Scleroderma: Nomenclature,etiology, pathogenesis,prognosis, and treatments: Facts and controversies

Scleroderma refers to a heterogeneous group of autoimmune fibrosing disorders. The nomenclature of scleroderma has changed dramatically in recent years, with morphea (localized scleroderma), limited cutaneous systemic sclerosis, diffuse cutaneous systemic sclerosis, and systemic sclerosis sine scleroderma encompassing the currently accepted disease subtypes. Major advances have been made in the molecular studies of morphea and systemic sclerosis; however, their etiologies and pathogenesis remain incompletely understood. Although morphea and systemic sclerosis demonstrate activation of similar inflammatory and fibrotic pathways, important differences in signaling pathways and gene signatures indicate they are likely biologically distinct processes. Morphea can cause significant morbidity but does not affect mortality, whereas systemic sclerosis has the highest disease-specific mortality of all autoimmune connective tissue diseases. Treatment recommendations for morphea and systemic sclerosis are based on limited data and largely expert opinions. Current collaborative efforts in morphea and systemic sclerosis research will hopefully lead to better understanding of the etiology and pathogenesis of these rare and varied diseases and improved treatment options.     

Traditions, anthrax, and children

Anthrax is sporadically seen in Turkey, especially among people who live in rural areas and who come in contact with animals. Two siblings with cutaneous anthrax are described in this report. A week before their admission to the hospital, contaminated cow's blood was smeared on their foreheads as part of a traditional ritual. Both children were successfully treated with crystalline penicillin. In developing countries, traditions such as blood smearing may be an important factor in the transmission of anthrax to children.     

Crack, sex, and STD

Increasing rates of syphilis, gonorrhea, chancroid, and sexually transmitted human immunodeficiency virus infection appear to be related to crack cocaine use. This article critically reviews 16 epidemiologic studies that examine drug use, sexual behavior, and sexually transmitted disease (STD). Eight studies found an association between crack and STD, one study found no association between crack and STD, and seven studies found STD to be related to other drugs or methods of cocaine use. The exchange of sex for money or drugs was associated with STD in seven studies. Publications that were reviewed have numerous methodologic weaknesses: broader sampling, uninfected comparison groups, and greater specification of drug use and sexual risk behaviors are needed. Further research should compare different drugs and associated sexual behavior and STD to assess the unique risk conferred by crack. Designing effective interventions will require investigation of risk behavior determinants and barriers to health care.     

Lasers,light, and acne

Acne vulgaris is a highly prevalent disease with significant potential for physical and emotional scarring. Acne lesions have long been noted to improve after exposure to sunlight. This improvement may be secondary to activation of endogenous porphyrins produced by Propionibacterium acnes. Recently, several investigators have presented studies in which light of particular wavelengths has been used to treat acne vulgaris. In this article, we review the results of these studies as we look to the future of light-based acne treatment.