Family Medicine

Help – the steroids are not working – Helping women with refractory vulvar lichen sclerosus

Help – the steroids are not working – Helping women with refractory vulvar lichen sclerosus

Lichen sclerosus (LS) is a chronic skin disorder with a remitting and relapsing clinical course. Women commonly present with severe vulvar itch and an urge to scratch the skin. The recommended treatment is a course of topical steroids. Most women will improve with treatment. However, some will report, “the steroids did not help”. Here are some practice tips to help.

Pearls and Pitfalls of Rheumatologic Lab Investigations

Pearls and Pitfalls of Rheumatologic Lab Investigations

Patients who present with non-specific symptoms are sometimes tested with rheumatologic lab investigations as part of a ‘panel’ of tests. When these tests come back positive, it can lead to more confusion, patient anxiety, misdiagnosis or unnecessary referral.

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

Over the last five years, on an ongoing basis, we have seen new HIV infections occurring in young gay, bisexual and other men who have sex with men (MSM). The majority of these individuals had had a prior negative HIV test within the last year, or were presenting with signs or symptoms supportive of an acute HIV infection, suggesting recent exposure and transmission of HIV infection, highlighting the need for novel HIV prevention strategies.

Whether or not to use systemic corticosteroids to treat a skin disease

Whether or not to use systemic corticosteroids to treat a skin disease

When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis (ACD), atopic dermatitis (AD), drug reactions and those with bullous diseases. Corticosteroids are potent and excellent immunosuppressive agents. The main problem with systemic use is the high risk of drug interactions, as well as multiple serious acute and long-term side effects.