Ecamsule (terephthalylidene dicamphor sulfonic acid), the first new sunscreen agent to be approved by the FDA in 18 years, is now available in the US in a moisturizer called Anthelios SX. Ecamsule has been used in Canada and Europe for more than 10 years.

Tretinoin (all-trans-retinoic acid; Retin-A), a vitamin A metabolite used for years for topical treatment of acne, is now being used (without the approval of the US Food and Drug Administration) to improve the appearance of aging skin. Available by prescription in various concentrations in cream, gel and liquid formulations, tretinoin is chemically similar to isotretinoin (13-cis-retinoic acid; Accutane), an oral drug used for treatment of severe acne which has recently caused concern because of its teratogenicity (Morbid Mortal Weekly Rep, 37:171, March 25, 1988).

In 1989, Photoplex (Allergan Herbert), a combination of the dibenzoyl methane avobenzone (Parsol 1789) and the aminobenzoic acid (PABA) ester padimate O, was the first 'broad spectrum' sunscreen to become available in the USA (Medical Letter, 31:59, 1989). Now, Shade UVAGuard (Schering-Plough), a similar product, has been approved by the US Food and Drug Administration; it also contains avobenzone, plus the benzophenone oxybenzone and octyl methoxycinnamate.

The FDA has approved mavacamten (Camzyos – MyoKardia/BMS), a modulator of cardiac myosin, to improve functional capacity and symptoms in adults with New York Heart Association (NYHA) class II or III obstructive hypertrophic cardiomyopathy (HCM) who have a baseline left ventricular ejection fraction (LVEF) ≥55%. Mavacamten is the first drug in its class to become available in the US.

The Drug Enforcement Administration (DEA) has reclassified all hydrocodone combination products as schedule II controlled substances; they were previously classified as schedule III. Hydrocodone alone (Zohydro ER) is already a schedule II controlled substance.

The FDA has approved Cologuard (Exact Sciences), a stool DNA test, to screen average-risk adults ≥50 years old for colorectal cancer.

Diclofenac epolamine patch 1.3% (Flector Patch - Alpharma), a topical formulation of the nonsteroidal anti-inflammatory drug (NSAID) diclofenac, has been approved by the FDA for topical treatment of acute pain due to minor strains, sprains and contusions. It is the first topical NSAID patch approved in the US. A diclofenac patch has been used in Europe since 1993. Diclofenac sodium (Voltaren, and others) is available in the US as an oral tablet, in a 1% gel for treatment of osteoarthritis (to be reviewed in a future issue), in a 3% gel (Solaraze) for treatment of actinic keratoses, and in an...

Onychomycosis is caused most commonly by Trichophyton rubrum or T. mentagrophytes. About 10% of all persons worldwide and 40% of those ≥60 years old are believed to have the disease. Risk factors include older age, diabetes, poor peripheral circulation, smoking, HIV infection, psoriasis, and immunosuppression. Left untreated, onychomycosis can cause nail plate destruction, ingrown nails, and (particularly in patients with diabetes) secondary infections. Guidelines on treatment of onychomycosis have been published.