Asides
Cosmetic & Surgery Times
Psoriasis Patients: Now Is the Time To “Try Again”
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Psoriasis Patients: Now Is the Time To “Try Again” | |
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![]() 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). |
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
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Treating “Brown Spots” With Bleaching Cream | |
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![]() 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 |
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. |