Skin care products: What do they promise,what do they deliver

The industry offers a vast armamentarium of skin care products to clean, soothe, restore, reinforce, protect and to treat our skin and hence to keep it in “good condition”. Skin care products are readily available and their promotions with fanciful claims are omnipresent. The promotions are based on effects, evoked by actives that are delivered through vehicles that rely on specific technologies. Due to the fact, that these products are in direct contact to the target tissue, their vehicle and ingredients are able to profoundly modulate the characteristics of the skin and some of its functions. This makes products for the skin absolute unique and versatile delivery systems. This paper discusses the concept of skin care and skin protection, the choice of skin care products, their vehicles, their functionality and their regulatory status.     

Tales of bugs,delusions of parasitosis,and what to do

Delusions of parasitosis are usually a monosymptomatic dermatopsychiatric disorder manifested by the fixed false belief that insects are crawling over the body producing an intractable itch. Also known as parasitophobia, this disease can also be associated with other psychiatric disorders, such as schizophrenia or obsessive compulsive disorders. In most cases, the delusion is encapsulated and other mental functions remain intact. Parasitophobia is usually seen in middle-aged women and has proven a vexing problem for dermatologists to treat because patients are often reluctant to obtain a psychiatric consultation and wary of taking antipsychotic or antidepressant medication. Four patients with this disorder illustrate the problem, provide a new approach to understanding the precipitating factors in the onset of the disease, and permit the introduction of a previously undescribed therapy, escitalopram (Lexapro, Forest Pharmaceuticals, New York, NY), a selective serotonin reuptake inhibitor with less side effects than the previously favored therapy with pimozide.     

Benign cutaneous vascular tumors of infancy: when to worry, what to do

OBJECTIVES: To discuss the current knowledge regarding complicated hemangiomas (cervicofacial, periorbital, lumbosacral, and parotid), including the associated syndromes of diffuse neonatal hemangiomatosis and PHACES (posterior fossa malformations, most commonly of the Dandy-Walker variant; hemangiomas [especially large, plaquelike, facial lesions]; arterial anomalies; cardiac anomalies and coarctation of the aorta; eye abnormalities; and sternal cleft and/or supraumbilical raphe). To discuss 2 newly recognized entities that may be a source of diagnostic confusion with the common hemangioma, the kaposiform hemangioendothelioma and tufted angioma. To discuss the risks and benefits of current treatment options, including the use of systemic corticosteroids and interferon in necessary situations. DATA SOURCES: The pertinent world literature was reviewed and incorporated into experience from our pediatric dermatology practice at the University of Texas Medical School at Houston. CONCLUSIONS: The common hemangioma, kaposiform hemangioendothelioma, and tufted angioma, though benign histologically, may cause serious consequences for children. Dermatologists should be able to recognize unique clinical presentations of these lesions and obtain further diagnostic evaluation accordingly. Dermatologists should also be aware of available treatment options, including the use of systemic chemotherapy in life-threatening situations.     

Psychiatric morbidity and skin disease: what dermatologists think they see

It has been suggested that skin disease and psychological disturbance may be linked. Recent work has focused on the fatal outcome associated with some dermatological disorders as a result of suicide. The impressions of dermatologists about how much psychological or psychiatric morbidity they see related to dermatological disease has not been addressed. The survey reported here revealed that most dermatologists recognized the relationship and demonstrated the perceived need for clinical psychology and psychiatric services for patients with dermatological disorders. It confirmed the impression that in a small number of cases, skin complaints are associated with attempted or completed suicide.     

Molecular diagnosis in dermatopathology: What makes sense, and what doesn't

Abstract:  Molecular techniques have provided us with a wealth of information about biological events in healthy individual, and improved tremendously our understanding about the pathogenesis of a huge variety of cutaneous diseases. Those methods have originally been invented to support basic scientific investigations on a molecular level and are translated increasingly into sophisticated diagnostic tools changing the classic paradigm of diagnostic pathology; among them are immunohistochemistry (IHC), polymerase chain reaction (PCR), G-banding, loss of heterozygosity, fluorescence in situ hybridization (FISH), chromogen in situ hybridization (CISH), comparative genomic hybridization on chromosomes and microarray technology. Some of them such as IHC and PCR have already been standardized to a level that allows its utility in daily routine diagnostics for several dermatological diseases. For others like array-based technologies, their optimal indications await to be fully determined. These ancillary methods have the great potential to contribute important new information to challenging cases, and will help to improve diagnostic accuracy particularly in cases in which conventional histopathology is ambiguous. Thus, they will broaden our armamentarium for diagnostic pathology.
Herein, some key techniques will be reviewed and their applicability towards the diagnosis of dermatological diseases critically discussed.     

Atopic eczema in children: What to do when treatment fails to work

Atopic eczema in infants and children usually responds to a management programme involving patient education, the avoidance of environmental irritants, the regular use of emollients and the application of topical steroids. If a child fails to respond to this management programme, the dermatologist should initially ensure that the diagnosis is correct and exclude a coexistent disease process (for example, infection or immunodeficiency) that may be hampering response to treatment. The next step is to ensure that environmental irritants have been identified and eliminated from the child's environment and that prescribed medication is being used as instructed. Allergy assessment and ancillary therapy are reserved for those infants and children with severe disease not responding to basic therapy.     

Chronic vulvovaginal candidiasis: What we know and what we have yet to learn

Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of persistent vulvovaginitis and yet this chronic condition is yet to be formally defined and explained. The classic symptom complex of chronic itch, pain and dyspareunia exacerbating premenstrually and remitting during menstruation associated with an erythematous vulval eruption is well described but the exact aetiology remains elusive. Research in recent years has suggested that VVC is not an opportunistic infection or an immunodeficiency but a hypersensitivity response to a commensal organism that may be genetically determined. Further, it is apparent on clinical grounds that oestrogen plays an essential permissive role and that, in healthy non‐diabetic patients, VVC does not occur in the absence of oestrogen whether endogenous or exogenous. The nature of this relationship has not been established. In this article I discuss the diagnostic features of VVC, its management and what is currently understood of its aetiology.