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CME / CE

Testing Your Decision-Making in Difficult Cases of Dermatologic Fungus

  • Authors: Tracey C. Vlahovic, DPM
  • CME / CE Released: 10/29/2015
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 10/29/2016
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Target Audience and Goal Statement

This activity is intended for dermatologists, primary care physicians, podiatrists, nurses, and pediatricians.

The goal of this activity is to illustrate the application of learning related to diagnosis, selection of assessment methods, and tailoring treatments for onychomycosis.

Upon completion of this activity, participants will be able to:

  1. Select appropriate tools to diagnose and assess severity in patients presenting with possible onychomycosis
  2. Recognize risks and comorbidities associated with onychomycosis
  3. Individualize treatment selection for patients with onychomycosis based on disease severity and safety/efficacy of therapies


Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author

  • Tracey C. Vlahovic, DPM

    Associate Professor, J. Stanley and Pearl Landau Faculty Fellow, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Tracey C. Vlahovic, DPM, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: PharmaDerm; Valeant Pharmaceuticals International
    Served as a speaker or a member of a speakers bureau for: PharmaDerm; Valeant Pharmaceuticals International
    Received grants for clinical research from: PharmaDerm; Valeant Pharmaceuticals International

    Dr Vlahovic does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr Vlahovic does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

  • Boni E. Elewski, MD

    Professor, University of Alabama, Birmingham

    Disclosures

    Disclosure: Boni E. Elewski, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Anacor Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc; Valeant Pharmaceuticals International
    Received grants for clinical research from: AbbVie Inc; Amgen, Inc.; Lilly; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc; Valeant Pharmaceuticals International

  • Aditya K. Gupta, MD, PhD, FRCPC, FAAD, MBA

    Professor, University of Toronto, Toronto, Ontario

    Disclosures

    Disclosure: Aditya K. Gupta, MD, PhD, FRCPC, FAAD, MBA, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Anacor Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; Moberg Pharma; Valeant Pharmaceuticals International
    Received grants for clinical research from: Valeant Pharmaceuticals International
    Clinical trials investigator: Lilly; Merck & Co., Inc.; UCB Pharma, Inc.

  • Jeffrey M. Robbins, DPM

    Professor of Podiatric Medicine; Director, Podiatry Services VACO; Kent State University College of Podiatric Medicine, Independence, Ohio

    Disclosures

    Disclosure: Jeffrey M. Robbins, DPM, has disclosed no relevant financial relationships.

  • Antonella Tosti, MD

    Professor, Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, Florida

    Disclosures

    Disclosure: Antonella Tosti, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Anacor Pharmaceuticals, Inc.; PharmaDerm; Polichem; Valeant Pharmaceuticals International; Viamet Pharmaceuticals Holdings, LLC
    Served as a speaker or a member of a speakers bureau for: PharmDerm; Sandoz

  • Dyanne P. Westerberg, DO

    Associate Professor, Cooper Medical School of Rowan University, Camden, New Jersey

    Disclosures

    Disclosure: Dyanne P. Westerberg, DO, has disclosed no relevant financial relationships.

Editors

  • Shari J. Dermer, PhD

    Scientific Director, Medscape, LLC

    Disclosures

    Disclosure: Shari J. Dermer, PhD has disclosed no relevant financial relationships.

  • Gina K. Kaeuper

    Freelance Medical Writer, Knoxville, Tennessee

    Disclosures

    Disclosure: Gina K. Kaeuper has disclosed no relevant financial relationships.

CME Reviewer/Nurse Planner

  • Amy Bernard, MS, BSN, RN-BC

    Lead Nurse Planner, Medscape, LLC

    Disclosures

    Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

  • Robert Eckles, DPM, MPH

    Dean, Clinical and Graduate Medical Education Associate Professor, Department of Orthopedic Sciences, New York College of Podiatric Medicine

    Disclosures

    Disclosure: Robert Eckles, DPM, MPH has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and New York College of Podiatric Medicine. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

    Medscape, LLC designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 1.25 contact hour(s) of continuing nursing education for RNs and APNs; 0.75 contact hours are in the area of pharmacology.

    Contact This Provider

  • For Podiatrists

    This activity has been planned and implemented in accordance with the standards and requirements for approval of providers of continuing education in podiatric medicine through a joint provider agreement between New York College of Podiatric Medicine and Medscape, LLC. New York College of Podiatric Medicine is approved by the Council on Podiatric Medical Education as a provider of continuing education in podiatric medicine. New York College of Podiatric Medicine has approved this activity for a maximum of 1.25 continuing education contact hours.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / CE

Testing Your Decision-Making in Difficult Cases of Dermatologic Fungus

Authors: Tracey C. Vlahovic, DPMFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME / CE Released: 10/29/2015

Valid for credit through: 10/29/2016

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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.

Onychomycosis is a common fungal infection of the nails estimated to affect approximately 14% of the North American population.[1-3] The infection is frequently chronic and has high rates of recurrence after treatment, posing significant clinical and therapeutic challenges. Historically, treatment options have been limited, with oral antifungals representing the mainstay of medical treatment. Although oral antifungal agents can be effective, potential side effects, drug-drug interactions, and other medication-management challenges limit their use in many patient groups. The 2014 approval of 2 new topical agents has expanded the onychomycosis treatment armamentarium. Increased treatment options enable greater optimization of treatment based on patient disease presentation, comorbidities, and lifestyle factors. Understanding the best use of various treatments can greatly improve treatment outcomes and quality of life for more patients. Through the use of 2 challenging patient cases, this activity will test your knowledge of the patient, disease, and treatment considerations inherent to promoting good outcomes in patients with onychomycosis of the toenails.

Case Presentation – Case 1

Karen is a 52-year-old woman who is concerned about some recent changes she has noted to several of her toenails. She tells you at today's visit that she noticed some discoloration of one of her great toenails during the previous summer but did not "think much of it." She has frequent pedicures and assumed that her nail polish had perhaps discolored her nails. However, she has noticed that several nails now show similar changes. Karen is an active person, having started regularly swimming and taking group fitness classes several times per week about 5 years earlier. She tells you that the appearance of her nails makes her want to hide her feet when she is at the pool and gym.

Karen's medical history reveals a 20-year history of mild plaque psoriasis, although she is not currently experiencing any symptoms. She is otherwise in excellent health, with a body mass index (BMI) of 23.6 kg/m2 and blood pressure of 124/78 mm Hg. Her last primary care visit was 9 months ago, and her lipid values were in a healthy range at that time. Karen drinks alcohol approximately once per week and reports that she has never smoked. She takes several vitamin supplements but is not currently taking any prescription medications.

You examine Karen's feet, noting that the great toenails on both feet are yellowing and thickened, and an additional 2 toes on her right foot and 3 toes on her left foot show similar changes (Figures 1 and 2). There is no clinical evidence of bacterial infection, and her circulation appears strong. Karen has no memory of any trauma to her feet and reports no pain associated with the nail changes. Karen is married and has 2 children who no longer live at home. She cannot recall any other family members who have mentioned similar symptoms.

Figures 1 and 2. Case patient's feet at initial visit. Images courtesy of T. Vlahovic, DPM.

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