UNASSIGNED: Psoriasis is a chronic inflammatory cutaneous disease that causes patients psychosocial distress. Topical therapies are utilized for mild-to-moderate disease and for more severe disease in conjunction with systemic therapies. Topical corticosteroids are a cornerstone of treatment for psoriasis, but long-term use can cause stria and cutaneous atrophy and as well as systemic side effects such as topical steroid withdrawal. Non-steroidal topical therapies tend to be safer than topical corticosteroids for long-term use.
UNASSIGNED: We conducted a literature review on the pharmacokinetic (PK) and pharmacodynamic (PD) properties of topical therapies for psoriasis. We discuss how the PK and PD characteristics of these therapies inform clinicians on efficacy and toxicity when prescribing for patients.
UNASSIGNED: Topical corticosteroids, used intermittently, are very safe and effective. Long-term, continuous use of topical corticosteroids can cause systemic side effects. Several generic and newly approved non-steroidal options are available, but no head-to-head studies compare the effectiveness of the generics (vitamin D analogs, tacrolimus, pimecrolimus) against the newer therapies (roflumilast, tapinarof). Patients often do not respond to topical therapies due to poor adherence to treatment regimens. For patients resistant to topical treatment, phototherapy or systemic therapy may be an option.

OBJECTIVE: Dry eye disease (DED) is a prevalent ocular surface disease that is conventionally characterized by tear film hyperosmolarity and instability. This review presents a summarized classification of DED, followed by a comprehensive discussion of the most recent topical and systemic medications and clinical recommendations for selecting the most appropriate option for each patient.
METHODS: An extensive literature search was conducted on electronic databases, such as PubMed, Scopus, and Web of Science, using keywords including \"dry eye syndrome,\" \"ocular surface disease,\" \"medical management,\" \"artificial tears,\" \"topical immunomodulators,\" and \"meibomian gland dysfunction.\"
RESULTS: The underlying reasons for DED can range from insufficient aqueous tear production to increased tear evaporation. Recent literature has provided a more in-depth understanding of the pathophysiology of DED by examining the tear film\'s lipid, aqueous, and mucin layers. However, despite these advancements, medical management of patients with symptomatic DED has not fully reflected this modernized knowledge of its pathophysiology.
CONCLUSIONS: To develop a rationalized strategy for treating DED, it is crucial to have updated knowledge of therapeutic options, their mechanisms of actions, and indications based on the DED type and underlying causes.

Topical medications are key agents in treating a range of skin conditions, as they allow affected areas to be targeted while avoiding systemic side effects. Although there is a wide range of topical agents available, it is helpful to be familiar with a few commonly used formulations. This article describes how to select appropriate agents, prescribe appropriate quantities, and counsel patients on safe and effective treatment regimens.

Introduction Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes which is characterized by circumscribed depigmented macules and patches. Vitiligo is a progressive disorder in which some or all of the melanocytes in the affected skin are selectively destroyed. Around 0.5-2% of the world population is affected by vitiligo and the average age of onset is 20 years. The objective of the study was to evaluate the efficacy of tacrolimus versus clobetasol in the treatment of vitiligo. It is an open randomized control trial conducted in the Department of Dermatology, Nishtar Hospital, Multan for six months.  Methods One hundred sixty-two patients of vitiligo were included in the study. The disease was diagnosed on basis of clinical features and the Standard Assessment scale proposed by Hossain which was used to monitor and grade the response. Patients were randomly allocated into two groups by lottery method having 81 patients in each group. Group A was given tacrolimus whereas Group B was given clobetasol. Patients were followed up every four weeks. On the 12th week of treatment, effectiveness was assessed by measuring the Assessment scale proposed by Hossain. The results of the two groups were then compared. Results Sixty-three patients (38.9%) were males whereas 99 patients (61.1%) were females. The mean age of the patients included in the study was 29.68 + 8.162 years. The mean weight of the patients was 62.25 + 9.529 Kg. Out of 162, treatment was effective in 89 patients (54.9%) whereas in 73 patients (45.1%) the treatment was ineffective. In Group A (tacrolimus), 42 patients (51.9%) had effective treatment (on the complete resolution of symptoms) whereas 39 patients (48.1 %) had ineffective treatment. In Group B (clobetasol), 47 patients (58%) had effective treatment, and the rest (34, 42%) had ineffective treatment. A Chi-Square test was applied to compare the efficacy of the two groups. There was no statistically significant difference in both the groups in terms of efficacy. Group B was numerically superior in terms of effective treatment (47 versus 42) but not superior statistically. Conclusion Comparison of tacrolimus and clobetasol in patients of vitiligo showed no significant difference in the efficacy of the two groups. It can be concluded that tacrolimus may be considered superior to corticosteroids as its local and systemic adverse effects are less.

BACKGROUND: Topical immunomodulators (TI)-including corticosteroids, calcineurin inhibitors, and vitamin D analogues-are commonly prescribed in multiple specialties, but cost comparisons are lacking.
OBJECTIVE: To evaluate differences in costs of TI across specialties and determine associated variables.
METHODS: A cross-sectional study was performed using the Centers for Medicare & Medicaid Services 2008 and 2010 Prescription Drug Public Use Profiles, which contain 100% of drug claims made by Medicare beneficiaries.
RESULTS: Branded drugs cost an average of $174.02 more than generics per 30-day supply (P < .001). Differences in health insurance benefit phase, drug choice, brand name, and coverage type were the greatest determinants of patient cost (P < .001). Prescriptions for low-, medium-, and high-potency TI from specialists (mostly dermatologists) cost more than those from family medicine, internal medicine, and psychiatry/neurology physicians; total costs of a 30-day supply from a specialist differed from family and internal medicine physicians by $7.36-$14.57, and patient costs were higher for specialists by $1.69-$3.16 (P < .01). Brand names were prescribed 8% of the time by specialists and 1.4%-3.1% by nonspecialists.
CONCLUSIONS: We were unable to adjust for some confounders of cost, such as medication weight or treated body area, and the data does not reflect previous treatment failures or use by non-Medicare patients.
CONCLUSIONS: The costs of TIs prescribed by specialists (primarily dermatologists) are higher than those prescribed by primary care physicians and could be reduced by choosing more generics within the respective potency classes.

The pathophysiology of atopic dermatitis (AD) is complex, and future treatment options will likely be incorporated in a multimodal approach to management. The new, directed therapies that have been developed will likely be used in conjunction with concomitant continuous or intermittent use of standard therapies; the goal is to optimize therapeutic outcomes while minimizing adverse impacts on safety and cost. Current data regarding disease course and expression throughout life suggest that treatment strategies also will need to be adjusted as a patient grows. Research also indicates that interventions begun in infancy-such as the use of emollients-may mitigate or prevent AD signs and symptoms in children at high risk for the disease. Semin Cutan Med Surg 35(supp5):S97-S99.

BACKGROUND: More data are needed to define factors that predict long-term success after imiquimod therapy for lentigo maligna (LM).
OBJECTIVE: We sought to determine the demographic, clinical, and histologic prognostic markers of relapse-free survival in patients with LM who were treated with imiquimod.
METHODS: This was a single-arm, open-label, nonrandomized, prospective study.
RESULTS: Eighty-nine patients with histologically confirmed LM and a median follow-up time of 4.8 years after imiquimod treatment were included in our study. Sixteen patients (18%) relapsed. Statistically significant indicators of an increased risk of local recurrence included: the total number of melanocytes, the number of basal and suprabasal melanocytes and the number of pagetoid spreading melanocytes.
CONCLUSIONS: Our study was a single-center, nonrandomized study.
CONCLUSIONS: An assessment of different melanocyte fractions in the diagnostic baseline biopsy specimen may help to predict the response of LM to imiquimod therapy.