Editorial, JCMS Vol. 2(2)
Clinical dermatology developed as a result of astute clinical observation based on patterned recognition. As with trends in medicine in general, dermatology is now being greatly influenced by evidence-based medicine, both in terms of diagnosis, treatment and pathogenesis of cutaneous disease.
Warts, acne, and psoriasis are some of the most common cutaneous diseases seen in the practice of dermatology. While clinicians diagnose these entities primarily by patterned recognition, a more rigorous assessment tool would be useful. In our basic and clinical sciences section, Young et al. develop a minimum set of diagnostic criteria for warts. One of the major advances in the treatment of acne over the last decade has been the use of isotretinoin. Willoughby and Rosenthal have reviewed laboratory monitoring trends for isotretinoin and assessed the rationale and cost-effectiveness of various laboratory tests. After performing their analysis, they propose a rational laboratory program for monitoring patients on isotretinoin therapy. Vera Morhenn evaluates the role of nitric oxide as an inflammatory mediator and speculates on a potential role in psoriasis. She then translates this potential pathophysiologic mechanism into a treatment with nitroglycerin ointment, and raises interesting possibilities in terms of therapeutic interventions.
Much of the art and science of clinical dermatology is based on the results from clinical trials. With evidence-based medicine having a major impact on dermatology, it is imperative that the practising dermatologist understands the potential pitfalls in these trials. Cohort studies have provided valuable clinical and etiological information, but strengths and limitations of this approach are crucial to recognize. In this issue, Margaret Karagas provides an insightful analysis of this topic in our continuing critical appraisal series.
A rapidly developing area in dermatology is genodermatoses. In our ongoing section on genetic studies in skin disease, Sherri Bale utilizes genes for familial psoriasis susceptibility as an example of how genetic analysis is done in the context of skin disorders. The results of studies conducted in this area will have a significant effect on our understanding of dermatologic diseases.
One of the new and exciting advancements in dermatologic therapeutics is the progress that has been made in our understanding of percutaneous delivery of therapeutic agents. These developments are vital not only to the treatment of dermatologic diseases, but also in utilizing the percutaneous delivery system to deliver drugs useful for internal diseases. In our review section, Merino et al. examine the area of transdermal and skin targeted drug delivery by focusing on the treatment of dermatologic diseases, the targeted delivery of drugs to deeper layers in the skin, and transdermal administration to elicit systemic effects. They speculate that in the not too distant future, the skin may play a major role not only in drug delivery, but also with respect to measurements in clinical chemistry. It is likely that these developments will have a dramatic impact on the practice of our specialty.
Daniel N. Sauder
Division of Dermatology
University of Toronto
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