The primary intent of this book is to familiarize the medical practitioner with the "nail unit" in a way which will render, correctly and more easily, the diagnosis of nail diseases. At the same time, it serves to encourage the treatment and corrective measures of the ab normalities, if possible, based on anatomical and physiological knowledge. The chapters on anatomy, regeneration, and nail formation are basic to the author's in tent. The content ofthe references quoted represents information which is proven and not controversial material. In addition, my own material not previously published is included. I would like to introduce the anatomical concept that the nail unit consists of four dif ferent epithelial structures, each with its own characteristics, yet all interrelated. These four constituents are the Proximal Nail Fold (PNF), the Matrix (M), the Nail Bed (NB) and the Hyponychium (HYP). A disease may occur in any number of or all nail unit structures. A clear understanding of the anatomy, histology, and tissue kinetics of each constituent will be necessary and is the key factor in interpreting the abnormal findings of each of these constituents as disease occurs. It follows, therefore, that treatment and Cor rective measures should include the knowledge of not only the nail but also of its relation ship to the bony phalanx and the digit.

The skin on the fingertips and palmar and plantar surfaces of man is not smooth. It is grooved by curious ridges, which form a variety of configurations. These ridge configurations have attracted the at tention of laymen for millenia. They have also evoked the serious interest of scientists for more than three centuries. The anatomist Bidloo provided a description of ridge detail in the seventeenth cen tury. Since then, additional information has been added by anthro pologists, biologists, and geneticists. For the last century, the fact that each individual's ridge configurations are unique has been uti lized as a means of personal identification especially by law enforce ment officials. Widespread medical interest in epidermal ridges de veloped only in the last several decades when it became apparent that many patients with chromosomal aberrations had unusual ridge formations. Inspection of skin ridges, therefore, promised to provide a simple, inexpensive means for determining whether a given patient had a particular chromosomal defect. However, the promise was only partially fulfilled because of the inherent variability of skin ridge configurations. It was possible to draw conclusions about ridge ab normalities in groups of patients but not always in a given individual. Patients and clinicians became somewhat disenchanted with the clinical value of studying ridges."

Dr. BRUNO BLOCH, professor of the Dermatological clinic of Zurich, began a new era of eczema research by attempting to sensitize guinea pigs to primula. It was during this period that I had the pleasure of being Dr. BLOCH's chief resident, and could observe these experiments. It was only in 1955 that Dr. E. BUJARD, professor of Histology of the University of Geneva, Dr. R. BRUN, chief of laboratories of my Dermatology Department and I began to work in the field of experimental eczema on the nipples and flanks of guinea pigs. Besides these collaborators, to whom I am very grateful, a few others have participated in our experiments. Among these new co-workers the most im portant was Mrs. NICOLE HUNZIKER, chief resident of my clinic. From 1960 on, she worked on the eczema experiments with guinea pigs. Our research has been conside rably advanced by Dr. HUNZIKER. Untill now we have published 30 communica tions on this subject, but the publications about our results have been very short. It now seemed appropriate to publish a monograph and Dr. HUNZIKER undertook this very toilsome task. I would like to take this occasion to thank her for her many years of collaboration both in the clinic and in the laboratory. I am also very grateful to Professor BUJARD who, in spite of the fact that he is retired, continues to work with us. We continually profit from his great experience. Dr.

Professor George Fegan is a world authority on the use of sclerotherapy for the treatment of varicose veins. His technique for injecting varicose veins is regarded by many to be the best method for achieving success with sclerotherapy. Professor Fegan first published his method in 1963. This book is an update to his previous work and describes his method step by step as well as relevant information on the anatomy, physiology, pathology and investigations of varicose veins. Sclerotherapy is finding its place as an effective weapon in the phlebologist's armamentarium, and its indications are becoming clearer. All involved in the care of patients with venous disease will find this an invaluable read.

In the view of most experts pharmacology is on drugs, targets, and actions. In the context the drug as a rule is seen as an active pharmaceutical ingredient and not as a complex mixture of chemical entities of a well defined structure. Today, we are becoming more and more aware of the fact that delivery of the active compound to the target site is a key. The present volume gives a topical overview on various modern approaches to drug targeting covering today s options for specific carrier systems allowing successful drug treatment at various sites of the body difficult to address and allowing to increase the benefit-risk-ratio to the optimum possible."

The international symposium "New Trends in Allergy," held in Munich from July 13 to 15, 1990, brought together for the third time since 1980 some of the most experienced researchers working in the field of allergy. This volume comprises the papers presented at this meeting. All over the world, and not merely in the industrialized countries, allergy is becoming a cause of evermore serious diseases. In recent years, research in the field of allergy has provided numerous impor tant and fascinating results extending our knowledge considerably. Despite the new insights into basic mechanisms of allergic reactions, improved diagnostic methods, and new therapeutic approaches, how ever, many questions remain to be answered, including: Are allergies really increasing in frequency? If so, what are the reasons? Especially, does environmental pollution playa role? Which factors influence IgE synthesis? Can the IgE immune response be switched off? Does the nervous system interact with allergic reactions? If so, what are the mechanisms? Are new approaches in allergy prophylaxis and allergy therapy effi cient? What measures have proven useful and deserve to be employed in daily practice? In this volume, these questions and other current topics are dealt with. As each issue is covered by authors competent in the respective fields, the result is an extensive and critical review of the state of the art. Going through these papers, one comes to the conviction that allergy research is a multifacetted, explosively expanding, most stimulating field of work."

During the last 40 years, the study of the biological basis of aging has progressed tremendously, and it has now become an independent and respectable field of study and research. The essential cause of aging is molecular damage that slowly overwhelms cellular and organismic defense, repair and maintenance systems. In recent years, a wealth of highly sophisticated research has transformed this idea from a credible hypothesis not only to a major theory, but essentially to accepted knowledge. Aging at the Molecular Level examines the key elements in this transformation.
Bringing together contributions from an international team of authors, this volume will be of interest to graduates and postgraduates in the fields of medicine and nursing, researchers of different aspects of biogerontology and those in the pharmaceutical, cosmeceutical, nutraceutical and health-care industry.

This book offers a unique insight into the world of cutaneous lymphomas. In addition to the case description it gives the clinical, histological, and in most cases also the phenotypical features and the results of molecular techniques. A commentary puts the observations into the context of cutaneous lymphomas. High quality pictures accompany this exceptional collection of rare and unusual cases. These will interest dermatologists, oncologists, pathologists and hematologists.

It is now thirty years since William Montagna and Richard Ellis edited 'The Biology of Hair Growth". In his introduction, Stephen Rothman, of the University of Chicago, USA and one of the driving forces behind research on skin at the time, wrote: 'The pilary system is a perfect micr9cosmic structure. In this microcos- mos we find birth, development, ageing and death, activity and rest, color for- mation and decolorification, greasiness and dryness, infection and sterilization, hypertrophy and atrophy, Qenign tumours and malignant ones. " He foresaw the human pilary system as a model for the study of a multitude of human diseases including ageing and cancer. It was not, how- ever, until the seventies that the development of micro-biochemical tech- niques indeed allowed the use of the human hair follicle as a convenient biopsy tissue for Biomedical Research in general. Measurement of enzyme activities, and important co-factors, and culturing of cells from single follicles all became possible. In the eighties dermal papilla cells were grown in cul- ture and this opened the way to study hair differentiation in vitro. Studying hair differentiation is, in fact, studying growth regulation and it is this aspect that by far transcends the importance of studying hair growth itself. Let us not forget that metastatic prostate cancer is treated with the same drug -cyproterone acetate -that is used for the treatment of alopecia and hirsutism in women.

The two organs of the body most accessible to examination are the eye and the skin and its appendages. That is why, it is said, ophthalmological genetics is in such flourishing good health. Dermatological genetics does not seem to have benefited so much from the skin being on the outside, and there are but few dermatological counterparts to the volumes of Sorsby, Waardenburg, Franceschetti and Franr; ois, among others. But thanks to the growing interest in medical genetics, and the modern sophisticated tech niques of molecular, biochemical, and ultrastructural examination, der matology is beginning to catch up, as the appearance of this volume testifies. Because of the growing body of knowledge and the heightened awareness of genetics by both patients and physicians, dermatologists not only will be asked more often about the inheritance of skin conditions they diagnose but increasingly will have the opportunity to diagnose a variety of inborn errors and syndromes by their dermatologic manifestations. On the other hand, syndromologists, clinical geneticists, and physicians are continually seeing patients with diagnostic clues in the skin that they must be able to appreciate. For both groups this book will be a new and valuable source of help. Spring 1979 F. CLARKE FRASER, Ph.D., M.D."

The impact of the retinoids in clinical practice has primarily been in dermatology. When Dr Werner Bollag began his basic research and screening programme in the early 1960's, the expectation was that the retinoids would have a major impact on oncology. However, the laboratory and clinical experiences of Bollag and his colleagues in Switzerland, Stuttgen and Orfanos in Germany, led to publications on both etretinates (Tigason) and isotretinoin (Roaccutane) in the years between 1972 and 1976 in the field of dermatology. In fact the first symposium on retinoid research held in Berlin in 1981 was almost entirely dermatological. A year later a retinoid workshop in Iowa was designed to provide a forum for dermatolog ists from the USA involved in specific protocols investigating oral retinoids. In the UK, research into the retinoids began rather later than in Continental Europe or in the USA, although Tigason was first marketed here. It was felt in late 1982 that as many dermatologists had relatively little experience with these compounds it would be appropriate to hold an International Symposium on retinoid therapy in the UK. Thus on 16-18 May 1983 in London, 37 speakers from 11 countries addressed an audience of 300, aminly UK, dermatologists. The scientific organizing committee consisted of but two persons Dr William Cunliffe of Leeds General Infirmary, representing the European Society of Dermatolo gical Research, and myself from Roche Clinical Research. The Symposium was held under the auspices of the ESDR and of Roche Products Limited."

The induction of immune responses against tumor cells by vaccination is rapidly evolving as a therapeutic modality with new potentials for the treatment of cancer. It is based on the fact that our immune system can identify tumor cells and, once activated, is capable of developing specific immunity against the neoplastic cells. Numerous observations and intense research clearly document the major contribution of the immune system to the prevention of cancer. And there are many re ports of patients suffering from malignant melanoma or other tumors who mount a spontaneous immune response against their tumor cells that results in tumor regression. Based on the recent advances in our understanding of the compo nents of our immune system, their interactions and the regulation of immune responses, we are now able to design vaccination strategies that induce or enhance cell-mediated immunity against tumors. A ma jor advancement came with the identification and characterization of relevant tumor antigens, which are suitable target structures for anti-tu mor immune response. First clinical trials using such vaccine strategies have yielded encouraging results in patients. However, in spite of many reported cases of successful therapy of cancer by vaccination many patients still do not experience relief after such treatments. These initial clinical trials and the accompanying investigations have revealed a number of important results that indicate the direction of future re search and development in the field.

The detection of cancer risk factors and their possible avoid ance would most effectively contribute to the fight against cancer. Research in these areas depends to a substantial degree on in vivo experimental animal models and on epide miologic studies, including data from cancer registries. When the Deutsches Krebsforschungszentrum was founded in 1964, its division "Mechanisms of Tumorigenesis" and a number of other divisions became engaged in research on chemical carcinogenesis of the skin, mainly using the mouse skin as an experimental model. Their interest orig inated in part from investigations of the new and at that time controversial pathogenic principle of conditional car cinogens as represented by certain tumor promoters which are per se noncarcinogenic. During the past 25 years, conditional carcinogens in terms of tumor promoters were established as anew, nonclassical category of cancer risk factors besides the classical solitary carcinogens. In the course of this exciting period, scientists of our center started cooperative programs with clinical dermato logists of the University of Heidelberg at the Clinics of Dermatology in Heidelberg and Mannheim, to extend the scope of their investigations into clinical oncology and to contribute by experimental approaches to solving problems in clinical oncology. This led to a gradual shift from mere animal studies to the more direct analyses of human tumors and opened up for us a new phase of research.

Several years ago a friendly looking young man walked into my office at the University Department of Dermatology in Cologne, introduced himself as a diplomate chemist, executive member of a family-owned, rather small German company manufacturing hair care products, and proposed to me straight forward to organize an international meeting on hair research. In view of the large number of new developments in the field something like this should be done after all, he said; he also promised to provide financial support. Such a meeting should be on the highest possible level, I said; and he agreed. I took the challenge and my visitor kept his promise. Three years later the First International Hair Congress was organized at the sophisticated new Congress Center in Hamburg, in which 630 participants from 36 countries were registered. After three and a half days of formal sessions, informal discussions, workshops and poster presentations our unanimous feeling was that this has been a most successful meeting. The young chemist was right. The idea was excellent. The growth and presence of hair and its distribution over the human body as a cosmetic attribute has become during the last two decades a matter of tremendous emotional significance. Hair can be rather easily formed according to one's sence of style, representing his personal image and his social feeling. If it becomes unacceptable or out of fashion, the hair style can be easily changed; the hair regrows as a biological requisite, without any additional cost.

Each of the four authors of this book has a particular interest in disorders of porphyrin metabolism and special experience in their management. Their individual involvement in the field varies from 12 to 52 years and, combined, represents more than a century of personal experience. Since it has been written by both basic scientists and practicing physicians, the book is intended to be of value to all those involved in porphyrin metab olism and the porphyrias. It is hoped that the fascination of porphyrin metabolism and the clinical challenge of the porphyrias experienced by each of the authors will be conveyed to the readers. Michael R. Moore Kenneth E. L. McColl Claude Rimington Abraham Goldberg vii CONTENTS Color Plates ............................................ xvii 1. The History, Classification, and Incidence of the Porphyrias 1 1.1. History ........................................ 1 1.1.1. Early Chemistry . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1.2. Early Descriptions of Porphyria .............. 4 1.1.3. Biochemical Developments .................. 4 1.1.4. Acute Porphyria . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.1.5. A Complete Pathway ...................... 8 1.2. Classification of the Porphyrias . . . . . . . . . . . . . . . . . . . . . 9 1.2.1. The Current Classification. . . . . . . . . . . . . . . 12 . . . .

Part of the practical and dynamic Procedures in Cosmetic Dermatology Series, Chemical Peels, 3rd Edition, brings you up to speed with today's best uses of traditional and new acids for skin rejuvenation. This well-organized, superbly illustrated text covers every aspect of this must-know field, including patient evaluation, skin preparation, procedural technique from light peels to advanced deep peels, and managing complications. Dr. Suzan Obagi leads a team of global experts to offer evidence-based, procedural how-to's and step-by-step advice on proper techniques, pitfalls, and tricks of the trade, so you can successfully incorporate the latest procedures into your practice. Features many new chapters dedicated to specific peels or skin conditions: trichloroacetic acid (TCA) peels of the chest, neck, and upper extremities; peels as an adjuvant treatment of acne; chemical peels in male patients; several chapters on unique approaches to acne scars; a chapter on combining peels with surgical procedures; and several chapters on safely performing deeper, modified phenol peels. Covers new acid formulas, new peel types, and need-to-know procedures such as the combined Jessner-TCA-retinoid peel and how to vary technique for darker skin types. Features a well-organized format with key points lists, pearls, and case studies as they appear in practice. Includes many new images and procedural videos that depict exactly how to perform the techniques, allowing you to easily incorporate chemical peels into your practice and take your knowledge of chemical peels to the next level. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

It goes almost without saying that there has been a marked increase in the incidence of sexually transmitted diseases throughout the world in the past two to three decades. Indeed, despite the progress that has been made in methods of diagnosis and treatment, the sexually transmitted diseases as a whole are the most common communicable diseases and as such constitute an important health problem. The increase in incidence may be accounted for by changes in sexual behaviour, the introduction of contraceptives and the increasing mobility of the population. In addition, during the same time period, the number of infectious agents recognized as being sexually transmitted has increased considerably. These include Chlamydia trachomatis, herpes simplex virus, cytomegalovirus and hepatitis B virus. Indeed, some are as dependent on sexual transmission as the agents which cause the traditional venereal diseases and collectively they cause morbidity which has out-stripped that caused by gonorrhoea and syphilis. It could almost be said that to know the sexually transmitted diseases is to know micro biology. However, the approach taken in this book has not been to consider individual infectious agents and evaluate what they do and do not cause but to consider clinical conditions and what might be responsible for them. To cover the complete spectrum of the sexually transmitted diseases in a comprehensive way now takes a text book of massive proportion."

Urticaria is one of the most common dermatological and allergological cutaneous reactions and, compared to other diseases, it is easily recognized by patients and physicians alike. Nevertheless, the disease is highly complex regarding its eliciting causes, its clinical manifestations and its therapy. Thus, a famous New York dermatologist once mentioned that he would rather have a lion than a patient with chronic urticaria walk into his office. This may seem surprising since, to the uninitiated, different types of urticaria look alike, and the pathomechanisms are rather well understood, with mast cells being almost invariably the main effector cells. In 1986, a monograph of the first editor (Prof. Czarnetzki, now with the married name Henz) appeared, giving a detailed and thorough review of the then current state of knowledge regarding all aspects of the disease. Since then, two updates of this book have appeared in the German language, with coworkers of the clinic of Prof. Henz helping in the revision of the various chapters of the old monograph, and with particular emphasis on practical aspects of the disease. The present book is mainly a translation of the second German edition, with only minor updates and with more citations from the literature since the 1986 monograph is no longer available for purchase.

This concise practical guide is designed to facilitate the clinical decision-making process by reviewing a number of cases and defining the various diagnostic and management decisions open to clinicians. It is richly illustrated and diverse in scope, enabling the reader to obtain relevant information regarding both standard and unusual cases in a rapid, easy to digest format. The first in the series will be on Geriatric Dermatology and will be prepared within one month of acceptance and include photos. Each case will also include a narrative description and patient management tips

Over the past ten years, carbon dioxide laser surgery has made impressive strides and is now applied to every field of surgery without exception. It is the intention of this book to record the work done in this field in the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center and Tel Aviv University Medical School, Israel, as well as that performed in association with other depart ments. In this context, one feels that it is incumbent upon one to acknowledge the cooperation of the medical and paramedical staff of the Department of Plastic and Maxillofacial Surgery of the Beilinson Medical Center, as well as that of Prof. Yehuda Shindel and Dr. Daniel Katenelson of the Department of Ear, Nose and Throat, Dr. Y ona Tadir of the Department of Obstetrics and Gynecology and Dr. Itamar Kott of the Department of General Surgery. I should like to make special mention of Dr. Ralph Ger of New York, who worked with me on the original clinical trials, and the engineer Uzi Sharon, who developed the Sharplan Laser with me. The progress of Laser Surgery is well demonstrated by the participation in the four meetings of the International Society for Laser Surgery, the first of which was held in Tel Aviv in 1975 with an attendance of 65 and the last in Tokyo in 1981 with an attendance of 1200.

Proceedings of the 5th Biannual International Meeting on Angiogenesis: From the Molecular to Integrative Pharmacology, held July 1-7, 1999, in Crete, Greece. Angiogenesis, as a vastly complex biological process, has challenged researchers from all basic scientific disciplines, including pharmacology, biochemistry, physiology, embryology and anatomy. The significance of this phenomenon for the study of disease states has also interested clinicians from a number of specialist fields. This multidisciplinary work reflects the growth of awareness of concepts such as angiogenesis based therapy, the enormous therapeutic and commercial potential of which has attracted major research and investment in recent years. This volume, which aims to bridge the gap between basic and clinical methodology and understanding, presents the most up-to-date developments in this field.

In the past two decades, considerable interest in skin cancer has developed in the public and scientific communities. There may have been several reasons for this: - The rise in the global incidence of cutaneous cancers - New molecular biology techniques resulting in a better understanding of pathogenesis and improved diagnostic procedures - The advent of new pathological entities, e. g. , the endemic form of Kaposi's sarcoma - A constantly increasing range of therapeutic modalities, providing even more efficacious treatment and manage ment of skin cancers As N. E. Fusenig describes in the first chapter of this volume, basic research is only beginning to unravel the complex mechanism involved in cellular dedifferentiation and tumor progression. Progress is dearly needed, especially in dermato oncology, where the rise in the incidence of epithelial tumors has inflated the overall skin cancer incidence. The incidence of tumors of the skin exceeds that of all other neoplasias in humans, with recreational sun exposure being a suspected primary cause. Several studies on the effects of UV radiation have been included at the beginning of this volume. Even the role of long wavelength UV (UVA) has become a focus of research activities. The main concern is that the low carcinogenicity of UVA, in comparison to UVB, may be outweighed and exceeded in its effects by increased UV A exposure, e. g.

In this handbook the opportunity has been taken firstly to present the waterbalance in the horny layer and the sweat secretion process with particular emphasis on their relationship to the pharmacodynamical aspects of the micro circulation and permeability of the skin. F. A. 1. THIELE was unable to witness the printing of his life-work concerning the water balance of skin, which he had compiled at the university in Nijmegen with J. W. H. MALI and G. 1. DE JONGH and D. A. REAY from Great Britain. Their contribution concentrates on evaluating the cooling function of the sweat glands with their heat-pipe system and on the physico-chemical effects of dermatological therapy and topically applied cosmetics. A certain amount of overlapping with Volume I/4A (E. SCHWARZ) could not be avoided, and yet the presentation by THIELE and co-workers considers different aspects. The pharmacodynamics of externally applied substances involved in microcirculation are related thematically also to percutaneous resorption. Function and morphology of pharmacodynamics in microcirculation are inseparable. Therefore the structural alterations of the blood vessels in reaction to foreign agents or as an adaptation to endogenous tissue hormone release have been examined electronmicroscopically by W. G. FORSSMANN and his team, and relay a distinct picture of the microcirculation in the area of skin reactiveness. The direct pharmacological aspects of the skin and the systemic effects on blood vessels and their permeability have been listed according to the latest research material."

Not since the 1965 pUblication of Skin Bacteria lind Their Role in Infection has our knowledge of clinical skin microbiology been reviewed and sum marized. In the more than a decade and a half since that publication, we have seen a careful reevaluation of the ideas and information current in 1965 and the development of important new discoveries and information. This volume, Skin Microbiology: Relevance to Clinical Infection, reviews developments in the field since 1965 and summarizes the current state ofthe art in thirty-six carefully prepared chapters. Emphasis is on the clinical per spective rather than straight microbiology, although we include enough of the latter to put the clinical aspects in a proper scientific context. The authors contributing to this volume represent a cross section of authorities in the many specialty areas that contribute to our knowledge of skin microbiology. They include investigators in microbiology, infectious disease, epidemiology, surgery, pediatrics, and dermatology. Significant ef forts have been made to minimize repetition and overlap in the various chapters. In some cases, however, information is deliberately repeated in order to provide for the reader a necessary frame of reference. We hope that this volume will be of value to dermatologists, microbio logists, pediatricians, surgeons, public health workers, nurses, and others in volved in the diagnosis and treatment of dermatologic problems caused by bacteria. The editors acknowledge with appreciation the assistance of Drs. A. Allen, F. Marzulli, F. Engley, G. Hildick-Smith, A. Kligman, M. Bruch, H. Eiermann, and D. Taplin."