Monoclonal antibodies in dermatologic research. Studies with a unique cell-surface antigen defined specifically for keratinocytes by a monoclonal antibody

Basic principles of production of monoclonal antibodies are discussed in this paper. In order to illustrate the usefulness of such production, studies of a new monoclonal antibody designated KF-2 which defines a unique cell-surface antigen found exclusively in the stratum spinosum of man and lower primates are recounted.     

Antibiotic use in dermatologic surgery

Few situations in dermatologic surgery require prophylactic antibiotics. The AHA has decreased the dose for endocarditis prophylaxis from antibiotics before and after the procedure to only 1 hour prior to the procedure. In the 1997 guidelines, fewer procedures are listed as requiring antibiotics compared with prior guidelines. In fact, several authors have questioned the efficacy of prophylactic antibiotics. The sequela of endocarditis or an infected prosthetic joint are certainly serious and possibly life-threatening conditions, yet this should not be a justification for using a therapy that is not proven and has potential serious side effects of its own. The authors suggest not using antibiotics on clean or clean-contaminated wounds regardless of cardiac history. Patients with prosthetic joint replacements probably do not need prophylactic antibiotics in cutaneous surgery unless mucosa is invaded; in such cases the guidelines set by the ADA and the AAOS should be followed. The authors believe that antibiotics should be reserved for contaminated or infected wounds when their application is therapeutic. Table 2 contains a summary of the authors' recommendations for the use of antibiotics in cutaneous surgery. Each patient should be evaluated on an individual basis, and consultation with the patient's primary physician, cardiologist, or orthopedist should be sought when the need arises.     

Antibiotics used in nonbacterial dermatologic conditions

The majority of nonbacterial dermatological conditions treated with antibiotics benefit from the anti-inflammatory properties of these medications, usually dapsone or tetracycline. Many other antimicrobials are used to treat noninfectious conditions. The following chapter is an overview of select noninfectious dermatological conditions for which antibiotics are used, with a focus on the most common antibiotics used for their nonantimicrobial properties.     

The use of dermatologic drugs in pregnancy and lactation

Physicians are generally reluctant to prescribe dermatologic drugs to pregnant or nursing women because treatment is often elective and can be harmful to the patient, her fetus, or nursing infant; concerns for potential litigation also give pause. Yet, some effective dermatologic drugs have been determined to be safe during pregnancy and lactation. Of great practicality is an easily accessed reference guide that condenses information on such drugs into a set of tables that list pregnancy and teratogenicity ratings. Indications and contraindications are ordered in relation to the phases and trimesters of pregnancy. A discussion of the necessity of considering stages of childbearing in choosing drug therapies introduces the tables. A summary list of cautions spells out the steps physicians should take in treating women of childbearing age.     

Oral antibiotic therapy of dermatologic conditions

Oral antibiotics that may be useful in dermatology can be classified as beta-lactams (penicillins and cephalosporins), tetracyclines, macrolides, or quinolones; other options are clindamycin, trimethoprim-sulfamethoxazole, rifampin, and metronidazole. Proper understanding of the mechanisms of action and resistance, pharmacology, antimicrobial spectra, and adverse effects of these drugs will enable the clinician to obtain the best results.     

Ultrasound diagnostic techniques in dermatologic angiology and phlebology

The diagnostic uses of high-resolution ultrasonography (7.5-20 MHZ) have dramatically advanced in the past 20 years. We present representative examples of ultrasound diagnosis, based on our experience with over 15,000 examinations. For example, peripheral arterial disease was identified in 30% of older patients with venous diseases, while peripheral emboli and vasculitis can lead to widespread skin disease. Ultrasonographic diagnosis is required for appropriate interdisciplinary treatment. In addition, regular evaluation of the supra-aortic vessels and coronary arteries as well as arteries and veins of the limbs is needed in some forms of vasculitis. The causes of peripheral venous disease can be subdivided into four groups based on sonographic findings: Primary or secondary epi- and/or subfascial venous insufficiency, thrombotic venous occlusion, venous compression syndrome and arteriovenous-lymphatic malformations. The diagnosis and therapeutic approach to lymphedema and soft tissue diseases, with or without lymphadenopathy, requires careful sonographic evaluation. Ultrasonography is an essential part of dermatologic oncology, both for planning primary therapy and for follow-up. A sound command of ultrasonography is today an essential aspect of dermatologic diagnosis and therapy.     

Infectious complications and antibiotic use in dermatologic surgery

Infection rates in dermatologic surgery are low, ranging on average from 1 to 3%. Studies have shown that many practitioners likely overuse antibiotics, both for prevention of wound infection and in endocarditis prophylaxis. This article discusses patient and environmental risk factors in would infection. Data on wound infection prophylaxis are reviewed, and specific guidelines set forth with regards to appropriate antibiotic usage, drug selection, dosage, and timing. In addition, recommendations surrounding endocarditis and prosthetic joint infection prophylaxis are presented as they apply to dermatologic surgery.     

Photodynamic therapy for dermatologic conditions in the pediatric population: a literature review

Photodynamic therapy (PDT), using topical aminolevulinic acid (ALA), has been used for years to treat a variety of dermatologic conditions, including actinic keratosis, superficial basal cell carcinoma, and in situ squamous cell carcinoma. While there is a wide range of neoplastic and non‐neoplastic skin diseases for which ALA‐PDT is used in adults, there is a knowledge gap when it comes to its use in children. This review highlights what is currently known regarding the use and efficacy of this therapy in the pediatric population. A PubMed search was conducted to identify studies including pediatric patients undergoing monotherapy PDT with topical aminolevulinate (published 2005–2016). Twenty pediatric articles were identified. ALA‐PDT has been used successfully in children to reduce the number and size of basal cell tumors, inflammatory acne lesions, plantar warts, and linear porokeratoses. ALA ‐ PDT may be an attractive alternative to surgery for children with basal cell nevus syndrome, or to conventional destructive and/or topical methods used for plantar warts or linear porokeratoses. PDT can be considered for inflammatory acne when topical treatments have failed and systemic medications are not an option. Pain associated with treatment and insurance coverage may be a barrier to use.