Clinics in dermatology
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Conflicts of interest (COIs) exist when someone who has a fiduciary responsibility for another's welfare acts, or has the potential to act, in a manner inconsistent with their charge's best interests. COIs exist in all professions as well as in public service; however, in medicine, COIs pose a unique problem, given the responsibilities and special status that society grants to physicians. ⋯ I define the term "conflicts of interest" and review its ethical basis, offer common examples of COIs, discuss the importance of disclosure, and suggest ways beyond disclosure to minimize or limit COIs in the various settings in which physicians work. Ideally, physicians should try to avoid COIs, but when situations arise where physicians have COIs, how they manage them will depend on a combination of physicians' personal conscience and professional ethics, professional society ethics codes, and governmental regulation.
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Clinics in dermatology · Jan 2012
ReviewInherited epidermolysis bullosa: new diagnostic criteria and classification.
Epidermolysis bullosa (EB) is a group of inherited, mechanobullous disorders caused by mutations in various structural proteins in the skin. There have been several advances in the classification of EB since it was first introduced in the late 19th century. We now recognize four major types of EB, depending on the location of the target proteins and level of the blisters: EB simplex (epidermolytic), junctional EB (lucidolytic), dystrophic EB (dermolytic), and Kindler syndrome (mixed levels of blistering). ⋯ We have also included new subtypes, such as autosomal dominant junctional EB and autosomal recessive EB due to mutations in the dystonin (DST) gene, which encodes the epithelial isoform of bullouspemphigoid antigen 1. The main laboratory diagnostic techniques-immunofluorescence mapping, transmission electron microscopy, and mutation analysis-will also be discussed. Finally, the clinical characteristics of the different major EB types and subtypes will be reviewed.
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Autoimmune blistering diseases are a significant cause of morbidity and mortality in the elderly population. Given the advancing age of the population, the incidence of these disorders, particularly bullous pemphigoid, is expected to rise. This contribution reviews autoimmune immunobullous disorders of particular relevance in the elderly population. ⋯ Elucidation of antigenic targets at the molecular level has allowed for development of serum enzyme-linked immunofluorescence assays, which have enhanced diagnostic accuracy for several autoimmune blistering disorders. Given the relative rarity of these diseases, large randomized trials evaluating efficacy of various treatments are few, and therapy for most immunobullous disorders in the elderly has not been standardized. Despite this, appropriate therapeutic considerations for each condition are presented and the evidence for them is reviewed.
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Clinics in dermatology · Jan 2010
ReviewA new era in the management of psoriasis? The biologics: facts and controversies.
During the last 30 years, the tremendous progress in our knowledge of the pathogenesis of psoriasis has led to the development of new agents, the so-called biologics, that have revolutionized the management of severe psoriasis. Dermatologists and patients see this emerging therapy as a new perspective in the state of the art in managing moderate to severe psoriasis. After a few years of use in daily practice, we may begin to analyze the power of the currently available biologic agents in the management of severe psoriasis from the perspective of facts.
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Clinics in dermatology · Sep 2008
ReviewPsoriasis treatment in difficult locations: scalp, nails, and intertriginous areas.
Psoriasis comprises a broad spectrum of different clinical courses among which the chronic stable psoriasis by far occurs most frequently. The clinical presentation ranges from mild disease to more serious forms involving large areas of skin and/or joint disease. A number of modifying factors may impact on treatment choice in individual cases (eg, location of the lesions, disease phase, treatment history, response to previous treatments, comorbidity). ⋯ Finally, the usefulness of corticosteroids, vitamin D and analogues, and calcineurin inhibitors in treating intertriginous psoriasis clearly is demonstrated. Especially the use of calcineurin inhibitors exhibits efficacy in intertriginous regions and therefore may be seen as a promising treatment option in the future. Besides the important innovations in the last years, there is a need for new effective and well-tolerated treatment modalities, especially for long-term use in the 3 difficult-to-treat locations, which encompass cosmetic acceptability.