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Ultraviolet Therapy

Key features ■ Phototherapy represents the use of ultraviolet (UV) radiation for the treatment of skin diseases ■ Currently, phototherapy encompasses irradiation with broadband UVB (290–320 nm), narrowband UVB (311–313 nm), 308 nm excimer laser, UVA1 (340–400 nm), UVA (320–400 nm) plus psoralens (PUVA) or alone, and extracorporeal photochemotherapy (photopheresis) ■ Therapeutic success depends upon proper selection of the phototherapy modality for a given disease ■ Proper dosimetry is required to…

Complementary and Alternative Medicine

Key features ▪ Globally, complementary and alternative medicine (CAM) is commonly utilized by patients with skin disease ▪ CAM encompasses a diverse group of therapies and systems, many without strong evidence of efficacy ▪ Among dermatology patients, the most popular forms of CAM include herbals, dietary supplements, homeopathy, and acupuncture ▪ Scientific research regarding CAM is ongoing, with results varying from promising to demonstrating minimal, if…

Sunscreens and Photoprotection

Key features ▪ Modern sunscreens were first developed during the 1940s with the primary aim of preventing sunburn. Today, sunscreens are also used to prevent other aspects of photodamage, including carcinogenesis and photoaging ▪ The active ingredients in sunscreens include: (1) soluble organic filters, i.e. “chemical” compounds, that absorb UV radiation; and (2) insoluble metal oxide filters, i.e. “physical” agents, that both absorb and scatter UV…

Drug Interactions

Introduction There are two concerns in drug safety: drug reactions and drug interactions. When multiple medications are prescribed, drug interactions become an important safety and efficacy consideration for patients and physicians alike . Non-prescription drugs, as well as herbal or alternative medicines and foods (such as grapefruit juice), may also be implicated in interactions with drug therapy. It is difficult to obtain precise rates of incidence…

Other Systemic Drugs

Introduction This chapter is designed to be a broad overview of selected systemic therapies for dermatologic diseases. It provides an historical perspective for each drug, a discussion of its mechanism of action and side effects, and touches briefly on indications and clinical use. This information should serve as a starting point, allowing the reader to readily compare and contrast treatment options. It is not a substitute…

Other Topical Medications

Key features ▪ Absorption of topical medications depends upon several factors, including cutaneous barrier function, the anatomic site, the active agent, and characteristics of the vehicle ▪ In neonates, there is a greater risk of systemic toxicity with use of topical medications ▪ Combination or rotational therapy using topical agents may result in increased efficacy and decreased risk of side effects Introduction Topical medications are fundamental…

Systemic Immunomodulators

Interferons Key features ■ Human cells produce three antigenically distinct forms of interferon (IFN), originally described as leukocyte (α), fibroblast (β), and immune (γ) ■ Recombinant DNA technology can produce large quantities of highly purified human IFN ■ IFNs have antiviral, antiproliferative, and immunoregulatory properties ■ Dermatologic FDA-approved indications for IFNs include condyloma acuminata (IFN-α-2b), melanoma (IFN-α-2b), and AIDS-associated Kaposi sarcoma (IFN-α-2a and IFN-α-2b) ■ Side…

Antimicrobial Drugs

Key features ▪ Bacterial, fungal, and viral infections of the skin and soft tissue are very common ▪ Selection of the appropriate treatment depends on the infecting microorganism, the site and extent of the infection, and patient characteristics (e.g. age, pregnancy/lactation, comorbid medical conditions) ▪ Physicians must be aware of the drug interactions and potential adverse effects of antimicrobial medications Antibacterial Agents Introduction The hundreds of…

Retinoids

Key features ▪ Retinoids are structural and functional analogues of vitamin A that exert multiple effects on cellular differentiation and proliferation, the immune system, and embryonic development ▪ Retinoic acid receptors (RARs) and retinoid X receptors (RXRs) are ligand-dependent transcription factors belonging to the steroid–thyroid hormone nuclear receptor superfamily ▪ Topical retinoids are used to treat a number of conditions including acne, photoaging, and psoriasis; the…

Glucocorticoids

Key features ▪ Glucocorticoids continue to be among the most commonly prescribed anti-inflammatory agents in dermatology and all of medicine, with a large number of disorders responding to these drugs ▪ Proper use of systemic glucocorticoids requires a working knowledge of the hypothalamic–pituitary–adrenal (HPA) axis ▪ Proper use of topical and intralesional glucocorticoids requires awareness of their various formulations and potencies ▪ Glucocorticoids have a broad…

Skin Barrier and Transdermal Drug Delivery

Skin Barrier Matthias Schmuth Peter M. Elias Thomas J. Franz Jui-Chen Tsai Gopinathan K. Menon Kenneth R. Feingold Chapter Contents Stratum corneum structure and organization 2176 Epidermal metabolism and the skin barrier 2176 Impaired skin barrier and cutaneous inflammation 2179 The skin provides the largest interface between the human body and the external environment. Therefore, one of its most important functions is to prevent ingress of potentially harmful exogenous substances (outside-in barrier).…

Public Health and Dermatology

Introduction As a dermatologist walks into the examination room of the patient in Fig. 123.1 , several diagnostic possibilities likely come to mind. The patient's history, additional physical findings, and other clues help narrow the differential diagnosis. In this case, knowing the patient's history of atopic dermatitis lends context to the appearance of punched-out erosions and allows one to arrive at the diagnosis of eczema herpeticum.…

Cutaneous Metastases

Key features ▪ Cutaneous metastases are uncommon and rarely may be the presenting sign of an internal malignancy ▪ In general, cutaneous metastases are associated with a poor prognosis ▪ In women, breast carcinoma and melanoma are the malignancies that most frequently metastasize to the skin ▪ In men, melanoma and carcinomas of the head and neck, lung, and colon are the malignancies that most frequently…

Other Lymphoproliferative and Myeloproliferative Diseases

Benign Lymphocytic Infiltrates Lymphocytic Infiltrate of Jessner Synonyms ▪ Lymphocytic infiltrate of Jessner–Kanof ▪ Benign lymphocytic infiltrate of the skin ▪ Jessner lymphocytic infiltrate ofthe skin ▪ Jessner lymphocytic infiltration of the skin ▪ Jessner–Kanof lymphocytic infiltration of the skin Key features ▪ Erythematous papules, plaques and, less commonly, nodules ▪ Most common on the head, neck and back ▪ Dermal infiltrate of lymphocytes without epidermal…

Cutaneous T-Cell Lymphoma

Introduction The term cutaneous T-cell lymphoma (CTCL) describes a heterogeneous group of neoplasms of skin-homing T cells that show considerable variation in clinical presentation, histologic appearance, immunophenotype, and prognosis. CTCLs represent approximately 75–80% of all primary cutaneous lymphomas, whereas primary cutaneous B-cell lymphomas (CBCLs) account for approximately 20–25% . For many years, mycosis fungoides (MF) and Sézary syndrome (SS) were the only known types of CTCL.…

B-Cell Lymphomas of the Skin

Synonyms ▪ Cutaneous B-cell lymphomas ▪ S kin- a ssociated l ymphoid t issue (SALT)-related B-cell lymphomas Key features ▪ Cutaneous B-cell lymphomas represent a group of lymphomas whose primary site is the skin; they are derived from B lymphocytes in different stages of differentiation. The skin can also be the site of secondary involvement by extracutaneous (usually nodal) B-cell lymphomas ▪ Most primary cutaneous B-cell…

Mastocytosis

Key features ▪ Mastocytosis can develop from birth to adulthood and may involve only the skin (most children and some adults) or multiple organs such as the bone marrow, liver, spleen, and/or lymph nodes (primarily adults) ▪ Childhood disease is more common and often presents with one or more tan to brown papules or plaques (“urticaria pigmentosa”) that frequently resolve by adolescence ▪ Mastocytomas are thicker…

Smooth Muscle, Adipose and Cartilage Neoplasms

Introduction Smooth muscle, adipose and cartilage neoplasms arising in the skin and subcutis comprise a wide spectrum of benign and malignant neoplasms that show myocyte, adipocyte, and chondrocyte differentiation, respectively. Tumors of fat, especially lipomas, occur most commonly. These neoplasms often present as solitary lesions with significant overlap in clinical appearance. In addition, the clinical differential diagnosis can be rather broad ( Fig. 117.1 ). As…

Fibrous and Fibrohistiocytic Proliferations of the Skin and Tendons

Key features ▪ Fibrous and fibrohistiocytic proliferations of the skin and tendons are common lesions that include both neoplastic and “reactive” processes ▪ Common benign fibrous and fibrohistiocytic proliferations, some of their atypical variants that could be misdiagnosed as malignant tumors, and corresponding malignant neoplasms are reviewed ▪ These tumors are composed of fibroblasts, myofibroblasts, histiocytes, dermal dendritic cells, collagen fibers, elastic fibers and connective tissue…

Neural and Neuroendocrine Neoplasms (Other than Neurofibromatosis)

In the past, neural tumors were often misdiagnosed histopathologically because of confusing classifications. As a result, their clinical relevance was poorly understood. Clinically, cutaneous neural tumors often look alike and most of them are benign. However, their correct diagnosis can be helpful in recognizing important clinical syndromes and this can contribute to better patient management . Classification, Terminology, and Histogenesis Cutaneous neural tumors can be classified…