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PubMed1996

Psychopharmacology for dermatologic patients.

In the recent past, there has been great progress made in making psychopharmacologic agents both more efficacious and more user friendly. If dermatologists are to more effectively treat psychodermatologic patients who refuse to see a mental health professional, judicious and responsible use of psychopharmacology is still the most feasible way to treat many of these patients. This article illustrates the use of several commonly used psychopharmacologic agents. Even for psychiatrists, it is not realistic to try to master all psychopharmacologic agents that are on the market. Familiarity with the use of medications discussed in this article is likely to add significantly to the therapeutic armamentarium of a dermatologic practitioner.

Antipsychotic Agents↗

PubMed1997

Advances in dermatologic surgery.

The major advances in dermatologic surgery for this period reside in the areas of diagnosis and management of cutaneous melanoma, laser surgery, tumescent liposuction, and tumorigenesis. A closer look at these advances is presented.

Forecasting↗

PubMed1997

Pediatric dermatology.

The latest studies regarding the controversial and concerning subjects of pigmented nevi and melanoma in children are reviewed. Additional topics covered include dermatologic conditions that feature genetic mosaicism, theories of pathogenesis of Langerhans cell histiocytosis, new clinical information regarding juvenile xanthogranulomas, and the unique features of pyoderma gangrenosum in infants and children.

Age of Onset↗

PubMed1997

Current status of photodynamic therapy in dermatology.

The accessibility of skin to light treatment, as well as the expertise developed by dermatologists in laser surgery and phototherapy, creates an exciting opportunity for dermatologic PDT to become part of our standard therapeutic armamentarium. PDT appears to be viable alternative to conventional therapy for superficial BCC and Bowen's disease, although definitive controlled studies are lacking. The introduction of ongoing research developments, new photosensitizers, and better light sources into clinical PDT trials in the coming years will undoubtedly expand the range of indications for this novel form of therapy, particularly for nononcologic conditions.

Humans↗

PubMed1994

Llama dermatology.

The purpose of this article is to add information to the many dermatologic topics initially discussed in the 1989 issue on llama medicine (normal anatomy; bacterial, fungal, ectoparasitic, immune-mediated, and zinc-responsive disease) and make mention of newly recognized diseases. Since 1989, it appears that one of the most common and perplexing groups of dermatoses seen at Colorado State University are hyperkeratotic/inflammatory dermatoses. These remain poorly understood. Idiopathic hyperkeratosis (zinc-responsive dermatosis) may be a true zinc deficiency or a keratinizing disorder responsive to supraphysiologic dosages of zinc supplementation. Idiopathic nasal/perioral hyperkeratotic/ inflammatory dermatosis (munge) and idiopathic necrolytic/neutrophilic/hyperkeratotic dermatosis bear clinical, histologic, and therapeutic similarities, and may be subsets of the same disease. Further studies (e.g., looking for metabolic derangements) are necessary to better answer these questions.

Animals↗

PubMed2005

[Dermatological aspects in the risk of biological warfare].

The possible cutaneous manifestations of infectious biological warfare are multiple and vary depending on the agent used. An ulcerous and/or necrotic syndrome and/or regional lymphadenitis syndrome are possible with anthrax, tularaemia, bubonic plague and emission of trichotecene mycotoxins. A vesiculo-pustular syndrome with fever is provoked by smallpox, melioidosis and glanders. A purpural and/or haemorrhagic syndrome is seen during haemorrhagic fever viruses and septicaemic plague. These cutaneous manifestations are excellent markers that orient and alert when they occur in a context of a situation at risk, when several cases are observed in a usually non-exposed population and with extra-dermatological syndromes. They permit the early initiation of treatment.

Biological Warfare↗

PubMed2001

Dermatologic infections in the immunocompromised (non-HIV) host.

The immunocompromised host's susceptibility to infections often present a difficult diagnostic challenge to the physician. A working knowledge of the host immune defenses and microbiologic complications that can occur when these functions are compromised provides a more focused framework for further evaluation and management. Infections in these patients are often morbid and life-threatening, creating an urgent need for prompt diagnosis. The skin may manifest the first clue(s) of a serious underlying infection. Appropriate workup and diagnosis of cutaneous lesions provide an expeditious, noninvasive, and potentially life-saving approach to the immunocompromised host with a dermatologic infection.

Humans↗

PubMedDate not supplied

A fuzzy-based histogram analysis technique for skin lesion discrimination in dermatology clinical images.

A fuzzy logic-based color histogram analysis technique is presented for discriminating benign skin lesions from malignant melanomas in dermatology clinical images. The approach utilizes a fuzzy set for benign skin lesion color, and alpha-cut and support set cardinality for quantifying a fuzzy ratio skin lesion color feature. Skin lesion discrimination results are reported for the fuzzy ratio and fusion with a previously determined percent melanoma color feature over a data set of 258 clinical images. For the fusion technique, alpha-cuts for the fuzzy ratio can be chosen to recognize over 93.30% of melanomas with approximately 15.67% false positive lesions.

Algorithms↗

PubMed2003

Pharmacokinetic analysis of the FDA guidance for industry--'Topical dermatologic corticosteroids: in vivo bioequivalence'.

The FDA (Food and Drug Administration) Guidance for Industry 'Topical Dermatologic Corticosteroids: In vivo Bioequivalence' describes two methods for evaluation of cutaneously applied corticosteroid formulations by measurement of the skin blanching response with a chromameter. The experimental options are: staggered application with synchronized removal or synchronized application with staggered removal. From the resulting response vs. time profiles, the areas under the effect curves (AUECs) are calculated and plotted as a function of the exposure time period to obtain dose/response-like relationships. If these experimental procedures are analyzed pharmacokinetically applying the Bateman equation and Fick's First Law of diffusion, several critical factors may be determined that need to be considered in order to avoid misinterpretation of the data. If solution-type preparations are investigated, the applied formulation volume should be the same on all application sites. In the case of suspension-type preparations, the applied drug dose is not critical. Moreover, it is essential to guarantee zero order kinetics during the application time periods, which may only be achieved with suspension-type preparations or a sufficiently high volume of solution-type preparations. If all these critical factors are taken care of, bioavailability factors (solutions) and enhancement factors (suspensions) may be calculated as the quotient of the AUECs of test and reference formulations.

Administration, Cutaneous↗

PubMed1988

Dermatological conditions of the vulva.

Management of vulval conditions in the elderly will present no special problems if the following points are borne in mind: 1. The patient's condition will often be multifactorial; the components should be unravelled and the patient followed until the picture is clear. 2. Point 1 is particularly important because infections and neoplasia can easily go unrecognized. 3. Biopsy will often be needed. 4. Management of chronic dermatological conditions (especially where systemic treatment is indicated) is usually best carried out by the dermatologist. 5. It is vital to consider the area as one would any other as regards diagnosis of cutaneous and mucosal lesions. With this approach the vast majority of lesions can be accurately named and reasonable treatment given. To this end the naked-eye morphology, and the histopathological evidence which will sometimes be a necessary supplement, must be accurately described and understood. 6. The study of vulval conditions is interdisciplinary. 7. Much old and contentious terminology is now obsolete. The new classification is simple and should be universally applied by gynaecologists, dermatologists and pathologists so that other involved clinicians are helped rather than confused.

Aged↗

PubMed1998

New antiviral agents for dermatologic disease.

The topic of antiviral agents for dermatologic disease is an area that is rapidly changing and expanding as our knowledge of herpes viruses, HIV, and human papilloma viruses continues to expand. New drugs are continuing to make therapy for these viruses more efficacious day by day. This review will discuss the recent advances in antiviral therapy, new therapies currently being developed or studied, and the future of antiviral vaccines.

Anti-HIV Agents↗

PubMed2001

Dermatology of reptiles: a clinical approach to diagnosis and treatment.

As herpetoculture becomes more commonly practiced, many of the dermatologic problems discussed in this article will be encountered less frequently. Many of the problems result from a general lack of knowledge regarding proper nutrition, husbandry, and the overall needs of reptiles within a captive environment. As reptiles become more a part of the mainstream pet population, information about their care will undoubtedly become more accessible, and as more captive-raised reptiles become available in the pet trade, many of the dermatoses currently associated with wild-caught animals will become less common.

Animal Husbandry↗

PubMed2003

Herpes zoster guideline of the German Dermatology Society (DDG).

Varicella zoster virus (VZV) causes varicella (chickenpox), remains dormant in dorsal root and cranial nerve ganglia and can be reactivated as a consequence of declining VZV-specific cellular immunity leading to herpes zoster (shingles). Patients older than 50 years of age affected by herpes zoster may suffer a significant decrease of quality of life. These patients and immunocompromised individuals are at increased risks for severe complications, involving the eye, the peripheral and the central nervous system (prolonged pain, postherpetic neuralgia). Such complications occur with and without cutaneous symptoms. The German Dermatology Society (DDG) has released guidelines in order to guarantee updated management to anyone affected by herpes zoster. Diagnosis is primarily clinical. The gold standard of laboratory diagnosis comprises PCR and direct identification of VZV in cell cultures. Detection of IgM- and IgA-anti VZV antibodies may be helpful in immunocompromised patients. Therapy has become very effective in the last years. Systemic antiviral therapy is able to shorten the healing process of acute herpes zoster, to prevent or to alleviate pain and other acute and chronic complications, particularly, when given within 48 h to a maximum of 72 h after onset of the rash. Systemic antiviral therapy is urgently indicated in patients beyond the age of 50 years and in patients at any age with herpes zoster in the head and neck area, especially in patients with zoster ophthalmicus. Further urgent indications are severe herpes zoster on the trunk and on the extremities, herpes zoster in immunosuppressed patients and in patients with severe atopic dermatitis and severe ekzema. Only relative indications for antiviral therapy exist in patients younger than 50 years with zoster on the trunk and on the extremities. In Germany acyclovir, valacyclovir, famciclovir and brivudin are approved for the systemic antiviral treatment of herpes zoster. These compounds are all well tolerated by the patients and do not differ with regard to efficacy and safety. Brivudin has a markedly higher anti-VZV potency than oral acyclovir, valacyclovir and famciclovir and thus offers a simpler dosing regimen. It must be given only once daily during 7 days in comparison to three and five times dosing per day of valacyclovir, famciclovir and acyclovir, respectively. Brivudin is an antiviral agent with no nephrotoxic properties, which is an advantage when compared to acyclovir. The most important aim of therapy of herpes zoster is to achieve painlessness. Appropriately dosed analgesics in combination with a neuroactive agent (i.e. amitriptylin) are very helpful when given together with antiviral therapy. The additive therapy with corticosteroids may shorten the degree and duration of acute zoster pain, but has no essential effect on the development of postherpetic neuralgia, which is a very difficult condition to treat. Thus early presentation to a pain therapist is recommended in specific cases.

Adolescent↗

PubMed2002

Connexin mutations in hearing loss, dermatological and neurological disorders.

Gap junctions are important structures in cell-to-cell communication. Connexins, the protein units of gap junctions, are involved in several human disorders. Mutations in beta-connexin genes cause hearing, dermatological and peripheral nerve disorders. Recessive mutations in the gene encoding connexin 26 (GJB2) are the most common cause of childhood-onset deafness. The combination of mutations in the GJB2 and GJB6 (Cx30) genes also cause childhood hearing impairment. Although both recessive and dominant connexin mutants are functionally impaired, dominant mutations might have in addition a dominant-negative effect on wild-type connexins. Some dominant mutations in beta-connexin genes have a pleiotropic effect at the level of the skin, the auditory system and the peripheral nerves. Understanding the genotype-phenotype correlations in diseases caused by mutations in connexin genes might provide important insight into the mechanisms that lead to these disorders.

Caspase 1↗

PubMed1998

Skin diseases in immigrants seen as out-patients in the Institute of Dermatology of the University of Rome 'La Sapienza' from 1989 to 1994.

In the Institute of Dermatology of the University of Rome 'La Sapienza' (IDURLS) from 1989 to 1994, 2198 immigrants from countries outside the European Community were seen as out-patients. Their personal and pathological data were collected by a particular software 'Questio', set up together with colleagues of the Interdepartimental Center for Scientific Calculous (ICSC) of the University of Rome 'La Sapienza'. The number of patients has been increasing from 326 in 1989 to 436 in 1994. Most of the people were coming from Africa, but from 1989 to 1994 the number of patients from the regions of ex-Yugoslavia has been increasing. About one third of the immigrants were unemployed, whereas 40% of them had a job (worker or employee), and the remaining 20% was composed by students and housewives. Most immigrants (1474 patients) were 20-39-year-old. Their data were compared with those of a control group composed by 2100 Italian people of the same age and sex, seen as out-patients in IDURLS in the same period. The most frequent skin disorders observed in immigrants were skin infectious or parasitic diseases, above all scabies. Excluding people with scabies, both immigrants and Italian patients shared the same skin diseases typical of young adult people: many fungal infections, many contact dermatitis and very few skin malignant tumors.

Adolescent↗

PubMed1994

Evaluation of retinoids as therapeutic agents in dermatology.

Evaluation of 13-cis-12-substituted analogues of retinoic acid in a series of dermatologic screens has revealed that structural modifications can lead to selectivity and specificity. An analogue, 11-cis,13-cis-12-hydroxymethylretinoic acid, delta-lactone, has been found to have good activity and to be devoid of topical and systemic toxicity.

Administration, Topical↗

PubMed1999

Assessment of value and applications of in vitro testing of topical dermatological drug products.

The FDA recently issued a guidance covering practices of scaleup and post approval changes with semisolids (SUPAC-SS). This guidance outlines the steps that must be taken by a company to maintain certification of its semisolid dermatological products after quantitative changes have been made in their compositions and/or after changes have been made in the sourcing of their key ingredients, in their processing, in their batch sizes, and/or after their site of manufacture has been relocated. A key element within the guidance is a release test to be used to determine if the diffusional release of a drug found in a formulation is the same after changes have been made to the formulation as it was prior to implementing the changes. The AAPS-FDA sponsored workshop was set up to explore this qualifying test. The stated aims of the workshop were: a) to illustrate the methodology and techniques of in vitro release testing, b) to show the sensitivity of in vitro release with respect to manufacturing variables and to variations in components and composition (of specific formulations), c) to recognize in vitro release testing as a useful procedure for SUPAC documentation, d) to highlight and evaluate other applications of in vitro release testing, e) to explore the degree to which in vitro release testing and bioavailability may be related, and f) to evaluate the role of in vitro release testing of topical dosage forms as a tool to improve product quality.

Administration, Topical↗

PubMed2001

Another look at seasonal variation in patch test results. A multifactorial analysis of surveillance data of the IVDK. Information Network of Departments of Dermatology.

There is conflicting evidence concerning seasonal variability of patch test results and no evidence concerning the influence of season on weak-positive, possibly false-positive, irritant reactions, which was analysed in the present study. Data collected in the German Information Network of Departments of Dermatology (IVDK) 1992 to 1997 were combined with external environmental data on temperature and absolute humidity in Germany, and bivariate as well as logistic regression analyses performed concerning the association between reactivity to selected allergens and air temperature and absolute humidity on the respective days of patch testing. Between 39,239 and 41,629 patients had been tested with the 4 allergens considered here. Only formaldehyde exhibited a distinct increase in questionable or irritant as well as weak-positive reactions associated with dry, cold weather. Methylchloroisothiazolinone/methylisothiazolinone and lanolin alcohol showed only a weak, and epoxy resin no, association with climatic conditions. The results indicate that weak-positive reactions, at least to formaldehyde as a prototype of an allergen which is at the same time a marginal irritant, may sometimes be irritant rather than allergic. Patients showing these should be re-tested to improve the poor reproducibilty observed with this allergen.

Climate↗