Signs of aging skin include wrinkles and laxity. Reversing these signs is gaining more importance especially with increasing life expectancy. For many years, ablative lasers have been considered the gold standard for skin rejuvenation. However, the desire by both subjects and physicians to achieve this with minimal side effects and shorter recovery times led to the emergence of various nonablative modalities. Nonablative radiofrequency was described by many studies as an effective and safe procedure for skin tightening. Herein, the authors review the outcomes of the recent studies and the latest developments in nonablative radiofrequency skin rejuvenation.
{"title":"Nonablative radiofrequency for skin rejuvenation: a review of the literature","authors":"Shadi M. Alhalabi, Osama Qasim Agha, B. Hantash","doi":"10.1586/EDM.12.63","DOIUrl":"https://doi.org/10.1586/EDM.12.63","url":null,"abstract":"Signs of aging skin include wrinkles and laxity. Reversing these signs is gaining more importance especially with increasing life expectancy. For many years, ablative lasers have been considered the gold standard for skin rejuvenation. However, the desire by both subjects and physicians to achieve this with minimal side effects and shorter recovery times led to the emergence of various nonablative modalities. Nonablative radiofrequency was described by many studies as an effective and safe procedure for skin tightening. Herein, the authors review the outcomes of the recent studies and the latest developments in nonablative radiofrequency skin rejuvenation.","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"43 1","pages":"589-599"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84884533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ipilimumab is a human monoclonal antibody, that blocks cytotoxic T-lymphocyte antigen-4 (CTLA-4), normally expressed in activated T cells. CTLA-4 downregulates T-cell activation pathways and induces progressive immune tolerance. Blocking this downregulation, determines an enhancement of antitumor T-lymphocyte response. A recent randomized Phase III trial using ipilimumab (MDX020-010) demonstrated, for the first time, a statistically significant improvement in overall survival in patients with metastatic melanoma, prolonging median survival from 6.4 to 10.1 months. It is noteworthy that the study population was composed of previously treated patients, of whom more than 70% had poor prognostic factors and that the adverse events experienced were reversed with appropriate treatment. Further trials are now needed to evaluate the real impact of ipilimumab on survival and on response duration in treatment-naive patients. Clinical research is also warranted into the association of ipilimumab with chemoimmunother...
{"title":"Ipilimumab: report and comment about the MDX010-020 clinical trial","authors":"S. Nicoletti, F. D. Rosa, R. Ridolfi","doi":"10.1586/EDM.12.53","DOIUrl":"https://doi.org/10.1586/EDM.12.53","url":null,"abstract":"Ipilimumab is a human monoclonal antibody, that blocks cytotoxic T-lymphocyte antigen-4 (CTLA-4), normally expressed in activated T cells. CTLA-4 downregulates T-cell activation pathways and induces progressive immune tolerance. Blocking this downregulation, determines an enhancement of antitumor T-lymphocyte response. A recent randomized Phase III trial using ipilimumab (MDX020-010) demonstrated, for the first time, a statistically significant improvement in overall survival in patients with metastatic melanoma, prolonging median survival from 6.4 to 10.1 months. It is noteworthy that the study population was composed of previously treated patients, of whom more than 70% had poor prognostic factors and that the adverse events experienced were reversed with appropriate treatment. Further trials are now needed to evaluate the real impact of ipilimumab on survival and on response duration in treatment-naive patients. Clinical research is also warranted into the association of ipilimumab with chemoimmunother...","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"14 1","pages":"507-512"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89893903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scleroderma is characterized by vascular injury and increased production and accumulation of extracellular matrix proteins by activated fibroblasts in the skin of patients with immunologic abnormalities. A growing body of evidence has demonstrated that extracellular matrix overproduction in the sclerotic dermis by scleroderma fibroblasts results from complex interactions among endothelial cells, immunocytes and fibroblasts, mediated by various cytokines, chemokines and their receptors. Recently, novel signaling pathways leading to fibrosis have been clarified and genomic analysis have also been progressing. In tandem with investigation of human scleroderma, animal models are indispensable for a better understanding of the pathomechanisms of scleroderma, and a number of animal models have been developed. In this review, current insights into the pathophysiology of dermal sclerosis and therapeutic approaches are discussed.
{"title":"Updates on the pathophysiology of dermal sclerosis","authors":"Toshiyuki Yamamoto","doi":"10.1586/EDM.12.57","DOIUrl":"https://doi.org/10.1586/EDM.12.57","url":null,"abstract":"Scleroderma is characterized by vascular injury and increased production and accumulation of extracellular matrix proteins by activated fibroblasts in the skin of patients with immunologic abnormalities. A growing body of evidence has demonstrated that extracellular matrix overproduction in the sclerotic dermis by scleroderma fibroblasts results from complex interactions among endothelial cells, immunocytes and fibroblasts, mediated by various cytokines, chemokines and their receptors. Recently, novel signaling pathways leading to fibrosis have been clarified and genomic analysis have also been progressing. In tandem with investigation of human scleroderma, animal models are indispensable for a better understanding of the pathomechanisms of scleroderma, and a number of animal models have been developed. In this review, current insights into the pathophysiology of dermal sclerosis and therapeutic approaches are discussed.","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"117 1","pages":"559-568"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88425476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leprosy was considered incurable until the 1940s, when sulfones were discovered and gave hope for eradicating the disease. The emergence of dapsone-resistant bacteria, during the late 1970s, resulted in developing a multidrug therapy using rifampicin, curing more than 12 million patients worldwide. Most countries succeeded in achieving the target set by WHO to reduce prevalence to less than 1 per 10,000 population (elimination of leprosy) by the year 2000, and all countires succeeded by 2005. However, incidence rates have continued to remain high in several countries. Despite free multidrug therapy available through integrated health centers, owing to stigma and other factors, many patients, especially of multibacillary type, delay treatment, resulting in irreversible disabilities in the patient, and continued transmission of infection. Inadequate surveillance, poor research, dissemination of accurate information and declining political support add to the problem of not developing more effective strategie...
{"title":"Worldwide elimination of leprosy: historical journey from the past to the future","authors":"P. Rao","doi":"10.1586/EDM.12.55","DOIUrl":"https://doi.org/10.1586/EDM.12.55","url":null,"abstract":"Leprosy was considered incurable until the 1940s, when sulfones were discovered and gave hope for eradicating the disease. The emergence of dapsone-resistant bacteria, during the late 1970s, resulted in developing a multidrug therapy using rifampicin, curing more than 12 million patients worldwide. Most countries succeeded in achieving the target set by WHO to reduce prevalence to less than 1 per 10,000 population (elimination of leprosy) by the year 2000, and all countires succeeded by 2005. However, incidence rates have continued to remain high in several countries. Despite free multidrug therapy available through integrated health centers, owing to stigma and other factors, many patients, especially of multibacillary type, delay treatment, resulting in irreversible disabilities in the patient, and continued transmission of infection. Inadequate surveillance, poor research, dissemination of accurate information and declining political support add to the problem of not developing more effective strategie...","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"2 3 1","pages":"513-520"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88023330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Claessens, Marigje Vernooij, Monique N. H. Luijten, B. Coull, M. Steensel
Birt–Hogg–Dube syndrome (BHD) is a rare inherited condition, which predisposes to the development of benign hair follicle tumors called fibrofolliculomas, pneumothorax and kidney cancer. Lung and kidney cysts, respectively, are thought to cause the latter symptoms. The causative gene codes for a highly conserved protein called folliculin. Its function is still unknown, although recent data hint at a pervasive function in cellular signaling, affecting hypoxia responses and growth pathways. Because folliculin’s role in the cell is unclear, BHD symptoms are not well understood. Treatment, therefore, is still empirical. In this review, the authors summarize the current state of knowledge and report some of the most recent findings. The authors discuss the implications for pathogenesis and treatment of the cutaneous manifestations in BHD.
{"title":"What’s new in Birt–Hogg–Dubé syndrome?","authors":"T. Claessens, Marigje Vernooij, Monique N. H. Luijten, B. Coull, M. Steensel","doi":"10.1586/EDM.12.62","DOIUrl":"https://doi.org/10.1586/EDM.12.62","url":null,"abstract":"Birt–Hogg–Dube syndrome (BHD) is a rare inherited condition, which predisposes to the development of benign hair follicle tumors called fibrofolliculomas, pneumothorax and kidney cancer. Lung and kidney cysts, respectively, are thought to cause the latter symptoms. The causative gene codes for a highly conserved protein called folliculin. Its function is still unknown, although recent data hint at a pervasive function in cellular signaling, affecting hypoxia responses and growth pathways. Because folliculin’s role in the cell is unclear, BHD symptoms are not well understood. Treatment, therefore, is still empirical. In this review, the authors summarize the current state of knowledge and report some of the most recent findings. The authors discuss the implications for pathogenesis and treatment of the cutaneous manifestations in BHD.","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"2003 1","pages":"521-528"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87038780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Great strides have been made in the understanding of the pathogenesis and diversity of the clinical symptoms of severe cutaneous adverse drug reactions in the last decade. Among them, drug-induced hypersensitivity syndrome (DiHS) offers a unique opportunity to link between viral infections and the development of severe cutaneous adverse drug reactions, due to its strong association with human herpesvirus 6 infection. This syndrome has several unique features that cannot be solely explained by a drug antigen-driven T-cell activation: they include the delayed onset, paradoxical deterioration of clinical symptoms after withdrawal of the causative drug; unexplained crossreactivity to unrelated multiple drugs; and a variety of long-term sequelae. Dramatic expansions of Tregs observed during the acute stage of DiHS could explain the delayed onset and result in sequential occurrence of viral reactivations. A gradual loss of Treg function occurring after the resolution of DiHS could increase the risk of developin...
{"title":"Drug-induced hypersensitivity syndrome: recent advances in drug allergy","authors":"T. Shiohara, Y. Kano","doi":"10.1586/EDM.12.45","DOIUrl":"https://doi.org/10.1586/EDM.12.45","url":null,"abstract":"Great strides have been made in the understanding of the pathogenesis and diversity of the clinical symptoms of severe cutaneous adverse drug reactions in the last decade. Among them, drug-induced hypersensitivity syndrome (DiHS) offers a unique opportunity to link between viral infections and the development of severe cutaneous adverse drug reactions, due to its strong association with human herpesvirus 6 infection. This syndrome has several unique features that cannot be solely explained by a drug antigen-driven T-cell activation: they include the delayed onset, paradoxical deterioration of clinical symptoms after withdrawal of the causative drug; unexplained crossreactivity to unrelated multiple drugs; and a variety of long-term sequelae. Dramatic expansions of Tregs observed during the acute stage of DiHS could explain the delayed onset and result in sequential occurrence of viral reactivations. A gradual loss of Treg function occurring after the resolution of DiHS could increase the risk of developin...","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"31 1","pages":"539-547"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83137331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vitamin D and sun exposure: to bare all or cover up?","authors":"A. Hughes, J. Hoffman, Adiele Hoffman","doi":"10.1586/EDM.12.60","DOIUrl":"https://doi.org/10.1586/EDM.12.60","url":null,"abstract":"","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"71 1","pages":"495-497"},"PeriodicalIF":0.0,"publicationDate":"2012-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83176690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Two of the dietary tenets of the free radical theory of cancer, put forth by Denham Harman in 1962, require, in deference to newly accrued knowledge, refinement. The first was a recommendation for dietary reduction of vulnerable free radical targets, for example, polyunsaturated lipids. The second was the addition of one or more antioxidants to the diet. With respect to the first, it is now known that the equivalent levels of dietary ω-6, -3 polyunsaturated fatty acids (PUFA) have opposite effects upon photocarcinogenesis. Increasing levels of ω-6 PUFA exacerbate photocarcinogenesis, with regard to decreased tumor latent period and tumor multiplicity. Dietary ω-3 PUFA inhibits photocarcinogenesis, increasing tumor latent period and reducing tumor multiplicity. Yet the degree of unsaturation in both types of fats is almost equal. It is almost certain that the action of these two types of PUFA rests with the intermediates that each generates through the lipoxygenase and cyclooxygenase pathways. The general ...
{"title":"Nutritional lipid and antioxidant supplements: risks versus benefits","authors":"H. Black","doi":"10.1586/EDM.12.41","DOIUrl":"https://doi.org/10.1586/EDM.12.41","url":null,"abstract":"Two of the dietary tenets of the free radical theory of cancer, put forth by Denham Harman in 1962, require, in deference to newly accrued knowledge, refinement. The first was a recommendation for dietary reduction of vulnerable free radical targets, for example, polyunsaturated lipids. The second was the addition of one or more antioxidants to the diet. With respect to the first, it is now known that the equivalent levels of dietary ω-6, -3 polyunsaturated fatty acids (PUFA) have opposite effects upon photocarcinogenesis. Increasing levels of ω-6 PUFA exacerbate photocarcinogenesis, with regard to decreased tumor latent period and tumor multiplicity. Dietary ω-3 PUFA inhibits photocarcinogenesis, increasing tumor latent period and reducing tumor multiplicity. Yet the degree of unsaturation in both types of fats is almost equal. It is almost certain that the action of these two types of PUFA rests with the intermediates that each generates through the lipoxygenase and cyclooxygenase pathways. The general ...","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"1 1","pages":"483-492"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79815808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Dessinioti, C. Antoniou, S. Tiplica, A. Katsambas
Topical fixed-dose combinations are recommended as a first-line treatment for mild-to-moderate inflammatory (papulopustular) acne, as they target multiple acne pathogenetic factors, are associated with a favorable efficacy and tolerability profile, are easy to apply and may increase patient compliance, especially in teenage acne patients. The combination of a topical antibiotic with a retinoid combines the antibiotic-associated effects of improving inflammatory and noninflammatory acne lesions, with the retinoid-associated effects of normalizing desquamation and reducing comedogenesis, while aiming at reducing the risk of bacterial resistance. In this article, data regarding the efficacy, safety and tolerability of topical clindamycin 1.2%/tretinoin 0.025% gel for acne treatment will be presented. The effects of topical clindamycin 1.2%/tretinoin 0.025% gel therapy in children and young teenagers, as well as different skin types, will be addressed.
{"title":"Fixed-dose combination gel clindamycin 1.2%/tretinoin 0.025% for the treatment of acne vulgaris: a review","authors":"C. Dessinioti, C. Antoniou, S. Tiplica, A. Katsambas","doi":"10.1586/EDM.12.44","DOIUrl":"https://doi.org/10.1586/EDM.12.44","url":null,"abstract":"Topical fixed-dose combinations are recommended as a first-line treatment for mild-to-moderate inflammatory (papulopustular) acne, as they target multiple acne pathogenetic factors, are associated with a favorable efficacy and tolerability profile, are easy to apply and may increase patient compliance, especially in teenage acne patients. The combination of a topical antibiotic with a retinoid combines the antibiotic-associated effects of improving inflammatory and noninflammatory acne lesions, with the retinoid-associated effects of normalizing desquamation and reducing comedogenesis, while aiming at reducing the risk of bacterial resistance. In this article, data regarding the efficacy, safety and tolerability of topical clindamycin 1.2%/tretinoin 0.025% gel for acne treatment will be presented. The effects of topical clindamycin 1.2%/tretinoin 0.025% gel therapy in children and young teenagers, as well as different skin types, will be addressed.","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"110 1","pages":"407-417"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84944284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic venous leg ulcers are common. If good ulcer care alone does not lead to healing, other treatment options are warranted. Physical therapies have gained a wider interest in wound healing in general. In the present review, the authors will focus on recent advancements in various types of physical leg ulcer treatment (except compression therapy). Available evidence suggests that low-frequency therapeutic ultrasound, negative topical pressure therapy and electrical stimulation can contribute to improved wound healing, while other technologies need further research. Major effects include stimulation of granulation, microcirculatory effects, debridement and disinfection, which may result in higher healing rates and more rapid healing. These techniques are not negatively influenced by either bacterial multiresistance. They can also be used when there are limited budgets for drug therapies.
{"title":"Novel therapies developed for the treatment of leg ulcers: focus on physical therapies","authors":"U. Wollina, B. Heinig","doi":"10.1586/EDM.12.49","DOIUrl":"https://doi.org/10.1586/EDM.12.49","url":null,"abstract":"Chronic venous leg ulcers are common. If good ulcer care alone does not lead to healing, other treatment options are warranted. Physical therapies have gained a wider interest in wound healing in general. In the present review, the authors will focus on recent advancements in various types of physical leg ulcer treatment (except compression therapy). Available evidence suggests that low-frequency therapeutic ultrasound, negative topical pressure therapy and electrical stimulation can contribute to improved wound healing, while other technologies need further research. Major effects include stimulation of granulation, microcirculatory effects, debridement and disinfection, which may result in higher healing rates and more rapid healing. These techniques are not negatively influenced by either bacterial multiresistance. They can also be used when there are limited budgets for drug therapies.","PeriodicalId":12255,"journal":{"name":"Expert Review of Dermatology","volume":"259 1","pages":"419-427"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77122261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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