: Washing hands and affected areas regularly
                    2. Dry skin: Keeping skin dry, especially between folds
                    3. Avoid sharing personal items: Towels, clothing, and footwear
                    4. Wear breathable clothing: Cotton and natural fibers

                    Pharmacological Management of fungal infections

                    There are 3 main classes of antifungals, with the use of topicals being the most common.

                    1. Antifungal powders, creams and ointments: The choice of product texture and formulation recommended by your dermatologist takes into account lifestyle and preferences.
                    2. Oral Treatments: Usually taken as a daily oral pill. They may have certain drug interactions with existing medications. Do inform your dermatologist should you have any other regular medications.
                    3. Intravenous antifungals: Administered through the veins or injections, they are reserved for extremely ill patients.

                    Conclusion

                    Fungal infections are diverse and can affect various parts of the body. Understanding the types, symptoms, and management strategies is crucial for effective treatment and prevention. Consult a healthcare professional for proper diagnosis and treatment.

                    References

                    1. Centers for Disease Control and Prevention. (2022). Fungal Diseases.
                    2. American Family Physician. (2013). Onychomycosis: Current trends in diagnosis and management.
                    3. #psoriasis #psoriasis treatment #biologics #dermatology #dermatologist

                      Psoriasis is a chronic autoimmune disease affecting millions worldwide, characterized by thick, scaly, and inflamed skin lesions. Additionally, psoriasis can have extracutaneous (beyond the skin) manifestations, affecting joints of the body. Traditional treatments may not provide adequate relief, or may only be skin directed, leading to the development of biologic therapies. This essay delves into the pathophysiology of psoriasis, its clinical manifestations, and the various biologic agents available for treatment.

                      Pathophysiology of Psoriasis

                      Psoriasis results from a complex interplay between genetic, environmental, and immune system factors. Key contributors include:

                      1. Genetic predisposition: Mutations in genes involved in immune response and skin barrier function
                      2. Immune system dysregulation: Overactive T-cells and dendritic cells trigger inflammation
                      3. Cytokine imbalance: Elevated levels of tumor necrosis factor-alpha (TNF-α), interleukin-17 (IL-17), and interleukin-23 (IL-23)
                      4. Environmental triggers: Allergens, irritants, and stress exacerbate symptoms

                      Clinical Manifestations of Psoriasis

                      Psoriasis presents in various forms:

                      1. Plaque psoriasis: Most common form, characterized by red, scaly patches
                      2. Guttate psoriasis: Small, droplet-shaped lesions
                      3. Inverse psoriasis: Smooth, red lesions in skin folds
                      4. Pustular psoriasis: White pustules on red skin. It can be confluent (or joined together) to form lakes of pus
                      5. Erythrodermic psoriasis: Widespread, severe inflammation
                      6. Psoriatic arthritis: Joint inflammation and damage
                      7. A-E: Plaque (a), guttate (b), pustular (c), inverse (d), erythrodermic (e). Credits: Sharma et al. Annals of Phytomedicine (2023)

                        Sometimes, more than one appearance may be present at the same time.

                      Biologic Therapies for psoriasis

                      Psoriasis arise from a complex interplay of inflammatory signalling. Certain cell type e.g. T cells and signalling pathways / molecules.
                      Biologics target specific molecules involved in psoriasis pathogenesis. Available biologics can be classified into several categories based on the molecules they target. Broadly, there are a few categories:

                      1. TNF-α Inhibitors
                      2. IL-17 Inhibitors
                      3. IL-23 Inhibitors
                      4. Phosphodiesterase 4 (PDE4) Inhibitors
                      5. Janus Kinase (JAK) Inhibitors (for Psoriatic arthritis)

                      Efficacy and Safety of Biologics

                      Biologics have demonstrated significant efficacy in clinical trials, with many showing:

                      – PASI 75/90: 75%/90% improvement in Psoriasis Area and Severity Index

                      – IGA 0/1: Investigator’s Global Assessment of clear or almost clear skin.

                      What is PASI Grading

                      PASI (Psoriasis Area and Severity Index)

                      A widely used measure to assess the severity of psoriasis:

                      Components:

                      1. Area affected: Percentage of body surface area (BSA) affected
                      2. Erythema (redness)
                      3. Induration (thickness)
                      4. Scaling

                      PASI Response Rates:

                      1. PASI 50: 50% improvement from baseline
                      2. PASI 75: 75% improvement from baseline
                      3. PASI 90: 90% improvement from baseline

                      Common side effects

                        N.B. A non exhaustive list of side effects include:

                      1. Injection site reactions
                      2. Increased risk of infections (upper respiratory tract, sinusitis)
                      3. Headache
                      4. Malaise or general sense of unwell

                      Conclusion

                      Biologic therapies have revolutionized psoriasis treatment, offering targeted and effective options. Understanding the different types of biologics and their mechanisms enables healthcare providers to tailor treatment strategies to individual patient needs. The choice of biologics will depend on the disease severity, any previous treatments and their responses, comorbidities, patient preferences (administrative route, frequency) and/or insurance coverage.

                      References

                      1. Nestle et al. (2016). Psoriasis. New England Journal of Medicine
                      2. Sharma et al. (2023). Annals of Phytomedicine