Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
If you have hair thinning or psoriasis, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day urgent appointments often available. No referral is necessary for PPO insurance plans. Please call (626) 331-6411. We look forward to serving you!
"What’s New in..."
A monthly column by Dr. Chiang
What’s New in Eczema (atopic dermatitis)
The mainstay of therapy for moderate to severe eczema (atopic dermatitis) are topical steroids. They are effective and, when properly utilized and supervised, provide benefits that usually outweigh rare risks. However, there is a patient perception that some doctors call “steroid phobia”, when even some of the most severe patients that scratch daily, have open sores, and suffer from severe social and professional issues avoid the most effective treatment medicine has to offer. As someone who suffered from severe eczema until adulthood because my mother refused to accept the treatments recommended when I saw a dermatologist, it also saddens me when I see a parent decline topical steroids for a severely affected child I think will only worsen with time.
For patients and parents who choose not to use topical steroids, I currently discuss gentle over-the-counter products, avoiding harsh cosmetics, and prescribe medications called Protopic (tacrolimus) ointment and Elidel (pimecrolimus) cream. Although these medications are not topical steroids, they have different potential side effects and are clinically much weaker. They are also often not covered by insurance due to their cost (there are no generic versions).
Thankfully, there has been progress made in alternative therapies, esp. a class of medications called phosphodiesterase-4 inhibitors that have an anti-inflammatory effect. An oral version called Apremilast (Otezla) has been approved for psoriatic arthritis and has showed promise in trials for adult eczema and psoriasis. So far, side effects have been mild to moderate primarily consisting of gastrointestinal issues (nausea, vomiting, diarrhea) and headaches. No significant blood test abnormalities have been so far reported. While there is interest in the oral formulation, I am even more interested in an ointment called AN2728 (once FDA approved, medications are given more patient friendly names). So far it has completed a phase II trial in which 86 adolescents with eczema averaged a 71% improvement after 1 month. A phase III trial is in place and the medication should ideally be widely available next year.
If you or your child has severely itchy skin, I look forward to seeing him/her. Please make an appointment for a dermatology consultation at (626) 331-6411.
Charles Chiang, MD, FAAD
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