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."

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."

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."

Skin cancer is the most frequent malignancy in humans and its incidence is still increasing. This situation calls for major efforts to manage the disease. Preventive measures must include reduced UV exposure and an enhanced common awareness of skin lesions. Advanced surgical techniques allow safe removal with excellent cosmetic results. In many cases alternative treatment modalities such as radiotherapy, cryosurgery and photodynamic therapy are applicable. The development of optimal sun screens and UV-protective clothes, new tools for early diagnosis of malignant lesions including videomicroscopy, improved evaluation of biopsy material and new treatment schemes will contribute to better patient care. New developments in therapy including pegylated interferons, cytokine-inducing molecules, monoclonal antibodies and vaccination approaches using peptides, dendritic cells, viruses or nDNA give hope for well-tolerated and efficient treatments.

The industrialized world has witnessed a steady increase in diseases of the arteries, veins, and lymph vessels in recent years. The prevalence and incidence of arteriosclerotic vascular disease has taken on the character of an epidemic. Diseases of the superficial and deep veins are widespread. Everypracticing physician is confronted daily by arterial circulatory disorders of the supra-aortic vessels, the thoracic and abdominal aorta, and the pelvic and leg arteries as well as by venous and lymphatic diseases.Todayvascular disease isbest managed in an interdisciplinary way; interventional radiologists and neurologists should be part of the team at any established vascular center. Many older colleagues were forced to acquire their knowledge of vascular diseases on their own. There are still many medical schools and hospitals that lack vascular specialists who are capable of passing on their expertise to students. For manyyears there was no expertise in medical angiology in countries such as Great Britain or the United States. All of vascular medicine resided in the hands of vascular surgeons. It is only in the last few years that vascular internists have appeared in these countries as well

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 . . ."

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 vohimes 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."

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.

A brilliant collection of colour pictures, augmented by appropriate discussion, describing both common and unusual afflictions. Sections on clinical manifestations, histologic findings, differential diagnosis, and treatment, complemented by significant references, have been written by selected authorities in the field. Dermatologists, dentists, and even primary care physicians will find this an indispensable volume in their practices.

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 is the eighth volume in the New Clinical Applications Dermatology Series. Awareness of relationships is of prime importance in der matology. Professor Scully and Dr Porter cover the skin and mouth in a comprehensive and informative manner. Mr Peter Wright effortlessly and concisely brings the eye and the skin together. Dr C. Rowland Payne both relates and speculates on the enigma of sarcoidosis. Pro fessor Elder concludes the book with a scholarly update on porphyria and the skin. I thank all the above for their fine contributions. This volume should have widespread appeal. JULIAN VERBOV ABOUT THE EDITOR Dr Julian Verbov is Consultant Dermatologist to Liverpool Health Authority and Honorary Clinical Lecturer in Dermatology at the University of Liverpool. He is a member of the British Association of Dermatologists, repre senting the British Society for Paediatric Dermatology on its Executive Committee. He is Editor of the Proceedings of the North of England Dermatological Society. He is a Fellow of the Zoological Society of London and a Member of the Society of Authors. He is a popular national and international speaker and author of more than 200 publications."

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.

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."

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.