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January 6, 2015

Shannon Humphrey, MD, FRCPC, FAAD, Director of Continuing Medical Education, Clinical Instructor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

Abstract
While topical therapy remains a key therapeutic approach in the clinical management of AV, it can be associated with side effects that may compromise the stratum corneum and impair patient adherence. The use of adjunctive cleansers and moisturizers can help mitigate treatment side effects and subsequently enhance therapeutic efficacy. Providing patient-specific skin care recommendations, including product selection and proper use, is an important part of the clinical management of AV and may adjunctively augment the efficacy of topical medications in reducing acne lesions.
Key Words: acne vulgaris, adherence, cleansers, moisturizers.

Shannon Humphrey, MD, FRCPC, FAAD, Director of Continuing Medical Education, Clinical Instructor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

November 5, 2014

Jacky Lo1, Joseph M. Lam, MD, FRCSC2
1Medical student, Department of Pediatrics, University of British Columbia, Vancouver, BC.
2Clinical Assistant Professor, Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC.

Abstract
Diaper dermatitis is one of the most common skin conditions seen in the pediatric population and can cause significant distress for infants and their families. While many diaper rashes can resolve with simple treatments, having a thorough understanding of different diaper lesions can help rule out more serious conditions, guide treatment and alleviate some of the caregivers' anxiety. The following review article will provide an overview of select common and uncommon diaper eruptions.
Key Words: diaper dermatitis, pediatric, diaper rash, treatment.

Jacky Lo1, Joseph M. Lam, MD, FRCSC2
1Medical student, Department of Pediatrics, University of British Columbia, Vancouver, BC.
2Clinical Assistant Professor, Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC.

September 8, 2014

Jordan Isenberg,1 Tessa Weinberg,2 Nowell Solish,3
1McGill University, Faculty of Medicine, Montreal, Quebec; 2The Royal College of Surgeons in Ireland, Faculty of Medicine, Dublin, Ireland;
3University of Toronto, Department of Dermatology, Toronto, Ontario.


Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy. It is seen most frequently in those over 60 years old and in Caucasian males. It usually presents as an asymptomatic rapidly growing violatious nodule on a sun exposed area. The mainstay of treatment is surgical by standard wide local excision or MOHs chemosurgery. Radiation is added frequently for local control. The only factor significantly associated with overall survival is the stage of disease at presentation. This stresses the importance of early diagnosis and treatment.
Key Words: Merkel cell carcinoma, wide local excision, MOHs chemosurgery, adjuvant radiotherapy, review, case.

Jordan Isenberg,1 Tessa Weinberg,2 Nowell Solish,3
1McGill University, Faculty of Medicine, Montreal, Quebec; 2The Royal College of Surgeons in Ireland, Faculty of Medicine, Dublin, Ireland;
3University of Toronto, Department of Dermatology, Toronto, Ontario.


Abstract
July 9, 2014

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Mammary Paget disease (PD) is a less common form of breast cancer which involves the nipple-areola complex and occurs almost exclusively in females. Erythema, skin thickening, pruritus, burning sensation, inversion of the nipple, ulceration, serosanguineous nipple discharge are common clinical symptoms. Approximately 1-4% of female breast carcinoma are associated with PD of the nipple-areola complex. A biopsy including the dermal and subcutaneous tissue should be performed on all suspicious lesions of the nipple-areola complex for accurate diagnosis. The first line treatment of mammary PD is mastectomy (radical or modified) and lymph node clearance for patients with a palpable mass and underlying invasive breast carcinoma. The prognosis of mammary PD is determined by the disease stage and is similar to that of other types of breast cancer.
Key Words: Mammary Paget disease, breast cancer, nipple-areola complex, metastasis.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

April 15, 2014

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Herpes simplex viruses (HSVs) are DNA viruses that present as vesicles in clusters on an erythematous base. Infection occurs when close contact between an individual without antibodies against the virus and a person shedding the virus takes place. Most HSV infections are self-limited. Lesions tend to reappear at or near the same location of the initial site of infection. Systemic symptoms such as fever, malaise and acute toxicity may appear, especially in primary infection. A viral culture from the skin vesicles can identify up to 80 to 90% of untreated infection early in the course. Antiviral treatments aim at shortening the disease course and preventing viral dissemination and transmission. Treatments are most effective when they are administered at the first sign of symptom onset.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

March 31, 2014

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Tinea incognito is a superficial dermatophyte infection in which the clinical appearance of the symptoms has been altered by inappropriate treatments, such as topical corticosteroids.
Dermatophyte infection may result from contact with infected humans, animals, or inanimate objects. An erythematous, pruritic, annular and scaly plaque is characteristic of a symptomatic infection. A potassium hydroxide (KOH) examination of skin scrapings is usually diagnostic. If topical corticosteroids have been applied recently, the amount of surface scales may be reduced and may lead to false negative results. Topical therapy is the first line treatment for localized infections. Systemic antifungals should be used in extensive condition, immunosuppression, resistance to topical antifungal therapy.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

February 4, 2014

Shannon Humphrey, MD, FRCPC, FAAD, Clinical Assistant Professor, Director of Continuing Medical Education, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

Abstract
The pathogenesis of acne is tied to Propionibacterium acnes (P. acnes), an anaerobic bacteria. There has been a dramatic rise in resistance to antibiotics that are usually prescribed to treat acne. Given resistance to antibiotic therapy can occur in more pathogenic bacteria than P. acnes, and the fact that a rise in pathogenic P. acnes has been reported, the development of antibiotic resistance in acne is a public health matter globally. Clinical practice guidelines are aiming to curb the further development of antibiotic resistance without detracting from effective management of both inflammatory and non-inflammatory acne.
Key Words: acne vulgaris, antibiotic resistance, benzoyl peroxide, anti-inflammatory, sub-antimicrobial dosing.

Shannon Humphrey, MD, FRCPC, FAAD, Clinical Assistant Professor, Director of Continuing Medical Education, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

November 24, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Hairy tongue, or known as lingua villosa, is a result of hypertrophy, elongation, and defective desquamation of the filiform papillae of the tongue. This condition may present in a variety of colors depending on the specific etiology. Etiologies of hairy tongue include poor oral hygiene, lack of mechanical stimulation and debridement of the tongue, the use of medications (especially broad-spectrum antibiotics), and therapeutic radiation of the head and the neck. This condition is also commonly seen in people having high consumption in coffee and tea, heavy use of tobacco, individuals addicted to drugs, patients who are HIV positive, and intravenous drug users. In most cases, non-pharmacologic interventions are used for the management of hairy tongue. Treatment involves brushing the tongue with a toothbrush or using a commercially available tongue scraper to retard the growth or to remove elongated filiform papillae. If Candida albicans is present, topical antifungal medications are used for patients who are symptomatic.
Key Words:
Hairy tongue, Lingua villosa, Glossopyrosis, Halitosis.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

September 27, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Green nail syndrome is a paronychia caused by Pseudomonas aeruginosa. The affected toenail may show discoloration that ranges from greenish-yellow, greenish-brown, and greenish-black. Differential diagnosis includes other conditions causing nail plate discolouration such as subungual hematoma, malignant melanoma or infections by other pathogens including Aspergillus, Candida, and Proteus. Gram stain and culture of the subungual scrapings confirm the diagnosis of suspected pseudomonas aeruginoa infection. Topical antibiotics, such as bacitracin, silver sulfadiazine, or gentamicin, applied 2 to 4 times daily will treat most patients within 1 to 4 months. Oral ciprofloxacin for 2 to 3 weeks has been successful in treating patents who fail topical therapies.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

August 22, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Erythema ab igne (EAI) is a localized hypermelanosis with erythema in a reticulated pattern. It is triggered from repeated exposure to heat and infrared radiation. Actinic keratosis, squamous cell carcinoma, and Merkel cell carcinoma have been reported in patients after chronic exposure to infrared radiation. EAI is diagnosed based on clinical symptoms. If the diagnosis is uncertain, a skin biopsy may be performed. Early in the disease process, elimination of the heat source may lead to complete resolution of the symptoms.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

July 18, 2013

What is acne?
Human skin is covered in hundreds of thousands of microscopic hair follicles, called pores. These are particularly prominent on the face, neck, back, and chest. These pores are connected to oil glands under the skin that make a substance called sebum. Sometimes these follicles produce too many cells and become blocked. As a result, sebum (oil) gets trapped and bacteria (P. acnes) begin to grow.1,2,4
Acne is the most common skin condition.1,4

What is acne?
Human skin is covered in hundreds of thousands of microscopic hair follicles, called pores. These are particularly prominent on the face, neck, back, and chest. These pores are connected to oil glands under the skin that make a substance called sebum. Sometimes these follicles produce too many cells and become blocked. As a result, sebum (oil) gets trapped and bacteria (P. acnes) begin to grow.1,2,4
Acne is the most common skin condition.1,4

July 17, 2013

Caring for your skin

  • Cleanse your skin gently. Do not scrub – this can aggravate acne.1
  • Wash your skin twice a day with a mild cleanser and water. More frequent washing will not improve your acne, and it might irritate your skin and make the acne worse.2
  • Don’t squeeze or pick at your pimples. Squeezing forces infected material deeper into the skin, making the inflammation worse and possibly leading to scarring.1,2
  • Shave carefully and lightly.1
  • Use oil-free makeup (only makeup that states that it is “non-comedogenic”).1,2
  • Wash your makeup brushes with antimicrobial soap.3
  • Shampoo every day if you have oily hair.1
  • Wash your pillowcase and sheets frequently so that they are not depositing oil and dirt back onto your clean skin.3

Caring for your skin

July 17, 2013

What is acne?

  • Human skin is covered in hundreds of thousands of microscopic hair follicles, called pores. These are particularly prominent on the face, neck, back, and chest. These pores are connected to oil glands under the skin that make a substance called sebum. Sometimes these follicles produce too many cells and become blocked. As a result, sebum (oil) gets trapped and bacteria (P. acnes) begin to grow.1,2,4

What causes acne?

  • Why people get acne is unknown. However, there are some contributing factors: increases or changes in hormones (for example, during adolescence or pregnancy), heredity, some medications, and greasy makeup.1

What is acne?

July 17, 2013
  • Treatment for acne has several goals: to heal pimples, to prevent pimples (by decreasing sebum production, killing bacteria, and normalizing skin shedding), and to prevent scarring.1,6
  • Over-the-counter (OTC) or prescription drugs may be used.
  • Some drugs are topical (on the skin) treatments. Examples include salicylic acid and benzoyl peroxide and, to a lesser extent, antibiotics (erythromycin, clindamycin), retinoids (tretinoin, adapalene, tazarotene), and anti-inflammatories.3,6
  • Other drugs, such as some antibiotics (tetracycline, minocycline) and isotretinoin (a retinoid), are taken in pill form.3,6
  • For some women, oral contraceptives are effective at controlling acne.3,6
  • Chemical peels and laser treatments have also shown some effectiveness.3
  • For more severe forms of acne, isotretinoin and/or oral steroids are often prescribed.2
  • Treatment for acne has several goals: to heal pimples, to prevent pimples (by decreasing sebum production, killing bacteria, and normalizing skin shedding), and to prevent scarring.1,6
  • Over-the-counter (OTC) or prescription drugs may be used.
  • Some drugs are topical (on the skin) treatments.
July 15, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Kaposi varicelliform eruption (KVE) is an infection of a dermatosis by pathogens such as herpes simplex virus (HSV) type 1, HSV-2, coxsackievirus A16, or vaccinia virus. KVE begins as a sudden eruption of painful and crusted or hemorrhagic vesicles, pustules, or erosions in areas of a preexisting dermatosis. Transmission occurs through contact with an infected individual or by dissemination of primary or recurrent herpes. Viral cultures of fresh vesicular fluid or direct observation of infected cells scraped from ulcerated lesions by direct fluorescent antibody staining are the most reliable diagnostic tests for KVE. Antivirals, such as acyclovir and valacyclovir, are used in the treatment of KVE.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

July 15, 2013

Caroline Weisser, BHSc, Faculty of Medicine University of Ottawa, Ottawa, Ontario.
Joseph M Lam MD, Clinical Assistant Professor, Departments of Paediatrics and Dermatology, University of British Columbia, Vancouver, BC.

Abstract
Infantile hemangiomas (IH) are the most common tumor of infancy and have been estimated to occur in 4% of infants. While IH are typically absent at birth, they become noticeable within the first few weeks of life. Approximately one third of IH present shortly after birth, another third present in the first month and the remainder develop within the first six months of life.
Key words: infantile hemangiomas, tumor, lesions, vascular patches.

Caroline Weisser, BHSc, Faculty of Medicine University of Ottawa, Ottawa, Ontario.
Joseph M Lam MD, Clinical Assistant Professor, Departments of Paediatrics and Dermatology, University of British Columbia, Vancouver, BC.

June 11, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Basal cell carcinoma (BCC) is a type of non-melanoma skin cancer that arises from basal cells found in the lower layer of the epidermis. It is the most common type of skin cancer in humans, but they rarely metastasize. If BCC is left untreated and progresses, it may lead to significant morbidity and cosmetic disgurement. In nearly all cases, the recommended treatment modality for BCC is surgery. Small and superficial BCC may respond to local immune-modulating therapies. For tumors that are more difficult to treat or those in which tissue preservation is essential, Mohs micrographic surgery should be considered. Radiation therapy can be used for advanced and extended BCC and in those patients for whom surgery is contraindicated. Photodynamic therapy is usually used as an adjunct in BCCs with poorly defined border, in cases which oculoplastic surgery will be extensive or difficult, or in recurrent BCCs with tissue atrophy or scar formation. Oral vismodegib has been approved for the treatment of adult patients with locally advanced basal cell carcinoma who are not candidates for surgery or radiation and for those with metastatic disease. The prognosis for BCC is generally great with 100% survival rate for localized cases.
Keywords: Basal cell carcinoma, Nonmelanoma skin cancer, Hedgehog intracellular signalling pathway, Imiquimod 5% cream, 5-Fluorouracil 5% cream.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

June 11, 2013

Fatemeh Akbarian, MD,1 Mehdi Aarabi, MD,2 Ali Vahidirad, MD,3 Mehrdad Ghobadi, MD,4 Mohaddeseh Ghelichli MD,5
Mohammad A. Shafiee, MD, MSc, FRCPC,6

1Dermatologist, Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. 2Research Fellow, Department of Medicine, University of Toronto, Toronto, ON. 3,4,5Joint, Bone, Connective Tissue Research Center, Golestan University of Medical Sciences, Iran. 6Division of General Internal Medicine, Assistant Professor, Department of Medicine, University of Toronto, Toronto, ON.

Abstract
Cutaneous Malignant Melanoma has the highest morbidity and mortality among different types of skin cancers; as one of the most common malignancies in the world. Early detection and diagnosis of Cutaneous Malignant Melanoma followed by adequate surgical excision are the most important tasks in management of this potentially curable skin cancer. Screening methods and diagnostic criteria including clinical and dermoscopic findings will be discussed in this article.
Keywords: Melanoma, Dermoscopy, UV Exposure, Epiluminescence Microscopy (ELM).

Fatemeh Akbarian, MD,1 Mehdi Aarabi, MD,2 Ali Vahidirad, MD,3 Mehrdad Ghobadi, MD,4 Mohaddeseh Ghelichli MD,5
Mohammad A. Shafiee, MD, MSc, FRCPC,6

January 31, 2013

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Impetigo is a gram-positive bacterial infection of the superficial layers of the epidermis. There are two forms of impetigo: bullous and nonbullous. Diagnosis of impetigo is usually based solely on the history and clinical presentation. Culture and sensitivity results can help the physician choose appropriate antibiotic therapy. Treatment of impetigo typically involves local wound care, along with antibiotic therapy, either topical alone or in conjunction with systemic therapy. For mild or localized cases, topical mupirocin or topical fusidic acid applied 2 to 3 times daily for 7 to 10 days are adequate treatment. Systemic antibiotics are indicated for widespread, complicated, or severe cases associated with systemic manifestations of impetigo. Beta-lactam antibiotics remain an appropriate initial empiric choice, with coverage against both Staphylococcus aureus and Streptococcus pyogenes. For patients with recurrent impetigo or Staphylococcus aureus nasal carriers, topical mupirocin cream or ointment can be applied inside the nostrils 3 times daily for 5 days each month to reduce colonization in the nose.
Keywords: Impetigo, Staphylococcus aureus, Group A beta hemolytic streptococci Bullous impetigo, Nonbullous impetigo.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

November 20, 2012

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Periorificial dermatitis is a common eczematous eruption on the face. Clusters of follicular papules, vesicles, and pustules on an erythematous base are usually found in a perioral distribution. Other common locations include the nasolabial folds and periocular area. An underlying cause may not be found in all cases, but the use of topical corticosteroids on the face may precede onset of symptoms. Periorificial dermatitis is diagnosed clinically and no specific investigation is required. Topical anti-inflammatory therapies (such as metronidazole and erythromycin) are appropriate in mild cases. In severe cases, systemic treatments such as tetracycline or one of its derivatives are beneficial. Patients should be warned that symptoms might worsen before improvement is apparent. This complication is more commonly seen when topical corticosteroids are withdrawn.
Keywords: periorificial dermatitis, perioral dermatitis, facial rash, steroid-induced.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

October 31, 2012

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Juvenile spring eruption is a photodermatosis that is considered a localized variant of polymorphic light eruption. This condition appears on the light exposed areas of the ears and is primarily found in boys and young males in early spring or summer. The exact pathogenesis of juvenile spring eruption is not clear. The symptoms usually clear within 2 weeks, but recurrences are common under similar climatic conditions. The diagnosis of juvenile spring eruption is made clinically and investigations are not required. Treatments include avoidance of sun exposure, emollients, potent topical corticosteroids, and antihistamines.
Keywords: juvenile spring eruption, photodermatosis, polymorphic light eruption, spring, ears.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

October 31, 2012

Katia Faustini, Faculty of Medicine, McGill University, Montreal, Quebec.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia.


Abstract
Atopic dermatitis is the most common inflammatory skin condition affecting children. Given the complex waxing and waning nature of this common dermatologic condition, patient education and frequent family physician involvement, is the key to proper long term management. While topical steroids have long been accepted as the standard therapy in management of eczema, concern over its side effects by both family doctors and patients greatly impact compliance. Topical steroids are safe and efficacious if used properly. This article examines the top ten things to know about atopic dermatitis in order to properly and safely manage this chronic disease.
Keywords: atopic dermatitis, inflammatory skin condition, topical corticosteroids.

Katia Faustini, Faculty of Medicine, McGill University, Montreal, Quebec.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia.

August 28, 2012

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Cutaneous larva migrans is a parasitic infection caused by percutaneous penetration and subsequent migration of the larvae of hookworm. The tracks are commonly raised, erythematous, serpiginous, and pruritic. Cutaneous larva migrans is diagnosed based on its clinical characteristics. It is a self-limiting condition because larvae eventually die in humans without being able to infest new hosts. Treatment is used to shorten the disease course, control the intense pruritus, and prevent the risk of secondary infection. Topical thiabendazole is the treatment of choice for mild and localized condition. Systemic treatment such as albendazole, mebendazole, and ivermectin are used in widespread cases or cases recalcitrant to topical treatment.
Keywords: cutaneous larva migrans, parasitic infection, hookworm, Ancylostoma braziliense, thiabendazole.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

July 19, 2012

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Granuloma annulare (GA) is a benign and usually self-limited cutaneous condition that classically presents as arciform to annular plaques in a symmetrical and acral distribution. The exact etiology of GA is unknown. Two-thirds of patients with GA are less than 30 years old. GA is recognized based on its characteristic appearance and no specific investigation is necessary. Reassurance and clinical observation may be the treatment of choice for localized and asymptomatic disease. Spontaneous resolution occurs within 2 years in 50% of cases. Persistent lesions may be treated with very potent topical corticosteroids, intralesional corticosteroid injections, or cryotherapy. Use of more toxic treatments are controversial in recalcitrant cases.
Keywords: Granuloma annulare, Overview, Paraneoplastic, Self-limiting, Treatment.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.