Hand dermatitis affects a significant portion of the population and can be caused by a variety of endogenous factors (ie, atopy) as well as occupational and environmental exposures. It is often a chronic problem with high costs to individuals, employers, and society. This review discusses subtypes of hand dermatitis based on their clinical features and pathogenesis. It also offers an approach to treatment.
Semin Cutan Med Surg 32:147-157 © 2013 Frontline Medical Communications
“Vitamin D” is the term commonly used to denote the lipid-soluble hormone critical for
calcium homeostasis and skeletal maintenance. A precursor to the active compound is
found in many plants and animal tissues and can be absorbed from the gut; it can also be
derived from cell membranes in the epidermis during ultraviolet B irradiation. This compound
is then hydroxylated sequentially in the liver and kidney to produce the active
hormone 1,25(OH)2D that binds its nuclear receptor to modulate gene expression. Recently,
vitamin D hydroxylases and the nuclear receptor have been identified in many
tissues, suggesting previously unrecognized roles for vitamin D. Some epidemiologic
studies have also correlated low levels of the inactive storage form 25(OH)D with an
increased incidence or prevalence of a variety of diseases, suggesting that large oral
supplements and/or increased ultraviolet (UV) exposure might therefore improve individual
health. However, randomized, prospective controlled trials comparing vitamin D supplements
with placebo have not supported this belief. Moreover, current evidence supports
the conclusion that protection from UV radiation does not compromise vitamin D status or
lead to iatrogenic disease. In contrast, high vitamin D levels appear to incur a risk of kidney
stones and other adverse effects. In the case of true vitamin D deficiency, supplements are
a more reliable and quantifiable source of the vitamin than UV exposure.
Semin Cutan Med Surg 31:2-10 © 2012 Elsevier Inc. All rights reserved.
In this review we focus on 2 of the noninfectious granulomatous dermatitides, granuloma annulare and interstitial granulomatous dermatitis (the remaining 6 will be discussed in Parts 2 and 3), with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and no randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebocontrolled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
Semin Cutan Med Surg 32:177-182 © 2013 Frontline Medical Communications
Vitamin A is required for the proper functioning of many important metabolic and physiologic
activities, including vision, gene transcription, the immune system and skin cell
differentiation. Both excessive and deficient levels of vitamin A lead to poor functioning of
many human systems. The biologically active form, retinoic acid, binds to nuclear receptors
that facilitate transcription that ultimately leads to it’s physiological effects. Retinoids are
derivatives of vitamin A that are medications used to treat acne vulgaris, psoriasis,
ichthyosis (and other disorders of keratinization), skin cancer prevention as well as several
bone marrow derived neoplasias. Systemic retinoids are teratogenic and have to be
prescribed with caution and close oversight. Other potential adverse events are controversial.
These include the relationship of retinoid derivatives in sunscreens, their effects on
bone mineral density, depression and suicidal ideation and inflammatory bowel disease.
These controversies will be discussed in detail.
Semin Cutan Med Surg 31:11-16 © 2012 Published by Elsevier Inc.
Atopic dermatitis (AD) is a chronic inflammatory skin condition marked by intensely
pruritic, eczematous changes. First-line therapy includes topical corticosteroids during an
exacerbation and long-term emollient use, followed by topical calcineurin inhibitors, phototherapy,
and systemic therapy in more difficult cases. The need for more effective AD
therapies with safer side effect profiles has pushed researchers to devise new therapies
and to recycle traditional treatments for use in a novel manner. Innovative therapies include
barrier therapy, novel antistaphylococcal treatments, new immunomodulatory agents, unconventional
antipruritic agents, exclusionary diets, and probiotics. Advancements in these
options have paved the way for a targeted approach to AD therapy. We will review the latest
clinical research exploring these cutting-edge AD treatment modalities and discuss forward-
thinking therapy strategies that use conventional AD medications in a novel manner.
Semin Cutan Med Surg 31:17-24 © 2012 Elsevier Inc. All rights reserved.