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Radioactive iodine is also used to treat thyrotoxicosis and to assess thyroid function. Eventually it causes hypothyroidism, which has to be treated by thyroid hormone replacement. Hyposecretion of thyroid hormone due to absence or incomplete development of the thyroid in early life sildenafil tablets buy cretinism, which is characterized by stunted growth and mental deficiency. Hyposecretion in adults results in myxoedema, a condition where there is a characteristic thickening of the skin together with low metabolic rate, slow speech, poor appetite, weight gain, lethargy, bradycardia, sensitivity to cold and mental impairment. One form is Hashimotos thyroiditis, an autoimmune condition where antibodies are produced against thyroglobulin.

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Other more specialized treatments are cryotherapy, using liquid nitrogen, electrosurgery, surgical excision, bleomycin injections and carbon dioxide laser. Fungal infection of the skin and nails will be familiar to podiatrists. There are many topical antifungal drugs available over the counter and of varying efficacy. Drugs of choice are imidazoles, terbinafine and amorolfine.

Adverse effects of mercaptopurine are similar to methotrexate. Mercaptopurine is metabolized by xanthine oxidase. It should be used with caution in combination with allopurinol because allopurinol inhibits xanthine oxidase.

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With very severe resistant eczema, immunosuppressant drugs may be needed. Psoriasis is a chronic inflammatory skin disease with hyperproliferation of keratinocytes, which leads to thickening of the epidermis and typical silvery scales on the surface. Topical treatments include drugs that reduce cell division, such as calcipotriol, dithranol and coal tar, and keratolytics and emollients. Phototherapy using UVB and photochemotherapy using UVA plus an oral photosensitizing drug, psoralen, can be successful in severe resistant psoriasis, although relapse may occur. For patients who do not respond to topical therapy, systemic drugs such as methotrexate, ciclosporin, efalizumab and acitretin can be used.

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