Bone & Joint ProblemsDermatologyDrugs & MedicationsPreventive Medicine


What is the most effective treatment for acne?

     Multiple studies have shown that oral isotretinoin (Accutane—now called Absorbica, Claravis, Amnesteem, Myorisan, or Zenatane) is the most effective therapy for decreasing the number of lesions in acne patients. First-line therapy, however, is topical retinoids and benzoyl peroxide combined with oral or topical antibiotics. This combination was comparable in achieving success. 

Topical Retinoids—Retin-A, Differin, Avita , Renova,Tretin-X

Topical Antibiotics—erythromycin, clindamycin

Oral Antibiotics—tetracycline (minocycline, doxycycline), azithromycin, trimethoprim-sulfamethoxazole.

Dr. G’s Opinion: There is no longer any need for teenagers to suffer the embarrassment of acne. Oral isotretinoin is a cure. It clears up the large cystic lesions that lead to scarring and restores the skin to almost normal. Every teen should be afforded that luxury.

Reference: AFP Clinical Answers. Am Fam Phys 2024 June;109(6):512.

Is switching to e-cigarettes effective for helping smokers quit?

     Maybe. Nicotine delivery via e-cigarettes plus counseling “may be more effective than other means of nicotine replacement for long-term smoking cessation.” A review of studies has not reported the percentage of patients who continued e-cigarette use and remained abstinent from smoking.

Dr. G’s Opinion: To stop smoking, anything is worth a try. This merely changes the delivery vehicle, but it may be effective.

Reference: AFP Clinical Answers. Am Fam Phys 2024 June;109(6):512.

What do you do if you can’t take a statin?

     Bempedoic Acid (Nexletol) is the answer. 

It decreases the incidence of major adverse cardiovascular events without significantly increasing liver and muscle enzyme levels or causing muscle pain, gout, or gallstones. It is more effective than placebo at lowering total cholesterol (TC) and LDL cholesterol. When taken with Zetia, TC and LDL lowering are enhanced. It is a once-daily oral medication.

Reference: Mounsey A, Jeyaraju M. Bempedoic Acid for the Prevention of Cardiovascular Disease. Am Fam Phys 2024 June;109(6):573-574.

How can you tell if you have carpal tunnel syndrome (CTS)?

     You have a CTS-6 score of 16.5 or more (range 0-26). There are 6 criteria in this scale:

  1. If the fat pad in the palm below the thumb is weak and shrunken—5 pts
  2. Bend your wrist downward and hold it there. In CTS the thumb, index and middle finger  will get numb or tingle—5 pts
  3. Loss of ability to feel two sharp needle sticks at areas close to one another—4.5 pts
  4. Numbness of thumb, index and middle fingers occurring at night—4 pts
  5. Tapping on the palm surface of the wrist causes tingling or an electric shock in the thumb, index and middle fingers—4 pts
  6. Numbness in thumb, index and middle fingers—3.5 pts

Dr. G’s Opinion: When any of these criteria are present, the point value of each is added, and if the sum exceeds 16.5, CTS is most likely present. Carpal tunnel can, thus, be diagnosed without any invasive diagnostic procedures. “Activity limitations, splinting, and corticosteroid injections may be effective treatment options for patients with non-severe CTS.”

Reference: Alvarez CA, Brown SR. Carpal Tunnel Syndrome Am Fam Phys 2024 June;109(6):571-572.

Tamiflu does not reduce the likelihood of hospitalization in adults.

     Several studies have shown that patients with influenza who received Tamiflu as treatment were not less likely to be hospitalized nor did it reduce the number of hospitalizations in older and high risk patients. Also, as far as shortening the duration of flu symptoms, it was less effective than what was reported in clinical trials, and there was no difference in the likelihood  of complications. 

Reference: Patient-Oriented Evidence That Matters. Ebell MH Am Fam Phys 2024 June;109(6):580.

Patients with a history of gout and high baseline uric acid level are prone to more gout attacks.

     More than 95% of recurrent gout attacks occurred in patients with a baseline uric acid level of 6.0 or more. The higher the uric acid level, the greater the likelihood of recurrent attacks. That behoves physicians to prescribe uric acid-lowering drugs and monitor results. 

Reference: Patient-Oriented Evidence That Matters. Slawson DC. Am Fam Phys 2024 June;109(6):581-582. 

Are testosterone patches and gel safe for men with heart disease or risk thereof?

     Men with testosterone deficiency who have known heart disease are safe to use testosterone gel/patch for hormone replacement. Serious cardiovascular events were not more common in these patients. There was, however, a higher rate of acute kidney injury, atrial fibrillation, pulmonary embolism, and non-fatal arrhythmias. These patients should use testosterone replacements with great caution.

Reference: AFP Clinical Answers. Transdermal testosterone replacement in men with known heart disease. Am Fam Phys 2024 March;109(3):208.

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