Chapter 19. Advances in Dermatology

Abstract

Publisher Summary This chapter discusses the recent therapeutic advances in acne, psoriasis, and cutaneous inflammatory disorders. For milder forms of acne, that may be inflammatory, topical benzoyl peroxide (BP), an antibacterial and oxidizing agent, or topical (erythromycin (EM) or clindamycin phosphate (CP)) or oral antibiotics are usually effective. In female antibiotic non-responders, systemic cyproterone acetate, combined ethinyl estradiol, or chlormadinone acetate have been effective in the treatment of acne. Topical 11α-hydroxyprogesterone had some beneficial effects in male acne patients. Insight into the pathogenesis of psoriasis is evolving towards a better understanding of the major components of the lesion— namely, dermal/epidermal inflammation, acanthosis, altered keratinocyte differentiation and absence of the granular layer. Forskolin has normalized response to P-agonists in psoriatic and TPA-dosed skin. Considerable effort is underway to evaluate the therapeutic potential of specific 5-lipoxygenase (LO) inhibitors. Oral methotrexate (MTX) inhibits human C5a-induced inflammatory skin responses in psoriatics. Calcium plays a major role in regulating epidermal keratinocyte hyperproliferation and terminal differentiation. The search continues for safer topical corticosteroids, the mainstay of therapy for most forms of dermatitis. Arotinoid has displayed potent anti-inflammatory activity in a delayed hypersensitivity model. Thus, the field of dermatology has witnessed an explosion of information on the role of cytokines and inflammatory mediators in cutaneous inflammation and hyperproliferation. The potential therapeutic use for these factors and new agents that may influence the metabolism or action of endogenous regulators is being vigorously pursued.