More than 10 years ago, I had the chance to visit the university hospital in Munster, Germany. At the outpatient clinic there, I accidently met a young dermatologist who was devoted to the study of the quantification of irritated skin during his busy daily clinical work. I sensed immediately that this Dr. P. Frosch was conducting his research with the ideals and enthusiasm which were so familiar to me. Soon we found that we shared a similar past experience; we both had begun our careers in dermatological investigation with the same mentor. For me it was more than 25 years ago that I first met Dr. Kligman, Professor at the University of Pennsylvania in Philadelphia, USA. I reminisced that I had been greatly shocked by his initial question ''As a dermatologist, do you want to study living or dead skin?" because, at that time and even today, whenever we cannot collect enough information about the skin with the naked eye, it is invasively removed is common practice to histologically examine a skin sample that from living tissue. Many dermatologists still would never think of studying the living intact skin itself noninvasively with the aid of existing advanced technologies to assess its structural and functional properties. At that time Dr. Kligman intended to build up a system of evaluating the skin from various aspects, using methods that had been unduly neglected in the past and introducing various technological instruments.

The epididymis has great significance in the reproductive biology of the male and it is gaining recognition as an organ worthy of study in its own right - where the secretory and absorptive activities of one tissue (the epithelium) profoundly modify the function of another (the spermatozoon). Apart from cases of epididymal agenesis or physical blockage, however, it is not yet known to what extent mal functions of the epididymis contribute to "unexplained" male infer tility, but its importance as a target for antifertility agents in the male is now widely appreciated. This monograph evolved from two lectures on epididymal func tion given at the National Research Institute for Family Planning, Beijing and the Sichuan Provincial Family Planning Research Insti tute, Chengdu, China in 1983. In order to stress for this audience the central importance of the epididymis in fertilisation, and so highlight its potential for attack by antifertility agents, the talks attempted to put the epididymis in reproductive perspective by stressing the func tional development of the sperm cells during their sojourn in the epididymis, rather than merely listing the changes observed in them."

Both the major and minor salivary glands can be the site of a wide variety of diseases and functional disturbances. This monograph covers both the common lesions and conditions of the salivary glands as well as the rare ones. Much attention is given to the problematic complaint of dry mouth and the even more cumbersome diagnostic aspects of Sjogren's syndrome. Emphasis is on the clinical aspects and the management of the various disorders. The vast experience of the authors is reflected in their clear and concise style. The illustrations are well chosen and updated references are provided, where appropriate."

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.

Urticaria is a vexing problem, to the patient who teachers who have stimulated my interest and helped suffers from the annoying pruritus and the fear oflife me to understand the basic and clinical aspects of mast threatening reactions, to the physician who faces the cell-related problems is long. I would like to specifi challenge to find the cause of the eruption and to cally mention J.N. Fink during medical school train control the symptomatology, and to the scientist who ing in Milwaukee, J.R. Pomeranz and R.W. Belcher is asked to explain the process that elicits tissue during dermatology residency in Cleveland, L.M. swelling at the cellular and molecular levels. Lichtenstein and P. Norman during a research fellow The last thorough treatise on urticaria was the ship at the Department of Clinical Immunology and superb monograph by R. P. Warin and R.H. Champion, Allergy at Johns Hopkins University in Baltimore, and published more than a decade ago. Since then, there E. Macher at the University Clinics in Miinster where have been major advances in the field. This holds much of what I have learned in the past could be particularly for the clinical aspects of anaphylactoid broadened through further basic research and clinical reactions, the urticarial vasculitis syndrome, and the experience.

Herpes Simplex Virus is the fifth monograph to be published in the Bloomsbury Series of Clinical Science. It provides an authoritative review of the key issues related to this common clinical problem. The characteristics of the virus, its epidemiology and the diag nosis and management of the various forms of infection are all considered. Adrian Mindel is an international authority on this subject; he joined the Academic Department of Genito-urinary Medicine at the Middlesex Hospital in 1980 and has been actively involved in HSV research since that time. His major research interests include the epidemiology and treatment of genital herpes, the epidemi ology of neo-natal herpes and the many and varied features of HSV infections in immuno-compromised patients. The continuing aim of the Bloomsbury Series is to identify the growing areas of clinical research and relate these to current and future medical practice. In Herpes Simplex Virus such aspirations have been successfully achieved. London, May 1989 Jack Tinker Preface There has been considerable interest in herpes simplex viruses (HSV) over recent years. Amongst the many reasons for this are the introduction of safe and efficacious therapy, the recognition that HSV may cause life-threatening infections in neonates and immunocompromised patients, the observation that genital herpes is one of the commonest viral sexually transmitted diseases and the possible association of HSV with cervical cancer."

The first edition of "Testosterone: Action, Deficiency, Substitu tion" was published in 1990. Since then our understanding of the hormone that turns males into men has tremendously increased. Therefore, the editors felt that a second extended edition of the book is warranted in order to summarize established and recent findings in the field and to present the reader with an up-to-date is reflected by the textbook. The increased mass of knowledge growth of the volume from 14 to 20 chapters. In the updated edition the biochemistry and metabolism of androgens have been complemented by extensive information on the molecular biology of the androgen receptor and its disorders. The key role of testosterone in spermatogenesis is now better de fined. We have a more complete understanding of the psychotro pic effects of testosterone and know so much about the different target organs and functions that individual chapters deal with testosterone and the prostate, lipids and the cardiovascular sys tem, hair, bones and muscles. The general chapter on pharmacol ogy and clinical uses of testosterone, in particular in male hypo gonadism, is extended by pharmacokinetic studies on testoster one preparations and individual substitution modalities using testosterone esters as well as implants and advanced trans dermal applications. The physiologic basis and possible clinical applica tions of testosterone in non-gonadal diseases, in male senes cence, in hormonal male contraception and in transsexuals are discussed. The last chapter describes the role of "investigative" steroid biochemistry applied to tracking anabolic steroid abuse."

Measuring the Skin presents all techniques devoted to non-invasive normal or diseased skin measurement. As opposed to other books, this text embraces old and new validated techniques for all skin suborgans and functions, and is ideal as a small encyclopedia since it provides the answer to any question concerning skin measurement. Within each chapter, the meaning of the obtained parameters is highlighted so that the user is able to interpret the results correctly, and each technique is discussed to help select the most appropriate one for each special case. Another novel feature is that the book bases the skin investigation on the physiology and anatomy. A compendium of current knowledge on the structure or function dealt with precedes each chapter. The book may also be used as a research tool. This comprehensive text contains an innovative and unique list of more than 400 physical and biological skin constants, which are all referenced. The clinical dermatologist will also find this text useful as some chapters contain valuable maps and are devoted to clinical scoring of current skin diseases. Measuring the Skin is a resource for all those interested in or already dealing with the skin.

In this volume the impact of cell culture models on dermatological research is discussed by scientists from medicine, physiology, biology, pharmacology, and pharmacy. The book includes the following topics: orthology and pathology of the skin, differentiation of keratinocytes and fibroblasts, problems of the cultivation of melanocytes, biochemistry of pigment metabolism, models for wound healing and tissue renewal, fibroblast function and metabolism of collagen, models for the investigation of ageing as well as models for pharmacological and toxicologial tests. Thus, a wide arch is spanned, from basic problems with cultivation and characterization of cell cultures to examples of application. Dermatologists as well as cell biologists will benefit from this publication.

Aspects of Lyme Borreliosis is a comprehensive scientific presentation of virtually all aspects of lyme borreliosis. It starts with a concise history of lyme borreliosis and its causative agent, Borrelia burgdorferi. The morphological and biological characteristics of B. burgdorferi are presented, followed by outlines on the ecology and histopathology of LB.The various aspects of the clinical manifestations of LB are systematically dealt with, starting with a clinical overview. A special chapter covers the microbiological diagnosis. After a presentation on the susceptibility of B. burgdorferi in vitro and in animals against a great variety of antibiotics, a thorough discussion on the treatment of LB including criticalremarks follows. The book closes with a chapter on the epidemiology of LB.

Lasers in Dermatology presents an excellent and complete survey of the numerous applications of lasers in dermatological therapy and research, the fundamentals of laser-skin interaction, and the various laser sources and tools in use. A comprehensive outlook to new instrumentation, such as pulsed lasers of ultraviolet and infrared wavelengths, completes this up-to-date overview, which is indispensable not only to practitioners and clinical researchers in dermatology but also to engineers and laser physicists in biomedicine.

Wc have felt for some years that an atlas of paediatrie dermatology merired a place in the world dcrmatologicallitcrature. Non-dermatologists find skin conditiom difficult to describe and diagnose and this may bc cvcn mare difficult in children. Wc usually rely on the paTents for a history in childrcn, although many conclitions can bc spur dtagnoses. In this atlas wc have med to illustrare cOllditions seen regularly 111 our dinics as weIl as some seen mare rarely but which arc nevercheless important to recognize. Wc have limired the number of illustrations tn order to producc a realistically-priced book and thus it has not always becn easy to decide what to indude and whae to omu. Howevee, wc hope that wc havc produced a reasonably comprehensive work. We hope that this atlas will have a wide appeal both at home and abroad. It is a book either to read or to browse through. It is intended for senior medical students, family practitioners, and for trainees both 111 dermatology and in paediatrics. We would like it acttlally taken to skin clinics to be avatlablc for instant pcrusal, and to bc on hand in the paediatric ward. Wc have said comparatively little about treatment because this alters regularly and often varies in different centres and bccause we do not think that an atlas is the place for this."

In the past 10 years hirsutism has been the object of a considerable number of fundamental studies. It provides endocrinologists with an experimental model for the investigation of androgen secretion, metabolism and mechanism of action. Plasma androgen assay, free testosterone measurement, hepatic and extrahepatic androgen metabolic clearance and androgen metabolism in the skin are the different steps which were studied by many groups and represent valuable parameters of the mechanisms of hirsutism. Determination of the origin of androgen oversecretion has become easier by technical progress in differential effiuent venous catheterism, which makes it possible to compare androgens in adrenal or ovarian effiuent veins to their peripheral levels, and to determine the ovarian or adrenal source of the androgen oversecretion as well as the side responsible, essential in the case of tumors. The study of androgen metabolism and the discovery of androgen receptors in the skin confIrm the latter as an actual target cell for androgens. This target cell uses the circulating active androgen, i. e., testosterone and can also metabolize local inactive androgens into active ones. This is the case of androstenedione and dehy droepiandrosterone which are the two main androgens secreted in women, since women secrete very little testosterone. The capacity of the skin to transform inactive androgens into active ones varies from one individual to another. That would support the concept of variable skin receptivity from one woman to another and from one ethnic group to another."

R. MARKS Biology has become a 'numbers game'. The advantages of being able to grade changes in tissue, submit results to statistical analysis and accurately record biological phenomena make measurement essential. This is as true for the various disciplines in applied biology as it is for the more esoteric aspects ofthe subject. Regrettably, sk in biologists until recently had not seized the opportunities that the availability of their tissue of interest afforded and fell behind in the exploration of measurement techniques. Probably this resulted in part from the mistaken sentiment that 'to see is to know'. It also originated from the complexity ofthe skin which. as a closely interwoven mixture oftissue types. makes assessments technically difficult. However, we are optimistic about the future. The International Society for Bioengineering and the Skin was formed in Cardiff in ] uly 1979 in response to the wishes of the delegates who had attended the first International Symposium on the subject in Miami in 1976 and the second in Cardiff 3 years later. This volume is the proceedings of the Cardiff meeting. We believe that it demonstrates the brave efforts and variety of new ideas that characterise the studies of scientists who realise the importance of blending the phYSICal sciences with skin biology.

The morphological behaviour of leucocytes* leaving the blood has been studied for more than a hundred years and can be described in some detail, but the mechanisms involved are for the most part still unclear. Following an inflammatory stimulus, dy- namic changes occur in small blood vessels near the inflamed site and are followed by margination of leucocytes and by their adherence to the endovascular surface of endo- out of the vessel in the gaps between endothelial thelial cells. The leucocytes migrate cells and move towards the noxious stimulus, directed presumably by chemotactic gra- dients. Having reached the gradient source, they may engage in phagocytosis, killing and digestion of micro-organisms or of damaged tissue. In this review, we deal with the adhesive properties of leucocytes, which have US1,l;ll- ly been measured in vitro, and with their possible relevance to the leucocyte-endo- We also deal with the locomotion of leucocytes, its machinery thelial cell interaction.

This is an invaluable collection of information designed to help residents, fellows, and students - as well as any already qualified medical professional interested in revising the essentials of skin conditions - to master the basics of skin pathology. Using the principle of pattern recognition, it simplifies the multitude of dermatopathologic signs by using easy-to-memorize images of what the key features look like - photomnemonics. There are also helpful sections on the technical aspects of dermatopathology and on the key findings at each level of the skin. Organized simply and abundantly illustrated, this text will be an indispensable guide to revision for all its readers.

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."

Dermatology is a complex and puzzling world of itching bumps, pim ples, and rashes. The multitude of clinically distinct skin diseases, their frequently unresolved pathogenesis, and the exponentially in creasing amount of scientific information add to the confusion about skin diseases. The great prevalence of skin diseases makes them an urgent priority for intensive research effort, and although many scientists and academic clinicians are vigorously trying to uncover we are only at the very brink of understanding the etiol their secrets, ogy of most dermatoses. The principle mechanisms of general organ pathology (physical, chemical, microbial, ischemic, degenerative, and neoplastic disturb ances) are believed to be relatively well understood. In contrast to skin pathomorphology, however little is known regarding the bio chemistry and physiology of dermatoses. The difficulty in under standing skin diseases may be overcome partially by finding biome dical simplifications, and the concept of "oxidative injury in dermatopathology" is just such a simplification. It should, of course, always be kept in mind that no single mechanism alone can explain the pathogenesis of a disease and that there may be a danger of over looking other important biological determinants."

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.

Wounds have existed since the beginning of time, and records of their nature and treatment are found in the earliest documents. Interestingly, many of these treat ments are now being rediscovered or re-used in modern-day clinical practice. In addition to the diverse nature of treatments that have been suggested as being beneficial for wounds, over many centuries there has been a range of clinicians who have cared for patients with wounds, and in many parts of the world today it is not doctors but other professional colleagues - e. g. nurses or podiatrists - who are the most knowledgeable persons on wounds and wound treatments. Finally, the nature of wounds seen in clinical practice is changing. Increasing destructive power is resulting in more severe injuries occurring in patients involved in conflict. Developments in surgical techniques have enabled new surgical procedures to be offered to patients, but novel and more severe complications can result from such technical advances. In addition, many societies around the world are having to deal with an increasing ageing population, and huge increases in the number of patients suffering from chronic wounds are being seen. In summary, expanding treatment options, diverse groups of clinicians caring for patients and changes in the nature of wounds seen in clinical practice are real issues that have to be faced, and solutions have to be found if patients are to receive optional care for their wounds."

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."

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."

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."