Marti J. Rothe

The mast cell in health and disease

The presence of mast cells, often in an activated state or increased numbers, has been noted in various cutaneous disorders. Recent studies suggest that mast cells are of primary importance in these conditions and their presence does not merely represent a secondary event. This review focuses on atopic dermatitis, contact hypersensitivity reactions, bullous pemphigoid, fibrosing conditions, neurofibromatosis, wound healing, polycythemia vera, and psoriasis, in which there is significant evidence to indicate a pathophysiologic role for mast cells.

Atopic dermatitis: an update.

This review focuses on recent literature regarding the following clinical features of atopic dermatitis (AD); diagnostic criteria, epidemiology and genetics, provocative factors, predictors of disease development and markers of disease severity, therapy, and prognosis. For example, the frequency of AD appears to be increasing, perhaps in response to provocative factors such as food allergens and house dust mites. Determination of reliable markers for disease development may identify susceptible newborns and facilitate avoidance of relevant triggers. Immunomodulating therapy holds promise in the treatment of refractory AD, and new investigation has led to refinements in conventional modalities such as antihistamines and phototherapy.

Delusional parasitosis: A dermatologic, psychiatric, and pharmacologic approach

Delusional parasitosis is a syndrome in which the patient has the false belief that he is infested by parasites. Although this is a psychiatric disorder, patients usually seek care from dermatologists. DP has various causes. It may occur as the sole psychologic disturbance, or it may be associated with an underlying psychiatric disorder or physical illness. A dermatology-psychiatry liaison is advocated for establishing a viable differential diagnosis and selecting appropriate therapy. The antipsychotic agent pimozide is currently the most effective treatment when DP occurs as an encapsulated delusion. Pimozide therapy requires careful monitoring because this drug has several potentially serious adverse effects, and relapse often occurs on discontinuation of the drug.

The burning mouth syndrome

The burning mouth syndrome is characterized by burning and painful sensations of the mouth in the absence of significant mucosal abnormalities. For patients in whom no causative factor can be identified, empiric antifungal, nutritional, and estrogen replacement therapy can be initiated. If these fail, long-term therapy with antidepressants, benzodiazepines, and clonazepam can be considered. Topical capsaicin and laser therapy have been reported beneficial in a few patients.

Diet and dermatology. The role of dietary manipulation in the prevention and treatment of cutaneous disorders.

The role of dietary manipulation and vitamins in the prevention and treatment of certain skin diseases is reviewed. Manipulation of nutrition by either diet restriction or supplementation can effect cutaneous disorders such as skin cancer, wound healing, atopic dermatitis, psoriasis, and dermatitis herpetiformis.

Growth factors and wound healing

BACKGROUND Over the last decade, there has been an exponential increase in our knowledge of the biology of growth factors. The hope has been and remains that these potent biologic agents will effect a fundamental improvement in the way we treat wounds. OBJECTIVE We will discuss the biology of growth factors and the dramatic effects these proteins have on cell proliferation, cell chemotaxis, and on the formation of extracellular matrix molecules. RESULTS Growth factors are extremely potent biologic agents that show promise in accelerating wound repair in both animal and human studies. They improve granulation tissue, enhance tensile strength, and promote reepithelialization. Cosmetic effects are also to be expected by antagonizing and blocking the action of these peptides. CONCLUSION Growth factors are likely to become an important therapeutic tool for the dermatologic surgeon.

Optimal Treatment of Pyoderma Gangrenosum

AbstractThe optimal treatment of pyoderma gangrenosum includes a combination of local wound care and systemic medications. Oral and pulse intravenous corticosteroids have traditionally been the most commonly recommended first-line systemic therapies. Cyclosporine, with or without corticosteroids, has more recently emerged as a first-line systemic treatment. A multitude of immunosuppressive and immune-modulating medications, as well as antimicrobial agents with anti-inflammatory properties have also been widely prescribed. Often, it is difficult to achieve control of aggressive cases of pyoderma gangrenosum, necessitating administration of a combination of systemic therapies. Furthermore, patients recalcitrant to one or many medications are frequently reported. Concomitant disease, intolerance to a class of medications, and the patient’s response to prior therapies can help guide a practitioner in choosing the optimal treatment of pyoderma gangrenosum.

Nutrition and psoriasis.

Nutritional supplementation may provide a viable treatment alternative in patients with psoriasis. Randomized, controlled trials have shown the effectiveness of topical vitamin A and D derivatives, intravenous ω-3 fatty acids, oral inositol, and various combined therapies. Dual therapies of ultraviolet B phototherapy and fish oil, retinoids and thiazolidinediones, and cyclosporine and a low-calorie diet were effective in the treatment of psoriasis in randomized, controlled trials. This contribution also reviews the potential negative effect of alcohol and the potential positive effects of vitamin B(12), selenium, retinoic acid metabolism-blocking agents, and a gluten-free diet in the treatment of psoriasis.

Severe adverse cardiovascular effects of pulse steroid therapy : is continuous cardiac monitoring necessary ?

Pulse steroid therapy (PST) has been used in dermatology to treat a variety of severe inflammatory disorders. Dermatologists have usually recommended that patients be hospitalized for continuous cardiac monitoring during PST administration, although specialists in other fields have administered PST in an outpatient setting. We reviewed the literature concerning serious adverse cardiovascular effects of PST. These were rare and have been mainly reported in nondermatologic patients, typically those with kidney or heart disease. Although outpatient administration of PST may be a safe practice for some dermatologic patients, we cannot make a firm recommendation without a prospective trial.

The premature aging syndromes

T he premature aging syndromes are rare disorders that mimic senescence. Interest in these syndromes has been great, in part because a more complete understanding of the pathophysiology of these syndromes may provide enhanced insight into the natural aging process. Thus, these syndromes have been the subject of numerous publications of original research as well as general reviews.lA Reviews in the dermatologic literature generally focus on syndromes that are characterized by the following progeroid cutaneous features identified by Gilchrest: dermal atrophy, loss of subcutaneous fat, premature graying of the hair, alopecia, poikiloderma, pigmentary aberrations, persistent cutaneous ulceration, cutaneous sclerosis, wrinkling, and nail dystrophy.‘-4 The epidemiologic, clinical, laboratory, and pathologic characteristics of progeria, Werner’s syndrome, acrogeria/metageria, Rothmund-Thomson syndrome, Cockayne’s syndrome, and ataxia-telangiectasia are reviewed herein (Table 1).