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Dermatology

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Discolouration of the Tongue

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, Hairy tongue, Lingua villosa, Glossopyrosis, Halitosis

A Strange Looking Toenail

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, green nail syndrome, paronychia, pseudomonas aeruginosa

Something is Wrong with Her Back

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, laser, squamous cell carcinoma, erythema ab igne, infrared radiation, Merkel cell carcinoma

About Acne

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

Related Terms: Acne Vulgaris, Dermatology, acne

Quick Facts/Frequently Asked Questions

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.
Related Terms: Dermatology, acne

Treatment Options

MEDICATIONS FOR ACNE

  • 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.
Related Terms: Dermatology, acne

Living with Acne

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.
Related Terms: Acne Vulgaris, Dermatology, acne

An Unusual Facial Rash

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, Kaposi varicelliform eruption, eczema herpeticum, herpes simplex virus, atopic dermatitis, antivirals

Infantile Hemangiomas: What They Are, When To Worry And What To Do

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, infantile hemangiomas, lesions, vascular patches, tumor

A Non-Healing Facial Lesion

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

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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.

Related Terms: Dermatology, basal cell carcinoma, nonmelanoma skin cancer, Hedgehog intracellular signalling pathway, Imiquimod 5% cream, 5-Fluorouracil 5% cream
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