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Editorial, JCMS Vol. 1(4)

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In this issue of the Journal, the lead article by Hann and co-workers discusses a common but puzzling disease with an autoimmune basis, namely vitiligo. Vitiligo is associated with various autoantibodies including antibodies to melanocytes. As with many autoimmune diseases, the role of these autoantibodies in the pathogenesis of vitiligo is unknown. However, Hann et al. suggest an association between antimelanocyte antibodies and the pathogenesis of vitiligo by demonstrating that corticosteroid-induced improvement in vitiligo suppresses antimelanocyte antibodies. While this clearly does not prove causality, it does support a potential role of these autoantibodies in the pathogenesis of this disease.

Another condition with an immune basis is one of the most common diseases that we as dermatologists treat--psoriasis. Over the past decade, there has been a dramatic increase in our understanding of the pathogenesis of psoriasis, particularly in the immune pathogenic basis of psoriasis. One of the sentinel observations that lead to a new insurgence in examining potential immunopathogenic bases of psoriasis came from the observation of the dramatic efficacy of cyclosporine in the treatment of psoriasis. Ho and co-workers have published consensus guidelines for the use of cyclosporine in the treatment of psoriasis. In a related article, Singer, Shear, and I propose a sample framework for obtaining informed consent when using cyclosporine. In addition to immunologic changes seen in psoriasis, recent work has examined the role of growth factors and cytokines in the pathogenesis of psoriasis. Investigators have clearly demonstrated that changes are seen in both involved and noninvolved skin of psoriatic patients. Krueger and Jorgensen have supported the concept that normal-appearing skin from psoriatic patients exhibits significant abberation.

A controversy brewing in dermatology for the past decade has been the relationship of dermatologic surgery to medical dermatology. This controversy was brought to a head most recently by the discussions concerning the name change of the American Academy of Dermatology. Our Point-Counterpoint editorials focus on these concerns. Dr. Donald Rosenthal, one of Canada's pre-eminent dermatologists, writes the counterpoint to the editorial of Dr. Alastair Carruthers, president of the Canadian Society for Dermatologic Surgery.

In this issue, I am pleased to introduce the first in a series of articles reviewing medical genetics with particular emphasis on skin disorders. This rapidly changing area is having a major impact on the practice of all medicine, both at a basic and applied level. Dr. Sherri Bale, in an insightful and entertaining article, "Hair Today--Hair Tomorrow," begins this series with a review on genodermatoses and linkage mapping studies.

As this is the last issue of Volume 1 for the Journal, I would like to express my gratitude to our contributors for all the support we have received this past year. I am confident that Volume 2 will further solidify our success, and look forward to continuing to serve the interests of the international dermatologic and cutaneous biology community.

Daniel N. Sauder
Editor in Chief
Division of Dermatology
University of Toronto

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