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Psoriasis Patients: Now Is the Time To “Try Again”

Minars Dermatology | Columns & Newsletters | Psoriasis Patients: Now Is the Time To “Try Again”
Psoriasis Patients: Now Is the Time To “Try Again”
Dr. Todd MinarsTodd Minars, M.D.
Dermatology 

Psoriasis typically first strikes between the ages of 15 and 35, but it can affect anyone at any age. The main defect is that the skin’s cells regenerate too quickly. Extra skin cells build up on the skin’s surface, forming red, flaky lesions. Psoriasis can appear anywhere on the body, covering some people from head to toe, but other cases are so mild that people don’t even know they have it.

The new drugs being used to treat psoriasis are interesting for six reasons:

1. They’re very high-tech (these are custom-made drugs that target specific steps in a disease pathway).
2. They’re very expensive (often costing $10,000 to $12,000 per year).
3. They represent a completely different class of medications for the treatment of psoriasis, perhaps marking the beginning of a new era for the treatment of this and other diseases.
4. They’re very new: patients can now be helped by treatment options that simply did not exist 3 or 4 years ago.

 5. They are all injected, not swallowed or sprayed onto the skin.
6. You have probably seen ads for these drugs, they include: Enbrel, Raptiva, and Amevive. Each has its own set of pros and cons.
These drugs, as a group, are referred to as the “biologics”, because they are molecules that occur naturally in the body, but have been altered (or “customized” if you will) in the laboratory to suit our purposes. I can oversimplify with an example: if psoriasis was caused by molecule A binding to molecule B, then we take a piece of molecule B and use it to design a drug that will block molecule A from binding. That’s the theory, but do they work? The answer is “YES and NO”. Most trials of these drugs show 50% of patients achieving between 40 and 60% improvement. Not a “home run” in my book, but not bad for the treatment of psoriasis. The safety data, on the other hand seems to be overwhelming. Thousands of patients treated and very few serious adverse events (and that is a “home run” compared to older drugs for psoriasis like methotrexate and cyclosporine).

For more information, call Dr. Todd Minars at 954-987-7512.

Treating “Brown Spots” With Bleaching Cream

Minars Dermatology | Columns & Newsletters | Treating “Brown Spots” With Bleaching Cream
Treating “Brown Spots” With Bleaching Cream
Dr. Todd MinarsTodd Minars, M.D.
Dermatology 

This is the first of a two part email about treating “brown spots”. This month we will discuss the treatment of “brown spots” with bleaching cream, and next month we will talk about the treatment of “brown spots” with lasers.“Brown spots” is an intentionally vague term. But most people do not know the medical term for the type of brown spots that they have. Some people are familiar with the term melasma, which is also called “the mask of pregnancy” (though you do
not have to be pregnant to have it). Another very common form of “brown spots” is called post-inflammatory hyperpigmentation. Acne patients with darker skin are familiar with this form of “brown spots”. In these patients the inflammation from their acne leaves them with brown pigmentation on their face that can last from months to years. Any type of inflammation can leave this form of pigmentation: burns, irritation from shaving, plucking, or ingrown hairs. Both of these conditions: melasma and post-inflammatory hyperpigmentation are notoriously difficult to treat. In fact, they are even notoriously resistant to laser therapy, so we turn to bleaching creams.Bleaching creams come in many varieties. The most common ingredient is hydroquinone. Over-the-counter preparations contain up to 2% hydroquinone and prescription creams contain up to 4% hydroquinone. But most patients who I see have already tried these creams, and they are coming to see me because they have failed to improve.The most effective bleaching cream was developed many years ago by a dermatologist at the University of Pennsylvania named Albert Kligman. His cream is a mixture of three ingredients (one of them being 4% hydroquinone) and was used with great success by dermatologists for years.

 The only problem was that a pharmacist had to compound (i.e. custom mix) the cream, and the art of compounding has been a dying art over the past few years due big chain pharmacies, poor insurance reimbursement, and the availability of pre-packaged creams. For example, Triluma came on the market a few years ago as a pre-packaged/ pre-mixed, prescription version of Kligman’s formula and is very effective for the treatment of hyperpigmentation (though also very expensive and usually not covered by insurance). Again however, being a specialist (and therefore often the last resort for some difficult cases) I will often see patients who have already tried Triluma, and failed to improve.

So the question is what kind of bleaching creams do I prescribe for my patients? As a specialist I have the unique opportunity to treat many patients with the same problem and I have tried just about every version of bleaching cream an (just as important) several pharmacies who compound these creams, and I now use one pharmacy to make my bleaching cream compounds based on Kligman’s formula, because they provide the following advantages:

• We can use stronger concentrations than available in pre-packaged prescription creams. For example, Triluma has 4% hydroquinone, and we often like to use 6, 8, or 10% hydroquinone.
• We can use any combination of those three ingredients and can “fine tune” it according to your skin type or according to what stage of treatment you are in. For example, we may start with high concentrations of all three ingredients for two or three months to achieve initial clearing of the pigment, and then use lower concentrations of only one or two of the ingredients to maintain the results.
• Finally, we get all of these advantages at a significantly lower cost. Triluma usually costs about $90 to $100 for 30 grams. The pharmacy that we use will compound the same cream for $30 to $40. (please note: The pharmacy bills you directly. We in no way profit from this or any other prescriptions we write.)

MINARS DERMATOLOGY RAISES AWARENESS OF ECZEMA IN PREPARATION FOR NATIONAL ECZEMA AWARENESS MONTH

HOLLYWOOD, FL.In preparation for National Eczema Month in October,Minars Dermatology,is promoting awareness of the disease, symptoms and treatments.

More than 30 million Americans are affected by eczema, a synonym for dermatitis, which simply means “inflammation of the skin”.While there are eight different types of eczema, the term is often used interchangeably with atopic dermatitis.

Atopic dermatitis is part of the “atopic triad” which also includes asthma and allergic rhinitis, which are seasonal allergies. Some patients have two or all three of these conditions. Atopic Dermatitis is diagnosed clinically based on personal, family history and physical exam. Allergy testing including pinprick test, blood allergen tests and patch testing can be helpful in certain cases but are not routinely done.

“Treating eczema in both adults and children is one of our office specialties,” explained Dr. Norman Minars, Founder of Minars Dermatology. “We hope by raising awareness, we can give hope for those who have eczema and those who care for them.”

Eczema treatment consists of using theright products, appropriate topical steroids, treatment of bacterial colonization of the skin and avoidance of scratching among others. If one topical steroid does not work, there are many others including, Eucrisa,the first and only non-steroidal topical monotherapy, that inhibits the PDE-4 enzyme in the skin.

Minars suggests a number of proven treatments worth trying in addition to medications. To avoid a flare up, patients should take one short bath or shower daily in lukewarm water.  He also suggests avoiding scrubbing and unnecessary use of soap while keeping skin hydrated by moisturizing several times a day.Some patients find hypoallergenic detergents like Tide Free best for severe eczema patients. Fabric softeners, including dryer sheets, should be avoided. Interestingly, dark dye in clothing can exacerbate eczema so wearing dark clothes should be avoided.For flare ups, try a bleach bath.  This does not take the place of topical steroids, but can help quite a bit.

About Minars Dermatology
Located in Hollywood, FL, Minars Dermatology was established in 1976 by Dr. Norman Minars. His son, Dr. Todd Minars, joined the practice in xxx and together they have set a standard for unparalleled excellence in medical, cosmetic and laser dermatology care. For more information, please call 954.987.7512 or visit www.minarsdermatology.com

Do This Not That: Five Dermatologist Tips for Treating Eczema

Is your skin dry and rough? Do you have white blotches on your cheeks and arms and or dark circles under your eyes?

You may have eczema.

Let’s be more precise as “eczema” is a broad term and when most people say “eczema” they mean “atopic dermatitis.”

Children under the age of two are more likely to have a food allergy or sensitivity; but searching for this with extensive allergy testing is usually low yield.  Having said that, if you notice that a certain food makes your child worse, avoid it.

Atopic dermatitis is part of the “atopic triad”which also includes asthma and allergic rhinitis which are seasonal allergies. Some patients have two or all three of these conditions.

There is a theory that bacteria (usually staph) on the skin plays a role in eczema flare-up.  It is called the “super-antigen” theory.

Instead of acting like a normal antigen and activating the part of the immune system designed to fight bacteria, it acts as a “super” antigen in eczema patients and activates “everything” so that your immune system goes haywire and results in itchy eczema.

Atopic Dermatitis is diagnosed clinically based on personal, family history and physical exam. Allergy testing including pinprick test, blood allergen tests and patch testing can be helpful in certain cases but are not routinely done.

Eczema treatment consists of a strict sensitive skin care regimen with the use of the right products, appropriate topical steroids, treatment of bacterial colonization of the skin and avoidance of scratching among others.

Here are our top favorite Eczema treatment tips:

  • To avoid a flare up, patients should take one short five to ten minute bath or shower daily in lukewarm water. Avoid scrubbing and unnecessary use of soap. We have found Dove Unscented is the least irritating.
  • Keep your skin super-hydrated! We recommend moisturizing several times a day but most importantly after showering, when the skin is damp for maximum absorption. Our staff at Minas Dermatology personally recommendsAquaphor,but CeraVe and Vanicream are also excellent moisturizers.
  • Keep nails short to avoid scratching.
  • Hypoallergenic detergents like Tide Free or All Free and Clear are best for severe eczema patients. Fabric softeners including dryer sheets should be avoided.Interestingly, dark dye in clothing can exacerbate eczema so avoid wearing dark clothes.
  • For flare ups, try a bleach bath.  Fill your bathtub and add a 1/4 cup of plain old Clorox bleach. It becomes very diluted and smells like a swimming pool. This does not take the place of topical steroids, but can help quite a bit.

And of course, see your dermatologist.

If one topical steroid does not work, we have others

One of the newest ones on the market is Eucrisathe first and only non-steroidal topical monotherapy that inhibits the PDE-4 enzyme in the skin.

Have you tried it?