- Topical therapy is the mainstay of treatment for psoriasis, particularly in mild cases. Topical corticosteroids are the most commonly prescribed class of medication but are now often used together with topical calcipotriene, a vitamin D3 analogue, or topical tazarotene, a retinoid; both calcipotriene and tazarotene were approved by the Food and Drug Administration (FDA) for the treatment of psoriasis.
- Emollients are an important part of any topical regimen for psoriasis. Application of petrolatum alone may be sufficient therapy for some patients. More elegant creams and lotions are helpful but are somewhat less effective than greasy ointments. Tar and salicylic acid shampoos are valuable in the treatment of patients with scalp involvement. These preparations are available without prescription.
- Short-term use of the antimetabolite methotrexate can be an extremely effective treatment of psoriasis. Methotrexate is indicated for patients who do not respond adequately to phototherapy and for patients with psoriatic arthritis. The source of methotrexate’s efficacy against psoriasis was once thought to be its antimitotic effect on proliferating macrophages and T cells.
Latest Updates
- Members of the European Organisation for Research and Treatment of Cancer–Invasive Fungal Infection Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group formed a consensus committee to develop standard definitions for invasive fungal infections for clinical research.
- The development of standardized methodology for antifungal susceptibility testing is another recent advance in the laboratory evaluation of Aspergillus species. Although azole resistance by Aspergillus species is unusual, patients exposed chronically to antifungal triazoles have been reported to have refractory infection caused by isolates with elevated minimum inhibitory concentrations.
- Fusarium and Scedosporium species are increasingly common causes of infections in surgical patients, especially in recipients of stem cell or organ transplants.
- Visceral artery aneurysms are increasingly identified with the widespread use of advanced imaging techniques.
- Increasing incidence is thought to be linked with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma.
- Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies.
- Ultrasonography criteria for the diagnosis of early pregnancy loss have recently been redefined.
- Medical and surgical management are safe and effective, and should be influenced largely by patient preference.
- Recommendations regarding interval to next conception have recently shifted away from the traditional 3 months.
Coding and Practice Management
- 2021 introduced changes to E/M billing that place greater importance on medical decision making.
- The COVID-19 Pandemic accelerated the use of Telehealth and development of associated coding strategies.
- ICD-10-CM became commonly used in the US in 2015 and ICD-11 will begin utilization in the coming years.
Medical Management of Lower Extremity Manifestations of Peripheral Artery Disease
- Randomized trials studying medical therapies to improve walking performance in patients with PAD have traditionally used treadmill walking performance as the primary outcome measure. Clinical trials of medical therapies in PAD have also measured changes in quality of life, patient perceived walking performance in daily life, the 6-minute walk, and other functional outcomes.
- Two medications are FDA-approved for treating claudication symptoms in people with PAD: pentoxifylline and cilostazol. Pentoxifylline, a methylxanthine derivative, was FDA-approved in 1984 for treating intermittent claudication symptoms due to PAD. Pentoxifylline lowers blood viscosity by increasing red blood cell deformability and flexibility. Cilostazol is a phosphodiesterase III inhibitor that was FDA-approved in 1999 for treating walking impairment due to intermittent claudication symptoms in patients with PAD.
Medical Management of Lower Extremity Manifestations of Peripheral Artery Disease
- Randomized trials studying medical therapies to improve walking performance in patients with PAD have traditionally used treadmill walking performance as the primary outcome measure. Clinical trials of medical therapies in PAD have also measured changes in quality of life, patient perceived walking performance in daily life, the 6-minute walk, and other functional outcomes.
- Two medications are FDA-approved for treating claudication symptoms in people with PAD: pentoxifylline and cilostazol. Pentoxifylline, a methylxanthine derivative, was FDA-approved in 1984 for treating intermittent claudication symptoms due to PAD. Pentoxifylline lowers blood viscosity by increasing red blood cell deformability and flexibility. Cilostazol is a phosphodiesterase III inhibitor that was FDA-approved in 1999 for treating walking impairment due to intermittent claudication symptoms in patients with PAD.
Part 2: Borderline Personality Disorder and Its Clinical Management
- Although borderline personality disorder has traditionally been perceived as difficult or impossible to treat, significant progress has been made in developing and validating treatments.
- Specialized psychotherapy remains the treatment of choice.
- Short-term or stepped care interventions may represent a more efficient treatment model.
- Common factors, such as structured therapies, may be nearly as effective as specialized treatments.
- Pharmacotherapy plays a limited role in treatment.
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