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Medical Articles

M.D. 1978 Boston University School of Medicine

Internal Medicine: 1978-79; 1980-81, Good Samaritan Hospital, Portland Oregon

Dermatology, 1982-1985, Oregon Health Science University

Board Certified, American Board of Dermatology, 1985

Section Head and Dermatology Residency Program Director, University of Chicago, 1997- 2001

Division Head, Dermatology, Women’s College Hospital, University of Toronto 2012- 2015

Published in the Online Journal of Community and Patient-centered Dermatology:

PubMed Selected References

Cyclosporine in the Management of Poststreptococcal Pustulosis

Poststreptococcal pustulosis (PSP) is a rare neutrophilic disease occurring after a streptococcal pharyngitis.1 In our report, we describe a mother and daughter who developed PSP and were successfully treated with low-dose cyclosporine.

Treatment of Acne Vulgaris

The Management of Acne Vulgaris
by nondermatologists is increasing. In this article, we attempt to answer the question: what treatments in acne vulgaris have proven efficacy and how are these treatments best administered and individualized to optimize results and minimize complications? We considered the efficacy and safety of topical retinoids, topical antimicrobials, systemic antibiotics, hormonal treatments for women, and oral isotretinoin.

An American Dermatologist Goes to Canada

I moved to Canada two years ago after having trained and practiced medicine in the United States for 20 years, in both private and academic sectors. Many of my Canadian patients expressed surprise that an American physician would choose to practice in Canada; they perceive that Canada usually loses its physicians to the United States.

Hormonal Therapies in Acne 

Hormones, in particular androgen hormones, are the main cause of acne in men, women, children and adults, in both normal states and endocrine disorders. Therefore, the use of hormonal therapies in acne is rational in concept and gratifying in practice. Although non-hormonal therapies enjoy wide usage and continue to be developed, there is a solid place for hormonal in women with acne, especially adult women with persistent acne.

Long-Term Safety of Spironolactone in Acne

 Spironolactone has been used for over 20 years as an antiandrogen in the treatment of acne and hirsutism. No long-term studies of the safety of spironolactone used in this manner have been published. We present a study of the long-term safety and tolerance of spironolactone in 91 women with acne who were followed for up to 8 years.

Low-dose Adjunctive Spironolactone in the Treatment of Acne in Women

Spironolactone is well known for its use as an androgen receptor blocker in the treatment of hirsutism and acne in women and has been reviewed elsewhere.  In published studies of women with acne and hirsutism, effective doses of spironolactone have been mostly in the range of 100 to 200 mg/day.

Spironolactone in Dermatologic Therapy

In the treatment of androgen-mediated skin disorders spironolactone provides a valuable therapeutic option. This article reviews the use of spironolactone as an antiandrogen in dermatologic therapy. The endocrinologic effects, pharmacology, dermatologic uses, and side effects are discussed, and guidelines for its use are provided. 

Rules of Engagement in Dermatology

Humans usually respond favorably to being respected and taken seriously, and it is in that vein that I present the following rules of engagement. I give a version of this document to the dermatology residents who rotate through my clinics. There is no evidence-based medicine in what follows. Although these behaviors can be learned, they cannot easily be tested.

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