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pathogenesis

Clearing Up Acne Treatment for the Primary Care Physician

Teaser: 

Darcy Russell,1 Joseph M. Lam, MD, FRCPC,2

1Medical Undergraduate Program, University of British Columbia, Vancouver, BC.
2Clinical Assistant Professor, Department of Pediatrics and Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: Acne vulgaris is a common skin condition encountered in family practice and can cause significant distress during adolescence. Treatment options discussed include topical benzyl peroxide, topical retinoids, oral and topical antibiotics, hormonal therapy, and isotretinoin. The following review article provides up-to-date recommendations for treating mild to severe pediatric acne.
Key Words: acne vulgaris, adolescence, treatment, pathogenesis.
The differential diagnosis for acne in adolescence includes corticosteroid induced acne, folliculitis, keratosis pilaris, papular sarcoidosis, perioral dermatitis, pseudofolliculitis barbae, and tinea faceie.
Acne may be classified as mild, moderate or severe based on the number and type of lesions involved as well as the total surface area involved.
Acne therapy is targeted at treating as many pathogenic factors as possible.
Topical fixed-dose combination therapies can be used for all types and severities of acne in children 9 years of age and older.
Both topical and oral antibiotics work by inhibiting P acnes protein synthesis and decreasing inflammation.
Do not be afraid of isotretinoin. It can be used first line in patients with severe nodular and/or inflammatory acne, acne conglobata, and recalcitrant acne.12 It is the only treatment that targets all four pathogenic factors implicated in acne vulgaris and can permanently decrease acne.
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Osteoarthritis: Understanding Pathogenesis May Lead to Innovative Treatment

Osteoarthritis: Understanding Pathogenesis May Lead to Innovative Treatment

Teaser: 

Jerry Tenenbaum, MD, FRCPC
Rheumatologist,
Mount Sinai Hospital and
Baycrest Centre for Geriatric Care,
Associate Professor,
University of Toronto,
Toronto, ON.


Introduction
Osteoarthritis (OA) is a chronic disease of the joint that results in degeneration of the cartilage and bone. However, in osteoarthritis, it is not uncommon to see intermittent or even chronic evidence of inflammation in the affected joint. Patients may experience stiffness after immobility (in the morning or after sitting for a long time), warmth and erythema of the joint, and soft tissue swelling and/or synovial effusion. On history taking and physical exam, these findings attest to the inflammatory nature of the involved osteoarthritic joint at the time. A microscopic examination of the synovium of patients with osteoarthritis will often show the presence of inflammation. Though cartilage and bone seem to be the primary targets of damage, it is likely that inflammation within the synovium may play an important role in the progressive damage to these joint tissues. Primary involvement of synovium may occur in some patients and secondary synovitis is commonly seen. This is associated with the intermittent or chronic presence of crystals (calcium pyrophosphate dihydrate, hydroxyapatite) or synovitis associated with stimulation by joint damage debris.