The history of dermatology at the Woman's Medical College of Pennsylvania.

There is little written about the history of women in dermatology. In this paper, we summarize the information obtained from archival records from the Woman's Medical College of Pennsylvania, one of the first medical schools for women, where several of the early prominent women in dermatology obtained their medical degrees and practiced. Among others, graduates include Rose Hirschler, MD, and Margaret Gray Wood, MD. The school and its graduates made important contributions to dermatology and to the advancement of women in the field. The history of women in dermatology is not well documented, and this historical research provides background in the biographies of pioneering women in an effort to preserve and honor their important work.

Topical tacrolimus: a review of its uses in dermatology.

Tacrolimus is one of the newer immunosuppressants that act by inhibiting T-cell activation and cytokine release. It is approved for the treatment of atopic dermatitis, and its safety and efficacy have been extensively studied in large-scale randomized controlled trials and open-label studies worldwide involving over 12,000 patients and up to 3 years of follow-up. Since its introduction, anecdotal reports and case series have found topical tacrolimus also to be effective and well tolerated in patients with a variety of other skin disorders, including other types of eczema, papulosquamous disorders, disorders of cornification, rosacea, other inflammatory skin conditions, vesiculobullous diseases, vitiligo, connective-tissue diseases, graft-versus-host disease, and follicular disorders. This paper reviews the currently available evidence on the use of topical tacrolimus for these conditions, as well as its safety profile and cost-effectiveness. Tacrolimus does appear to offer a safe and efficacious alternative that minimizes the need for topical glucocorticoids and does not cause skin atrophy. However, the risk of systemic absorption is increased with generalized disruption of the skin barrier. Further large-scale studies are needed to clarify the efficacy of topical tacrolimus in a variety of conditions for which anecdotal reports of success exist, especially in regard to different racial groups and in comparison to (as well as in combination with) other existing therapies. Long-term safety data should continue to be monitored and reported.

Rosacea: II. Therapy

Despite an incomplete understanding of the pathogenesis of rosacea, therapeutic modalities continue to expand. The principal subtypes of rosacea include erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea. These phenotypic expressions are probably caused by divergent pathogenic factors and consequently respond to different therapeutic regimens. A subtype-directed approach to therapy is discussed in part II of this review. We provide an overview of the available topical, oral, laser, and light therapies in the context of these cutaneous subtypes, review the evidence that supports their use, and outline their therapeutic approach. Suggestions for future areas of study also are provided

Rosacea: I. Etiology, pathogenesis, and subtype classification

Rosacea is one of the most common conditions dermatologists treat. Rosacea is most often characterized by transient or persistent central facial erythema, visible blood vessels, and often papules ans pustules. Based on patterns of physical findings, rosacea can be classified into 4 broad subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular. The cause of rosacea remains somewhat of a mystery. Several hypotheses have been documented in the literature and include potential roles for vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms such as Demodex folliculorum and Helicobacter pylory. This article reviews the current literature on rosacea with emphasis placed on the new classification system and the main pathogenic theories.

Tumor necrosis factor

Tumor necrosis factor is important in systemic and cutaneous defense, homeostasis, and many disease states. The numerous and diverse effects of tumor necrosis factor are best understood when considered as concentration-dependent, with normal homeostasis progressing to defense followed by toxic effects. Understanding tumor necrosis factor is important for the dermatologist as more studies appear in our literature and potential clinical uses of tumor necrosis factor (and possible anti-tumor necrosis factor agents) are realized.

Superficial thrombophlebitis I. Primary hypercoagulable states

This review concentrates on those disorders in which superficial thrombophlebitis can be a significant or presenting clinical sign. Primary hypercoagulable states are those conditions associated with an increased risk of thrombosis caused by a specific measurable defect in the proteins of coagulation and/or fibrinolytic systems. These disorders are frequently inherited and include deficiencies of antithrombin III, heparin cofactor 2, protein C, protein S, abnormal fibrinolytic activity, dysfibrinogenemia, and Hageman trait. Patients with a lupus anticoagulant and anticardiolipin antibody syndrome with thrombotic episodes are also considered to have a primary hypercoagulable state. The physiology, pathophysiology, clinical characteristics, and treatment of primary hypercoagulable states are reviewed.

Superficial thrombophlebitis II. Secondary hypercoagulable states

Secondary hypercoagulable states are complex clinical conditions associated with an increased risk of thrombosis in which the exact pathophysiology is poorly understood. Secondary causes of superficial thrombophlebitis include malignancy, pregnancy, use of oral contraceptives, infusion of prothrombin complex concentrates, Behçet's disease, Buerger's disease, Mondor's disease, infectious agents, conditions that promote venous stasis, intravenous catheters and intravenous drug use. Conditions that may stimulate superficial thrombophlebitis include dermatophyte cellulitis at saphenous phlebectomy sites, sarcoidal granulomas, cutaneous polyarteritis nodosa, and hyperalgesic pseudothrombophlebitis in patients who test positive for human immunodeficiency virus. The distinguishing features, clinical evaluation, treatment, and histologic characteristics of the various disorders are reviewed.

Microbiology of the skin; resident flora, ecology, infection

Humans exist in an environment replete with microorganisms, but only a few become resident on the skin surface. The skin possesses protective mechanisms to limit colonization, and the survival of organisms on the surface lies in part in the ability of the organisms to resist these mechanisms. Microbial colonization on the skin adds to the skin's defense against potentially pathogenic organisms. Although microbes normally live in synergy with their hosts, occasionally colonization can result in clinical infection. Common infections consist of superficial infections of the stratum corneum or appendageal structures that can respond dramatically to therapy but commonly relapse. In rare circumstances, these infections can be quite severe, particularly in immunocompromised patients or in hospitalized patients with indwelling foreign devices. These infections are often resistant to conventional antibiotics and can result in infection with other opportunistic pathogens.