Dermatology

British Medical Journal, March 25, 2000 by Peter A Foley

Mycophenolate mofetil is reported to be antibacterial, antifungal, antiviral, and immunosuppressive. It has been used systemically in the treatment of psoriasis, pyoderma gangrenosum, bullous pemphigoid, pemphigus vulgaris, and systemic vasculitis.[26-28] The usual dosage is 1 g orally twice daily. Side effects such as gastrointestinal intolerance and minor urinary symptoms are usually mild and are predominantly dose dependent. Bone marrow suppression with mild to moderate leucocytosis and anaemia is seen in less than 5% of patients. Early reports suggesting an increased risk of carcinogenicity, especially lymphoma, have not been borne out in subsequent studies.[27] Topical mycophenolic acid is being assessed for its value in inflammatory skin conditions such as eczema and psoriasis.

Imiquimod induces production of interferon alfa, along with pro-inflammatory cytokines such as interleukin 1, interleukin 6, interleukin 8, and tumour necrosis factor alpha. It is an immune enhancing agent with antiviral and anti-tumour effects. Interferon alfa has been shown to be an effective treatment for several cutaneous conditions, including anogenital warts and non-melanoma skin cancer. However, it is not absorbed after topical application and requires intralesional injections. Imiquimod is applied topically, is well absorbed, and induces local interferon alfa.[29]

Imiquimod cream (5%) applied three times per week eradicates about 50% of anogenital warts. The recurrence rate is the same as placebo. The most common side effect is local inflammation.[29] Trial applications of 1% imiquimod cream three time a day for five days a week for the treatment of molluscum contagiosum resulted in resolution in over 80% of patients and lesions. There were no adverse effects.[30] The potential of imiquimod in the treatment of cutaneous malignancy is the subject of current therapeutic trials.

The future

The important advances in dermatology touched on in this review illustrate some of the ways in which dermatology has exploited advances in molecular biology, pharmacology, and physical therapeutic techniques, permitting improved patient management. In the future, detailed epidemiological studies will enable us to recognise who is at risk of particular dermatological conditions. Establishment of familial tendencies will allow more detailed genetic and molecular biological investigation. With time, improved understanding of the genetic basis and molecular biology of skin disease will result in current empirical treatments becoming more specific to the underlying abnormality.

Electronic sources of dermatological information

Dermatology Online Journal         tray.dermatology.uiowa.edu/
                                   home.html

Internet Dermatology Society       www.telemedicin.org

RxDerm-L                           listpro@ucdavis.edu (email)

Tumours of the skin, University    www.ucdavis.edu-huntley/tumors/
 of California at Davis            tradition/tumors.html

Dermatology online atlas           www.derma.med.uni-erlagen.de/
                                   index_e.htm

Dermatology atlas                  www.meddean.luc.edu/lumen/medEd/
                                   medicine/dermatology/melton/
                                   atlas.htm

Skin cancer and benign tumor       www.meddean.luc.edu/lumen/medEd/
 image atlas                       medicine/dermatology/content.htm

Dermatology image bank             www.tmc.edu.tw/medimage/
                                   derma_bank/default_eng.htm

Contact dermatitis                 telemedicine.org?contact.htm

DermNet (atlas and information)    www.dermnet.org.nz/dna2a.html

Virtual Dermatology (case          erl.pathology.iupui.edu/cases/
 directory)                        dermcases/dermcases.cfm

Skindex-case directory (news,      www.skindex.com/
 reviews, treatment trends,
 meeting reports, CME, case
 reports, disease descriptions,
 atlas, Q&A site)