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[Anti-aging medicine in dermatologic practice].

In the future, the increasing number of older individuals will play an even greater social and medicopolitical role. One challenge for dermatology is to incorporate preventive or anti-aging measures into daily practice. Solid understanding of the mechanisms of aging is required. An organized approach to such patients with emphasis on history, physical examination, imaging and skin physiology studies, and laboratory diagnosis is presented. Topical and systemic interventions should be based on the results of this complete evaluation.

Aging↗

[Guidelines for rehabilitation of dermatological diseases].

Guidelines for dermatological rehabilitation are based on the International Classification of Functioning, Disabilities and Health (ICF), which includes context factors such as physical environment, socioeconomic conditions, and the personal situation of the patient. Guidelines give specific recommendations for personal conditions of rehabilitation, staff, equipment, process of treatment, and evaluation. They assist doctors, patients, and public institutions in orientation and decision making. The latest publications are a joint summary obtained from experts, with substantial participation of the social insurance agencies, and demonstrate the growing importance of guidelines which are the result of a compromise between the conflicting interests of medical progress on the one hand and economic restrictions on the other. Consequences for allocation of financial resources in the health system are discussed.

Dermatology↗

[The international classification of functioning, disability and health (ICF) in dermatological rehabilitation: conception, application, perspective].

Medical rehabilitation represents the interdisciplinary management of a person's functional health. This term implies concepts of functioning, disability and health and represents the core notion of the international classification of functioning, disability and health (ICF). Four components -- anatomic structure, body functions, activities and participation, environmental factors and personal factors -- make the ICF applicable from a biological, individual and social perspective. At present the ICF is used as a system of classification, a research tool and as a theoretical basis in rehabilitation medicine. Its clinical application will depend on the improvement of its practicability and compatibility with currently used tools in dermatologic rehabilitation. ICF offers the opportunity to define, weight and classify diseases of the skin and their psychosocial consequences.

Dermatology↗

[Community-based MRSA. A new challenge for dermatology].

Treatment options for infections with MRSA are extremely limited because of resistance to all beta-lactam antibiotics and primarily because of the fast acquisition of further antibiotic resistance. During the past six years MRSA possessing the genomic determinant of an additional virulence factor emerged. This virulence factor, Panton-Valentine-Leukocidin, seems to be responsible for deep skin infections as well as necrotizing pneumonia. In order to avoid a continuous spread of MRSA, consequent prevention measures both in dermatological practices and for colonized patients in their general environment are essential.

Carrier State↗

[Health economics studies in dermatology].

Because of reduced resources for health care, provision of modern effective dermatologic care for patients with German public health insurances has become more and more difficult. This survey is designed to aid in the assessment of published health economic studies as well as encourage participation in health economic evaluations. These studies should analyze and optimize the allocation of the available resources. Four main approaches can be used to calculate the incidental expenses; they differ in their methods of evaluation and assessment of health services. They all offer methods to calculate the anticipated costs and consequences. The methods include cost minimization analysis (CMA), cost effectiveness analysis (CEA), cost utility analysis (CUA) or cost benefit analysis (CBA). Many subgroups also exist. Important criteria for the evaluation of health economic trials and hints for the publication of the results are provided on the basis of the recommendations for health economic evaluations.

Clinical Trials as Topic↗

[Outpatient dermatological chemotherapy].

Cytostatic chemotherapy is an integral therapeutic concept in dermatological oncology. The cytostatic drugs are mostly used in palliative situations and in most cases can be applied in an outpatient setting. Special medical knowledge as well as organizational structures are necessary for managing ambulant chemotherapy. A broad spectrum of cytostatic drugs is available and their special indications and use for the treatment of different types of dermato-oncological diseases is reviewed. Specific tools have to be taken into account before, during and after the application of chemotherapy. These include prevention of nausea and emesis, safety guidelines related to the prevention of extravasation, as well as special situations related to patient age.

Ambulatory Care↗

[50 years Zwickau Dermatologic Clinic in the Heinrich-Braum Hospital].

The dermatological clinic in Zwickau celebrated 50 years of existence in 1996. We review the clinics history, starting with its founding in 1946 because of the upsurge in venerological diseases during the post-world war II years. The most important clinic directory and their scientific activities are described.

Dermatology↗

[Human experimentation in dermatology 100 years ago and today].

The problem of ethics in dermatology is explored using selected examples from the literature. The classic case of Neisser as well as Eduard Arning's experiments on a Hawaiian with leprosy convicted to death are discussed. In addition, inoculation studies with syphilis 100 years ago and the author's own experiences are cited. The differences in the approaches to medical ethics 100 years ago and today lead to the conclusion that ethics change to fit the needs of the society and do not have a permanent fixed status.

Dermatology↗

Arachidonic acid-derived bioactive lipids: their role and the role for their inhibitors in dermatology.

BACKGROUND: In addition to corticosteroids, there are increasing numbers of anti-inflammatory agents that specifically target bioactive lipids generated from arachidonic acid. Knowledge of the diverse mechanisms of action of these different bioactive lipids holds promise in the therapy of a wide spectrum of cutaneous and systemic disorders. OBJECTIVE: Therapeutic manipulations of these lipid molecules through inhibition, stimulation, or direct replacement have broad physiologic effects. These therapeutic strategies not only modulate inflammation, pain, and hemostatic parameters, they also play a role in cardiac, respiratory, renal, and gastrointestinal function and disease, as well as in angiogenesis and in factors that control cell growth and apoptosis important in carcinogenesis. CONCLUSION: Newer drug discovery methods, including combinatorial chemistry with molecular modeling, have made it possible to develop inhibitors and analogs with increasing specificity and bioactivity and decreasing toxicity. Although the application of these analogs and inhibitors for cutaneous disease is limited today, either as primary agents or adjuvant therapy, these drugs will have a place in our therapeutic regimes of the future. We present a review of the therapeutic agents now available from manipulation of these bioactive lipids, and their role and future in dermatology.

Anti-Inflammatory Agents↗

NSAIDs in dermatologic therapy: review and preview.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades. OBJECTIVE: In this retrospective review, we document the use of NSAIDs in more than 15 common and uncommon dermatoses, including acne, psoriasis, sunburn, erythema nodosum, cryoglobulinemia, Sweet's syndrome, systemic mastocytosis, as well as urticarial, livedoid, and nodular vasculitis. NSAIDs act mainly by inhibiting prostaglandin synthesis by the cyclooxygenase (COX) pathway. CONCLUSION: Recent studies link prostaglandin to cutaneous carcinogenesis, thus expanding the dermatologic use of NSAIDs. They may be effective in the treatment and prevention of non-melanoma skin cancer, and specific COX-2 inhibitors promise safer, broader, long-term use of these pharmacologically innovative drugs.

Anti-Inflammatory Agents, Non-Steroidal↗

[Dermatology in telemedicine. Possibilities and limits].

Telemedicine including teledermatology is the application of telecommunication technology for the purpose of diagnostics, planning and guiding of therapy and education. With the possibility to gain fast access to specialty knowledge, telemedicine makes it possible to deliver health care to patients at distant sites. By participating in telemedical consultations, patients receive accurate diagnosis in a rapid manner and save travel costs and time. Due to recent advances in computing and telecommunications technology, telemedicine will assume a more and more important role in future health care delivery. Telemedicine is utilized by almost all medical specialties but to varying degrees. Dermatology as a visually based specialty is predestined to use the various capabilities of telemedicine. The main applications so far include teledermatohistology and clinical teledermatology. The objective of this paper is to present the current status of teledermatology as part of telemedicine with a look toward future applications.

Dermatology↗

Arsenic-induced skin conditions identified in southwest dermatology practices: an epidemiologic tool?

Populations living in the Southwest United States are more likely to be exposed to elevated drinking water arsenic levels compared to other areas of the country. Skin changes, including hyperpigmentation and generalized hyperkeratosis, are the most common signs of chronic arsenic ingestion from drinking water. The purpose of this study was to determine the feasibility of using dermatology practices in New Mexico, Arizona, and western Texas as a surveillance system for arsenical skin disorders related to drinking water. Postcard questionnaires were mailed to practicing dermatologists. The number of cases of arsenical hyperpigmentation/keratoses seen by these dermatologists during the past 10 years and the past year were estimated. Of 240 dermatologists who were mailed questionnaires, 37 reported seeing 237 patients with arsenical hyperpigmentation/keratoses in the past 10 years and 35 patients in the past year. Since approximately one-eighth of dermatologists practicing in the Southwest saw at least one patient with arsenical hyperpigmentation/keratoses during one year, it appears feasible to complete a population-based study of these conditions.

Arsenic↗

Monitoring for adverse effects from systemic drugs used in dermatology.

Systemic drugs with an associated element of risk are essential in managing many important dermatoses. This review identifies eight major drugs or drug groups used in dermatology that require systematic monitoring for adverse effects. The complete monitoring process is emphasized, including significant patient involvement in reporting key signs or symptoms that allow early diagnosis of many of these adverse effects. The concepts of "risk-risk" assessment and "critical toxicities" are defined, emphasizing their important role in maximizing drug benefits and safety. Drug-related risk factors, disease-specific risk factors, and patient characteristics or habits that increase the risks from systemic drugs are identified. Basic principles of monitoring for adverse effects, specific clinical features of the most important adverse effects, along with detailed monitoring guidelines for methotrexate, retinoids, dapsone, corticosteroids, and cyclosporine are presented.

Dermatologic Agents↗

American Academy of Dermatology Patch Testing Survey: use and effectiveness of this procedure.

The results of an American Academy of Dermatology (AAD)-sponsored survey on the use and effectiveness of patch testing are presented. Academy members' responses indicate that 27% do not patch test at all. Reasons given for not testing included (1) the patient history was adequate for diagnosis, (2) patch testing was too time-consuming, and (3) reimbursement was not sufficient. Dermatologists in residency training programs who responded to a similar survey are testing frequently and report a high degree of positivity and relevancy among tests applied. Recommendations are presented with a focus toward increasing interest in patch testing among the membership.

Academies and Institutes↗

Management of cutaneous malignant melanoma by dermatologists of the American Academy of Dermatology. I. Survey of biopsy practices of pigmented lesions suspected as melanoma.

BACKGROUND: The incidence of malignant melanoma (MM) has rapidly increased during the past five decades. Relatively little information is available on whether the role of the dermatologist has increased concomitantly in the surgical management of this cancer. OBJECTIVE: Our purpose was to learn how members of the American Academy of Dermatology (AAD) treat patients with lesions highly suspected as being MM and how the management of these patients may have changed over the past decade. This, the first of a two-part series, concerns biopsies. METHODS: The data for the study were collected by means of a questionnaire that was sent to all members of the AAD practicing in the United States (N = 7412). RESULTS: A total of 2991 valid questionnaires were returned, a response rate of 40%. The majority of respondents (89% in 1982; 90% in 1992) stated that they performed the biopsies of pigmented lesions suspected of being MMs. Excisional biopsy was the preferred technique (58% in 1982; 68% in 1992). The type of biopsy and who performed the initial biopsy of a suspected MM were associated with the following factors: (1) the number of years in practice, (2) the type of practice, and (3) whether the dermatologist subsequently performed the definitive surgery for the MM. Regional variations in biopsy practices were also noted. CONCLUSION: Most AAD dermatologists who responded to the questionnaire perform the biopsies of lesions highly suspected of being MM. During the last decade an increasing proportion of dermatologists are performing excisional biopsies rather than other types of biopsies for such lesions.

Attitude of Health Personnel↗

Objectives to direct the training of emergency medicine residents on off-service rotations: dermatology.

This is the fifth in a continuing series of objectives to direct resident training in emergency medicine. Approximately 50% of resident experience and training in emergency medicine takes place outside of the direct control and influence of full-time emergency medicine faculty. To gain some direction and control over these off-service rotations, objectives and references are offered here. Objectives for a dermatology rotation as well as contents and references are presented.

Curriculum↗

History of dermatologic surgery. From the beginnings to late antiquity.

We stop short, with Celsus, our glimpse of ancient dermatologic surgery in the West. As was stated at the beginning of the chapter, only a few examples and speculations are mentioned in this brief account. Much has gone unmentioned, including the contributions of great Eastern civilizations, such as ancient India, China, and Persia; the Bible; and the "ancient" inhabitants of the "new" world. We note especially the omission of the amazing ancient Hindu cosmetic operations that successfully employed rotating pedicle flaps in reconstructing amputated ears and noses. Important names before Celsus are missing from this account, especially the two Alexandrian physician-surgeons who flourished three centuries earlier--Herophilus (the Father of Anatomy) and Erasistratus (the Father of Physiology). Except for a few extant anatomic fragments, the works of Herophilus and Erasistratus are completely lost. We may with confidence, however, infer from the writings of Celsus and Galen that the brillant anatomy and physiology of the Alexandrian period made for good surgical diagnosis and practice. We must remember, too, that after Celsus' time, the slow disintergration of the Roman Empire took more than 500 years. This period of 500 years saw a number of important Roman physician-surgeons who contributed significantly with daring new operations and original surgical concepts and techniques: Heliodorus, Soranus, Rufus, Archigenes, Galen, Antyllus, Leonides, Oribasius, Aetius, Paulus, and others. The positive surgical contributions of these giants would be lost and rediscovered, many times.

Animals↗

Changing paradigms in dermatology: new ways to examine the skin using noninvasive imaging methods.

Detailed visualization of the skin in the practice of dermatology is key to a comprehensive examination and accurate diagnosis. Advancements in digital dermoscopy, microscopy, imaging and photography have formed an impressive arsenal with which dermatologists can offer state-of-the-art patient care while streamlining their clinical practice and improving their academic and research capacities. Many types of advanced imaging are used in the biologic sciences at the bench; however, our paper reviews the clinical, noninvasive in vivo human applications of these emerging technologies. Our experiences with these instruments reinforce such reviews.

Dermatology↗