Haptoglobin is a natural regulator of Langerhans cell function in the skin.

Langerhans cells (LC), the best-understood antigen presenting cells (APC) of the skin, are functionally plastic. Freshly obtained LC readily activate allogeneic T cells, but are incapable of activating autologous, naive T cells. When placed in culture in the presence of GM-CSF, LC up-regulate surface expression of class I and II MHC molecules along with co-stimulatory molecules, such as B7, CD40 and IL-12. This functional transformation enables the cells to activate naive, autologous T cells in vitro. It is paradoxical that intracutaneous administration of exogenous GM-CSF fails to induce intraepidermal LC to undergo functional transformation in situ. It has been reported that serum contains a factor that prevents fresh LC from undergoing functional transformation in culture, and the relevant serum factor has now been identified as haptoglobin (Hp), based on the following experimental results: (a) SDS-PAGE, amino acid sequencing, and mass spectrometric analyses of the inhibitory factor purified by high performance liquid chromatography (HPLC) from normal human serum revealed molecules completely homologous to Hp alpha-1 chain; (b) pure human Hp, but not serum depleted of Hp, inhibited fresh LC from acquiring the capacity to activate autologous T cells in vitro; (c) abundant Hp was detected in cytoplasmic compartments of fresh, but not cultured, LC. It was concluded that Hp, an acute phase protein, is a systemically-derived factor that prevents epidermal LC from spontaneously undergoing functional maturation in the skin. This novel property of Hp may be important in ameliorating or preventing certain T cell-dependent inflammatory skin diseases.

Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photodamaged skin. A double-blind vehicle-controlled clinical trial.

OBJECTIVE: To evaluate the efficacy and tolerability of 2 widely used topical alpha-hydroxy acids at low concentrations, 8% glycolic acid and 8% lactic (L-isoform) acid creams, in the treatment of photodamaged skin. DESIGN: A single-center, 22-week, double-blind, vehicle-controlled, randomized clinical trial assessed the overall severity of photodamage on the faces and forearms of volunteers, based on 7 individual clinical components of cutaneous photodamage. SETTING: The study was performed in an outpatient clinical research unit at the Massachusetts General Hospital, Boston. PATIENTS: Seventy-four women, aged 40 to 70 years, with moderately severe photodamaged facial skin were enrolled in the study. One subject withdrew from the study early because of skin irritation, and 6 subjects withdrew from the study for personal reasons. INTERVENTIONS: Glycolic acid, L-lactic acid, or vehicle creams were applied twice daily to the face and outer aspect of the forearms. MAIN OUTCOME MEASURES: Improvement in alpha-hydroxy acid-treated photodamaged skin as determined by patient self-assessments and physician evaluations of efficacy and irritancy. RESULTS: The percentage of patients using either 8% glycolic acid or 8% L-lactic acid creams on the face achieving at least 1 grade of improvement (using a scale from 0 through 9) in overall severity of photodamage was significantly greater than with the vehicle cream (76% glycolic acid, 71% lactic acid, and 40% vehicle; P < .05). On the forearms, after 22 weeks, treatment with glycolic acid cream was superior to the vehicle in improving the overall severity of photodamage and sallowness (P < .05). L-Lactic acid cream was significantly superior to the vehicle in reducing the overall severity of photodamage (P < .05), mottled hyperpigmentation (P < .05), sallowness (P < .05), and roughness on the forearms (P < .05) at week 22. CONCLUSIONS: Topical 8% glycolic acid and 8% L-lactic acid creams are modestly useful in ameliorating some of the signs of chronic cutaneous photodamage. These agents are well tolerated and available without prescription.

Inocoterone and acne. The effect of a topical antiandrogen: results of a multicenter clinical trial.

BACKGROUND AND METHODS: Because acne is androgen dependent, antiandrogen therapy might improve the condition. Inocoterone acetate (RU 882) is a nonsteroidal antiandrogen that binds to the androgen receptor and has antiandrogenic activity in animal models. To test its topical effect on acne, 126 male subjects with facial acne completed a 16-week, multi-center, double-blind study in which the twice-daily application of a 10% solution of inocoterone was compared with vehicle solution. Baseline and monthly examinations included acne lesion counts and general and endocrine laboratory tests. RESULTS: Inflammatory papules and pustules showed greater reduction in the inocoterone-treated subjects than in the subjects treated with vehicle. This difference achieved statistical significance by week 12 (24% reduction vs 10%) and week 16 (26% reduction vs 13%) and, with longitudinal analysis, throughout the course of the study. Global assessments and changes in comedo counts and sebum excretion rates were not significantly different between the groups. No serious adverse reactions were encountered. CONCLUSIONS: In this double-blind study of 126 male subjects with acne, a topical solution of the antiandrogen inocoterone, compared with vehicle, produced a modest but statistically significant reduction in the number of inflammatory acne lesions.

Dental curettes: useful tools for obtaining nail material for mycologic examination.

Obtaining material, especially subungually, from suspected onychomycotic nails can be difficult and/or traumatic with instrumentation frequently utilized by dermatologists. Use of scalpel blades and standard dermal curettes is often awkward and/or traumatic to the nail bed. Large clippings require micronization with a nail mill or tedious processing with less specialized instruments prior to microscopic examination (potassium hydroxide preparation) and fungal culture. A mycologist at our institution has efficaciously utilized dental curettes to obtain powdery subungual material suitable for immediate mycological assessment. This nontraumatic technique is becoming increasingly popular among clinicians.

Better dermatologic office photography: taking the photograph.

In a previous article we reviewed the questions every medical photographer must ask when looking through the viewfinder, as well as the difference between plastic surgical and dermatologic photography. We conclude by offering a mnemonic for the three views necessary in dermatologic photography: Location, Scan, and Detail, and by suggesting a technique for preadjusting the camera, lens setting, and flash that will guarantee consistent, high-quality clinical photos.

Better dermatologic office photography: getting started.

In an earlier paper, we defined a medical photograph as one that accurately maximizes clinical information while minimizing irrelevant data. This paper expands on this concept, providing specific hints to assist the practitioner in obtaining consistent high-quality clinical photos. We review the important question every medical photographer must ask when looking through the viewfinder as well as the difference between photography for practitioners of plastic surgery and dermatology.

Snapshots versus medical photographs: understanding the difference is your key to better dermatologic office photography.

A medical photograph in contradistinction to a snapshot accurately reproduces and maximizes clinically significant information while minimizing extraneous or irrelevant factors. Obtaining a top-notch medical photograph requires not only proper equipment but also rapid, sophisticated analysis of the clinical situation. Only then can major features including lesional size and distribution and more subtle details such as borders, color, and topography be selectively highlighted. First-rate medical photographs not only enhance the accuracy of diagnosis but also facilitate subsequent assessment of therapeutic efficacy. Furthermore, instruction of students and residents and continuing medical education of practicing clinicians depend on our photographic acumen.

Eruptive paraneoplastic keloids.

We present a 66-year-old woman who developed eruptive keloids in association with endometrial carcinoma in the absence of trauma, surgery, inflammation, or other known preludes to keloid formation. Keloid formation and endometrial carcinoma are both associated with similar cytokine abnormalities and as such, we hypothesize that this is a previously unreported paraneoplastic phenomenon.

Diagnostic ultrasound in dermatology: current uses and future potential.

Although ultrasound has been used for many years for a variety of medical diagnostic purposes, only recently have systems been designed that allow for its application to skin. High-resolution ultrasound systems now permit accurate, quantitative, noninvasive assessment of skin and cutaneous diseases. This technique will assist in the management of both inflammatory and neoplastic processes. Scans of skin obtained with a prototype high-resolution ultrasound system are presented. The computer-assisted creation of three-dimensional images from sequential B-mode scans is described.

Dapsone and sulfones in dermatology: overview and update.

In their 60-year history, dapsone and the sulfones have been used as both antibacterial and anti-inflammatory agents. Dapsone has been used successfully to treat a range of dermatologic disorders, most successfully those characterized by abnormal neutrophil and eosinophil accumulation. This article reviews and updates the chemistry, pharmacokinetics, clinical application, mechanism of action, adverse effects, and drug interactions of dapsone and the sulfones in dermatology.

Preview of potential therapeutic applications of leukotriene B4 inhibitors in dermatology.

This article reviews the mechanisms and potential therapeutic uses of compounds with inhibitory effects on leukotriene B4 (LTB4) production or its activity, and focuses on compounds that have been shown in animal and/or human studies to have potential efficacy in treating dermatological disorders. These compounds, many of which are not familiar to many dermatologists, include inhibitors of 5-lipoxygenase such as ETH615, 15-hydroxyeicosatetraenoic acid, leflunomide, linetastine, lonapalene, MK886, R-68151 and zileuton, and antagonists of LTB4 such as SC53228, SC50605, SC51146 and VML295. The purpose of this paper is to introduce our colleagues to these potentially useful compounds currently in preclinical or early clinical testing.

Photography without film: low-cost digital cameras come of age in dermatology.

BACKGROUND: Photography is integral to the practice of dermatology. Digital imaging techniques have only recently been used to assess cutaneous disorders. Previously reported imaging systems have been both expensive and cumbersome. Consequently, they have failed to gain wide-spread acceptance. METHODS: We describe our experience using an inexpensive digital camera. Photographs taken with this portable digital camera (FotoMan) compare favorably to those obtained with conventional 35 mm cameras. RESULTS: This inexpensive digital camera provides photographs of acceptable quality for a variety of dermatologic applications. Images created with this system are available within minutes and are less expensive than traditional photographs. CONCLUSIONS: Digital imaging is a new and exciting development. The digital camera described is simple to operate and provides a useful alternative or adjunct to conventional photography.

Acquired dermal melanocytosis: appearance during pregnancy.

We report the first case of acquired dermal melanocytosis (ADM) appearing during pregnancy. A 23-year-old Hispanic woman presented to the Dermatology Clinic of Columbia-Presbyterian Medical Center during the second trimester of pregnancy with a nonpalpable blue-gray patch with interspersed discrete brown macules on the right lower extremity. It had appeared during the first trimester of pregnancy. Cutaneous biopsy specimens revealed dermal melanocytes. A review of all reported cases of this rare dermatosis in the international literature is presented.

Physical enhancement of dermatologic drug delivery: iontophoresis and phonophoresis.

Iontophoresis and phonophoresis are emerging technologies capable of enhancing drug penetration through the stratum corneum, the principal barrier to percutaneous absorption. With utilization of applied electric current or ultrasonic waves, respectively, iontophoresis and phonophoresis have shown efficacy in an increasing number of clinical applications. This article reviews the underlying principles, current status, and potential of iontophoresis and phonophoresis in dermatologic therapy.

The future of topical therapy for cutaneous aging.

The elements of cutaneous aging have been well described and include changes of intrinsic or chronologic aging as well as changes of extrinsic or environmental aging. We also include male pattern alopecia in this category. The current dominance of tretinoin in cutaneous aging therapy is likely to be challenged by newer classes of retinoids, by topical antiandrogens, and by alternative treatments for proliferative lesions.

Diflorasone diacetate ointment 0.05% versus betamethasone dipropionate ointment 0.05% in moderate-severe plaque-type psoriasis.

We report the results of a 2-week double-blind, parallel clinical trial comparing two superpotent topical glucocorticosteroid ointments, diflorasone diacetate 0.05% and betamethasone dipropionate 0.05%, in psoriatic adults. Both corticosteroid ointments were fast acting and highly efficacious. 40 of the 44 patients who initially enrolled completed the trial. There were no statistically significant differences between the two glucocorticoids with respect to erythema, scaling, induration or the investigator's global evaluation after either 1 or 2 weeks of therapy. The level of patient satisfaction with the efficacy and cosmetic acceptability of these two category I glucocorticoids was similar. No systemic or local adverse reactions were noted.