Dermatologic Clinics

Published by WB Saunders
Print ISSN: 0733-8635
In conclusion, there can be no doubt that CP is a remarkable local steroid with potency greater than anything previously available to the dermatologist. It may be useful for short-term (less than 2 weeks) and intermittent treatment of widespread inflammatory dermatoses. It is excellent for treating some stubborn localized inflammatory dermatoses before moving on to more dilute preparations. When prescribing CP, it is important to warn the patient of common side effects, such as atrophy and striae, and to instruct the patient carefully in its use, mentioning body areas that should be spared its application. CP should not be applied to flexural, scrotal, or, with a few exceptions such as discoid lupus erythematosus and actinic reticuloid, facial skin. Its use is contraindicated in infants, toddlers, and children under 12 years of age. In addition, adult patients must be told never to use more than 50 gm per week (the manufacturer's recommendation). The prescribing physician must monitor and regularly review the amount used per unit time. Treatment with CP beyond 2 weeks is not recommended in the product information on CP listed in the Physicians' Desk Reference (1988). Those few patients taking CP for a long period should be managed as though they are on systemic steroids. Episodes of acute stress, such as surgery and intercurrent infection, should be managed with supplemental, if necessary parenteral, glucocorticoid administration.(ABSTRACT TRUNCATED AT 250 WORDS)
Antiseptics used for studies
Histological appearance of the three-dimensional model in the 3-min application of antiseptic. a Control. b PVP-I. c CHG. d BEC. Hematoxylin and eosin stain.  
Time course change of skin irritancy. P = PVP-I; d = BAC; o = BEC; $ = CHG; ) = AEG; [ = EtOH.  
Correlation between the in vivo primary skin irritation test and in vitro cytotoxicity. P = 3-min application; ) = 10-min application ; d = 30-min application. In vivo test modified from Tsuji et al. [10].  
Eight patients are described with adverse skin reactions to povidone-iodine-containing preparations (Betadine). Patch test reactions were positive to povidone-iodine 5 or 10 per cent in petrolatum or to Betadine Solution, Ointment, or Scrub. In five of eight patients, also tested with potassium iodide in concentrations ranging from 5 to 20 per cent in petrolatum, the reactions were negative. Open tests with iodine tincture performed in three patients were completely negative. Allergy to povidone-iodine seems not to be based on sensitization to iodine.
Growing evidence in the literature indicates that mast cells are integrally involved in the process of dermal wound repair. They are resident cells of the normal dermis and have several cytokines stored in their granules that are stimulatory to fibroblasts. They also contain serine proteases that may be involved in remodeling of the extracellular matrix during healing. Mast cells are found in increased numbers in acute wounds and in certain chronic fibrotic diseases. Their influence on fibroblast growth and collagen production may be an important element in fibrosis. The effects of mast cell mediators on dermal fibroblasts are currently being explored by our laboratory and others. Myofibroblasts are implicated in the phenomenon of wound contraction. These phenotypically altered fibroblasts express some features of smooth muscle cells, notably actin filaments, and are abundant in granulation tissue. It has been proposed that they are responsible for wound contraction and possibly certain types of contracture. However, this hypothesis has been challenged by studies demonstrating the presence of myofibroblasts in wounds that do not contract, or the process of contraction in vitro in the absence of myofibroblasts. At this time the issue remains open to debate and further research.
Nevoid basal cell carcinoma syndrome has as its hallmarks such diverse manifestations as numerous cutaneous basal cell cancers and epidermal cysts, palmar and plantar pits, keratocysts of the jaw, calcified dural folds, various skeletal anomalies, cleft lip and/or palate, and various other neoplasms or hamartomas. Inheritance is autosomal dominant. The etiology of all of the above findings appears to be a mutation in a tumor suppressor gene that also plays a role in normal embryonic development.
Hospital-derived criteria for atopic dermatitis may need to be refined before being applied to epidemiologic studies. Atopic dermatitis is a common and miserable condition, and environmental factors are probably at least as important as genetic factors in determining disease expression. These findings put us one step nearer to our dream of disease prevention.
Presence of large numbers of acquired melanocytic nevi is a strong risk factor for malignant melanoma in adults. A series of studies conducted over the past 10 to 15 years have shown that the lighter skin color, propensity to burn rather than to tan in the sun, and frequent episodes of childhood sunburn increase nevus prevalence in childhood and adolescence. Solar ultraviolet radiation exposure itself has been implicated in both the genesis of new nevi in children and the disappearance of nevi in older adult life.
Acne vulgaris is a common skin condition seen by physicians. It primarily affects adolescents, but can continue into adulthood. A key factor in the pathogenesis of acne is sebum production. Typical therapy includes combinations of topical retinoids and antimicrobials for mild acne, with the addition of oral antibiotics for moderate to severe disease. In the most recalcitrant cases or for nodulocystic acne, oral retinoids are indicated. In women who fail to respond to conventional treatment, hormonal therapy is often used adjunctively. Only isotretinoin and hormonal therapy improve acne via their action on the sebaceous glands. This article focuses on the mechanisms by which these treatment modalities act on the sebaceous glands and their clinical use in the practice of medicine.
Some of the new therapeutic agents of the 1980s, such as acyclovir and etretinate, will have a long-lasting impact on the treatment of skin diseases. Others have seemingly fallen from grace after an initial period of popularity. This article reviews a number of new agents and provides sources of further information. As with all new treatments, any physician unfamiliar with a product should consult these references and the manufacturer's labeling.
Protein issues confront the dermatologic practitioner in this last decade of the twentieth century, including 1) the role of managed care; 2) the decline of direct access to the specialist; 3) malpractice liability and the need for reform; 4) declining reimbursements in the face of escalating practice overhead; and 5) conflict between the individual's right to care and society's ability to subsidize that right. Correcting and improving the American health care system demands a return to the emphasis and values that made that system the envy of the entire world. We must re-emphasize the sanctity of the doctor-patient relationship, halt the incursion upon physician autonomy, and eliminate those third party factors such as insurance companies, bureaucrats, and administrators that accentuate commerce instead of compassion in medicine. It is hoped that by expanding and equalizing the American health care system, it is not made unpalatable and unresponsive to every citizen.
This article presents a retrospective case-note review of patients diagnosed and hospitalized with acquired syphilis between January 1999 and December 2005 performed at the two Departments of Dermatovenereology in Prague. The syphilis epidemic in the Czech Republic between 1994 and 2001 now seems to be declining. The high rates of immigration from Eastern Europe, unprotected sex, and prostitution provide the basis for an epidemic of sexually transmitted infections. Early identification of infected individuals and high-risk population groups, adequate treatment, partner notification, and treatment of infected partners therefore is essential.
On the 12th of January 2010, Haiti was struck by a 7.0 Richter magnitude earthquake that devastated its already fragile capital region. Approximately 230,000 people died immediately or during ensuing weeks, mostly due to acute trauma. Countless others suffered significant life- or limb-threatening injuries. As a part of the United States' response to this tragedy, eventually named Operation Unified Response, the United States Navy deployed hundreds of physicians and other medical response individuals on a hospital ship. Operation Unified Response was a military joint task force operation augmented by governmental and nongovernmental organizations. Its mission was to bring medical and logistical support to the region.
Skin cancer prevalence in ethnic skin is low. Squamous cell carcinoma, hypopigmented mycosis fungoides, and acral lentiginous melanoma are the most serious types of skin cancer noted in the darker-skinned population. Photoaging occurs less frequently and is less severe in ethnic skin.
Multiple endocrine neoplasia type 2A (MEN 2A, Sipple syndrome) is an autosomal dominant phakomatosis and is most likely a paracrinopathy. The cardinal manifestations of MEN 2A--medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism--indicate that the condition is one of the inherited cancer syndromes. Cutaneous, lichen amyloidosis-like lesions place MEN 2A among the genodermatoses. The gene of MEN 2A, designated as MEN2A, is in the pericentromeric region of chromosome 10; this allows for reliable prenatal and presymptomatic DNA diagnosis.
Multiple endocrine neoplasia type 2B/3 is characterized by multiple mucosal neuromas, a marfanoid appearance, medullary thyroid carcinoma, pheochromocytoma, gastrointestinal ganglioneuromatosis, and thickened corneal nerves. This rare syndrome is inherited in an autosomal dominant pattern. Early recognition followed by appropriate screening and treatment can be life-saving.
Face lifting fails to correct many aging changes because it does not restore lost tissues but merely removes excess tissue. Volume expansion of involuted tissues must be accomplished to properly rejuvenate the face. Fat grafting can be used to fill involuted facial tissues. This can be accomplished by transfer of cylinders of fat. Cellular micro-implants can also be used as autologous grafts.
The term "dysplastic nevus" is a misnomer and should be abandoned. Dysplastic nevus is not just a name, it is the root of the concept that histomorphology (or any morphologic examination including dermatoscopy) is able to predict the fate of a benign melanocytic proliferation. There is no evidence that this hypothesis is true but there are observations that falsify it. Preferably a specific diagnosis should be made based on dermatoscopic pattern and, if this is not possible, on clinical or dermatoscopic grounds alone the term "nevus, not otherwise specified" should be used.
As one of the most frequent regions treated by liposuction in both men and women, the abdomen presents unique learning opportunities for the liposuction surgeon. Because of anatomic variation, the upper abdomen is more fibrous than the lower abdomen, requiring a slightly different approach to achieve optimal fat removal. The periumbilical area also provides unique challenges for the operator and care must be taken to avoid leaving a ring of residual fat. Potentially excellent skin retraction in the area, combined with relatively aggressive fat removal can lead to dramatic results including, in some cases, significant contraction of a long-standing panniculus. In this article, the basic techniques and potential pitfalls of abdominal liposuction are presented in detail.
Treating the entire area as a cosmetic unit is the best approach to tumescent liposculpture of the abdomen, waist, and flanks. This "Three-Dimensional Tumescent Liposculpture" procedure is performed under tumescent local anesthesia with optional intraoperative external ultrasound. Areas treated are the abdomen, waist, flanks, and infrascapular fat pad if indicated. Postoperatively, patients show a flatter abdomen, a smaller and better-defined waist (the "Cook waist"), reduction of unsightly bulges, and a smoother, better proportioned and more attractive overall contour. Patient recovery is rapid with minimal complications.
This article presupposes that the surgeon has complete command of the process or craft of liposuction. This consideration of form does not presume to issue a commentary upon the ultimate fitness of the form; rather, form confines itself with shape. The final question that matters is, "has the surgeon used the craft to successfully alter the three-dimensional mass into an aesthetically pleasing end."
Surgical science continues to increase the options available to an individual seeking an improved abdominal contour. Appropriately applied, abdominal-contouring procedures offer significant aesthetic improvements and result in a high level of patient satisfaction. Liposuction is one procedure in a continuum of techniques available for addressing abdominal contour, and it is the one with which patients are most familiar and most likely to request. Advising patients of the many available methods involves an understanding of the scope of each technique and an accurate assessment of individuals' anatomy and their expectations and perceptions of what a successful result represents. This article outlines the various surgical methods of abdominal contouring and fosters an understanding of how to select the appropriate procedure.
Although the Mohs technique is most often applied to moderate and large lesions, with appropriate modifications it can also be applied to massive lesions. Reconstructive procedures after resection of large defects are also discussed.
Ablative resurfacing is a powerful tool for rejuvenation of the aging face and for the treatment of a wide array of skin lesions. In the proper hands, it is a safe and effective way to treat many of the problems of photodamaged skin that surgery or nonablative methods cannot address. This article discusses the three most common modalities used in ablative facial resurfacing: chemical peels, dermabrasion, and laser resurfacing. Indications, mechanism of action, techniques, results, and complications all are reviewed.
The field of nonsurgical laser resurfacing for aesthetic enhancement continues to improve with new research and technological advances. Since its beginnings in the 1980s, the laser-resurfacing industry has produced a multitude of devices employing ablative, nonablative, and fractional ablative technologies. The three approaches largely differ in their method of thermal damage, weighing degrees of efficacy, downtime, and side effect profiles against each other. Nonablative technologies generate some interest, although only for those patient populations seeking mild improvements. Fractional technologies, however, have gained dramatic ground on fully ablative resurfacing. Fractional laser resurfacing, while exhibiting results that fall just short of the ideal outcomes of fully ablative treatments, is an increasingly attractive alternative because of its far more favorable side effect profile, reduced recovery time, and significant clinical outcome.
The mesenchyme-derived dermal papilla plays a major regulatory role in the complex cell biology of the hair follicle. The ability to culture dermal papilla cells from a range of species and particularly a range of normal and disordered human hair follicles has enabled the development of a powerful new model system for investigating hair follicle biology. Already these studies have reinforced the importance of dermal papilla cells in initiating new follicle growth and in androgen action in human hair follicles. The retention of hair growth inducing capabilities and characteristics that reflect their in vivo responsiveness to androgens in culture means that they offer a potentially useful approach despite significant drawbacks in working with the cells themselves. Further studies using dermal papilla cells may well elucidate key molecules involved in hair biology in health and disease and, thereby, lead to better therapeutic regimens.
This article focuses on a few of the most common genetically inherited disorders of pigmentation: multiple lentigines syndromes, Peutz-Jeghers syndrome, dyskeratosis congenita, incontinentia pigmenti, tuberous sclerosis, neurofibromatosis, and Albright's polyostotic fibrous dysplasia.
The nails can change colors for many reasons. White bands called leukonychia are especially common. The shape of the white band, that is, concave or convex, indicates the site of injury. Color changes in the nails may also be a sign of a variety of cutaneous or systemic disorders.
In summary, the aging process in skin has at least two major manifestations: elastic fiber abnormalities involving degradation and assembly, and microvascular wall alterations of widening and atrophy depending upon the functional state of the veil cell. The abnormalities of the elastic fiber network most likely correlate with the increasing cutaneous laxity associated with aging. The microvascular abnormalities are not easily related to any specific clinical feature of aging skin. The finding of identical abnormalities in the skin of juvenile diabetics strengthens this hypothesis, as well as suggesting that these alterations are accelerated in diabetic patients. Diabetic skin might be another model system for studying cutaneous aging.
Color changes of the nail unit may be innocent or may be associated with disease. Four tables provide the reader with a means of categorizing pigmentation abnormalities in the following manner: changes attributable to systemic disorders and some predominantly dermatologic conditions, changes caused by systemic drugs or ingestants, changes attributable to local agents, and changes attributable to some named nail entities.
The work described in this article reveals a remarkable lack of consensus as to whether percutaneous absorption changes as humans grow older. The data that have been recorded point to possible significant alterations in the barrier function with age. The importance of these observations with respect to dermatopharmacology and dermatotoxicology is clear. The absence of a clearly defined relationship between aging, percutaneous penetration, and the properties of the molecules crossing the skin barrier represents an unacceptable gap in fundamental dermatologic knowledge. With the changing demographic pattern of Western civilization and the increasing awareness of human subjects for the condition of their skin, and the potential for drug delivery via their skin, it is crucial that we begin to establish precisely how the barrier function alters with increasing age. The answer to this question may permit unique improvements in the quality of both local and systemic health in aging populations.
In 2008, the American Academy of Dermatology began sponsoring North American dermatology residents to travel to Botswana in sub-Saharan Africa and spend 4 to 6 weeks working with the Botswana-UPenn Partnership, the Baylor International Pediatrics AIDS Initiative, Princess Marina Hospital, and surrounding smaller district hospitals. During their time in Botswana, the residents staff the busy outpatient dermatology clinic and see adult and pediatric inpatients at Princess Marina Hospital in Gaborone, the capital city. The residents also travel to 4 rural hospitals to provide clinical services to patient and education to local health care providers. The program goals include providing direct care to the people of Botswana, capacity-building through dermatologic education for local clinicians, and educating the residents about delivering dermatologic care in resource-limited and culturally diverse settings and using teledermatology consulting services. Since the start of the program, more than 1500 patients have been seen, and 35 residents would have completed the program by the end of 2010.
Lethal acantholytic epidermolysis bullosa (LAEB) is an autosomal recessive disorder caused by mutations in the gene encoding the desmosomal protein, desmoplakin (DSP). It is recognized as a distinct form of suprabasal epidermolysis bullosa simplex, although only a single case has been reported. The phenotype comprises severe fragility of skin and mucous membranes with marked transcutaneous fluid loss. Other features include total alopecia, neonatal teeth, and anonychia. Skin biopsy reveals abnormal desmosomes with suprabasal clefting and acantholysis and disconnection of keratin intermediate filaments from desmosomes. The DSP abnormalities present in the affected individual involved expression of truncated DSP polypeptides that lacked the tail domain of the protein. This part of DSP has a vital role in binding to keratin filaments. The affected neonate died after 10 days because of heart failure with evidence of loss of epithelial integrity in the skin, lung, gastrointestinal tract, and bladder. This article provides a clinicopathologic overview of this unique desmosomal genodermatosis, set in the context of other DSP gene mutations, both dominant and recessive, that can cause a spectrum of skin, hair, and heart abnormalities.
Epidermolysis bullosa (EB) is a spectrum of rare, inherited, blistering skin disorders, primarily affecting the skin and pharyngoesophageal mucosa. EB affects approximately 2 to 4 per 100,000 children each year. Blistering and scarring occur in response to even the most minor trauma. In this article, the authors outline the potential management options for patients with EB complicated by feeding difficulties secondary to esophageal strictures as well as those with nutritional deficiencies requiring a gastrostomy tube for supplemental feeding.
In this article, the authors summarize the published literature on the reliability and accuracy of teledermatology. The first section reports on the diagnostic reliability of teledermatology compared with face-to-face clinic consultation. In the second section, the authors report on the "intragroup" diagnostic agreement between either clinic dermatologists or teledermatologists. The third section discusses the diagnostic accuracy for those studies that include definitive histopathologic diagnosis. The last section summarizes the literature comparing clinical management decisions by clinic dermatologists to those made by teledermatologists.
Central centrifugal cicatricial alopecia is an inflammatory type of central scalp hair loss seen primarily in women of African descent. The prevalence is unknown, but may vary from 2.7% to 5.7% and increases with age. This review outlines the history and current beliefs and identifies clues for future research for this enigmatic condition. Despite that the cause of central centrifugal cicatricial alopecia is unknown, research is ongoing. The role of cytokeratins, androgens, genetics, and various possible sources of chronic inflammation in disease pathogenesis remain to be elucidated.
DERM/INFONET, a group of dermatologic data bases, has been reorganized for easy log-ons and log-offs, plus fast, unambiguous selections from simplified menus. DERM/RX and DERM/PHARM data bases are dermatologic exclusives. The medical literature search will retrieve the most unencumbered dermatologic information for both the academician and clinician for getting the day's work done.
Nearly two decades after the advent of synthetic retinoids for the treatment of many severe and incapacitating dermatologic conditions, the usefulness of these drugs is not universally accepted. The safety profile is well established. Other than teratogenicity, which can be avoided if the recommended precautions for use are followed, serious or unexpected adverse reactions rarely occur. This article concisely addresses some questions about etretinate and acitretin therapy that are most pertinent for the dermatologist.
Acne vulgaris is a common skin disorder. Although it is most prevalent in the second decade of life, its beginnings are heralded by increased activity of the sebaceous glands and faulty follicular keratinization, which are already evident in mid to late childhood. The subsequent and increasing proliferation of the follicular anaerobic diphtheroid microflora contribute further as an important pathogenic factor in the generation of inflammatory lesions. Treatments of acne, therefore, are aimed at reducing the follicular anaerobic bacteria, counteracting the follicular hyperkeratosis, and inhibiting the activity of sebaceous glands.
Since the July 1983 Symposium on Acne in which the article entitled 'Rehabilitation of Acne Scarring' appeared, there have been few major breakthroughs in the correction of acne scarring. However, the refinements developed since the previous publication have improved the results and are included here. The objective of rehabilitative surgery is to impart to the surface of the skin. Although a total correction of the tissue deformities caused by acne cannot always be achieved, the rationale for such surgery goes beyond the cosmetic to a concern for improving the patient's self-image. Acne can produce a variety of skin defects. A scar can be characterized as narrow or wide, deep or shallow, pitted, ice-pick-like, crater-like, diffusely depressed, hypotrophic, hypertrophic, keloidal, and hypopigmented or hyperpigmented. Rehabilitation techniques are selected by the type of scar. The typical patient has a variety of scar types, and several different techniques usually are required to achieve optimal reconstruction. Good photographic documentation of the skin's preoperative condition is usually necessary.
Acne vulgaris affects most adolescents and two-thirds of adults and is associated with substantial psychosocial burden. Health-related quality of life (HRQOL) for patients with acne is an important factor of patient care, and several dermatologic and acne-specific measures have been created to assist in acne research, management, and care. This review describes several skin disease and acne-specific HRQOL measures and their applications in clinical care or research. The ideal HRQOL measure for the management of patients with acne is a concise questionnaire that places minimal burden on respondents and allows physicians to track improvement in HRQOL with successful treatment.
This article reviews the anti-inflammatory and nonantimicrobial effects of antibiotics in acne and other diseases and examines issues relating to the emergence of decreased bacterial sensitivity to antibiotics and how these issues relate to clinical practice. It includes an overview of the inflammatory activities of some antibiotic agents and their potential for use in various dermatologic and nondermatologic diseases. It demonstrates that P. acnes-resistant organisms may be associated with therapeutic failure in some patients with acne, and that the prudent use of antibiotics is necessary to ensure that we can continue to use these drugs to combat disease effectively. It concludes that there are treatment strategies that can effectively minimize the potential for development of resistant P. acnes organisms.
Acne is the most common disorder observed in ethnic skin. Clinical presentation is different than in white skin. Postinflammatory hyperpigmentation is a common sequelae of acne in darker skin. The management of acne in ethnic skin is based largely on the prevention and treatment of hyperpigmentation.
Although acne represents the most common chronic skin condition seen by dermatologists, there are still many unanswered questions regarding its pathophysiology, and patients are still in need of more effective therapies, particularly those aimed at the hormonal aspects of acne. Recent clinical research has led to advances in our understanding of factors such as cytokines in follicular hyperkeratinization and the role of androgens in acne, the emergence and significance of antibiotic resistance of P. acnes, the long-term safety and efficacy of isotretinoin, and the safety and efficacy of new topical retinoids, such as tazarotene and adapalene. Fruitful interactions between basic scientists and clinical researchers within medicine and the pharmaceutical industry will, it is hoped, provide for future advances in this area.
Acne vulgaris is a common skin condition with substantial cutaneous and psychologic disease burden. Studies suggest that the emotional impact of acne is comparable to that experienced by patients with systemic diseases, like diabetes and epilepsy. In conjunction with the considerable personal burden experienced by patients with acne, acne vulgaris also accounts for substantial societal and health care burden. The pathogenesis and existing treatment strategies for acne are complex. This article discusses the epidemiology, pathogenesis, and treatment of acne vulgaris. The burden of disease in the United States and future directions in the management of acne are also addressed.
Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity. These agents are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid. The most common oral antibiotics for treating acne vulgaris are the tetracycline derivatives, although macrolide agents such as erythromycin have also been used extensively. Over the past 4 decades, as the sensitivity of Propionibacterium acnes to several oral and topical antibiotics has decreased, the efficacy of oral tetracycline and erythromycin has markedly diminished, leading to increased use of doxycycline, minocycline, and other agents, such as trimethoprim/sulfamethoxazole.
Pseudofolliculitis barbae is essentially a disorder of the beard in black men who shave. The only permanent cures are beard growth and depilation. An important part of the therapeutic regimen is patient education. Acne keloidalis nuchae refers to the occurrence of keloidal-like papules and plaques on the occipital scalp and posterior neck, almost exclusively in black men. It usually starts after puberty as an acute folliculitis and perifolliculitis, which becomes chronic. As the disease progresses the papules enlarge and some form keloidal-like plaques. There is therapeutic and help and hope for acne keloidalis nuchae patients using the excision and second-intention healing technique plus some of the recently reported laser techniques.
This article describes scenarios of patients who have acne vulgaris have tried over-the-counter products and cosmetics and are disheartened by the persistence of their disease and the resulting scars. They may have seen an aesthetician, plastic surgeon, or even a general practitioner before seeing a well-informed skin specialist. Patients perceive the dermatologist to be the skin care expert and seek guidance to obtain otherwise unobtainable results. Therefore, practicing dermatologists should take advantage of the available tools to treat patients aggressively and completely. Appropriately applied cosmetics can play a role in achieving this goal. This article describes scenarios that integrate cosmetics into an anti-acne treatment regimen that is effective and safe for all ethnic groups and is well tolerated by both male and female patients.
The goal of this article is to highlight recent developments in the treatment of acne and rosacea. An update on the use of isotretinoin, minocycline, topical retinoids, and hormones in the treatment of acne are presented. Highlights of research findings that may lead to future acne therapies are discussed. New in the management of rosacea are studies demonstrating the efficacy of 1% topical metronidazole in the treatment of rosacea, reports on the successful maintenance of remissions of rosacea with 0.75% metronidazole gel, and data regarding the controversial association of rosacea with Helicobacter pylori infection.
The combination of newer laser and light sources, the long-pulsed pulsed dye laser (LP PDL) and intense pulsed light, with topical aminolevulinic acid photodynamic therapy (PDT) has achieved enhanced efficacy and rapid treatment and recovery, while diminishing unwanted side effects. In particular, LP PDL PDT has been shown to be safe and effective in the treatment of actinic keratoses, actinic cheilitis, photodamage, and acne vulgaris with minimal discomfort, rapid treatment and recovery, and excellent posttreatment cosmesis.
Acne-Prone Skin. Acne-prone skin appears to be more susceptible to certain extrinsic factors that can either exacerbate existing disease or generate new lesions. Awareness of the factors that could worsen or interfere with therapy is important. In addition, identification of patients with minimal acne who are prone to outbreaks from extrinsic factors and provision of relevant advice could prove beneficial to significant numbers of patients. Sensitive Skin. From the perspective of our research, the definition of sensitive skin is still evolving. Certain individuals may view sensitive skin as fashionable; however, clinicians and the people who work in the personal-care industry know that when certain materials are applied to the skin, some individuals report symptoms (burning, stinging, itching, a tight feeling) and sometimes show traditional signs of irritation. The reasons for sensitive skin in these individuals may be obvious, but many times the complaints and signs of irritation occur in individuals who appear to be normal. Using our ongoing work we would like to suggest that the label "sensitive skin" apply to the following four categories: 1. Those individuals with obvious skin disease. 2. Those individuals with subclinical (mild) or atypical clinical signs of disease. 3. Those individuals who have experienced past insults to the skin. 4. Those individuals who do not fit into one of the above three categories and appear to be "normal". To define sensitive skin fully we may need to perform full profiles of the skin of these patients. In addition to history and examination, a battery of noninvasive tests may be helpful.(ABSTRACT TRUNCATED AT 250 WORDS)
Top-cited authors
Aditya Gupta
  • Mediprobe Research
Roy Rogers
  • Mayo Clinic - Scottsdale
Jouni Uitto
  • Thomas Jefferson University
Bianca Maria Piraccini
  • University of Bologna
Tina Alster
  • Washington Institute of Dermatologic Laser Surgery