Clinics in Dermatology

Published by Elsevier
Print ISSN: 0738-081X
Pemphigoid is a chronic blistering autoimmune disease that is frequently seen in the elderly. It was grouped with other blistering diseases until it was differentiated from them on the basis of characteristic histology and natural history.1 Subsequent definition came from definitive immunopathologic features.2Pemphigoid is a wide-spectrum disease that can affect the skin and all stratified squamous epithelial mucous membranes. In the literature it has been defined under various terms. A simple classification that is clinically relevant and has important ramification and utilization in management and therapy is presented in Table 1.Generally, patients have predominantly cutaneous or mucous membrane involvement; however, patients with the generalized cutaneous variety can have mucous membrane involvement, and patients with cicatricial pemphigoid do have cutaneous manifestations.2 Separation into localized and generalized forms is quite helpful in planning and focusing on therapy but is not necessarily rigid or complete, and overlaps do occur.Bullous pemphigoid (BP) is a disease of the elderly. The great majority of patients are over 60 years of age at onset of the disease process. In one series, 77% of the patients were over 70,3 though it can rarely occur in adults less than 40 years of age.4 It has been reported in children, and this is dealt with in detail in Chapter 3. Before the age of 60 it appears that women are more frequently affected than men; nonetheless, when the age of onset is over 70, men are probably more frequently affected than women, and this predominance in men increases with each subsequent decade.5The true incidence is unknown since pemphigoid is not a reportable disease. It is believed to be twice as common as pemphigus.6 In our opinion, it is much more common than that because there is a significant increase in the percentage of the American population that is now over 60 years of age. This trend is likely to continue, and it can be expected that a larger number of patients with bullous pemphigoid may be seen in the years ahead.Pemphigoid is known to occur worldwide. There is not racial predilection or increased susceptibility. Furthermore, there is no increased prevalence of any specific HLA phenotype.7,8
In contrast to the direct effect of augmentation materials, the smoothing effect on folds and wrinkles after a botulinum toxin treatment (BTX) is a reactive, secondary effect after achieving reduction of muscle activity first. Besides the relaxing effect on mimic muscles and overlying skin, the treatment leads to psychological effects as well. The interruption of long-established, reflexlike muscle hyperactivity or even pathologic muscle activity (tics) changes not only the patient's personal perception of his environment and the impression he leaves on his environment but also his entire aspect.
The treatment of seborrheic dermatitis includes topical antifungal agents to eradicate Malassezia spp, corticosteroids, which treat the inflammatory component of the disease and keratolytics which remove scale and crust. This study compared the efficacy of a nonsteroidal topical cream and a low-potency topical corticosteroid for the treatment of mild to moderate seborrheic dermatitis of the face in 77 volunteers randomized to twice-daily treatment with nonsteroidal cream or corticosteroid cream for up to 28 days. If the individual was rated clear by day 14, the study drug was collected and the participant was told not to use any topical products on the previously treated areas until after the 28-day follow-up visit. Both treatments were similarly effective in reducing disease severity, with approximately 90% of participants clearing or almost clear during the study. Both treatments demonstrated significant reductions in erythema, scaling, and pruritus (P < .0001). Safety in both groups was rated as excellent in more than 90%. Those using the nonsteroidal cream who cleared after 14 days of treatment were more likely to remain clear than were participants using the corticosteroid cream (P = .0173). Investigator global assessments of improvement found both study agents were essentially the same, and participants in both groups achieved clinically important improvement.
August Paul von Wassermann (1866-1925), German bacteriologist, together with Albert Neisser (1855-1916), German dermatologist and venereologist, and Carl Bruck (1879-1944), German dermatologist and venereologist, developed the first serologic test for the diagnosis of syphilis. They published their first article about it on May 10, 1906 (Dtsch Med Wochenschr 1906;32:745). They made use of the idea of the complement fixation test of Jules Bordet (1870-1961) and Octave Gengou (1875-1957), so the Wassermann reaction is sometimes called Bordet-Wassermann reaction. The study was done at the Berlin Institute of Infectious Diseases (Berliner Institut für Infektionskrankheiten) and at the Breslau (Wroclaw) Department of Dermatology. The Wassermann reaction was used in the diagnosis of syphilis. The antigen used in it was prepared empirically. Originally, the so-called antigens were extracts of human or monkey tissue rich in Treponema pallidum. The most active one was a liver extract of a syphilitic fetus. Later on, the active substance, referred to as cardiolipin, was found in normal nonsyphilitic tissues, including the heart (usually bovine heart). Karl Landsteiner (1868-1943) identified the antigen involved in the Wassermann reaction as a lipoid substance, which finally was identified as diphosphatidylglycerol. Wassermann antibodies, produced in the course of syphilis infection, are reactive with cardiolipin in the presence of lecithin and cholesterol. The antigen-antibody reaction produces immune complexes, which results in complement fixation via the classic pathway; this may be used to determine the serum level of antibodies (if <1 microg/mL). In the final step, indicator cells (erythrocytes) together with a subagglutinating amount of antibodies (antierythrocyte antibodies) are added to the mixture. If there remains any complement left, these cells will be lysed; if it has been consumed by immune complexes, the amount of the remaining complement will be insufficient to produce the lysis of the red cells. In the first experiment of Wassermann et al, the reaction was positive exclusively with the sera of patients with syphilis, but it was soon discovered that some other diseases gave positive results in nonsyphilitic individuals. First such cases were reported in 1909. With the discovery of new and more specific tests for syphilis, the complement fixation tests of Wassermann type gradually went into oblivion. A new era in venereology was started with the discovery of T pallidum by Fritz Schaudinn (1871-1906) and Erich Hoffmann (1868-1954) in 1905, and the development of serology of syphilis by Wassermann, Neisser, and Bruck in 1906. Although the Wassermann reaction is no longer in use now, it should be emphasized that it was one of the very first serodiagnostic tests ever used in medical practice. Carl Bruck said in the 1920s: "This fortunate and unique mistake constituted the basis of a very important discovery, whose significance was both theoretical and practical."
In contemporary medicine, the erythrocyte sedimentation rate (ESR) is used to assess severity in patients with such diseases as erysipelas, psoriasis, eosinophilic fasciitis, dermatomyositis, and Behçet's disease. We remember the scientific achievements of a Polish physician, the discoverer of the erythrocyte sedimentation rate (ESR), Edmund Faustyn Biernacki (1866-1911), on the 100th anniversary of his death. The practical application of ESR in clinical diagnostics in 1897 by Biernacki was little known for many years, because it was often neglected owing to the work of Robert Fåhraeusand Alf Westergren from 1921. In addition, it is also frequently omitted that before Westergren's and Fåhraeus's reports were published, ESR was also noticed by Ludwig Hirschfeld in 1917.
What is a Toxicodendron and why is poison ivy now termed Toxicodendron radicans rather than Rhus radicans? Many scientific articles today continue to use Rhus to describe poison oak and poison ivy, because Linnaeus, the father of taxonomic botany, classified poison ivy, poison oak, and poison sumac in the genus Rhus. The name Toxicodendron originated with Tournefort,1 who preceded Linnaeus, so it is not new. The reasons for its separation from Rhus are cogent,1,2 but until classic treatises by Barkley3 on the Anacardiaceae and Gillis1 on Toxicodendron, there was little tendency to change from the old ways. Brizicky,4 emphasizing exceptions, argued against separation of Toxicodendron, and Barkley5 wrote a rebuttal. Fortunately, a major shift toward use of Toxicodendron now has occurred in scientific publications.
In 1991, we proposed that neutrophilic dermatoses—Sweet’s syndrome (SS), pyoderma gangrenosum (PG), subcorneal pustular dermatosis (SPD), erythema elevatum diutinum (EED), and their atypical or transitional forms— could be considered as conditions occurring along a continuous spectrum, and we suggested the concept of “neutrophilic disease.”1 These dermatoses, characterized by a cutaneous infiltration of mature neutrophils, may have a similar sterile neutrophilic infiltration in many organs such as the lung, bones, joints, digestive tract, liver, spleen, nodes, pancreas, central nervous system, heart and blood vessels.2 Furthermore, some patients may suffer from aseptic systemic abscesses without cutaneous involvement.3 The diagnosis of systemic disease is quite difficult, often requiring intensive investigations to rule out an infectious or neoplastic process. A comprehensive approach of the cutaneous condition allows in almost all cases a better understanding and management of the patients. The term neutrophilic disease reflects the spectrum of these manifestations.1,4 The purpose of this article was to review the literature on cases of neutrophilic dermatoses (ND) with extracutaneous neutrophilic involvement. Lung Culture-negative pulmonary lesions in patients with ND have been reported in 40 cases1,3,5‐39: 20 women, 14
Robert Remak was the first scientist to undertake successful research on fungal skin infections. A neurologist, physiologist, and embryologist, Remak was the first to observe the fungal changes causing the disease of favus; however, he gave credit for the discovery to Professor Johann Schönlein and denied all attempts by others to credit him with the discovery by calling them a mistake. He named the disease Achorion schönleinii; however, over time, the name was changed to Trichophyton schoenleinii. Remak also described axial fibers encased in a medullary sheath and was the first to recognize nonmyelated (sympathetic) nerve fibers, today called fibers of Remak. He demonstrated the existence of the medullary nerve sheath and its production in the process of structured cell division. Remak also was the first to demonstrate that the cerebral cortex consists of six layers and to assert that there are three germ layers in the early embryo and not four.
Twenty International congresses for dermatology and sexually transmitted diseases were held between 1889 and 2002. The number of attendees and the subjects discussed during such congresses progressively increased in number and quality. The continuous progress and development in the knowledge presented year after year was a natural reflection of development in science, culture, and social standard of the countries that hosted these congresses. In this paper, we highlight the achievements of the great universal figures in dermatology who contributed to its progress, and the important milestones of scientific development that will remain as history and references for the future generation.
Maria Goeppert-Mayer's part of her Nobel Lecture: magnetic moments of nuclei. (Used with permission from the Noble Lecture of Maria Goeppert Mayer. The Shell Model, 1963. © The Noble Foundation 1963. Available at:  physics/laureates/1963/mayer-lecture.pdf.) 
Maria Goeppert-Mayer (1906–1972) created the theoretic basis for investigations using the double-photon effect. She was also involved in work on the Manhattan Project for the development of the atomic bomb. In 1963, she received the Nobel Prize in physics for her discoveries concerning nuclear shell structure. Her theoretic results on double-photon absorption are directly used today in dermatology in nonlinear microscopy, multiphoton tomography, and photodynamic therapy.
Top-cited authors
Ronni Wolf
Nikolai Tsankov
  • Tokuda Hospital Sofia
Robert F Diegelmann
  • Virginia Commonwealth University
Lawrence Charles Parish
  • Thomas Jefferson University