Clinics in Dermatology RSS feed: Current Issue. Clinics in Dermatology brings you the most practical and comprehensive information on the treatment and care of skin disorders. Each issue features a Guest Editor and is devoted to a single timely topic relating to clinical dermatology. Clinics in Dermatology provides information that is... • Clinically oriented -- from evaluation to treatment, Clinics in Dermatology covers what is most relevant to you in your practice. • Authoritative -- world-renowned experts in the field assure the high-quality and currency of each issue by reporting on their areas of expertise. • Well-illustrated -- each issue is complete with photos, drawings and diagrams to illustrate points and demonstrate techniques. Now affiliated with the International Academy of Cosmetic Dermatology (IACD). Visit the IACD web site at: www.dermato.med.br/iacd for more information.http://www.cidjournal.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Clinics in Dermatology0738-081X285September 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.cidjournal.com/article/PIIS0738081X1000132X/abstract?rss=yesEditorial Board10.1016/S0738-081X(10)00132-XClinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0IFCIFChttp://www.cidjournal.com/article/PIIS0738081X10001355/abstract?rss=yesTable of Contents10.1016/S0738-081X(10)00135-5Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0iiiivhttp://www.cidjournal.com/article/PIIS0738081X1000129X/abstract?rss=yesWith this third installment, the initial compilation of “Controversies in Dermatology” is complete. We have taken you, our audience, on an excursion through the various aspects of dermatology, ranging from infections to malignancies and from idiopathic entities to diagnostic tools. What has become very evident is that medicine, including dermatology, remains an art, rather than a science, despite all of the wonderful improvements to our diagnostic and therapeutic skills that have occurred in recent years.Controversies in Dermatology, Part IIILawrence Charles Parish, Batya Davidovici, Ronni Wolf10.1016/j.clindermatol.2010.07.014Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0477477http://www.cidjournal.com/article/PIIS0738081X1000026X/abstract?rss=yesAbstract: Helicobacter pylori is a Gram-negative bacterium that is considered a causative agent of peptic ulcer disease, gastric lymphoma, and gastric carcinoma. H pylori triggers an intense leucocyte infiltration of the gastric submucosa, an action that is mediated by proinflammatory cytokines. Because this pathogenetic mechanism is common to many other diseases, H pylori seroprevalence has also been investigated in other diseases. H pylori seropositivity is associated with various dermatologic disorders. Although the precise role of H pylori is unknown in these diseases, the organism can be eradicated, using simple and reliable drug regimens. This contribution highlights the dermatologic diseases associated with H pylori seropositivity.The role of Helicobacter pylori infection in skin diseases: Facts and controversiesYalçın Tüzün, Sadiye Keskin, Eneida Kote10.1016/j.clindermatol.2010.03.002Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0478482http://www.cidjournal.com/article/PIIS0738081X10000271/abstract?rss=yesAbstract: The genus Bartonella is composed of a series of species and subspecies. Ten of them are responsible for human infections. The best-identified diseases are cat scratch disease (B henselae and possibly B clarridgeiae), trench fever (B quintana), bacillary angiomatosis (B quintana and B henselae), and the spectrum of verruga peruana, Carrion disease, and Oroya fever (B bacilliformis). Controversies exist about the implication of a few other microorganisms being involved in these diseases. Several other conditions have been associated with the presence of Bartonella spp, but these observations await confirmation.Skin diseases associated with Bartonella infection: Facts and controversiesClaudine Piérard-Franchimont, Pascale Quatresooz, Gérald E. Piérard10.1016/j.clindermatol.2010.03.003Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0483488http://www.cidjournal.com/article/PIIS0738081X10000283/abstract?rss=yesAbstract: Hepatitis C virus (HCV) is a common infectious agent and may induce several systemic disorders like mixed cryoglobulinemia. In the geographic areas where HCV infection is hyperendemic, HCV is the predominant etiologic factor for porphyria cutanea tarda and lichen planus. Vasculitides and autoimmune disorders, such as sicca syndrome, are probably often related to the virus. Interferon-a2b, which is largely used in the treatment of HCV-positive patients, may induce cell-mediated autoimmune side effects. Dermatologists may help to identify those patients timely.Skin diseases associated with hepatitis C virus: Facts and controversiesAlfredo Rebora10.1016/j.clindermatol.2010.03.004Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0489496http://www.cidjournal.com/article/PIIS0738081X10000295/abstract?rss=yesAbstract: Pityriasis rosea is an acute exanthem with many clinical and epidemiologic features of an infectious disease. To date, human herpesvirus (HHV)-6 and HHV-7 appear to be the most indicted culprits, and the evidence in favor of this hypothesis and the controversial results produced elsewhere are discussed. The complex pathophysiology of HHV-6 and HHV-7 infection, their diffusion in the population at large, the difficulties of understanding whether the infection is still latent or is clinically manifest, and well as whether pityriasis rosea depends on a reinfection or on a viral reactivation, all make the issue extremely difficult to study and understand.Pityriasis rosea and herpesviruses: Facts and controversiesAlfredo Rebora, Francesco Drago, Francesco Broccolo10.1016/j.clindermatol.2010.03.005Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0497501http://www.cidjournal.com/article/PIIS0738081X10000301/abstract?rss=yesAbstract: Because Demodex mites are ubiquitous, their potential as human pathogens has often been ignored. This contribution focuses on the growing body of evidence linking Demodex mites with various skin disorders. Histologically, spongiosis and lymphoid inflammation are regularly seen in follicles containing Demodex mites. In animals, they are well established as a cause of mange, and a human counterpart–demodectic alopecia–appears to exist. There is also a statistical association between Demodex mite density and rosacea, facial itching, and chronic blepharitis. Papulovesicular rosacealike lesions and spiny blepharitis often respond to agents that reduce Demodex numbers. Although these observations are not sufficient to fulfill Koch's postulates, Koch's postulates are also not fulfilled for the association between brown recluse spiders and dermal necrosis or the association between streptococci and guttate psoriasis. The evidence linking Demodex mites to human disease has implications regarding treatment.Demodex mites: Facts and controversiesDirk M. Elston10.1016/j.clindermatol.2010.03.006Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0502504http://www.cidjournal.com/article/PIIS0738081X10000313/abstract?rss=yesAbstract: The two main uses of antimicrobials in dermatologic surgery include prophylaxis for bacteremia and prevention of localized surgical skin infection (LSSI). Bacteremia can result in hematogenous surgical infections such as infective endocarditis and prosthetic joint infection. Comprehensive guidelines from the American Heart Society (AHA), American Dental Association (ADA), and the American Academy of Orthopedic Surgeons (AAOS) have significantly reduced the number of patients in which prophylaxis is indicated for hematogenous surgical infection. The use of antimicrobials for localized surgical skin infection in dermatology is controversial. Although the overall trend in the literature supports the decreased use of antimicrobials in dermatologic surgery as a whole, it is important to know which situations still warrant antibiotics. This contribution will address the updated guidelines of the AHA, ADA, and AAOS, evidence-based techniques to decrease localized surgical skin infections, and situations in which antibiotics should be considered during dermatologic surgery.Antimicrobials in dermatologic surgery: Facts and controversiesDaniel L. Shurman, Anthony V. Benedetto10.1016/j.clindermatol.2010.03.007Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0505510http://www.cidjournal.com/article/PIIS0738081X10000325/abstract?rss=yesAbstract: Unlike many other skin diseases, success or failure of therapy of ectoparasitic infestation depends much more on how to use the topical preparation and whom we treat than on which scabicide or pediculicides to use. The diagnosis of scabies should no longer rely on the rather uncommon and unpractical sign of finding a burrow or the number of parasites per infected patient. Most infested individuals have been shown to have several-fold more acari than the oft-quoted average of 12 adult acari per infected patient that appears in most of our textbooks (stemming from Mellanby's work). Contrary to what Mellanby taught us, we know that indirect transmission (ie, without personal contact) does occur. As to which agent to use, the winner remains undeclared at present. Although indirect contact transmission of hair lice has been clarified after thousands of years of infestation, there are still numerous questions, uncertainties, disagreements, and controversies on the subject; for example, we know that lice survive immersion in water but are probably not transmitted in swimming pools. There is no consensus on the best or most correct way to diagnose lice, nor is the problem of resistance resolved. We do not recommend a “no-nit” policy.Treatment of scabies and pediculosis: Facts and controversiesRonni Wolf, Batya Davidovici10.1016/j.clindermatol.2010.03.008Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0511518http://www.cidjournal.com/article/PIIS0738081X10000337/abstract?rss=yesAbstract: Chronic wound infections are responsible for considerable morbidity and significantly contribute to the escalation in the cost of health care. Wound infection may initially be manifest as bacterial colonization, and it is only when colonization is combined with other factors, such as decreased vascular supply, intrinsic virulence of specific bacteria (eg, Staphylococcus aureus), and host immune factors, that true infection occurs. The microbiology of chronic wounds is complex, and it is difficult to discern which bacteria are culpable. Deep cultures or quantitative biopsies of wound tissue may be necessary. In some instances, such as in the presence of certain mycobacteria, isolation of specific organisms confirms causation. In many instances, it is appropriate to treat these wounds empirically with a combination of topical antiseptics and systemic antibiotics, especially in the presence of invasive infections.Chronic wound infection: Facts and controversiesAbdul R. Siddiqui, Jack M. Bernstein10.1016/j.clindermatol.2010.03.009Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0519526http://www.cidjournal.com/article/PIIS0738081X10000349/abstract?rss=yesAbstract: Defining the decubitus ulcer proves as difficult as agreeing on a name for the condition. Causes include pressure over bony prominences, shearing force, destruction of skin, and compromised blood flow. Evidence is emerging of the importance of ischemia as a primary causative agent, rather than pressure, which needs further investigation. Scales, staging, and treatment and prevention guidelines should be used with caution due to their arbitrary implementation and lack of evidence-based support. Unfortunately, much of the research and expert opinion developed by the government and touted as regulation lacks appropriate strength-of-evidence. Although decubitus ulcers should be prevented and treated to the best of our abilities, recognizing the possibility that the skin, like any other organ in the body, may fail is crucial.The decubitus ulcer: Facts and controversiesCaren Campbell, Lawrence Charles Parish10.1016/j.clindermatol.2010.03.010Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0527532http://www.cidjournal.com/article/PIIS0738081X10000350/abstract?rss=yesAbstract: Despite the continued efficacy of penicillin since the 1940s, many aspects of the natural history, diagnosis, and management of syphilis remain controversial. A key factor among the numerous factors explaining the persistence of significant areas of controversies is the absence of a gold standard direct method for distinguishing between the different stages of syphilis and appraising treatment response. This contribution presents an overview of some of the most debated aspects of the origins, diagnosis, and management of syphilis in immunocompetent patients. The two main current hypotheses on the origins of Treponema pallidum are the “Columbian” and the “Pre-Columbian” hypotheses. Strong evidence supports that Columbus' crew brought T pallidum to Europe at the time of discovery of the New World. Because T pallidum culture and inoculation to animals are not readily available methods, the gold standard method for the diagnosis of syphilis is the direct identification of T pallidum by dark field microscopy or direct fluorescent antibody tests. These methods, however, are inapplicable in many patients, and thus the diagnosis of syphilis is usually based on the clinical and serologic picture. Serologic tests should only be considered as surrogate markers of the disease and do not provide definite distinction between syphilis stages. The optimal combination of serologic tests is still undefined. Other areas of controversy include the identification of patients who would benefit from a lumbar puncture, the diagnostic criteria of neurosyphilis, and the most relevant markers of treatment response.Origins of syphilis and management in the immunocompetent patient: Facts and controversiesDavid Farhi, Nicolas Dupin10.1016/j.clindermatol.2010.03.011Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0533538http://www.cidjournal.com/article/PIIS0738081X10000362/abstract?rss=yesAbstract: After reaching an all time low at the turn of the millennium in several industrialized countries, the syphilis incidence is rising again, perhaps as a consequence of unsafe sexual behavior in response to improved antiretroviral therapeutic options for HIV. Since the beginning of the HIV pandemic, numerous reports on the various aspects of the interaction between syphilis and HIV have been published. Controversies persist on many issues of the management of coinfected patients. This contribution presents a critical appraisal of the available literature. Few large-scale, properly designed, controlled studies have compared syphilis baseline presentation and treatment response according to HIV status. Among the weakness are (1) high rates of patients lost to follow-up, (2) lack of long-term follow-up, (3) lack of gold standard criteria for treatment response, (4) small sample size, and (5) lack of stratification according to syphilis stage, ongoing antiretroviral treatment, CD4 cell count and HIV viral load. From the available data, and given the ever-possible publication bias, we conclude that if HIV has an effect on the course of syphilis, it is small and clinically manageable in most cases. The controversial issues discussed should furnish the rational for clinical research during the forthcoming decade.Management of syphilis in the HIV-infected patient: Facts and controversiesDavid Farhi, Nicolas Dupin10.1016/j.clindermatol.2010.03.012Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0539545http://www.cidjournal.com/article/PIIS0738081X10000374/abstract?rss=yesAbstract: There are two opposing approaches in the treatment of genital warts: (1) the traditional approach advocates complete elimination of all lesions, and (2) a second approach regards condyloma as merely a cosmetic nuisance. After a long journey through many arguments and scientific papers, we have concluded that many unknowns, uncertainties, and controversies concerning the value of treatment of genital warts in terms of clearing and curing the disease (ie, eradicating the viruses, preventing cancer, and reducing infectivity). There is no consensus at present of whether treatment of men with evidence of genital human papillomavirus infection influences the natural history of their female sex partner's cervical disease.Treatment of genital warts: Facts and controversiesRonni Wolf, Batya Davidovici10.1016/j.clindermatol.2010.03.013Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0546548http://www.cidjournal.com/article/PIIS0738081X10000386/abstract?rss=yesAbstract: The role of the condom, as a protective prophylactic device, is one of the most important tools, if used appropriately, against the spread of sexually transmitted diseases and HIV/AIDS. It should be used by every man, worldwide, who is having casual penetrative sex. The word condom is derived from the Latin condere. This contribution describes its history from the first descriptions in English in the 18th century through rapid improvements in manufacture after the commercial cultivation of rubber. The age-old phony arguments against its use by men are noted. Recent studies of its acceptability to women are described, as well as the introduction of the female condom.The role of condom use in sexually transmitted disease prevention: Facts and controversiesMichael Waugh10.1016/j.clindermatol.2010.03.014Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0549552http://www.cidjournal.com/article/PIIS0738081X10000398/abstract?rss=yesAbstract: Evidence-based medicine is a paradigm shift in the biomedical field toward scientific-based clinical practice. It is recognized as the process of acquiring and applying into practice the best available research findings in a defined filed. Although the roots of evidenced-based medicine date back more than 150 years, the modern evidenced-based medicine concept has been rapidly and constantly developing in the past two decades. Since its introduction, evidenced-based medicine has simultaneously attracted proponents and critics. This contribution provides a critical overview of the major advantages and drawbacks of evidenced-based medicine. The discussion and the examples cover the field of biomedical research and dermatovenereology in particular.Evidence-based medicine: Facts and controversiesRazvigor Borislavov Darlenski, Neyko Valentinov Neykov, Vitan Dakov Vlahov, Nikolaï Konstantinov Tsankov10.1016/j.clindermatol.2010.03.015Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0553557http://www.cidjournal.com/article/PIIS0738081X10000404/abstract?rss=yesAbstract: Since their introduction in 1980s, medical guidelines have become a milestone in the modern medical practice and science. Being a key feature of modern evidence-based medicine, guidelines offer the opportunity for unification and standardization of diagnostic procedures, their use guarantees the equal access of patients to medical service, and they represent a scaffold for inexperienced physicians. The implementation of guidelines also can serve as a basis in malpractice issues and can contribute to the formation of national and international health care policies. In past decades, the process of development, update, and practical application of clinical guidelines has been seriously improved; however, certain limitations still exist, namely cost-effectiveness issues, editorial independence, applicability, accessibility, and external validity. This contribution discusses the advantages and the drawbacks in the use and the development of medical guidelines, emphasizing future perspectives and challenges in the development of clinical guidelines.Guidelines in dermatology—Quo vadis?: Facts and controversiesRazvigor Darlenski, Rositsa Dencheva, Jana Kazandjieva, Dobrin Svinarov, Nikolaï Tsankov10.1016/j.clindermatol.2010.03.016Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0558562http://www.cidjournal.com/article/PIIS0738081X10000635/abstract?rss=yesAbstract: Although many classifications include oral lesions of lichen planus in the category of a premalignant condition, there is still much discussion about whether the mucous membranes lesions should be characterized as an intrinsically premalignant condition or merely as a facilitator of the action of a carcinogenic factor. The possibility that an epidermoid carcinoma can emerge at the site of lichen planus lesions, mainly in mucous membranes, has been shown; however, several published cases omit information about other potential risk factors. This prevents a complete analysis of the triggering relationship between lichen planus and squamous cell carcinoma. This contribution reviews the literature on this subject. The question of whether oral or vulval lichen planus, or both, are premalignant conditions will only be answered after prospective studies with large samples and extensive follow-up are performed, taking into consideration the great variety of risk factors involved, together with the establishment of a consensus in relation to the points still without agreement.Premalignant nature of oral and vulval lichen planus: Facts and controversiesMarcia Ramos-e-Silva, Claudio de-Moura-Castro Jacques, Sueli Coelho da Silva Carneiro10.1016/j.clindermatol.2010.04.001Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0563567http://www.cidjournal.com/article/PIIS0738081X10000672/abstract?rss=yesAbstract: Cutaneous pseudolymphoma refers to a heterogenous group of benign reactive T-cell or B-cell lymphoproliferative processes of diverse causes that simulate cutaneous lymphomas clinically and histologically. Pseudolymphomas may arise in response to a wide variety of foreign antigens, but most are idiopathic. Major advances have been made in the histologic classification, immunohistochemistry, and molecular studies of cutaneous pseudolymphoma. Although this enables a more precise differentiation from cutaneous lymphoma, a substantial number of patients still present in whom the differential diagnosis is difficult or impossible. Some evidence suggests that pseudolymphomas may progress to cutaneous lymphoma due to persistent antigenic stimulation. More compelling evidence is needed, especially when most cutaneous pseudolymphoma are not associated with known antigens and the differentiation from cutaneous lymphoma may be difficult; therefore, a careful approach should be used, and the antigenic stimulus should be removed whenever possible. A watchful follow-up is warranted in idiopathic cases, and consideration should always be given to surgical or medical therapy.Pseudolymphoma and cutaneous lymphoma: Facts and controversiesReuven Bergman10.1016/j.clindermatol.2010.04.005Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0568574http://www.cidjournal.com/article/PIIS0738081X10001045/abstract?rss=yesInfestations are closely related to the phylogeny of their hosts and are still common in modern times. Head lice are one of the top ectoparasites found worldwide. This small book provides a resource for practical management of head lice infestations not only in developing countries but also in the Western world.Uwe Wollina10.1016/j.clindermatol.2010.06.004Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0Contemporary Dermatology576577http://www.cidjournal.com/article/PIIS0738081X10000684/abstract?rss=yesImagine a performance of a classic ballet, say by Fokine. Its choreography is known. Its music has been established. Its message is known by cognoscenti. Movements have been rehearsed many times. There is a particular way to raise a leg or to walk on toe points or to jump across the stage. Minor deviations are frowned upon. Major ones are bitterly criticized. There is a way to enter, to bow, and to exit.Periodic scientific publication: Reflections on a complex processMauricio Goihman-Yahr10.1016/j.clindermatol.2010.04.006Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0Contemporary Dermatology578580http://www.cidjournal.com/article/PIIS0738081X09001394/abstract?rss=yes…from time to time, a high wind would blow across the desert, whipping up the sand, which swirled and eddied, a thick yellow cloud. It rendered visibility as poor as a thick London fog. It penetrated everywhere. One breathed sand, one swallowed it, one's eyes and ears and nose were filled with it. One's hair was matted with sand. One's face and arms were yellow and sore from the tiny gritty particles which penetrated the pores of the skin.Nanotechnology and dermatology: Part II—risks of nanotechnologyAdnan Nasir10.1016/j.clindermatol.2009.06.006Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0Contemporary Dermatology581588http://www.cidjournal.com/article/PIIS0738081X10000131/abstract?rss=yesGeorge Clinton Andrews, Jr was born on November 26, 1891 in Tarrytown, New York, into a family with a historic connection to the region and the country. This pedigree was one he wholeheartedly embraced and endeavored to have others appreciate throughout his life. He was a direct descendant of George Clinton, Brigadier General of the American Revolutionary Army, first Governor of New York, and former Vice President of the United States under Jefferson and Madison. In fact, Andrews was known to begin his daily routine with a cup of tea and an English muffin while sitting at the Clinton campaign table from the Revolutionary War.A Collective Remembrance of George Clinton Andrews, Jr (1891-1978)William D. James, Jeremy A. Brauer10.1016/j.clindermatol.2010.02.001Clinics in Dermatology 28, 5 (2010)2010-09-01Clinics in Dermatology2010-09-01285S0738-081X(10)X0005-0Contemporary Dermatology589591