Apoptosis, the dermatologist, the venereologist and the patient

Apoptosis is the genetically mediated process whereby individual cells determine their deletion from normal and diseased tissues. Deregulation of apoptosis occurs to a greater or lesser extent in malignant tumours and in certain skin diseases, and also largely accounts for the progressive depletion of CD4⁺ lymphocytes in HIV infection. Greater understanding of apoptosis modulation by oncogenes and tumour suppressor genes such as c-myc. Fas, p53, bcl-2, and abl will facilitate the development of new therapeutic strategies for cancer and other diseases.     

Psoriasis,the liver,and the gastrointestinal tract

Psoriasis is a common chronic inflammatory, immune‐mediated skin disease that is frequently associated with comorbidities including psoriatic arthropathy, chronic inflammatory bowel diseases, and cardio‐metabolic disorders. In particular, nonalcoholic fatty liver disease affects about half of patients, Crohn's disease 0.5% and celiac disease 0.2–4.3% of patients with psoriasis. Some shared genetic traits as well as common inflammatory pathways may underlie these associations. The presence of comorbidities has important implications in the global approach to patients. In particular, traditional systemic antipsoriatic agents could negatively affect cardio‐metabolic comorbidities as well as nonalcoholic fatty liver disease and may have important interactions with drugs commonly used by psoriasis patients. Moreover, patients with psoriasis should be encouraged to drastically correct their modifiable cardiovascular and liver risk factors, in particular obesity, alcohol consumption, and smoking habit, because this could positively affect both psoriasis and their life expectance.     

Cosmetics, categories, and the future

Cosmetics is an interesting unregulated category of over-the-counter products designed to enhance appearance and skin health. The coloring agents used in cosmetics are regulated along with their preservative constituents. New understandings of skin physiology have allowed cosmetics to advance beyond appearance issues into the functional arena. Cosmeceuticals is an unrecognized term from a regulatory perspective that conveys the new cosmetic formulations ability to improve skin health.     

Cosmetics, diet, and the future

Cosmetics and diet are two new areas of antiaging interest for the dermatologist. Novel delivery systems in the form of nanoparticles may allow the penetration of cosmetic actives into the skin creating new opportunities for active agent efficacy, but possibly also creating safety issues. The best method of introducing active agents into the body is through the oral route. New understandings of diet and how it affects aging are also becoming important in dermatology.     

Dermatology, Medical Care, the Government, and Us

Several economic factors are forcing changes in the American health care system. Many of these future changes will be implemented by the government. If left unguided, the governmental agencies could regulate doctors' practices, duties, and fees and place them in a bureaucratic maze. The cost of these changes to society may not represent either a cash saving or increased quality of medical care. Some of the anticipated changes could make medicine a less rewarding intellectual career. We, as dermatologists, should be aware of these changes as they affect our specialty, and we should actively work with our governmental authorities to ensure that any changes in our profession will really benefit the tax-paying public.     

Cosmetics, the consumer, the factory worker and the occupational physician

Methods for investigating contact eczematous patients and for measuring the sensitizing potential of various substances are well known and in general, sufficiently effective. This is not true for irritant dermatitis, or for possible (skin) irritant substances; moreover, cosmetics commonly do not contain acutely harmful ingredients. The use of various instrumental measurements (insensible H2O loss, CO2 release, electrical impedance, sweat rate) as indicators of the irritant potentials of substances is advocated. At the same time it is suggested that the factory physician actively investigate the workers in his factory, since these workers are exposed to known substances in known concentrations and combinations, possibly for extensive periods. This may prove to be part of a new role for him. A cosmetic may be one of several factors increasing impairment and only beyond a certain limit may this result in overt disease. Below that limit the health reserve is only partially depleted. Whether this is harmful to a person depends on other stresses, such as medicaments, work materials, other cosmetics and environmental chemicals. The effect of these must also be quantified. A model of these cumulative stresses and reactions is presented and discussed.