Substances that are applied to the skin to heal it, make it feel better or improve its appearance, have much in common. They can all do damage to the skin as well as perform the task for which they were designed. They and the substances they contain are all absorbed through the skin to a greater or lesser extent. In addition, all these agents are constructed in the same general way. For these reasons it seems odd and uneconomical to consider topical pharmaceuticals, toiletry products and cosmetics separately. This was the reasoning behind the holding of a small symposium of workers involved with one or another aspect of the formulation of substances destined for application to the skin. Several aspects of the subject are covered in this book which is based on the symposium and the contents should be of interest to all who are concerned with the prescription, assess ment or formulation of topical agents. 9 1 Acne Caused and Treated by Topical Agents W. J. CUNLIFFE The four main aetiological factors involved in the development of l acne are (1) an elevated sebum excretion rate ; (2) ductal hyper 3 keratinization 2; (3) an abnormality of microbial function ; (4) host 4 inflammatory response * Although opinions differ on both sides of the Atlantic, most authorities in the United Kingdom believe that increased sebum excretion rate is the main drive to acne, there being a definitive relationship between the severity of the acne and the seborrhoea of this disease.

This text was designed for the physicians, nurses, technical personnel, and staff members of medical facilities using lasers for surgical, therapeutic, and diagnostic purposes. The objective is to provide an understanding of the potential health and safety hazards associated with the use of medical laser systems and the precautions needed to use them safely. To do this, it is necessary to have an awareness of applicable standargs and regula tions that apply to laser use. This book is not intended as a substitute for the American National Standards Institute (ANSI) Z-136. 3, "Safe Use of Lasers in Health Care Facilities," but to facilitate its implementation as well as the implementation of the many other related regulations and guidelines that are pertinent. These other regulations include the Medical Device Amendments to the Food and Drug Act, the Federal Laser Product Performance Standards issued under the Radiation Control for Health and Safety Act, and applicable regulations of the Occupational Safety and Health Administration (OSHA). The text is organized to provide first an overview of laser hazards, laser surgical applications, and laser biological effects. General safety control measures and safety standards are then presented. Because laser tech nology is rapidly evolving, these general guidelines will allow safe use of new laser systems as they become available. Finally, specific safety guide lines and precautions are provided for specialized laser applications in the different health care specialties."

In recent years, papillomaviruses in general and human papillo maviruses in particular have been recognized as possible agents of important diseases, including some forms of human cancer. The purpose of this book is to present a concise panorama of the pre sent status of knowledge of this topic. This knowledge is as impor tant to molecular biologists and virologists as it is to clinicians and pathologists. To bridge the gap among these diverse groups of investigators, we conceived of a book covering a broad spectrum of the basic scientific, clinical, and pathological aspects of diseases associated with papillomaviruses. Although the principal thrust of this book is directed at human papillomaviruses, fundamental knowledge of animal viruses is essential to the current understand ing of the molecular mechanisms of cell transformation. For this reason, a chapter on animal viruses has also been included. Some of the experimental work having to do with the elucidation of transformation and other aspects of interaction between the virus and the cell cannot be based on human papillomaviruses because of a lack of suitable experimental models. Hence, some of the chapters dealing with fundamental aspects of viral molecular biol ogy are based on animal models. We were very fortunate in having persuaded a number of distin guished colleagues to contribute to this work."

The control of cancer is at once a major public health problem and a problem of fundamental biologic interest. As a result of technologic developments and new insights in the realm of molecular biology, new and important approaches to an understanding of neoplasia are now possible. Several aspects of neoplasia are clearly of microbiologic interest, including the role of viruses in the etiology of cancer, control of the immune response to tumor cells, and the susceptibility of tumor-bearing hosts to overwhelming infection as a result of immuno deficiency. Recent advances in these areas led us to organize this symposium, and, through this publication, to record some of the progress being made in laboratories around the world in understanding some of the basic aspects of the cancer problem. This symposium was held as part of the commemoration of the twentieth anniversary of the Waksman Institute of Microbiology. Dr. Waksman's devo tion to the study of the smallest forms of life and the commitment of the Waksman Institute to the free pursuit of knowledge are the underpinnings of the institute's research eHorts in the broad area of microbiology, including the problem of neoplasia. It is of interest to note that actinomycin, one of the earliest antibiotics discovered in Waksman's laboratory, was also one of the first compounds found to be clinically useful in the treatment of certain types of cancer."

In the last fifty years dramatic progress has been made in the under standing of skin and skin diseases. Although we are still someway off understanding the ultimate causes of such disorders as psoriasis, atopic dermatitis and the congenital disorder of keratinization, we now have considerable information on the physiological disturbances in various diseases. This has permitted and encouraged a rational approach to treatment. The successful use of antimitotic agents, immunomodulators and retinoids may be cited as examples. A major reason for this im provement may be the fact that researchers accept models for the in vestigation of skin diseases. Increasing numbers of them have become available in the past years. So many have been described that it is doubtful whether anyone researcher is aware of all the other models described - even in his own field of interest. This book is a challenge for those involved in the study of skin and its disorders to use the sundry models of skin that have proven helpful. It would be impossible for this work to be all-embracing but it is hoped that the choice of models offered in this publication will be stimulating and helpful in the solution of knotty skin questions. April,1986 Ronald Marks, Cardiff Gerd Plewig, DUsseldorf Table of Contents In Vivo Models Human Model for Acne . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 L. C Brummitt, W. J. Cunliffe, G. Gowland Models to Study Follicular Diseases l3 G. Plewig Models for Wound Healing. . . . . . . . . . . . . . . . . . . . . . . . . 24 R. Marks, D. Williams, A. D."

Recent progress in the fields of pharmacology and immunology has provided us with new possibilities for treating dermatological diseases. This book reviews the most important immunosuppressive and immunostimulatory drugs and gives helpful, practical information on the treatment of various dermatoses, including autoimmundiseases, atopic dermatitis, psoriasis, vasculitis, contact dermatitis, pyoderma gangrenosum, infectious diseases, and neoplasms of the skin - in particular, malignant melanoma.

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.

There is no doubt among experts that the prevalence of allergic diseases has increased in many industrialized countries in recent years. The rea sons for this increase are unknown; only suppositions exist. Many people focus on environmental influences. However, the assumption that air pollution alone is responsible for this increase seems to be too simple: many other influences, including the genetic predisposition of individual patients, allergen exposure, and possibly socioeconomic factors, also have to be taken into consideration. Although our understanding of the complex mechanisms of allergic diseases has considerably improved thanks to the progress made in ex perimental immunology and allergology, we still have a long way to go before this scientific knowledge is translated into new therapeutic mo dalities. For this reason, the scientific community welcomed the gathering of scientists from very different disciplines and different parts of the world at an international symposium, "New Trends in Allergy IV" together with "Environmental Allergy and Allergotoxicology III" in Hamburg in 1995. This volume contains the invited papers, covering a wide range from basic science to practical clinical diagnosis and therapy. A further unique feature of this event was the concomitant first official workshop of the Environmental Pollution and Allergy Committee of the International Association of Allergy and Clinical Immunology (IAACI), at which the state of scientific knowledge in this field was defined and formulated."

Because skin blisters are the initial manifestation of epidermolysis bullosa (EB), patients invariably present to the dermatologist for diagnosis and treatment. However, EB is a systemic disease whose management requires input from clinicians in virtually all fields of medicine, including pediatri cians, surgeons, dentists, gastroenterologists, hematologists, otorhinolaryn gologists, dietitians, and physical therapists, to name a few. Because EB is a rare disease, few clinicians are familiar with it, and many recoil at the pros pect of caring for individuals covered with blisters caused by a disease they know little about. For patients, insult is thus added to injury and they feel abandoned, neglected, and frustrated. One way to remedy this deplorable situation is to provide clinicians with a compact source of information de tailing the principles of EB diagnosis and treatment. This text seeks to fulfill this role. From 1986-1991, The Rockefeller University Hospital has been the co ordinating center of the National EB Registry. Supported by The National Institutes of Health, this Registry consists of four university centers* commit ted to collecting clinical data concerning diagnosis, treatment, and epidemio logy on all American EB patients. As of April 1992, nearly 1,799 EB patients have enrolled nationwide. The Registry is now in its second five-year phase of operation."

practitioner up to date on the various aspects of conditions and diseases considered to be sexually transmitted. REFERENCES 1. Crissey JT, Denenholz DA: Development of the modern forms and concepts of syphilis. Clin Dermatol, 2(1):1-10, 1984. 2. Panconesi E, Mazzi M: The day syphilis came. Int 1 Dermatol, 23:284-286, 1984. 3. Washington AE, Johnson RE, Sanders LL: Chlamydia trachomatis infections in the United States: What are they costing us? lAMA, 257:2070-2074, 1987. 4. Bulkley LD: Syphilis in the Innocent. New York: Bailey and Fairchild, 1894. 5. Syphilis: Major perinatal killer. Med World Trib, 28(16):2, 1987. 6. Renshaw DC: Management of impotence. I. Psychological considerations. Clin Therap, 9:142-148,1987. Acknowledgments. We are very grateful to our teachers for the stimulation they provided in our studies of dermatology and sexually transmitted diseases. We partic ularly acknowledge the impetus given by Herman Beerman, M.D., Emeritus Professor of Dermatology, University of Pennsylvania School of Medicine, Philadel phia. Our office staffs have been particularly helpful, and we would like to recognize the contributions of Mrs. Carmela Ciferni. Lastly, this book was conceived through the inspiration of Dr. Jerry Stone, late Senior Medical Editor of Springer-Verlag, New York. Philadelphia, Pennsylvania LAWRENCE CHARLES PARISH Vienna, Austria FRIEDRICH GSCHNAIT Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl . . . . . . . . . . . . . . . What are Sexually Transmitted Diseases? Chapter 1 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . LOIS Y. MATSUOKA Chapter 2 Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . HARRY L. ARNOLD, JR. Diseases Chapter 3 Syphilis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . JOHN THORNE CRISSEY Chapter 4 Endemic Treponematoses . . . . . . . . . . .. . . . . . . . . . . . . . . . 32 . . ."

Until now, the general belief has been that premature baldness (male pattern bald- ness: M.P.B., or androgenetie alopeeia) is a hereditary eondition that progresses with age and for which there is no eure. If the father is bald, it is assumed that the ehild may also be destined to be bald sometime in the future. The existing theory throughout the world is that the eentral portion of the hair follicle is the hair root, and hair ean never regrow if the hair root has been removed. Dr. Inaba has introdueed a new theory that the eentral portion of the hair folliele is not only the hair root but the upper isthmal portion elose to the duet opening of the sebaeeous gland. This is a totaUy new understanding of the hair growth mechanism and the hair eyele. In his experienee in the surgieal removal of the sweat glands, whieh also removes the hair root, Dr. Inaba has found inereasing evidenee that hair regrows if the sebaeeous gland is left intaet.

Practical Procedures in Aesthetic Plastic Surgery, written by one of the foremost authorities in the field, is the definitive "hands-on" guide for the practicing plastic surgeon. Each chapter presents the actual execution of a specific surgical technique and illustrates the finer points that separate unacceptable from state-of-the-art surgical results. Aesthetic plastic surgery procedures from head-to-toe are covered, including blepharoplasty, rhytidectomy, abdominoplasty, suction-assisted lipectomy, breast augmentation, and lip enhancement. Over 500 photographs and line drawings, with 46 in full color, are the thrust of the book's benefit to the practicing surgeon, as each clearly defines the technical maneuvers essential in achieving flawless results. Prevention of mistakes as well as correction and repair of poor technique are also emphasized - an area that few books stress at all. Truly the most clear-cut technical volume available, this book should be in the hands of all practicing plastic surgeons and residents.

The book provides a comprehensive overview of the current state, and the new concepts for the future directions of modern cancer therapy. Bringing together all the relevant aspects from basic and applied science, and the clinical experiences of this new direction in medicine, it is an up-to-date summary of the activities in the field and will be the basis for evaluating future progress in this area.

Praxisgerecht aufbereitet vermittelt Ihnen das Buch die neuesten Erkenntnisse der AIDS-Forschung. o Aktuelle Daten zu Epidemiologie und Klinik o Moderne Labordiagnostik wie PCR o Neue Behandlungsformen und -strategien Im Mittelpunkt stehen die aktuellen Therapiekonzepte, z.B.: - Kombinationstherapie mit Nucleosid- und Proteinaseinhibitoren, - therapeutische Beeinflussung des Wasting-Syndroms, - Therapie der opportunistischen Erkrankungen, des Kaposi-Sarkoms und HIV-assoziierter Lymphome, - neue psycho-neuro-immunologische Konzepte. Mit diesem topaktuellen Uberblick bringen Sie Ihr Wissen uber HIV schnell auf den neuesten Stand!

A comprehensive source of information on variations found in skin diseases throughout the world is offered here. By considering the overall problems of hereditary variables, climate fluctuations, and therapeutic differences, this volume provides an appraisal of the diverse factors that make up the composite picture of cutaneous medicine. Divided by continent and then further organized into countries or regions, each entry presents basic information on the disease indigenous to the area, including its definition and symptoms, etiology, clinical manifestations, histopathology, appropriate laboratory tests, differential diagnosis, management, prevention and references. Additional chapters discuss the influence of travel and migration as well as of variables such as climate. 38 full color plates superbly illustrate the many variations of major dermatologic diseases. As technology has made global travel far quicker and more commonplace, this book is a must for all dermatologists, infectious disease specialists, and for all family practitioners and general internists.

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.

Features a wealth of clinical illustration Features anatomical correlation for the points being made Features many clinical tips and tricks to enhance results

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."