While suspected for some time, a study now confirms that people taking the acne drug isotretinoin appear to run an increased risk of developing inflammatory bowel disease, US researchers report.

Inflammatory bowel disease, or IBD, includes Crohn's disease and a similar condition called ulcerative colitis. Isotretinoin, more familiarly known by the brand name Accutane, was first approved for acne in the US in 1982, and numerous cases have surfaced linking the drug to IBD. Until now, a systematic review of the association had not been conducted.

Dr. Corey A. Siegel, from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues reviewed all reports of isotretinoin-associated IBD that were filed with the US Food and Drug Administration via the MedWatch system, which began in 1996.

The authors explain in the American Journal of Gastroenterology that they used a standard adverse drug reaction probability scale to grade the likelihood that a particular IBD case was, in fact, caused by isotretinoin use.

Between 1997 and 2002, a total of 85 isotretinoin-related cases of IBD were reported. In just four cases, isotretinoin was graded as a "highly probable" cause of the IBD, while in 58 cases it was deemed a "probable" cause, and in 23 cases it was seen as a "possible" cause. The link between isotretinoin use and IBD was never graded as "doubtful."

"Physicians and patients should be made aware of this possible association and it should be included in the already extensive consent process required before isotretinoin is prescribed," the investigators write.

The consent process covers the high risk of birth defects if a woman becomes pregnant while taking isotretinoin.

Should someone with severe acne take isotretinoin? "We do not think that this should prohibit the use of isotretinoin," Siegel and colleagues advise. However, "careful consideration should be made" for people with a prior personal history or family history of inflammatory bowel disease, or who have symptoms suggesting the possibility of IBD.

Following are the top 10 causes of contact dermatitis recently identified by Mayo Clinic physicians:

Nickel, commonly found on jewelry clasps or buttons.

Gold, usually worn as jewelry.

Balsam of Peru, a fragrance used in skin care products and perfume.

Thimerosal, a preservative used in vaccines.

Neomycin sulfate, a topical antibiotic.

Fragrance mix, which is comprised of eight of the most common flavorings found in various products.

Formaldehyde, a preservative that can be found in paper products, paints, building materials, medications, household cleaners and fabric finishes.

Cobalt chloride, a metal found in medical products, hair dye, antiperspirants, and in snaps, buttons and tools.

Bacitracin, a topical antibiotic.

Quaternium-15, a preservative found in skin care products and in industrial products such as pains, polishes and waxes.

abcd's of skin cancer

The Harvard Health Letter offers this alphabetical memory tool:

* Assymetry: One half of a mole doesn't match the other half.

* Border irregularity: Mole edges are ragged, notched or indistinct.

* Color: Mole pigmentation is uneven.

* Diameter: Mole is larger than a pencil eraser or shows a sudden or progressive increase in size.

Subantimicrobial Doxycycline Tablets Effective Against Moderate Acne

A DGReview of :"Effects of Subantimicrobial-Dose Doxycycline in the Treatment of Moderate Acne"

Archives of Dermatology

05/02/2003

By David Loshak

Oral subantimicrobial doxycycline, twice daily, significantly reduces the number of both inflammatory and non-inflammatory lesions in patients with moderate facial acne.

The treatment is well tolerated, report specialists from the University of Florida, Gainesville; West Virginia University, Morgantown; Princeton University, New Jersey; University of Pennsylvania, Philadelphia and CollaGenex Pharmaceuticals Inc., Newtown, Pennsylvania. Their research disclosed no detectable anti-microbial effect on the skin flora, nor was there any rise in the number or severity of resistant organisms.

The researchers studied 40 adults with moderate facial acne over 6 months in a double-blind, parallel-group trial at 2 university-based clinics. The patients were randomised to receive either sub-antimicrobial doses of doxycycline or placebo twice daily.

The aim of the study was to see if the doxycycline, compared to placebo, had any detectable effect on skin flora, led to overgrowth or colonisation of skin by opportunistic pathogens, or resulted in an increase in antibiotic resistance by the surface skin microflora.

At 6 months, the doxycycline recipients had a significantly greater percentage reduction in the number of comedones, inflammatory and non-inflammatory lesions combined and total inflammatory lesions. They also had significantly greater improvement according to the clinician's global assessment.

There were no significant differences in microbial counts between the two groups. Nor was there any evidence of change in antibiotic susceptibility or colonisation by potential pathogens.

Archives of Dermatology 2003;139:4:459-464. "Effects of Subantimicrobial-Dose Doxycycline in the Treatment of Moderate Acne"

Recommended Laboratory Monitoring for Patients Using Isotretinoin

Test	Frequency	Comments
Qualitative hCG (urine pregnancy tests are adequate if they meet the required sensitivity of 50 IU per L)*	One week before starting treatment, then monthly* Monthly pregnancy tests may be replaced by detailed questioning about contraceptive use, menses, etc., at monthly visits	Two forms of birth control (e.g., oral contraceptive plus barrier method) required; isotretinoin treatment should begin on the second or third day after the onset of a normal menstrual period; pregnancy should not be attempted until one month after discontinuation of therapy.*
Lipid levels*	Before starting treatment, then at weekly or biweekly intervals until the lipid response to isotretinoin is established, usually by four weeks*	Measure fasting triglyceride levels; if level rises to 350 mg per dL (3.95 mmol per L), repeat in two weeks. Isotretinoin therapy should be discontinued if levels exceed 700 mg per dL (7.9 mmol per L).
Liver function tests*	Before starting treatment, then at weekly or biweekly intervals until weekly or biweekly isotretinoin is established*	If elevations appear, reduce the dosage by 50 percent or interrupt treatment.

hCG = human chorionic gonadotropin.

*--Official U.S. Food and Drug Administration labeling requirements.

Lice

There are three varieties of lice; head, body and pubic lice. In order for lice to survive, they must feed on blood within 24 hours. The adult female lays eggs (nits) which are attached to individuals hairs. The young emerge seven to ten days later. Under favorable conditions, the louse will reach maturity in aproximately two weeks. The adult female lives 20 to 30 days and is capable of laying 50 eggs during that time.

Pubic Lice (Crabs)

Although more commonly found in the pubic hair, these crabs may also be located in the underarm area, on the chest, eyelashes and even mustaches.

Pubic lice are often the size and color of small freckles. When severe itching occurs in the genital area, investigate the possibility of crabs.

The diagnosis can be made by finding lice or nits on the hairs.

Body and Head Lice

These two species of lice live on hairs located on the body and head. The nits, or eggs, are deposited by the female at the base of the hairs.

Transmission

Crab lice are most frequently spread by sexual contact, however, transmission through infested clothing and contaminated toilet seats is possible yet infrequent.

Body and head lice are spread by:

Direct contact with an infested person or stray hairs that have nits.

Personal items-combs, brushes and hair care items as well as towels and pillow cases.

Clothing may also spread body and head lice (hats, ribbons and other head coverings included.)

Treatment

Treatment for pubic, body and head lice includes topical application of Nix (permethrin), A200 Pyrinate (pyrethrins), or Kwell (lindane 1%). Nix and A200 are available without a prescription. Simultaneous treatment of sexual partner(s), household members, clothing and living quarters is recommended.

Clean all articles that have been worn in the last two weeks. Adult lice will die after 24 hours without human contact and any eggs left by the female lice will hatch within two weeks. It is important to watch for later infestation.

Disinfect combs, brushes and similar items by washing with the medicated shampoo.

Items which cannot be washed or dry cleaned, i.e. furniture, can be isolated for two weeks or sealed in an airtight plastic bag.

Scabies

Commonly called the "itch mite," scabies is caused by a tiny organism named Scaroptes scabies. The pregnant female mite burrows under the skin and deposits her eggs. The intense itching is believed to be caused by the development of an allergic reaction to the waste material of the burrowing, feeding and egg-laying female mites.

The most common symptoms of scabies is severe itching, especially at night. The usual sites of the lesions which result from the burrows are the spaces between the fingers, back of hands, elbows, armpits, groin, breasts, penis, small of back and the buttocks. Diagnosis includes skin scrapings and microscopic identification.

Transmission

Scabies is not an indication of bad hygiene, nor nutritional deficiency. It is usually transmitted through close contact with another person who is infested or with clothing, bed linens or towels contaminated with itch mites. Family members, schoolmates, teammates, roommates and sexual partner(s) are likely candidates for infection and simultaneous treatment.

Treatment

Currently the most effective treatments are Elimite (permethrin) or Kwell (lindane, 1%). Itching may take several days or even weeks to resolve completely after effective treatment. Any soothing lotion may also be used. Additionally, clothing or bed linens used in the past two weeks should be washed and/or dried using a hot cycle, or dry cleaned. Simultaneous treatment of household members, sexual partner(s) and clothing is recommended.

directions for using lindane:

WARNING :

AVOID USING OIL TREATMENTS, OIL BASED |"HAIR DRESSINGS OR CONDITIONERS IMMEDIATELY BEFORE AND AFTER APPLYING |"LINDANE SHAMPOO.

(SHAKE WELL)

BEFORE APPLYING |"LINDANE SHAMPOO,

USE REGULAR SHAMPOO (WITHOUT CONDITIONERS),

RINSE AND COMPLETELY DRY |"HAIR.

USE

1----OUNCE FOR SHORT HAIR;

1.5--OUNCES FOR MEDIUM LENGTH HAIR;

2--- OUNCES | FOR LONG "HAIR.

APPLY SHAMPOO DIRECTLY TO DRY |"HAIR WITHOUT ADDING |"WATER

WORK THOROUGHLY INTO THE |"HAIR

ALLOW TO REMAIN IN PLACE FOR 4 MINUTES ONLY.

AFTER THE 4 MINUTES, ADD SMALL QUANTITIES OF WATER TO HAIR UNTIL A GOOD LATHER FORMS.

IMMEDIATELY RINSE ALL LATHER AWAY.

AVOID UNNECESSARY |"CONTACT OF LATHER WITH OTHER |"BODY SURFACES.

TOWEL BRISKLY AND REMOVE NITS WITH NIT COMB OR |"TWEEZERS.

RE-TREATMENT IS USUALLY NOT NECESSARY, BUT PRESENCE OF LIVING |"LICE IN |"HAIR 7 DAYS AFTER |"TREATMENT INDICATES THAT RE-TREATMENT MAY BE NECESSARY. DO NOT RE-TREAT WITHOUT THE ADVICE OF A |"PHYSICIAN.

Fluconazole Oral (floo kon' na zole) Brand name(s): Diflucan Oral

Why is this medication prescribed?

Fluconazole is used to treat pneumonia, meningitis, and fungal infections of the mouth, throat, liver, kidneys, heart, urinary tract, and abdomen. It also has been used to treat vaginal infections and oral thrush in certain patients.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Fluconazole comes as a tablet and liquid to take by mouth. It is usually taken once a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take fluconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the liquid well before each use to mix the medication evenly.

Continue to take fluconazole even if you feel well. Do not stop taking fluconazole without talking to your doctor.

What special precautions should I follow?

Before taking fluconazole,

tell your doctor and pharmacist if you are allergic to fluconazole or any other drugs.

tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially anticoagulants ('blood thinners') such as warfarin (Coumadin), antiviral agents such as zidovudine (Retrovir, AZT), astemizole (Hismanal), asthma medication, cisapride (Propulsid), cyclosporine (Neoral, Sandimmune), didanosine (DDI), hydrochlorothiazide (HCTZ), medications for stomach problems such as cimetidine (Tagamet), oral contraceptives, oral medicine for diabetes, phenytoin (Dilantin), rifabutin (Mycobutin), rifampin (Rifadin, Rimactane), tacrolimus (Prograf), terfenadine (Seldane), and vitamins.

tell your doctor if you have or have ever had kidney or liver disease or a history of alcohol abuse.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking fluconazole, call your doctor.

tell your doctor if you drink alcohol.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Although side effects from fluconazole are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

upset stomach

loss of appetite

altered taste

diarrhea or loose stools

headache

dizziness

fatigue

If you experience any of the following symptoms, call your doctor immediately:

rash

itching

vomiting

yellowing of the skin or eyes

dark urine

pale stools

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Throw away any unused liquid medication after 14 days. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to fluconazole.

Do not let anyone else take your medication. Your prescription is probably not refillable. If you still have symptoms of infection after you finish fluconazole, call your doctor.

Last Revised - 11/01/2001

Thrush

Thrush is the widely used term for a common fungal infection caused by Candida albicans. Usually this takes the form of trivial vaginal or mouth infections, although it can affect the body more widely and seriously on rare occasions.

Symptoms

Vaginal Thrush

This causes itch and a cheesy discharge. The area is often redder than usual. It is often painful too, especially on intercourse, and may be associated with frequency of passing water and burning or pain on passing water. It may, therefore be confused with bladder infections (cystitis). Thrush, however is usually associated with itching, which cystitis is not.

Oral Thrush

This may cause a sore mouth and throat, and as well as redness, it is characterised by white discharge on the surface. Babies, especially those being bottle fed, may suffer from this, as well as adults.

Nappy rash

One cause of a persistent nappy/diaper rash is infection of the area with thrush.

Causes

The cause is a fungus which is found widely in nature (Candida albicans), and indeed, is frequently present in the mouth and motions of people in good health. It seems that it is at periods when the defence mechanisms are down that it actually causes a problem. This can be when physically or mentally "run down", in women either pregnant, or on the oral contraceptive pill, in diabetes and people either on steroids, or whose immune systems are suppressed.

Antibiotics, which deplete the naturally occurring bacteria, which are useful to the body, as well as the invading bacteria which they are being used to treat, may disturb the natural balance of the body and lead to thrush developing.

Thrush is otherwise known as Candidiasis or Moniliasis.

Diagnosis

This can usually be made from the symptoms and the look of the affected area, but may be confirmed by a swab being taken by the nurse or doctor, which is examined at the laboratory.

Treatment

Locally applied creams, pessaries, lozenges or gels, depending on the site affected. The most widely used are the imidazoles although there are other useful preparations. If in doubt consult with your doctor or pharmacist.

Systemically administered preparations. These are costly, but very effective, and usually only require a single dose.

Prevention

Avoid unnecessary antibiotics.

When bottle feeding babies, ensure careful sterilisation of the bottles, including the whole teat.

If taking antibiotics, especially repeated courses, consider taking live yoghurts or preparations containing the same sort of micro-organisms.

Diabetics should attempt to control their blood glucose level as recommended by their doctor.

People using inhaled steroids for asthma should always rinse out their mouths after using their inhalers, and may find that their doctor can recommend a different inhaler device, if they seem to be unduly suffering from thrush.

Some women prone to vaginal thrush find that using cotton underwear and the avoidance of tight clothing help to reduce the risk.

In women with recurrent vaginal thrush, it is often worth their partner using some treatment at the same time as them, as the infection may affect him without symptoms, and be causing reinfection.

Ringworm

Ringworm is a contagious fungus infection that can affect the scalp, the body, the feet (athlete's foot), or the nails.

People can get Ringworm from: 1) direct skin-to-skin contact with an infected person or pet, 2) indirect contact with an object or surface that an infected person or pet has touched, or 3) rarely, by contact with soil.

Ringworm can be treated with fungus-killing medicine.

To prevent Ringworm, 1) make sure all infected persons and pets get appropriate treatment, 2) avoid contact with infected persons and pets, 3) do not share personal items, and 4) keep common-use areas clean.

What is Ringworm?

Ringworm is a contagious fungus infection that can affect the scalp, the body (particularly the groin), the feet, and the nails. Despite its name, it has nothing to do with worms. The name comes from the characteristic red ring that can appear on an infected person's skin. Ringworm is also called Tinea.

What is the infectious agent that causes Ringworm?

Ringworm is caused by several different fungus organisms that all belong to a group called "Dermatophytes." Different Dermatophytes affect different parts of the body and cause the various types of Ringworm:

Ringworm of the scalp

Ringworm of the body

Ringworm of the foot (athlete's foot)

Ringworm of the nails

Where is Ringworm found?

Ringworm is widespread around the world and in the United States. The fungus that causes scalp Ringworm lives in humans and animals. The fungus that causes Ringworm of the body lives in humans, animals, and soil. The fungi that cause Ringworm of the foot and Ringworm of the nails live only in humans.

How do people get Ringworm?

Ringworm is spread by either direct or indirect contact. People can get Ringworm by direct skin-to-skin contact with an infected person or pet. People can also get Ringworm indirectly by contact with objects or surfaces that an infected person or pet has touched, such as hats, combs, brushes, bed linens, stuffed animals, telephones, gym mats, and shower stalls. In rare cases Ringworm can be spread by contact with soil.

What are the signs and symptoms of Ringworm?

Ringworm of the scalp usually begins as a small pimple that becomes larger, leaving scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Yellowish crusty areas sometimes develop.

Ringworm of the body shows up as a flat, round patch anywhere on the skin except for the scalp and feet. The groin is a common area of infection (groin Ringworm). As the rash gradually expands, its center clears to produce a ring. More than one patch might appear, and the patches can overlap. The area is sometimes itchy.

Ringworm of the foot is also called athlete's foot. It appears as a scaling or cracking of the skin, especially between the toes.

Ringworm of the nails causes the affected nails to become thicker, discolored, and brittle, or to become chalky and disintegrate.

How soon after exposure do symptoms appear?

Scalp Ringworm usually appears 10 to 14 days after contact, and Ringworm of the skin 4 to 10 days after contact. The time between exposure and symptoms isnot known for the other types of Ringworm.

How is Ringworm diagnosed?

A health-care provider can diagnose Ringworm by examining the site of infection with special tests.

Who is at risk for Ringworm?

Anyone can get Ringworm. Scalp Ringworm often strikes young children; outbreaks have been recognized in schools, day-care centers, and infant nurseries. School athletes are at risk for scalp Ringworm, Ringworm of the body, and foot Ringworm; there have been outbreaks among high school wrestling teams. Children with young pets are at increased risk for Ringworm of the body.

What is the treatment for Ringworm?

Ringworm can be treated with fungus-killing medicine. The medicine can be in taken in tablet or liquid form by mouth or as a cream applied directly to the affected area.

What complications can result from Ringworm?

Lack of or inadequate treatment can result in an infection that will not clear up.

Is Ringworm an emerging infection?

Although Ringworm is not tracked by health authorities, infections appear to be increasing steadily, especially among pre-school and school-age children. Early recognition and treatment are needed to slow the spread of infection and to prevent re-infection.

How can Ringworm be prevented?

Ringworm is difficult to prevent. The fungus is very common, and it is contagious even before symptoms appear.

Steps to prevent infection include the following:

Educate the public, especially parents, about the risk of Ringworm from infected persons and pets.

Keep common-use areas clean, especially in schools, day-care centers, gyms, and locker rooms. Disinfect sleeping mats and gym mats after each use.

Do not share clothing, towels, hair brushes, or other personal items.

Infected persons should follow these steps to keep the infection from spreading:

Complete treatment as instructed, even after symptoms disappear.

Do not share towels, hats, clothing, or other personal items with others.

Minimize close contact with others until treated.

Make sure the person or animal that was the source of infection gets treated.

This fact sheet is for information only and is not meant to be used for self-diagnosis or as a substitute for consultation with a health-care provider. If you have any questions about the disease described above or think that you might have a fungus infection, consult a health-care provider.

DuoFilm Patch

Convenient medicated-patch system for the removal of common warts.

Indications:

For the concealment and removal of common warts. Common warts can be easily recognized by the rough cauliflower-like appearance of the surface.

Directions:

1. Wash affected area. May soak wart in warm water for 5 minutes.

2. Dry area thoroughly.

3. Apply medicated disc(packet a). If necessary, cut disc to fit wart. Repeat procedure every 48 hours as needed (until wart is removed) for up to 12 weeks.

Note: Self-adhesive comfort cushions (packet b) may be used to conceal medicated disc and wart.

Ingredients:

Active Ingredients: Each patch contains: Salicylic Acid (40%)

Warnings:

For external use only. Do not use this product on irritated skin, on any area that is infected or reddened, if you are a diabetic, or if you have poor blood circulation. If discomfort persists, see your doctor. Do not use on moles, birthmarks, warts with hair growing from them, genital warts, or warts on the face or mucous membranes. Keep this and all drugs out of the reach of children. In case of accidental ingestion, seek professional assistance or contact a poison control center immediately. Not recommended for children under two, except at the advice of a physician.

Sporanox Itraconazole

IMPORTANT WARNING:

Itraconazole can cause heart failure. Tell your doctor if you have or have ever had heart disease. If you experience any of the following side effects, call your doctor immediately: shortness of breath, cough, weakness, excessive tiredness, confusion, swelling of the legs or feet, and weight gain.Do not take cisapride (Propulsid), pimozide (Orap), quinidine (Quinaglute, Quinidex, others), or dofetilide (Tikosyn) while taking itraconazole. Taking these medications together with itraconazole can cause serious irregular hearbeats. Talk to your doctor about the risk of taking itraconazole.

Why is this medication prescribed?

Itraconazole capsules are used to treat fungal infections of the lungs, blood, and toenails. Itraconazole oral solution is used to treat fungal infections of the mouth and throat and suspected fungal infections in patients with fever and signs of infection.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

Itraconazole comes as a capsule and an oral solution to take by mouth. Itraconazole capsules are usually taken with a full meal one to three times a day for at least 3 months. Itraconazole solution is usually taken on an empty stomach Ifonce or twice a day for 1 to 4 weeks or longer. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take itraconazole exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you have achlorhydria (stomach does not produce acid), take itraconazole capsules with a cola beverage.

To take itraconazole oral solution for fungal infections of the mouth or throat, take 10 mL of solution at a time, swish in the mouth for a few seconds and swallow.

Continue to take itraconazole even if you feel well. Do not stop taking itraconazole without talking to your doctor.

What special precautions should I follow?

Before taking itraconazole,

tell your doctor and pharmacist if you are allergic to itraconazole or any other drugs.

in addition to the drugs listed in the IMPORTANT WARNING section, also tell your doctor and pharmacist what other prescription and nonprescription medications you are taking, especially alfentanil (Alfenta), alprazolam (Xanax), anticoagulants ('blood thinners') such as warfarin (Coumadin), buspirone (BuSpar), busulfan (Myleran), calcium channel blockers such as nifedipine (Adalat, Procardia) and nicardipine (Cardene), cholesterol-lowering medications, cisapride (Propulsid), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diazepam (Valium), docetaxel (Taxotere), erythromycin (E.E.S., Erythrocin, E-Mycin), heart medications, HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir), isoniazid (INH), medications for seizures such as carbamazepine (Tegretol) and phenytoin (Dilantin), medications for stomach problems such as cimetidine (Tagamet) or antacids (Mylanta), methylprednisolone (Medrol), midazolam (Versed), nevirapine (Viramune), oral contraceptives, oral medicine for diabetes, quinidine, rifabutin (Mycobutin), rifampin (Rifadin, Rimactane), sirolimus (Rapamune), tacrolimus (Prograf), triazolam (Halcion), trimetrexate (Neutrexin), verapamil (Calan, Covera, Verelan), vinblastine (Velban), vincristine (Oncovin), vinorelbine (Navelbine), and vitamins.

in addition to the condition listed in the IMPORTANT WARNING section, tell your doctor if you have or have ever had liver disease, achlorhydria (stomach does not produce acid), or a history of alcohol abuse.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking itraconazole, call your doctor.

tell your doctor if you drink alcohol.

itraconazole capsules and itraconazole oral solution should not be interchanged.

What should I do if I forget a dose?

What side effects can this medication cause?

Although side effects from itraconazole are not common, they can occur. Tell your doctor if any of these symptoms are severe or do not go away:

upset stomach

vomiting

diarrhea or loose stools

headache

dizziness

loss of appetite

If you experience any of the following symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

rash

itching

yellowing of the skin or eyes

dark urine

pale stools

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to itraconazole.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription. If you still have symptoms of infection after you finish the itraconazole, call your doctor.

Benzamycin

Description

Erythromycin and benzoyl peroxide (eh-rith-roe-MYE-sin and BEN-zoe-ill per-OX-ide) combination is used to help control acne.

This medicine is applied to the skin. It may be used alone or with other medicines that are applied to the skin or taken by mouth for acne.

Erythromycin and benzoyl peroxide combination is available only with your doctor's prescription, in the following dosage form:

Topical

Topical gel (U.S.)

Before Using This Medicine

In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For erythromycin and benzoyl peroxide combination, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to this medicine, to any of the other erythromycins, or to benzoyl peroxide (e.g., PanOxyl). Also tell your health care professional if you are allergic to any other substances, such as preservatives or dyes.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals. However, the benzoyl peroxide in this medicine may be absorbed into the body. Before using this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—It is not known whether topical erythromycin or topical benzoyl peroxide passes into the breast milk. Erythromycin (e.g., E-Mycin), given by mouth or by injection, does pass into the breast milk. In addition, the benzoyl peroxide in this medicine may be absorbed into the mother's body. However, erythromycin and benzoyl peroxide combination has not been reported to cause problems in nursing babies.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of this medicine in children up to 12 years of age with use in other age groups.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of this medicine in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are using any other topical prescription or nonprescription (over-the-counter [OTC]) medicine that is to be applied to the same area of the skin.

Proper Use of This Medicine

Do not use this medicine on raw or irritated skin

Before applying this medicine, thoroughly wash the affected area(s) with warm water and soap, rinse well, and gently pat dry. After washing or shaving, it is best to wait 30 minutes before applying the medicine. The alcohol in it may irritate freshly washed or shaved skin.

Avoid washing the acne-affected area(s) too often. This may dry your skin and make your acne worse. Washing with a mild, bland soap 2 or 3 times a day should be enough, unless you have oily skin. If you have any questions about this, check with your doctor.

To use:

Use this medicine only as directed. Do not use more of it and do not use it more often than your doctor ordered. To do so may cause your skin to become too dry or irritated.

After washing the affected area(s), you may apply this medicine with your fingertips. However, be sure to wash the medicine off your hands afterward.

Apply and rub in a thin film of medicine, using enough to cover the affected area(s) lightly. You should apply the medicine to the whole area usually affected by acne, not just to the pimples themselves .

Since this medicine contains alcohol, it may sting or burn. Therefore, do not get this medicine in or around your eyes, nose, or mouth, or on other mucous membranes. Spread the medicine away from these areas when applying. If this medicine does get in your eyes, wash them out immediately, but carefully, with large amounts of cool tap water. If your eyes still burn or are painful, check with your doctor.

Do not use this medicine after the expiration date on the label. The medicine may not work properly. Get a fresh supply from your pharmacist. Check with your pharmacist if you have any questions about this.

To help keep your acne under control, keep using this medicine for the full time of treatment. You may have to continue using this medicine every day for months or even longer in some cases.

Dosing—

The dose of erythromycin and benzoyl peroxide combination will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average dose of erythromycin and benzoyl peroxide combination. If your dose is different, do not change it unless your doctor tells you to do so.

For gel dosage form:

For acne:

Adults and children 12 years of age and over—Apply to the affected area(s) of the skin two times a day, morning and evening, or as directed by your doctor.

Children up to 12 years of age—Dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage—

To store this medicine:

Keep out of the reach of children.

Store in the refrigerator. Heat will cause this medicine to break down. However, keep the medicine from freezing. Follow the directions on the label.

Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If your acne does not improve within 3 to 4 weeks, or if it becomes worse, check with your health care professional. However, treatment of acne may take up to 8 to 12 weeks before you see full improvement.

If your doctor has ordered another medicine to be applied to the skin along with this medicine, it is best to apply the second medicine at least 1 hour after you apply the first medicine. This may help keep your skin from becoming too irritated. Also, if the medicines are used too close together, they may not work properly.

Mild stinging or burning of the skin may be expected after this medicine is applied. These effects may last up to a few minutes or more. If irritation continues, check with your doctor. You may have to use the medicine less often. Follow your doctor's directions.

This medicine may also cause the skin to become unusually dry, even with normal use. If this occurs, check with your doctor.

This medicine may bleach hair or colored fabrics

You may continue to use cosmetics (make-up) while you are using this medicine for acne. However, it is best to use only ``oil-free'' cosmetics. Also, it is best not to use cosmetics too heavily or too often. They may make your acne worse. If you have any questions about this, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare

Burning, blistering, crusting, itching, severe redness, or swelling of the skin; painful irritation of the skin; skin rash

Symptoms of topical overdose

Burning, itching, scaling, redness, or swelling of the skin (severe)

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Less common

Dryness or peeling of the skin; feeling of warmth, mild stinging, or redness of the skin

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Duct Tape Can Get Rid of Warts: Study

Mon Oct 14, 6:08 PM ET

NEW YORK (Reuters Health) - The next time you're in need of a wart cure-all, forget combing the aisles of the local pharmacy and head over to the hardware store instead.

According to the findings of a small study in children, applying plain old duct tape to the common wart (scientifically known as Verruca vulgaris) appears to be superior to traditional cryotherapy with liquid nitrogen.

While anecdotal reports abound of duct tape's wart-removing abilities, the therapy has not gone head-to-head with other wart removal techniques, according to the report published in the October issue of the Archives of Pediatric and Adolescent Medicine.

In the current study, the researchers compared duct tape therapy to cryotherapy, which involves several visits to the doctor's office. During the treatment, a physician freezes the wart by applying a quick, narrow blast of liquid nitrogen to the offending blemish. This is repeated once every two or three weeks until the wart is gone.

Aside from the inconvenience of frequent visits to the doctor's office, another potential drawback to this method is that many children are afraid of the treatment and may find it painful, according to lead author Dr. Dean R. Focht III, who conducted the study with colleagues Dr. Mary Fairchok and Carole Spicer while at the Madigan Army Medical Center in Tacoma, Washington.

"Tape occlusion, if proven effective, could be an inexpensive, convenient and painless alternative to cryotherapy in the treatment of pediatric warts," they write. Focht is now at the Children's Hospital Medical Center in Cincinnati.

In the study, the researchers randomly assigned 51 patients between the ages of 3 and 22 to receive either a maximum of 6 cryotherapy treatments, once every two to three weeks, or two months of duct tape therapy.

In duct tape therapy, a nurse covered the wart with a piece of duct tape roughly the same size as the wart. Patients (or their parents) were instructed to keep the duct tape on for 6 consecutive days and if the tape peeled off during that time, apply another at home.

At the end of 6 days, patients soaked the wart in water and rubbed it with an emery board or pumice stone. The next morning a new piece of tape was applied. The routine was repeated for a maximum of two months.

During the study, all of the patients returned frequently to the doctor's office to have their warts measured and evaluated by a nurse.

The investigators found that 85% of those in the duct tape group, compared to 60% of those in the cryotherapy group "had complete resolution of their warts.

"This study shows that duct tape occlusion therapy is not only equal to but exceeds the efficacy of cryotherapy in the treatment of the common wart. Tape occlusion therapy can now be offered as a nonthreatening, painless, and inexpensive technique for the treatment of warts in children," according to the report.

It's not clear exactly how the duct tape sends warts packing, according to the report, "but, as with other therapies, it may involve stimulation of the patient's immune system through local irritation."

SOURCE: Archives of Pediatric and Adolescent Medicine 2002;156:971-974.

People at highest risk for melanoma are those who:

have a family history -- meaning having two or more close relatives who have been diagnosed with melanomas;

have displastic (atypical) moles;

or have numerous moles -- more than 50 or so.

Melanoma Gene

New treatments for melanoma may be developed thanks to some

results from the Cancer Genome Project. In a study published

online in the journal Nature, researchers say they have found the

same genetic changes in about 70 percent of cases of the deadly

skin cancer. Using the map of the 30,000 genes in the human

genome, the researchers have taken samples of cancerous tumors

and in each sample analyzed all the genes, looking for

abnormalities, The Associated Press reports. The first

abnormality they have identified is in a gene called B-RAF, which

plays a role in cell division and growth. The researchers found

that a spontaneous mutation in this gene cause cells to multiply

unchecked, leading to cancer, the AP says. The B-RAF gene is the

one most likely to be abnormal in melanoma, and is also abnormal

in about 10 percent of colon cancers, the researchers found.

They say that pinpointing this specific gene fault may offer a

target for new melanoma drugs, the AP says.

Accutane

Using Isotretinoin the Right Way for Acne

What is isotretinoin?

Isotretinoin (brand name: Accutane) is a medicine for very bad acne that did not get better after you tried other medicines. It is important for you to take isotretinoin the right way. You should know about the side effects of isotretinoin. Talk to your doctor if you have any questions about this medicine or if you have side effects when you take it.

General Information

You should take isotretinoin with food. You don't have to keep the medicine in the refrigerator, but keep it out of sunlight. Try not to keep it in a place that is very warm.

Isotretinoin has been prescribed just for you. Don't share it with other people. Keep isotretinoin away from children. You may not give blood while you are taking this medicine or for at least one month after you stop taking it.

Before Treatment Starts

Tell your doctor if you or anyone in your family has diabetes, liver disease, heart disease or depression. You should also tell your doctor if you are allergic to any medicines, especially parabens (which are in the isotretinoin capsules). Be sure to tell your doctor if you are taking any other medicines, even over-the-counter medicines.

Isotretinoin is like vitamin A, so you should not take vitamin A pills or multivitamins with vitamin A while you are taking isotretinoin.

During Your Treatment

Your acne may get worse when you start using isotretinoin. This usually just lasts for a little while. You can tell your doctor if this happens to you because you might need to use other medicines along with the isotretinoin in this stage.

The dosage of isotretinoin is different for each person. During your treatment, your doctor may change your dosage. Be sure to take isotretinoin just the way your doctor tells you. If you miss one dose, don't take extra the next time.

Be sure you keep all of your appointments with your doctor because your doctor needs to check on you often. Your doctor may check your liver tests and cholesterol levels. During treatment you may have some of the following side effects. These side effects usually go away when you stop taking isotretinoin:

Dry skin and lips (your doctor can tell you which lotions or creams to use)

Fragile skin (easily injured), itching or rash

Increased sensitivity to the sun (easily sunburned)

Peeling skin on your palms and soles

Thinning hair

Dry, red eyes (you may find that you can't wear your contact lenses during treatment)

Nosebleeds

Bleeding gums

Pain in your muscles

Decreased night vision. If you have any vision problems, you should stop taking isotretinoin and talk to your doctor right away.

A few people have even more serious side effects. If they aren't treated, the problem could last forever. If you have any of the side effects listed below, stop taking isotretinoin and check with your doctor right away:

Headaches, nausea, vomiting or blurred vision

Depression or changes in your mood

Severe stomach pain, diarrhea or bleeding from your rectum

Very dry eyes

A yellow color in your skin or eyes, and dark yellow urine

After You Stop Taking Isotretinoin

Your skin might go on getting better even after you stop taking isotretinoin. Most of the side effects of isotretinoin go away in a few days or weeks after you stop taking isotretinoin. If your side effects last more than a few weeks after you stop taking isotretinoin, talk to your doctor.

Some patients have to take isotretinoin more than one time. If you need to take isotretinoin again, you can start taking it again 8 to 10 weeks after your first treatment is over. Do not give blood for at least one month after you stop taking isotretinoin.

Attention, Girls and Women:

You must not take isotretinoin if you are pregnant or if there is any chance you might get pregnant while taking this medicine!

Isotretinoin causes severe birth defects, including malformation of the head and face, mental retardation and severe internal defects of the brain, heart, glands and nervous system. It can also cause miscarriage, premature birth and death of the fetus.

You must use two forms of birth control at the same time for at least one month before you start taking isotretinoin and for all the time you are taking this medicine. Keep using two kinds of birth control for one month after you stop taking isotretinoin. If you are using Depo-Provera as your form of birth control, you may not need to use two forms of birth control. Check this with your doctor.

Your doctor will make sure you are not pregnant before starting isotretinoin and check again every month while you are taking it. You will be asked to read and sign a consent form to show that you understand the dangers of birth defects and agree to use birth control. If your period is late, stop taking isotretinoin and call your doctor right away. If you get pregnant while you are taking isotretinoin, talk with your doctor about going on with the pregnancy.

This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.

Visit familydoctor.org for information on this and many other health-related topics.

Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.

Cutaneous Melanoma: Update on Prevention, Screening, Diagnosis, and Treatment

ERIKA L. RAGER, M.D., M.P.H., EDWARD P. BRIDGEFORD, M.D., and DAVID W. OLLILA, M.D.

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

Melanoma is an increasingly common malignancy, and it affects a younger population than most cancers. Risk factors for melanoma include white race, sun sensitivity, family history of melanoma, and melanocytic nevi. Sunburn and intermittent sun exposure appear to increase the risk of developing melanoma. The role of population-based screening for skin cancer remains unclear. Consistent screening results in the diagnosis of thinner melanomas, but there is no evidence that this leads to decreased mortality. The ABCDs-asymmetry, border, color, diameter-can be used as a guide to differentiate melanoma from benign lesions. Suspicious pigmented lesions should undergo full thickness biopsy. Treatment consists of surgical resection, lymph node evaluation, and systemic therapy for some patients. Prognosis depends on the stage at diagnosis. Patients with melanoma require close follow-up because they are at risk for recurrence and diagnosis of a second primary tumor. Preventive strategies for melanoma should emphasize seeking shade when outdoors, wearing protective clothing, and avoiding exposure during the peak sunlight hours. (Am Fam Physician 2005;72:269-76. Copyright© 2005 American Academy of Family Physicians.)

Skin cancer is the most common malignancy in the United States. Although melanoma represents a small subset, it is the most deadly cutaneous neoplasm. The American Cancer Society estimates that there will be 59,580 new cases of melanoma and 7,770 deaths from melanoma in 2005.1 The incidence of melanoma increases by 4.1 percent per year, faster than any other malignancy.

Epidemiology

According to data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute, from 1995 to 1999 the annual age-adjusted incidence of melanoma was 20 per 100,000 persons among whites.2 The incidence was higher in men (24.4 per 100,000 persons) than in women (16.8 per 100,000 persons).2 The lifetime risk of developing invasive melanoma is 2.04 percent for white men and 1.45 percent for white women; about one in 74 Americans will be diagnosed with melanoma.2

Melanoma affects a younger patient population than many malignancies. The median age at diagnosis is 57 years. Sixty-two percent of cases are diagnosed before patients reach 65 years of age, and the median age at death is 67 years. Melanoma is the sixth leading cause of cancer death in the United States. According to statistics from SEER, an average of 18.8 life-years are lost per melanoma death.2

Melanoma is much more common in whites than in non-whites. California Cancer Registry data from 1988 to 1993 show the average annual age-adjusted incidence rates per 100,000 persons were 17.2 in men and 11.3 in women for non-Hispanic whites; 2.8 (men) and 3.0 (women) for Hispanics; 0.9 (men) and 0.8 (women) for Asians; and 1.0 (men) and 0.7 (women) for blacks.3

Risk Factors

Numerous risk factors for the development of melanoma have