This book is based upon a series of papers originally presented at a NATO Advanced Studies Workshop of the same title held at the study Center HI Cappuccini," a converted monastery in San Miniato, a small village located between Pisa and Florence, Italy, in October 1991. Authors were asked to submit their completed chapters by the following February; these were then scanned onto computer disks, edited and returned to the authors for final revision, and updating, with a final deadline of February 1993. The authors were encouraged to make whatever modifications they wanted, especially regarding updating their chapters, with an eye to making the final product both comprehensive and current. In this we succeeded beyond our expectations, with most chapters extensively altered and many completely re-written and significantly expanded. Thus, although the original meeting was held in 1991, the chapters in this volume may be regarded as current from at least February, 1993, with some of the final updated revisions received as late as July, 1993. This book, as agreed in our original contract, has been delivered to the publisher "camera-ready. " This means that all of the scanning, editing, proofing and typesetting were done here, by the office of the Department of Dermatology at the New Jersey Medical School. We essentially produced the book, which the publisher, for the most part, then photocopied. This has been an enormous burden, borne mainly by my colleague in this division, Robert A.

Allergy is one of the major health problems of most modern societies. Allergic diseases have increased in prevalence during the last decades; the reasons for this increase are unknown, there are only hypothetical concepts for explanation. The series New Trends in Allergy now covers five volumes origin- ing from special international symposia, started in 1980 and held every 5 years, which highlight specific areas of progress in allergy research and practice. The idea behind the 5-year interval between these s- posia is that real new developments do not occur very often and c- tainly not every year. The contents of this book focus on specific areas where progress in allergy research has shown fascinating developments, such as: - Elucidation of the complex genetic basis of atopy - The influence of environmental pollutants as well as natural biolo- cal environmental factors on allergy - Gene-environment interactions in the development of allergy - Psycho-neuro-immunological aspects of allergic sensitisation and disease - The nature and function of dendritic cells in skin and mucous m- branes - Interactions between lymphocytes and effector cells, such as mast cells, eosinophils and neutrophils - Allergen carriers, allergen release and bioavailability, allergen str- ture - Atopic eczema - Asthma and rhinoconjunctivitis - Food allergy and anaphylaxis - Pharmacotherapy - Unspecific (e. g.

In the future' the decade of the 1990s will likely be viewed as a Golden Age for retinoid research. There have been unprecedented research gains in the understanding of retinoid actions and physiology; since the retinoid nuclear receptors were first identified and the importance of retinoic acid in develop mental processes was first broadly recognized in the late 1980s. Between then and now, our knowledge of retinoid action has evolved from one of a near complete lack of understanding of how retinoids act within cells to one of sophisticated understanding of the molecular processes through which retinoids modulate transcription. In this volume, we have tried to provide a comprehensive update of the present understanding of retinoid actions, with an emphasis on re cent advances. The initial chapters of the volume, or Section A, focus on the physicochemical properties and metabolism of naturally occurring retinoids: - N OY provides an uncommonly encountered view of retinoid effects from the perspective of the physiochemical properties of retinoids. - V AKIANI and BUCK lend a perspective on the biological occurrence and actions of retro- and anhydro-retinoids. Section B considers both the retinoid nuclear receptors and their mechanisms of action as well as synthetic retinoids that have been used exper imentally to provide mechanistic insights into receptor actions and have potential therapeutic use for treating disease: - PIEDRAFITA and PFAHL provide a comprehensive review of retinoid nuclear receptor biochemistry and molecular biology.

This comprehensive volume examines the possible complications that can arise in cutaneous surgery. The demand for outpatient cutaneous surgery procedures has increased at a rapid rate over the last several decades. As the number of cutaneous surgery procedures rises, so will the rate of complications, which are inevitable and occur even with the most skilled, careful, and meticulous surgeons. This work will help the practicing physician to formulate a preoperative strategy that will prevent complications before they occur as well as properly diagnose and manage complications if they arise, allowing the physician to provide optimal care to the patient.

The recent interest in the pharmacology of the skin and the treatment of its diseases has come about for two reasons. The first is a realisation that many aspects of pharmacology can be studied as easily in human skin as in animal models, where they may be more relevant to human physiology and disease. Examples of this are the action of various vasoactive agents and the isolation of mediators of inflammation after UV irradiation and antigen-induced dermatitis. The second reason is the fortuitous realisation that a pharmacological approach to the treatment of skin disease need not always await the full elucidation of aetiology and mechanism. For example, whilst the argument continued un resolved as to whether the pilo-sebaceous infection which constitutes acne was due to a blocked duct or to a simple increase in sebum production, 13-cis retinoic acid, was found quite by chance totally to ablate the disease; again, whilst cyclosporin, fresh from its triumphs in organ transplantation, has been found able to suppress the rash of psoriasis, it has resuscitated the debate on aetiology. We are therefore entering a new era in which the pharmacology and clinical pharmacology of skin are being studied as a fascinating new way of exploring questions of human physiology and pharmacology as well as for the development and study of new drugs, use of which will improve disease control and at the same time help to define pathological mechanisms.

Numerous diseases in the areas of orthopaedics, rheumatology, and radiology can only be completely diagnosed if the corresponding conditions of the skin and mucous membranes are included in the diagnostic work-up (skin-bone). Conversely, dermatologic assessment of skin symptoms in isolation may lead to serious delays and errors in the diagnosis and treatment of associated changes in the musculoskeletal system. This monograph gives an interdisciplinary synopsis, from a dermatologic and clinical radiologic perspective, of 85 disease entities which in practice are likley to present. For orientation purposes the main dermatologic and radiologic symptoms are presented in table form at the beginning of the book.

Photodynamic therapy is a proven effective treatment of actinically damaged skin cells, nonmelanoma skin cancers, and acne and other pilosebaceous conditions. As an agent for general facial rejuvenatin it has untapped potential. The current state of PDT therapy and future applications are discussed in detail in this exciting new volume. Throughout, the focus is on evidence-based clinical uses of PDT, including pretreatment regimens, avoidance and management of complications, and posttreatment suggestions.

Evaluation and Treatment of the Aging Face is the definitive source for physicians wishing to master the latest advances in facial refinement. Solely addressing the aging face, the authors - all international authorities in dermatologic surgery - have compiled instructional, practical information on basic technique, anesthetics, causes, and treatment for a wide variety of procedures, including: - factors involved in the initial patient evaluation - sunscreens and retinoids - the use of glycolic acid - chemical peels and dermabrasion - liposuction and lipotransfer - rhytidectomy and blepharoplasty - diagnosis and treatment of skin lesions of the aging face - hair replacement - treatment of aging hands - how to develop an office based cosmetic surgery center.

Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology textbooks are generally out of date. Single papers in specialized journals are informative but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in-depth reviews of cancer topics, and published symposium lectures are often the best overviews available. Un fortunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes that aim to meet this need. It is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, revised frequently to keep the coverage up to date, easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion: first, by dividing the oncology literature into specific subdivisions such as lung can cer, genitourinary cancer, pediatric oncology, etc.; second, by asking emi nent authorities in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each topic and tumor type is covered in a volume appearing frequently and predictably, discussing current diagnosis, staging, markers, all forms of treatment modalities, basic biology, and more."

The recent interest in the pharmacology of the skin and the treatment of its diseases has come about for two reasons. The first is a realisation that many aspects of pharmacology can be studied as easily in human skin, where they may be more relevant to human physiology and diseases, as in animal models. Examples of this are the action of various vasoactive agents and the isolation of mediators of inflammation after UV irradiation and antigen-induced dermatitis. The second reason is the fortuitous realisation that a pharmacological approach to the treatment of skin disease need not always await the full elucidation of etiology and mechanism. For example, whilst the argument continued unresolved as to whether the pilo-sebaceous infection which constitutes acne was due to a blocked duct or to a simple increase in sebum production, 13-cis-retinoic acid was found quite by chance totally to ablate the disease; again, whilst cyclosporin, fresh from its triumphs in organ transplantation, has been found able to suppress the rash of psoriasis, it has resuscitated the debate on etiology. We are therefore entering a new era in which the pharmacology and clinical pharmacology of skin are being studied as a fascinating new way of exploring questions of human physiology and pharmacology as well as an important step in the development and study of new drugs, use of which will improve disease control and at the same time help to define pathological mechanisms.

The skin, the body's largest organ, is strategically located at the interface with the external environment where it detects, integrates and responds to a diverse range of stressors, including solar radiation. It has already been established that the skin is an important peripheral neuroendocrine-immune organ that is closely networked with central regulatory systems. These capabilities contribute to the maintenance of peripheral homeostasis. Specifically, epidermal and dermal cells produce and respond to classical stress neurotransmitters, neuropeptides and hormones, production which is stimulated by ultraviolet radiation (UVR), biological factors (infectious and non-infectious) and other physical and chemical agents. Examples of local biologically active products are cytokines, biogenic amines (catecholamines, histamine, serotonin and N-acetyl-serotonin), melatonin, acetylocholine, neuropeptides including pituitary (proopiomelanocortin-derived ACTH, b-endorphin or MSH peptides, thyroid stimulating hormone) and hypothalamic (corticotropin-releasing factor and related urocortins, thyroid-releasing hormone) hormones, as well as enkephalins and dynorphins, thyroid hormones, steroids (glucocorticoids, mineralocorticoids, sex hormones, 7- steroids), secosteroids, opioids and endocannabinoids. The production of these molecules is hierarchical, organized along the algorithms of classical neuroendocrine axes such as the hypothalamic pituitary adrenal axis (HPA), hypothalamic-thyroid axis (HPT), serotoninergic, melatoninergic, catecholaminergic, cholinergic, steroid/secosteroidogenic, opioid and endocannabinoid systems. Disruptions of these axes or of communication between them may lead to skin and/or systemic diseases. These local neuroendocrine networks also serve to limit the effect of noxious environmental agents to preserve local and consequently global homeostasis. Moreover, the skin-derived factors/systems can also activate cutaneous nerve endings to alert the brain to changes in the epidermal or dermal environments, or alternatively to activate other coordinating centers by direct (spinal cord) neurotransmission without brain involvement. Furthermore, rapid and reciprocal communications between epidermal and dermal and adnexal compartments are also mediated by neurotransmission including antidromic modes of conduction. Lastly, skin cells and the skin as an organ coordinate and/or regulate not only peripheral but also global homeostasis.

Allergic Contact Dermatitis presents all up-to-date chemical and physio-chemical concepts for the study and understanding of allergic contact dermatitis (ACD). The book covers all aspects of ACD - skin penetration and metabolism, identification of sensitizers and hapten-protein interaction, including new concepts of increasing importance such as molecular recognition and quantitative structure-activity relationships. In addition, comprehensive references are provided, making this the most complete available text-book for dermatologists.
Allergic Contact Dermatitis reaches an equilibrium between fundamental concepts and clinical applications and thus presents an essential guideline to dermatologists, allergologists, biochemists and toxicologists.

Aromas are an integral part of our civilised society. They are not only used in fine perfumes, but also in numerous other articles with which we have daily contact. Another new development has been the agricultural use of aromas as a "biological weapon" to combat insects and other pests. In the field of dermatology, aromas are today among the most frequent sensitizers and may trigger allergic contact eczemas. This volume presents numerous aspects of the topic for the first time in comprehensive form. In an introduction, the chemistry of frequently used aroma components is described, together with the art of perfume composition that has been refined over the centuries. In a chapter on neuropharmacology, the mechanisms of scent recognition are described in detail.

In any histopathology department, cutaneous biopsies form the major part of the workload. In many instances these may be readily dealt with by experienced pathologists and their documentation represents an essential step in organising therapy. However, in a number of areas dramatic changes have occurred in dermatopathology. The rapidly changing incidence of pigmented lesions of the skin and the availability of diagnostic cell markers in the complex cutaneous lymphomas have meant that for many pathologists a review in these fields will be valu- able. The distribution and pattern of skin pigmentation may allow us to make important assertions and draw importantconclusions about the genetics of skin disease, but also about human variability. Cutane- ous vasculitis is a difficult problem where clinicopathological consulta- tion is vital in diagnosis and the review presented has been written with this verymuch in mind. In the same way, many diagnostic difficul- ties exist in assessing buttous lesions in the skin and for this reason a review was invited. Finally, our understanding of certain skin diseases has been radical- ly altered by knowledge of the dynamics of the changes seen, a field which has also beenstudied with advantage inother systemsin patholo- gy. This volume is intended as an aide to those many pathologists and dermatologists who, often together, are responsible for the pro- vision of clinical care in this demanding field. London C. L. BERRY Contents Melanoma and Other Melanocytic Skin Lesions. With 8 Figures D. WEEDON . Cutaneous Vasculitis.

In the last decade of the 15th century a new and deadly disease called Morbus Gallicus, or syphilis, appeared and spread rapidly throughout Europe. The effects of syphilis were so severe that it, and those suffering from it, where regarded with horror and despair. It is difficult for the modern reader to appreciate the fog of confusion which surrounded sexually transmitted diseases in earlier times. Those suffering with these diseases were often condemned as victims of their own "sinful lust of the flesh"; a judgement attitude which hindered most of the early attempts at control and treatment. Despite this general attitude, there were some doctors who persevered in their attempts to understand the causes and discover treatments for syphilis and other sexually transmitted diseases. The Scars of Venus is illustrated with pictures of people, places, instruments and documents. It presents the historical background and achievements of the early venereologists through to the current venereologists' fight against HIV. This book will be of interest to anyone concerned with venereal diseases: doctors, nurses, counsellors, laboratory workers, medical historians, and those working in the areas of public/world health and the spread of infectious diseases.

A number of vital therapeutic modalities are not covered adequately in current dermatology textbooks. This book is intended to fill that gap. It originated in a series of special lectures on modem applications of physical modalities given at recent annual meetings of the American Academy of Dermatology; the main topics were radiotherapy, electrosurgery, phototherapy, cryosurgery, and related therapeutic modalities. The authors, recognized authorities in their field, have included much addi tional information which could not be covered in the original lectures because of time limitations. The indications for modem dermatological x-ray therapy reflect the basic views of the recently published guide lines of the National Academy of Sciences-National Research Council. Both text and illustrations are oriented toward the practical aspects of therapy with physical modalities. A special effort was made to bring the contributions up to date; pertinent references have been added for those who wish to pursue particular topics still further. Where there is an apparent overlap between chapters, it was felt to be advantageous because different authors approached their subject from different perspectives. I am most grateful to the various authors who generously contributed despite their many other commitments. I wish, also, to thank the staff of Springer-Verlag for their advice and assistance in the preparation of the manuscript."

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.

This book will, it is hoped, fill the gap between cur rent, smaller texts on dermatology and the standard, large reference books. It should be helpful to those embarking on a career in dermatology and to general practitioners and primary physicians with a special interest in this field. In this book the emphasis is on clinical aspects of skin diseases, and it is assumed that the reader has some knowledge of the anatomy and physiology of the skin. The differential diagnosis of each disorder is extensively discussed and sex predilection and age of onset are illustrated diagrammatically. As in other branches of medicine, treatments are now frequently changing and these are fully covered. Aetiological factors in skin disorders are now becoming clearer and separate sections on this subject are discussed for each disease. Prognosis and natural history are not always adequately covered in texts on derma tology, so these topics are set out under separate headings. A small number of the illustrations have been loaned from colleagues and institutions, and we gratefully acknowledge this assistance from the following: The Wellcome Museum of Medical Science; Photographic Department, Institute of Dermatology, St John's Hospital; Dr Roger Clayton; Dr W. H. Jopling; and Dr P. Rodin. We are also grateful to the staff of MTP for their assistance in preparing this book."

Infectious diseases remain a major problem for physicians and other health professionals dealing with problems of the reproductive system. Accordingly, this two-volume comprehensive presentation of infectious diseases involving the male and female reproductive systems promises to be a major contribution in this field and to fill a much-needed vacuum. During the past three decades, the introduction of antimicrobial therapy has dramatically altered both the clinical presentation and the therapeutic approaches employed in dealing with the traditional infections of the repro ductive system. In addition, the changing demographics of infectious problems in the industrial countries and the developing world have been a source of concern. A good deal of important information on this topic is included in this series. In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections. Current clinical information is included on these infections as well as on newer aspects of diagnosis, such as the use of laparoscopy in the diagnosis and treatment of pelvic inflammatory disease. Also addressed is new information regarding the role of actinomycosis in pelvic infections; current problems such as toxic shock syndrome and acquired immune deficiency syndrome (AIDS) are reviewed as well. New concepts are included in these volumes to complement the clinical information. The attachment of microbial organisms to sperm may help to explain access of these and other organisms to the upper female genital tract."

It is with great pleasure that I write this Foreword to the Proceedings of the International Conference on Behcet's Disease which was held in Berlin in June 2002. This was the first International Conference held under the auspices of the International Society for Behcet's Disease which was founded in 2000 in Seoul. First, I congratulate our colleagues in Berlin, led by Professor Christos Zouboulis of the Department of Dermatology at the Free University of Berlin, for having organised a most successful conference and for having compiled these proceedings so rapidly. It will be realised immediately on scanning the contents of this book that the conference was truly international with 210 participants from 26 countries, as Professor Zouboulis has noted in his preface. These included basic scientists, epidemiologists, pathologists, clinicians and, importantly, representatives from patient organisations. The latter held their own conference alongside the scientific-medical conference to mutual benefit. The combined session of patients and doctors (abstracts on pp 601 - 626) gave the opportunity for an exchange of information and fruitful discussion. The wide ranging scope of the communications is evident from the index and it was most encouraging to see their origin - from all parts of the world, from senior and junior colleagues and, from many different disciplines. Many communications may be regarded as preliminary reports of research in progress and we look forward to seeing the definitive publications in appropriate journals in due course."

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.

Physical and chemical agents in the environment damage the DNA of humans, and pose a major threat to human health today, and to the genetic integrity of human populations. Although studies on isolated DNA in vitro, on prokaryotes, on mammalian cells in culture, and on laboratory animals have provided essential background information, it is now possible to study DNA damage and repair in human tissues directly. New techniques of high sensitivity, especially those not requiring radioactive labeling have made possible quantitation of DNA damage and repair, as well as detection of residual, unrepaired DNA lesions . In recent years, several investigators have taken up the challenge of studying damage and repair responses in humans, and we have chosen that work as the special focus of this Symposium. Major advances in under standing damage and responses in human skin, in blood cells and in human internal organs indicate three major themes. First, DNA damage levels in human tissues depend not only on the initial exposures, but also on the capapacity of that tissue for repair of the specific lesion type. Second, repair in human tissues may differ quantitatively and qualitatively from that in human cells in culture.

Dermatology is a specialty in the field of medicine which constantly changes at a vast rate. Alongside technology, new drugs, methods and treatments are continuously developed for the treatment of all common skin diseases. The first edition of the European Handbook of Dermatological Treatments received an overwhelming response from dermatovenereologists all over Europe. Its easy-to-read format, which is also used for this 2nd edition, is aimed at helping the physician to obtain comprehensive information at a glance. The three main sections listed alphabetically define the different diseases, the drugs available and the various methods of treatment used in dermatological practice. Each chapter begins with a brief section of the aetiology and pathogenesis of the skin disease, and leads into the description of the clinical characteristics, the diagnosis and the differential diagnosis. Followed by a detailed discussion on treatment methods, alternative methods are covered as well. Each section ends with a reference list for further reading. This new edition provides an excellent update including the newest developments of drugs, methods and treatments in dermatological practice, maintaining the clear structure and well-proven format. It is a very comprehensive and practical guide and should not be missed by those treating patients with skin diseases.

A fully-illustrated, note-packed volume of information, "Dermatology: Illustrated Study Guide and Comprehensive Board Review" fulfills a real need for a single study guide for the Dermatology Board Exam. Written by a previous Chief Resident of Dermatology at the University of Illinois at Chicago Medical Center, the text focuses on presenting comprehensive information in an easy-to-understand, easy-to-remember format. Tips, tricks, short lists, and tables fill every inch of this book a must-have for any dermatology resident.

Features:

Acts as a concise go-to review book for the Dermatology Board Exam

Hundreds of author notes pinpointing important information

Information presented in an easy-to-read format

Scores of mnemonics and memory tricks to mentally organize information

Over 500 high-quality images placed parallel to the represented skin disorder

Life after Boards essential tips on coding and documentation

Knowledge about diagnostic procedures in melanoma has in creased rapidly within the past few years. Single tumor cells have been identified in normal tissue such as sentinel lymph nodes, as well as in bone marrow, peripheral blood, and other bodily fluids and cells, by molecular technologies. The introduction of polymerase chain reaction-based methods can be regarded as a prototype of this dramatic development towards molecular approaches in new diagnostic procedures. This fact opens up the possibility of clinical use in patients and of influencing treatment strategies. Considerable discrepancies have been described, how ever, in the success rates of these new techniques for the detec tion of minimal residual disease in cancer patients. Despite fav orable results reported by different groups of investigators, it will take several years to define the clinical and pathophysiological relevance of new diagnostic procedures. The 1st International Symposium "Minimal Residual Disease in Melanoma: Biology, Detection and Clinical Relevance of Microme tastases", held in September 1999 in Homburg/Saar, Germany, fo cused on recent developments in this particular area of cancer re search. The purpose of the meeting was to stimulate discussion and exchange of new data and ideas by renowned international scientists. The aim of this volume is to summarize major topics of basic research and clinical investigations presented by invited experts in this fascinating but still. controversial field of melanoma re search.