Acne - A Bibliography, Medical Dictionary, and Annotated Guide to Internet Research References

A B IBLIOGRAPHY , M EDICAL D ICTIONARY , AND A NNOTATED G UIDE TO I NTERNET R ESEARCH R EFERENCES J AMES N. P ARKER , M...

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A B IBLIOGRAPHY , M EDICAL D ICTIONARY , AND A NNOTATED G UIDE TO I NTERNET R ESEARCH R EFERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2003 by ICON Group International, Inc. Copyright Ó2003 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Acne: A Bibliography, Medical Dictionary, and Annotated Guide to Internet Research References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-83544-6 1. Acne-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on acne. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON ACNE ........................................................................................................ 3 Overview ....................................................................................................................................... 3 The Combined Health Information Database ................................................................................ 3 Federally Funded Research on Acne............................................................................................ 11 E-Journals: PubMed Central ....................................................................................................... 24 The National Library of Medicine: PubMed................................................................................ 25 CHAPTER 2. NUTRITION AND ACNE .............................................................................................. 47 Overview ..................................................................................................................................... 47 Finding Nutrition Studies on Acne ............................................................................................ 47 Federal Resources on Nutrition................................................................................................... 53 Additional Web Resources........................................................................................................... 53 CHAPTER 3. ALTERNATIVE MEDICINE AND ACNE ........................................................................ 57 Overview ..................................................................................................................................... 57 National Center for Complementary and Alternative Medicine ................................................. 57 Additional Web Resources........................................................................................................... 63 General References....................................................................................................................... 70 CHAPTER 4. CLINICAL TRIALS AND ACNE..................................................................................... 71 Overview ..................................................................................................................................... 71 Recent Trials on Acne ................................................................................................................. 71 Keeping Current on Clinical Trials ............................................................................................. 72 CHAPTER 5. PATENTS ON ACNE ..................................................................................................... 75 Overview ..................................................................................................................................... 75 Patents on Acne........................................................................................................................... 75 Patent Applications on Acne ..................................................................................................... 109 Keeping Current ........................................................................................................................ 127 CHAPTER 6. BOOKS ON ACNE ...................................................................................................... 129 Overview ................................................................................................................................... 129 Book Summaries: Online Booksellers ........................................................................................ 129 The National Library of Medicine Book Index........................................................................... 133 Chapters on Acne ...................................................................................................................... 135 CHAPTER 7. MULTIMEDIA ON ACNE............................................................................................ 141 Overview ................................................................................................................................... 141 Bibliography: Multimedia on Acne ........................................................................................... 141 CHAPTER 8. PERIODICALS AND NEWS ON ACNE......................................................................... 143 Overview ................................................................................................................................... 143 News Services and Press Releases ............................................................................................. 143 Newsletters on Acne.................................................................................................................. 148 Newsletter Articles .................................................................................................................... 149 Academic Periodicals covering Acne ......................................................................................... 149 APPENDIX A. PHYSICIAN RESOURCES.......................................................................................... 153 Overview ................................................................................................................................... 153 NIH Guidelines ......................................................................................................................... 153 NIH Databases .......................................................................................................................... 155 Other Commercial Databases .................................................................................................... 157 The Genome Project and Acne................................................................................................... 157 APPENDIX B. PATIENT RESOURCES .............................................................................................. 161 Overview ................................................................................................................................... 161 Patient Guideline Sources ......................................................................................................... 161 Finding Associations ................................................................................................................. 170 APPENDIX C. RESEARCHING MEDICATIONS ................................................................................ 173

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Contents Overview ................................................................................................................................... 173 U.S. Pharmacopeia .................................................................................................................... 173 Commercial Databases............................................................................................................... 176 Researching Orphan Drugs....................................................................................................... 176 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 179 Overview ................................................................................................................................... 179 Preparation ................................................................................................................................ 179 Finding a Local Medical Library ............................................................................................... 179 Medical Libraries in the U.S. and Canada................................................................................. 179

ONLINE GLOSSARIES ............................................................................................................... 185 Online Dictionary Directories................................................................................................... 187 ACNE DICTIONARY ................................................................................................................... 189 INDEX.............................................................................................................................................. 256

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with acne is indexed in search engines, such as www.google.com or others, a nonsystematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about acne, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to acne, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on acne. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to acne, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on acne. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON ACNE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on acne.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and acne, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “acne” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: ·

Acne Vulgaris in Skin of Color Source: Journal of the American Academy of Dermatology. 46(2): S98-S106. February 2002. Summary: This journal article provides health professionals with information on the pathogenesis, histology, and treatment of acne vulgaris in skin of color. Data came from a survey completed by people seen at a hospital dermatology department in New York City. Acne vulgaris is a cutaneous disorder that is common in people of color, as evidenced by the fact that relatively large numbers of these patients seek dermatologic care for the condition. However, not enough data are available from the general population to definitively determine the relative frequency of acne in people of color compared with whites. There is also insufficient evidence to conclude that the pathogenesis of acne vulgaris in skin of color differs from that in white skin. Studies

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comparing sebaceous gland size and activity of white and African American participants involved such small patient populations that accurate conclusions cannot be drawn. Comparative studies investigating sebaceous gland size and sebum levels in Hispanic or Asian patients are also lacking. However, evidence shows that acne vulgaris displays histological and clinical differences in people of color compared with whites. A high percentage of patients of color have the acne hyperpigmented macule (AHM). The presence of occult inflammatory infiltrates in comedonal lesions, coupled with the magnitude of the inflammation in papular and pustular lesions, explains the propensity of skin of color to develop marked postinflammatory hyperpigmentation. Skin of color also displays a high percentage of keloidal scarring. In addition, certain people of color develop pomade acne. The response to therapeutic agents may also vary in people of color. Irritant contact dermatitis from topical acne medications is a seemingly common occurrence in people of color, especially with agents that tend to dry the skin. Early and aggressive treatment of acne vulgaris is critical to preventing scarring and the AHM in skin of color. Topical azelaic acid is often used in combination therapy for the treatment of acne. Isotretinoin is also an effective and safe therapy in skin of color. In addition, adjunctive therapeutic agents such as noncomedonal topical sunscreen agents may be important agents for people of color. 2 figures, 10 tables, and 31 references. (AA-M). ·

Acne Vulgaris and Rosacea: Evaluation and Management Source: Clinical Cornerstone. 4(1): 15-20. 2001. Summary: This journal article provides health professionals with information on the evaluation and management of acne vulgaris and rosacea. Acne vulgaris, usually termed acne, is an extremely common disease that can be found in nearly all teenagers to some degree as well as in women in their 30s. The pathogenesis of acne vulgaris is multifactorial, involving disturbances of keratinization, hormonal secretion, and immunity. The central defect involves the formation of the comedo, a plug in the follicle that results from aberrant desquamation of the follicular wall. Although the cause of comedo formation is unknown, it is clear that comedones do not result from poor hygiene, diet, or use of brand name cosmetics. In most patients, acne remains for the most part in this first stage; however, in others, it progresses to inflammatory lesions of varying severity. The target of inflammation is Propionibacterium acnes, an aerotolerant anaerobic member of the normal flora in sebaceous regions of the skin. People who have excessive humoral and cellular immunity to P. acnes mount a more destructive inflammatory response that produces clinical lesions. A minority of women have an endocrine aspect to their acne. There are many acne grading systems. A practical approach is for the physician and patient to reach some consensus on how bad the acne is by looking at the actual lesions and the impact of the disease on the patient. Regardless of severity, acne often has a greater psychological than cutaneous effect. Most patients overestimate the severity of their disease, while most physicians underestimate its impact on their patients. Studies have shown that people who have severe acne as teens are less employable as adults and that they have low self esteem. When combined with other adolescent tensions, acne can be a difficult disease to treat. The first step is to be certain that the patient is educated about the cause of acne. There is wide variation in acne regimens. In general, one or two properly chosen drugs do better and are easier for the patient to comply with than a more complex regimen. Treatment may be topical or oral. Most effective regimens include a retinoid such as tretinoin or tazarotene. Tretinoin cream is the standard against which all other anticomedonal agents are compared. Tazarotene is a potent anticomedonal retinoid cream that is only slightly more irritating than tretinoin. Other drugs that are useful for inflammatory acne include adapalene and azelaic acid. Oral antibiotics that are effective in the treatment of

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acne include erythromycin, tetracyclines, trimethoprim sulfamethoxazole, and ciprofloxacin. Nodular, scarring acne that resists oral antibiotics and topical retinoids is usually treated with oral isotretinoin. Rosacea, which usually starts in the late 20s, may affect the eyes as well as the skin. It is most common in fair skinned people, especially those with a history of facial rubor. Lesions are most numerous on the central face. Although the cause of rosacea is uncertain, vascular reactivity is a predisposing factor. Topical drugs that are helpful in treating rosacea include metronidazole, azelaic acid, and sodium sulfacetamide. 5 tables. (AA-M). ·

Topical Therapy for Acne Source: American Family Physician. 61(2): 357-366. January 15, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides family physicians with information on the pathophysiology, clinical manifestations, and treatment of acne. This common skin condition typically affects adolescents and young adults. Acne is caused by abnormal desquamation of follicular epithelium that results in obstruction of the pilosebaceous canal. This obstruction leads to the formation of comedones, which can become inflamed because of overgrowth of Propionibacterium acnes. Acne is usually diagnosed by the patient. The physician needs to determine whether the condition is noninflammatory, inflammatory, or a mixture of both. Topical treatment is sufficient in most patients who have acne, but systemic therapy is required in patients who have deep acne nodules and cysts. In the treatment of acne, the vehicle may be as important as the active agent. Therefore, physicians need to assess the patient's skin type. Creams are appropriate for patients who have sensitive or dry skin. Patients who have oily skin may be more comfortable with gels. Lotions can be used with any skin type. Solutions are mainly used with topical antibiotics. Patients who have inflammatory lesions benefit from treatment with benzoyl peroxide, azelaic acid, sulfur preparations, or topical antibiotics. Topical retinoids such as tretinoin, adapalene, or tazarotene are effective in many patients with comedonal acne. Frequently, the use of comedonal and antibacterial agents is required. The therapeutic approach includes educating the patient about acne and selecting a treatment regimen. 5 figures, 2 tables, and 30 references. (AA-M).

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Topical Therapy for Acne Vulgaris Source: Postgraduate Medicine. 107(3): 69-70,73-76,79-80. March 2000. Summary: This journal article provides health professionals with information on the classification, differential diagnosis, and topical treatment options for acne vulgaris. Acne is a common skin disorder of the hair follicles and sebaceous glands. Factors that contribute to the development of acne include follicular plugging, increased sebum production by the sebaceous glands, colonization of the sebaceous follicles with Propionibacterium acnes, and inflammation. Acne can be classified as comedonal, inflammatory, and nodulocystic. Within each category, acne can be further divided into mild, moderate, or severe, based on the number of lesions and the amount of skin involved. The differential diagnosis of acne includes rosacea, perioral dermatitis, gram negative folliculitis, and topical or oral steroid induced acne. Topical agents are effective in the treatment of comedonal acne, and they may be useful adjuncts in the management of inflammatory acne and in the maintenance phase of management for nodulocystic acne. Topical agents that are helpful for managing acne vulgaris include salicylic acid,

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benzoyl peroxide, antibiotics, and tretinoin. New topical agents available for the treatment of acne include azelaic acid, reformulations of tretinoin, adapalene, and tazarotene. Combination regimens may be useful when a single agent is ineffective in treating acne or when more than one type of acne is present. 3 figures, 1 table, and 10 references. ·

Use of Systemic Agents in the Treatment of Acne Vulgaris Source: American Family Physician. 62(8): 1823-1830. October 15, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the pathophysiology, classification, and systemic treatment of acne vulgaris. This form of acne is a disorder of the pilosebaceous unit that generally develops in adolescence and improves in adulthood. Factors that are important in the development of acne include plugging of the hair follicle with abnormally cohesive desquamated cells, sebaceous gland hyperactivity, proliferation of bacteria within sebum, and inflammation. Effective treatment of acne vulgaris can prevent emotional and physical scarring. For the purposes of treatment, acne can be classified into comedonal, inflammatory, and nodulocystic. Topical medication is generally adequate in clearing comedonal acne, while inflammatory acne usually requires the addition of oral medication. Systemic antibiotics are used most frequently and can be highly effective. The antibiotics that have proved to be most effective include tetracycline, doxycycline, monocycline, and erythromycin. Newer formulations of combined oral contraceptives are also helpful in modulating sebum production in the female patient. The third generation progestin norgestimate has lower intrinsic androgenicity than other currently available progestins and is effective in treating moderate inflammatory acne. Severe nodulocystic acne that does not respond to topical retinoids and systemic antibiotics may be treated with isotretinoin. However, the side effect profile of this medication is extensive, and physicians should be well versed in its potential adverse effects. 4 figures, 4 tables, and 25 references. (AA-M).

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New Treatment Option for Acne Scars: Allograft Dermis Source: Dermatology Nursing. 11(2): 111-114. April 1999. Summary: This journal article provides health professionals with information on the use of allograft dermis to treat acne scars. The article begins reviews current treatment options for treating acne scars, including resurfacing techniques such as laser therapy, dermabrasion, and deep chemical peels and filling techniques such as autologous dermal grafts, dermal fat grafts, and fluid based collagen injections. Acellular allograft dermis is a new option: pre-packaged dermal graft material that is easy to use, safe, and effective. Patients most suitable for this scar revision procedures are those who have deep scars with loss of the dermal layer, saucer-type scars, and realistic expectations for results. The article then presents the steps involved in implanting the dermal graft material and explains postoperative care procedures. It concludes that this treatment option is advantageous because it is no more invasive than a punch biopsy in its ease of implantation, patients do not have to donate their own tissue, the scar can be permanently corrected with low risk of infection or allergic response, and cost is not a major consideration. 3 figures, 1 table, and 18 references. (AA-M).

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Saving Face: A Treatment Update for Acne Source: Patient Care. 33(11): 257-258,261-262,264-272,277. June 15, 1999. Summary: This journal article provides health professionals with updated information on evaluating and treating acne. Evaluation involves noting the extent to which the skin is affected, obtaining information on the current skin care regimen and use of acne and other medications, asking the patient about occupational and leisure activities, and determining the types of cosmetics and hair care products used. Monotherapy with resorcinol, salicylic acid, and sulfur is often sufficient for comedonal acne. However, none of these compounds is nearly as useful as the topical retinoid tretinoin. Other topical retinoids that are now available are adapalene and tazarotene. Benzoyl peroxide can also be used as monotherapy for comedonal acne. Azelaic acid 20 percent cream is available for topical treatment of mild to moderate inflammatory acne vulgaris. A very effective strategy is to prescribe benzoyl peroxide plus a topical retinoid. A somewhat gentler combination is benzoyl peroxide or a topical retinoid with a topical antibiotic. The most powerful topical approach for mild inflammatory acne is the gel combination of erythromycin-benzoyl peroxide and a retinoid. An oral antimicrobial, such as tetracycline and erythromycin, should be added to the topical regimen when papules and pustules outnumber comedones and there is some evidence of scarring. Trimethoprim sulfamethoxazole is an option when acne appears to be resistant to erythromycin or the tetracyclines. Other oral agents include cefadroxil, cephalexin, and ciprofloxacin. Isotretinoin can be prescribed for patients who have severe nodular or conglobate acne or those who have less severe inflammatory acne that does not respond to other agents. Adjunct skin care for acne prone skin includes washing the face twice a day, refraining from touching or squeezing lesions, and using oil free cosmetics and skin care products. 2 figures, 3 tables, and 7 references.

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Acne: Update on Therapeutic Choices Source: Consultant. 39(4): 1061-1064,1067-1068,1073-1075,1078-1080. April 1999. Summary: This journal article provides health professionals with updated information on the pathogenesis and management of acne, focusing on the indications for use and advantages and disadvantages of various antiacne medications. Mechanisms of acne therapy include hormonal manipulation, nonhormonal suppression of sebum production, normalization of follicular proliferation and hyperkeratosis, and antibacterial and anti-inflammatory action. Most patients who have acne can be managed successfully with topical retinoids, benzoyl peroxide, azelaic acid, and topical and oral antibiotics. The main side effects of these conventional therapies include skin irritation, photosensitivity, antibiotic resistance, and gastrointestinal intolerance. Hormonal regimens and isotretinoin are useful options for patients who have severe or recalcitrant acne. Although a potent teratogen, isotretinoin is safe and effective in carefully selected patients. Antiandrogen therapy with oral contraceptives or spironolactone may benefit women with so-called adult onset acne. Tetracyclines, isotretinoin, and spironolactone are contraindicated during pregnancy. Topical erythromycin, clindamycin, and benzoyl peroxide are the drugs of choice during pregnancy. Acne medications without known risk during lactation include topical and systemic erythromycin, azelaic acid, benzoyl peroxide, and tretinoin. 4 figures, 2 tables, and 29 references. (AA-M).

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Acneiform Eruptions After Facial Beauty Treatment Source: International Journal of Dermatology. 38(3): 196-199. March 1999.

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Summary: This journal article provides health professionals with information on a study that investigated the clinical and histologic profile of people who experienced acneiform eruptions following facial beauty treatment. The study population consisted of 36 women and one man who were questioned in detail about their acneiform eruptions. Specifically, they were questioned about any previous history of acne and its severity, facial beauty treatments, and the use of any other cosmetics and drugs. All patients were examined; a biopsy of typical lesions was taken in eight patients. The study found that, on direct questioning, all patients related the onset of their lesions to facial beauty treatment taken 3 to 8 weeks previously. Although the predominant types of lesion were deep-seated nodules, a few closed comedones were present in some cases. Most lesions took a long time to heal and, on healing, left behind hyperpigmentation. The cheeks were universally involved in all patients, and the chin and forehead were involved in 14. The histopathologic study revealed a predominantly peri-appendageal dermal infiltrate consisting of lymphocytes and histiocyctes admixed with polymorphs. A granulomatous infiltrate was seen in one-third of the biopsies. The article concludes that acneiform eruptions are unlike eruptions described as acne cosmetica in being inflammatory, indolent, and often occurring after the first cream massage itself. 3 figures and 7 references. (AA-M). ·

Topical Treatment of Acne Vulgaris for the Nurse Practitioner Source: Clinical Excellence for Nurse Practitioners. 3(3): 141-148. May 1999. Summary: This journal article provides health professionals with information on the pathophysiology, diagnosis, and treatment of acne vulgaris. This common skin disorder makes up 20 percent of a dermatology practice. The pathogenesis of acne is multifactorial. The known factors include the overproduction of sebum, the disruption of the normal keratinization process, and the presence of the bacterium Propionibacterium acnes. Acne can have significant psychosocial ramifications that may improve with treatment. Before initiating treatment, however, the proper diagnosis needs to be made. In addition, the severity of the acne should be determined according to an accepted classification system. Most patients have a mild to moderate grade of acne that can be successfully treated with topical therapy. A topical agent that affects sebum production is tretinoin cream. Topical agents that affect desquamation include tretinoin, adapalene, and azelaic acid. Topical agents that affect P. acnes proliferation includes benzoyl peroxide and antibiotics. Patients should be informed that treatment may continue for months and that if it is not effective, referral to a dermatologist may be needed to manage scarring. 1 appendix, 2 tables, and 20 references. (AA-M).

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Acne Vulgaris: A Treatment Update Source: Hospital Practice. 33(2): 111-114,116-117,121-124,127. February 15, 1998. Summary: This journal article presents health professionals with updated information on options for treating acne vulgaris, a chronic, polymorphic skin disease involving the pilosebaceous units of the face, chest, and back. The article explains the pathophysiology of the disease and discusses the topical agents and systemic therapies available to treat it. It discusses the mechanism, formulations, application methods, and potential side effects of benzoyl peroxide and tretinoin. It also describes other topical agents, including the topical antibiotics clindamycin and erythromycin, azelaic acid, alpha-hydroxy acids, adapalene, benzamycin, and tazarotene. The article presents the features and side effects of oral antibiotic agents such as doxycycline, minocycline, and isotretinoin. In addition, it comments on the use of estrogen to treat acne. In addition, the article presents an

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overview of ways to treat various types of acne, including comedonal, inflammatory, and severe or resistant acne. 6 figures and 3 tables. ·

Treatment of Acne in Patients With Sensitive Skin Source: Cosmetic Dermatology. p. 33-35. November 1998. Summary: This journal article provides health professionals with information on treating acne in patients who have sensitive skin. The determination of whether a patient has sensitive skin involves several subjective and objective factors. Subjective factors include patient reports of stinging, burning, pruritus, or tightness following the application of medications or cosmetics or exposure to environmental stimuli. Objective factors include all types of cutaneous reactions. Sensitive skin may occur as a result of heightened neurosensory input, enhanced immune responsiveness, and diminished barrier function. Factors that can trigger reactions in patients who have sensitive skin or exacerbate acne include exposure to ultraviolet radiation, dietary factors, overcleansing, use of cosmetics, and mechanical trauma. Therapeutic options for treating acne include topical preparations such as benzoyl peroxide, retinoids, azelaic acid, and 10 percent sodium sulfacetamide and systemic medications such as tetracyclines, erythromycin, and oral isotretinoin. Oral contraceptives have improved acne in some women. 2 tables and 16 references.

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Therapy for Acne Vulgaris Source: New England Journal of Medicine. 336(16): 1156-1162; April 17, 1997. Summary: This journal article for health professionals explains the pathophysiology of acne vulgaris and presents information on its treatment. Therapies for acne that reduce sebum production include systemic drugs such as estrogens, antiandrogens, and the retinoid isotretinoin. Topical agents that reduce epithelial desquamation in sebaceous follicles include tretinoin, isotretinoin, and salicylic acid. The proliferation of P. acnes may be prevented through topical therapy or systemic antibiotic therapy. Factors that should be considered in the treatment of comedonal, mild inflammatory, and inflammatory acne are discussed. 54 references, 2 figures, and 2 tables. (AA-M).

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Treatment of Acne With Topical Retinoids: One Man's Opinion Source: Journal of the American Academy of Dermatology. 36(6):S92-S95; June 1997. Summary: This journal article for health professionals focuses on the treatment of acne vulgaris with topical retinoids. Acne is a family of disorders that vary greatly in pathogenesis and clinical manifestation. Accordingly, no simple recipe for treatment can be given, and treatment options vary with the stage and intensity of the disease. Topical retinoids are the mainstay of treating common varieties of acne vulgaris. They also prevent development of comedones, halting progression to inflammatory lesions. Tretinoin was the first retinoid used in the topical treatment of acne more than 25 years ago. Isotretinoin, which has recently become available, is less irritating, but is probably somewhat less effective. Adapalene is a recently introduced topical retinoid used to treat acne. It is therapeutically equivalent to tretinoin but is less irritating. Except for very mild acne cases, topical retinoids should be used concomitantly with other drugs. The operating principle is to choose drugs whose modes of action are different from topical retinoids, that is, antibiotics or benzoyl peroxide. Topical retinoids, however, constitute the core of nearly all therapeutic programs for acne. 10 references. (AA-M).

10 Acne

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Dispelling Myths About Acne Source: Postgraduate Medicine. 102(2):94-99, 103-104,110,112; August 1997. Summary: This journal article for health professionals attempts to dispel stereotypical notions about the causes and treatment of acne. A definition of acne is provided, and data on its prevalence are presented. Pathophysiologic factors involved in acne formation are identified, including the presence of relatively large sebaceous follicles and some degree of hormonal stimulation. Types of acne are described. In addition, methods of treating acne are discussed, including educating the patient about acne; using topical antiacne agents such as tretinoin, benzoyl peroxide, azelaic acid, and antibiotics or oral antiacne agents such as antibiotics and isotretinoin; and undergoing hormone therapy. The medical effectiveness and side effects of these treatments are highlighted. 33 references, 2 figures, and 5 tables.

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Spironolactone Can Help With Acne in Women Source: Skin and Allergy News. 28(3):27; March 1997. Summary: This journal article for health professionals reports on the effectiveness of spironolactone for treating women who have adult-onset acne or acne that has worsened during their adulthood. Characteristics that make women candidates for treatment with this drug are outlined. In addition, guidelines for treating patients with this drug are provided. These guidelines include a suggested dose administration schedule and some common side effects caused by the drug.

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Azelaic Acid 20 Percent Cream (AZELEX) and the Medical Management of Acne Vulgaris Source: Dermatology Nursing. 9(5):339-344; October 1997. Summary: This journal article for health professionals discusses the use of azelaic acid 20 percent cream to treat acne vulgaris. This cream is an anti-acne agent with antimicrobial activity and keratinization-normalizing properties. The article explains the sequence of events leading to acnegenesis, presents an overview of the mechanism of action and clinical profile of azelaic acid, and presents evidence on the clinical efficacy and safety of this cream. Its efficacy is comparable to tretinoin 0.05 percent cream, benzoyl peroxide 5 percent gel, and erythromycin 2 percent ointment. In addition, the article explains how azelaic acid should be applied and offers suggestions for managing patient expectations and adverse effects. 30 references.

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Managing Acne in Adult Women Source: Patient Care. 31(10): 30-32,34-36,39-40,42-43. May 30, 1997. Summary: This journal article provides health professionals with information on the management of acne in adult women. Chronic, mild to moderate acne vulgaris currently affects an estimated 40 to 50 percent of all adult women. Acne vulgaris, a disease of the pilosebaceous structures, is caused by the interaction of sebum overproduction, abnormal keratinization, proliferation of Propionibacterium acnes and Staphylococcus epidermidis, and release of inflammatory mediators following follicular rupture. Various hormonal and nonhormonal factors increase the vulnerability of adult women to acne. Hormonal factors include progesterone release in the luteal phase of the menstrual cycle, use of high progestin oral contraceptives, menopause, and endocrine disorders. Nonhormonal factors include medications, cosmetics, sunlight, and friction. Treatment is case specific, with appropriate therapy determined by the predominant

Studies 11

lesion type, the skin type of the patient, and compliance issues. Topical treatment options include benzoyl peroxide, retinoids, antibiotics, alpha hydroxy acids, and azelaic acid. Systemic therapies for acne are usually prescribed for moderate to severe cases. These therapies include oral antibiotics and isotretinoin. The article highlights the efficacy and adverse effects of these topical and systemic medications. 8 figures, 2 tables, and 30 references. ·

Azelaic Acid Therapy for Acne Source: American Family Physician. 54(8):2457-2459. December 1996. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article for health professionals discusses the use of azelaic acid in the treatment of acne. Azelaic acid is another option for the topical treatment of mild to moderate inflammatory acne vulgaris. Azelaic acid is evaluated using the STEP approach. STEP is an acronym for safety, tolerability, effectiveness, and price. This evaluation shows that azelaic acid offers effectiveness similar to that of other agents without the systemic side effects of oral antibiotics or the allergic sensitization of topical benzoyl peroxide and with less irritation than tretinoin. Azelaic acid is less expensive than certain other prescription acne preparations, but it is much more expensive than nonprescription benzoyl peroxide preparations. Whether it is safe and effective when used in combination with other agents is not known. 9 references and 1 table. (AA-M).

Federally Funded Research on Acne The U.S. Government supports a variety of research studies relating to acne. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to acne. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore acne. The following is typical of the type of information found when searching the CRISP database for acne: ·

Project Title: ACCUTANE NF AND ORAL CONTRACEPTIVE TABLETS IN PREMENOPAUSAL WOMEN W NODULAR ACNE Principal Investigator & Institution: Leyden, James;; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

2

12 Acne

Timing: Fiscal Year 2001 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ACCUTANE/ORAL NODULAR ACNE

CONTRACEPTIVES

IN

WOMEN

WITH

Principal Investigator & Institution: Hendrix, Craig W.; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001 Summary: The clinical study will systematically evaluate whether isotretinoin affects the pharmacokinetics of ethinyl estradiol and norethindrone. We will also assess surrogate pharmacodynamic markers for oral contraceptive effectiveness, LH and FSH, to detect whether breakthrough ovulation occurred during the menstrual cycle. Finally, this study will describe the single dose and steady state pharmacokinetics of isotretinoin and its metabolites in these study patients. This is an open label, drug interaction study which will be done in two parts. The study design includes a screening/baseline evaluation followed by the administration of Ortho Novum 7/7/7+ and Accutane + 1.0 mg/kg/day in twice daily divided doses for 16 to 20 weeks. Pharmacokinetic/pharmacodynamic assessments will be made to compare periods with isotretinoin (month 4) to those periods without isotretinoin (month 2). Comparisons will be made both for the low dose phase (day 6) and high dose phase (day 20) of Ortho Novum 7/7/7. A second comparison will be made between single dose (beginning of month 3) and multiple dose isotretinoin pharmacokinetics (month 4, concurrent with hormonal kinetics). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: ACNE AND ANTIBACTERIAL PEPTIDES Principal Investigator & Institution: Froelich, Otto;; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2001; Project Start 1-MAR-1994; Project End 0-APR-2004 Summary: The aim of this proposal is to examine the involvement of defensins, a family of antibacterial peptides, in the etiology of acne. Acne is an inflammation of the pilosebaceous duct in the skin and afflicts a great number of adolescents, male and female, until early adulthood. The cause of acne is believed to be an increased sebum production, followed by colonization of the pilosebaceous duct by bacteria and an inflammatory reaction to the bacteria. While circulating androgens have been identified as a factor contributing to acne, they cannot be the only factor. The purpose of this proposal is to explore a different approach to studying acne, which, somewhat surprisingly, has not yet been mentioned in the1iterature. There is a growing awareness of the role of defensins and possibly other antibacterial peptides in the overall defense of the immune system against microbial invaders. The proposed experiments serve to examine the production of defensins in the sebaceous gland, with the goal of determining to which extent defensin levels may differ in normal skin and in acne. A long-term goal would be to find a method to enhance the production of endogenous defensins (or prevent their potential downregulation), or to treat the infected tissue with exogenous defensins. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 13

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Project Title: ACNE AND SCAR TREATMENT BY CONTROLLING LASER PENETRATION Principal Investigator & Institution: Domankevitz, Yacov;; Candela Corporation 530 Boston Post Rd Wayland, Ma 01778 Timing: Fiscal Year 2003; Project Start 1-SEP-2003; Project End 8-FEB-2004 Summary: (provided by applicant): Candela Corporation proposes to develop a laser system for a non-ablative treatment of Acne and related scars. The treatment is based on producing a sub-surface zone of laser-induced thermal injury within the dermis while preserving the epidermis. A laser system will be constructed, permitting a user to control the depth of laser-induced injury to an optimal value. Such a control can be achieved by delivering the laser energy to skin via an optical element contacting the skin and by varying the laser incident angle. Preservation of the epidermis will be achieved by properly cooling the optical element. This technique could be applied also towards other non-ablative and ablative laser therapies and could potentially lead to new applications as well. The specific aims for Phase I are to construct an apparatus capable of delivering laser energy at various angles of incidence to the tissue through a contacting optical element and then to examine the effects of incident angles and various cooling parameters on the induced thermal injury characteristics and epidermis preservation. Successful completion of phase I research would lead to an SBIR Phase II with an evaluation of the procedures in an in-vivo animal models followed by human clinical trials. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INHIBITORS OF 5ALPHA-REDUCTASE FOR ACNE THERAPY Principal Investigator & Institution: Li, Lingna;; Anticancer, Inc. 7917 Ostrow St San Diego, Ca 92111 Timing: Fiscal Year 2002; Project Start 0-JUN-2002; Project End 1-MAY-2003 Summary: This application addresses the need for selective non-toxic for acne. Excessive 5alpha-reductase activity is found in acne vulgaris as well as androgenic alopecia (male pattern baldness). Numerous side effects occur from current treatments of these diseases both of which originate in the pilosebaceous unit. We have developed a selective, effective, topically applied 5alpha-reductase inhibitor to modify pathological processes in the pilosebaceous unit. For example, toward this goal, we have previously developed a selective topical liposome hair follicle targeting technology fo r genes and other large and small molecules. The present application will focus on our recent observation that the 5-alpha- reductase inhibitor N, N-diethyl-4-methyl-3-oxo-4-aza-5alpha- androstane17beta-carboxamide (4-MA) incorporated into liposomes selectively induces apoptosis and inhibits growth of the dihydrotestosterone (DHT)-dependent hamster flank organ sebaceous gland. With regard to selectivity, when non-liposomal 4-MA was topically applied, the selective efficacy was lost resulting in the on- targeted contralateral gland being affected. With regards to safety, liposome 4-MA did not significantly affect prostate weight, T/DHT ratios or body weight gain compared to controls indicating safety as well as efficacy of topical application of liposome 4-MA. We proposed here to develop topical liposomal 4-MAS as an anti-acne agent. The Specific Aims of this application are as follows: 1) Optimize efficacy of topical liposomal 4-MA to selectively induce apoptosis of sebaceous glands of male hamsters; 2) Determine pharmacokinetics of topical liposomal 4- MA to hair follicles of human scalp grafted into SCID mice and in the hamster sebaceous gland; 5) Determine safety of effective doses of liposomal-4-MA by detection of changes in DHT/T blood ratios in treated animals. In Phase II, selective

14 Acne

efficacy and safety studies will be conducted on larger animals in order to enable liposomal 4-MA to enter the clinic as an anti-acne therapeutic. PROPOSED COMMERCIAL APPLICATIONS: Liposomal 4-MA will be developed as a topical selectively targeted therapeutic for acne for which they should be a very market. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: INNATE AND ADAPTIVE IMMUNITY IN ACNE VULGARIS Principal Investigator & Institution: Kim, Jenny J. Medicine; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2002; Project Start 1-AUG-2002; Project End 1-JUL-2007 Summary: (provided by applicant): The long term objective goal of this proposal is to gain insight into mechanisms of innate and adaptive immunity to microbes in skin. In inflammatory acne, Propionibacterium acnes plays a key role in eliciting host inflammatory response that is thought to be important for the pathogenesis of the disease. Recent data indicate that P. acnes activates the innate immune system, macrophages and polymorphonuclear leukocytes (PMNs) via Toll like receptor 2 (TLR2) to release proinflammatory cytokines. In addition, preliminary results suggest that granulysin, a product of adaptive immune T cell response is able to kill P. acnes directly. They propose experiments to investigate the role of TLRs and granulysin in pathogenesis of acne. They hypothesize that TLRs induce antimicrobial activity of PMNs, important cellular component of innate immunity. Furthermore, they hypothesize that adaptive immune system plays a role in controlling P. acnes growth by releasing granulysin. Better understanding of the innate and adaptive immune mechanisms against P. acnes could provide insight into host defense mechanisms in skin and suggest development of novel avenues of immunologic intervention in acne. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEW DRUGS FOR THE TREATMENT OF ACNE, REVISED PLAN Principal Investigator & Institution: Dunn, Joseph A.; Omnipharm Research International Inc. 255 Great Arrow Ave Buffalo, Ny 14207 Timing: Fiscal Year 2001; Project Start 0-SEP-1997; Project End 1-AUG-2002 Summary: (Adapted from the application): This Phase II grant application is to develop Trifluorosal (TMF-12), a derivative of lipophilic, 5-(n-alkylsulfonyl) salicylanilides. Since this agent is proposed to have anti-inflammatory properties and antimicrobial activity, including activity against P. acnes, a microbe that has been implicated in the pathogenesis of acne vulgaris. The investigators propose that this chemical may be useful as a topical anti-acne preparation. In the phase II studies, the investigators will continue their development of Trifluorosal to support the filing of an IND application for use as a topical acne treatment. This proposal will focus its attention on three issues: formulation, safety, and efficacy of their lead compound, TMF-12. In aim 1, they will incorporate their lead compound in 10 different formulations (5 gels and 5 lotions), and study tissue penetration in vitro using human skin in a Franz flow through chamber. They will also study its anti-inflammatory properties in the mouse TPA ear swelling model. In Aim 2, they will examine the safety of their formulated materials using 9 different standard animal models for eye, skin (irritation, sensitization, photoirritation/allergy and comedogenicity) and systemic toxicities. This aim is focused on providing background information for obtaining an IND from the FDA. Aim 3 will be mechanistic studies of TMF-12: inhibition of PKC, arachadonic acid release, inhibition of COX-1 and COX-2, and inhibition of cytokines and angiogenic factors. In aim 4, they

Studies 15

will focus on pharmaceutical development (TMF-12 chemistry scale-up, preservative efficacy, packaging studies, validation of a analytical method applied the refined, formulated TMF-12, and accelerated stability studies). In aim 5, they will perform efficacy (reduction of skin surface P. acnes counts) and safety data (irritation/sensitization potential, phototoxicity/allergy) on human volunteers, with the collaboration of contract laboratories. PR0P0SED COMMERCIAL APPLICATION: The primary market category for Trifluorosal as an acne product in the U.S. - adolescents between ages of thirteen and nineteen - is expected to grow by 9.4% in the next five years to 32 million people. A large secondary market category is comprised of adult women who are also susceptible to acne during certain stages of their menstruation cycle. It is expected that Trifluorosal will have an outstanding opportunity to break into these market categories because most of the existing treatments either do not treat the underlying cause of the disease or have significant, dose limiting side effects, whereas Trifluorosal inhibits both bacterial growth and inflammation at doses that are non-toxic. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CHOROID PLEXUS SYNTHESIZED RETINOIC ACID REGULATION Principal Investigator & Institution: Mccaffrey, Peter;; Eunice Kennedy Shriver Ctr Mtl Retardatn Waltham, Ma 02254 Timing: Fiscal Year 2001; Project Start 1-SEP-1977; Project End 0-NOV-2005 Summary: (Adapted from applicant's Description) The transcriptional activator retinoic acid (RA) is essential for the normal development of the central nervous system. Defects in either the RA receptors or the enzymes that produce RA result in severe developmental abnormalities. The normal requirement for RA in development explain its teratogenicity and the use of RA for the treatment of acne, psoriasis, and leukemia renders this the most teratogenic compound in use. Disruptions in RA signaling have been suggested to be the basis of several congenital and toxin induced diseases, including Dandy-Walker and Arnold-Chiari malformations, as well as alcohol, dioxin, and PCB teratogenicity. Cerebellar malformations occur in all of these diseases and the investigators propose to study the cerebellar abnormalities in the mouse which result from the application of either an excess or insuffiency of RA. These conditions will be achieved by the use of RA receptor agonists and antagonists, chemical inhibitors of RA synthesis, and the use of viral vectors to misexpress RA synthesizing and catabolic enzymes. The investigators' preliminary data in migration as events that normally require RA. They plan to investigate the distribution of a transgenic reporter gene for RA signaling in the cerebellum; the influence of excess recep6tor ligand on cerebellar ligand on cerebellar development; and the influence of RA signal inhibition of cerebellar development. These results will assist in the identification of cerebellar events normally regulated by RA, as well as provide insights into the etiology of diseases that result from disruption of RA signaling. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHRONIC ANOVULATORY HYPERANDROGENISM: SORTING GENOTYPES Principal Investigator & Institution: Witchel, Selma F.; Children's Pittsburgh/Upmc Hlth Sys of Upmc Health Systems Pittsburgh, Pa 15213

Hosp

Timing: Fiscal Year 2001; Project Start 5-JUL-1997; Project End 0-JUN-2003 Summary: Chronic anovulatory hyperandrogenism is a common heterogeneous disorder of unknown etiology characterized by hirsutism, oligo/amenorrhea,

16 Acne

anovulation, infertility, acne, hyperandrogenism, increased LH/FSH ratio, and insulin resistance. Because insulin resistance is often accompanied by known risk factors for coronary artery disease, it has been speculated that chronic anovulatory hyperandrogenism indicates a greater propensity for coronary artery disease. Recently, it has been suggested that premature pubic hair is a harbinger of chronic anovulatory hyperandrogenism. If this proves to be true, it may he possible to identify and intervene earlier in the subset of patients at risk for chronic anovulatory hyperandrogenism and its associated complications. Preliminary data supports genotype analysis of steroidogenic enzymes especially 21- hydroxylase (CYP21). The hypotheses of this proposal are: 1) premature pubic hair precedes chronic anovulatory hyperandrogenism in some patients; 2) the abnormal gonadal and/or adrenal steroid production limits FSH secretion to below the threshold concentrations needed for ovulation and 3) there are useful genetic and/or hormonal markers associated with an increased risk for chronic anovulatory hyperandrogenism. Genotype analysis of candidate genes in conjunction with sequential evaluation of patients with premature/excessive virilization, serial determinations of gonadotropin excretion and repeated assessments of insulin sensitivity will be used to test these hypotheses. Correlation of clinical features with results of hormonal and genetic evaluations may help unravel the sequence of events leading to chronic anovulatory hyperandrogenism. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CLINICAL TRANSLATIONAL RESEARCH IN DERMATOLOGY Principal Investigator & Institution: Kang, Sewon; Associate Professor; Dermatology; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 1-AUG-2000; Project End 1-JUL-2005 Summary: This application is in response to the Mid-career Investigator Award in Patient-Oriented Research (PA-98-053) which was created to support young, active and successful clinical investigators to overcome some of the major barriers to patientoriented research: time, resource and mentoring. Dr. Sewon Kang represents such a clinical researcher with years of specialty training and commitment to mentoring the next generation of clinical investigators. The objectives of this program are to further establish the candidate's independent patient-oriented clinical research program, especially in clinical translational research, and to provide him the time and resources necessary to mentor trainees pursuing clinical investigations in skin. The areas of activity of this project are Dr. Kang's research plan focused on therapeutic use of ultraviolet (UV)-A1 radiation in fibrosing skin diseases, effects of antioxidants in UVsignaling relevant to photoaging in human skin in vivo, and interleukin-10 in psoriasis, along with his plans for mentoring beginning clinical investigators. The three projects allow, in addition to the more traditional avenue of training in sound study design, execution, and analysis, opportunities for a novel avenue for training of clinical investigators to use tools required for reproducible observation and reliable documentation of molecular phenomenon relevant to human disease. The candidate has an established record of providing mentorship to pre- and post-doctoral trainees. Dr. Kang's research program will provide the context for him to continue to train beginning clinical investigators. His research and mentoring programs will be supported by the outstanding clinical research and training programs of the University of Michigan. These include the recently awarded institutional curriculum to teach the essentials of clinical research to young trainees and junior faculty (K-30), a well- funded General Clinical Research Center, the Center for Clinical Investigation and Therapeutics,

Studies 17

educational program in Clinical Research Design and Statistical Analysis, and the School of Public Health. In summary, the candidate's expertise and accomplishments in patient-oriented research, his ability and commitment to mentor beginning clinical investigators, and the research and training strengths of the University of Michigan combine to provide an ideal context to accomplish the specific aims of this proposal. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: CTRS FOR EDUCATION AND RESEARCH ON THERAPEUTICS (CERTS) Principal Investigator & Institution: Strom, Brian L. Professor of Medicine and Pharmacology; Medicine; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104 Timing: Fiscal Year 2001; Project Start 1-SEP-2000; Project End 1-AUG-2003 Summary: There remain enormous gaps in the information available to the public about the effects of their drugs, and in the application of that information to optimizing prescribing and thereby improving the risk/benefit balance from drugs. Centers for Education and Research on Therapeutics (CERTs) offer the opportunity to address many of these deficits, and this proposal goes a long way toward filling that gap. In particular, we propose to: 1. Establish a CERT with a coordinated infrastructure, including: a. Logistical support, including faculty time and core staff; b. Governance, including regular coordination and business meetings; c. Programmatic coordination, including linkage of the pharmacoepidemiology skills of the Center for Clinical Epidemiology and Biostatistics (CCEB) with the pharmacoeconomics skills of the Leonard Davis Institute of Health Economics, the experience in patient -oriented research of the General Clinical Research Center; basic science laboratories interested in evaluating the molecular mechanisms of drug effects; and the social science skills of non-biomedical researchers in other parts of the University; d. Regularly scheduled educational conference series; e. Active participation in the national network of CERTs; and f. A pilot research grant program targeted at the development of R01 quality grants and proposals. 2. Testing and building the capabilities of the current Penn ambulatory drug use evaluation program as a laboratory, expanding it to broader populations; 3. Improve the use of antibiotics locally and nationally, with studies leading to grant funding for larger scale efforts, as well as formal dissemination of evidence-based data both known and to be known. The initial studies will: a. evaluate techniques to reduce the use of antibiotics for acute bronchitis in the outpatient setting b. evaluate the impact of antimicrobial formulary interventions at different hospitals on the resistance patterns of extendedspectrum beta-lactamase- producing Escherichia coli and Klebsiella species; c. simulate data, in order to expand the use of meta-analysis to study rare adverse outcomes from antibiotics; d. study the effects of tetracycline used to treat acne in a dermatology clinic on antibiotic resistance patterns; and e. study the use of the GPRD Database to explore the epidemiology of drug -resistant pneumococcal pneumonia 4. Conduct an extensive education program, including: i) a Masters in Clinical Epidemiology (MSCE) and PhD pharmacoepidemiology fellowship training program; ii) opportunities for MSCE and PhD students in epidemiology and biostatistics to use existing in-house databases to answer new questions, to participate in ongoing research, and to develop new research projects; iii) courses for university physicians housestaff, nurses, and nursing students; iv) courses for pharmacists and pharmacy students; v) courses for medical students; and vi) a degree credit course in pharmacoepidemiology for MSCE students. 5. Organize and formally disseminate the results of our work, consisting of: publications and presentations for the Scientific/Professional community; ii) the FDA, AHCPR, other

18 Acne

CERTs, etc. and iii) the public, building on the dissemination program of the Leonard Davis Institute of Health Economics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: EFFECT CONTRACEPTION

OF

CONTINUOUS

VS.

SEQUENTIAL

ORAL

Principal Investigator & Institution: Legro, Richard S. Associate Professor; ObstetricsGynecology; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2002; Project Start 0-SEP-2002; Project End 0-JUN-2005 Summary: (provided by applicant): Withdrawal bleeding that occurs during the placebo period of the traditional OCP regimen is unnecessary and unwanted, and contributes to substantial method discontinuation rates. In U.S. women this contributes to one of the highest unwanted pregnancy rates in the world. In this proposal we will test the hypothesis that a long-term (6 month) continuous combined oral contraceptive pill (CCOCP) regimen (20 mug ethinyl estradiol/1 mg norethindrone acetate) will result in more profound endometrial and ovarian suppression than a traditional 21 day active pill/7 day placebo OCP regimen (21/70CP) with a randomized double blind trial. Currently CCOCP is commonly used by clinicians for a variety of indications, with little data of its safety and efficacy. As the clinical marker of endometrial and ovarian activity, we will be using number of bleeding days as the primary outcome in this study. We will secondarily monitor endometrial thickness and ovarian follicle formation by ultrasound, endometrial histology by biopsy, ovarian steroid production by monthly serum and daily urinary measurements, and patient satisfaction by questionnaire. We believe that a reduction in days of bleeding that will occur on a CCOCP regimen will improve patient satisfaction and compliance with this contraceptive regimen. We theorize that a tongterm CCOCP regimen may more effectively suppress ovarian follicular development and endometrial growth, because there are fewer rebounds in hormone levels due to loss of suppression during placebo periods. This regimen may therefore provide both effective contraception (with greater leeway for skipped pills) as well as more effective treatment of multiple gynecological conditions such as dysmenorrhea, dysfunctional uterine bleeding, endometriosis, and peripheral androgen disorders such as acne and hirsutism, as well as a greater reduction in risk for endometrial and ovarian cancer. Therefore, the risks and benefits of a CCOCP regimen are an important women's health issue that warrant investigation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: FREE PLASMA SEX HORMONE AND ANDROGEN ACTION Principal Investigator & Institution: Rosenfield, Robert L. Professor of Pediatrics; Pediatrics; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2001; Project Start 1-JUL-1978; Project End 0-JUN-2003 Summary: A primary sebaceous cell monolayer culture system has been developed in which for the first time a high level of terminal differentiation and sebum formation can be reproducibly induced. This has been accomplished using rat preputial cells, by activation of peroxisome proliferator activated receptors (PPARs) in a chemical defined, serum free medium. These findings imply that sebum formation is transduced via PPARs and that the factors regulating sebocyte growth and differentiation can now be precisely defined. W propose studies of sebaceous cell physiology to do so. Specific aim: 1)To measure sebocyte proliferation by 3H thymidine incorporatio and sebocyte

Studies 19

differentiation by analysis of lipid staining cells and lipid-forming colonies (LFCs) to define the interactions among PPAR activators and other factors regulating sebocyte growth and development. Pharmacologic probes will be used in order to test the hypothesis about the biological effects of interactions among PPAR activators-ligands and retinoid X receptor (RXR)-ligands, factors such as retinoic acid receptor (RAR) ligands affecting RXR availability to form PPAR heterodimers, steroid hormones, the insulin/insulin like growth factor (IGF) system, and hormones signaling via other second messengers. 2) To use riboprobes and immunoprobes to test the hypothesis that sebocytes express specific PPAR, RXR, and RAR subtypes and isoforms. 3) To determine the factors regulating PPAR gene expression using riboprobes and immunoprobes. The hypotheses will be tested that PPAR ligand-activators and androgens increase sebocytes PPAR gene expression. The hypothesis will also be tested that PPARd is constitutively expressed and expression of other PPARS is developmentally regulated. The long term goals are to address specific basic issues in sebocyte developmental biology which have implication for the development of new therapies for acne vuglaris. These issues are equally important in providing a new primary cell culture, biological model system for examining interactions among factors regulating cell proliferation and differentiation, particularly in comparison to adipocyte and reporter construct model systems. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: JENSENIIN P AND NISIN TO TREAT TOPICAL INFECTIONS Principal Investigator & Institution: Coughlin, Richard T. Senior Director R&d; Immucell Corporation 56 Evergreen Dr Portland, Me 04103 Timing: Fiscal Year 2002; Project Start 1-MAR-2002; Project End 8-FEB-2003 Summary: (provided by applicant): Developing strategies and products to prevent the spread of antibiotic resistance is a national priority. A significant contributing factor in the rise of antibiotic resistance is the use of antibiotics to treat diseases which are not life threatening. We propose to develop two novel anti-microbial agents, Nisin and Jenseniin P, to treat topical infections including acne, wounds, sores, and burns. Each year there are 5 million prescriptions for oral antibiotics and other drugs to treat acne. Hospital-acquired infections caused by just six common kinds of resistant bacteria costs at least $1.3 billion/year. This bactericin based product would have three characteristics. First, it would be a highly effective treatment of acne. Second, it would be inherently safe for use on human skin. Third, it would replace antibiotics that are known to select for resistance to Class I and II antibiotics used to treat life threatening human disease and therefore reduce the problem of antibiotic resistance. PROPOSED COMMERCIAL APPLICATION: This novel formulation would have both prophylactic and therapeutic use to replace existing acne controlling products. The market size is difficult to estimate both one product, Retin-A, has a $500 million market. Other applications of this product are also possible. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MC5 RECEPTOR--REGULATION OF EXOCRINE GLAND FUNCTION Principal Investigator & Institution: Cone, Roger D. Senior Scientist; None; Oregon Health & Science University Portland, or 972393098 Timing: Fiscal Year 2001; Project Start 1-DEC-1993; Project End 0-MAR-2004 Summary: (Adapted from the applicant's abstract) - The known systemic effects of pituitary-derived melanocortin peptides result primarily from ACTH-mediated adrenocortical glucocorticoid production. The identification of a widely-distributed

20 Acne

peripheral receptor for ACTH/MSH peptides, called the melanocortin-5 receptor (MC5R), raises the possibility of non-steroidally mediated systemic effects of these peptides. Targeted disruption of the MC5-R produced a mouse with a severe defect in water repulsion and thermoregulation due to a defect in the production of sebaceous lipids. Further investigation demonstrated high levels of MC5-R in multiple exocrine tissues, including the Harderian, preputial, lacrimal, and sebaceous glands. The MC5-R is also required for the production of porphyrins by the Harderian gland, and regulation of protein secretion by the lacrimal gland via the MC5-R. The data show a requirement for the MC5-R in multiple exocrine glands for the production of a diverse set of products, including lipids, proteins, and porphyrins, and suggest the existence of a coordinated system for the regulation of exocrine gland function by melanocortin peptides. The MC5-R may thus have clinical applications to a number of human diseases involving exocrine gland dysfunction, such as acne, dry eye syndromes, and blepharitis. In this application the investigator proposes to characterize the extent of expression of the MC5-R in exocrine tissues, to begin to identify exocrine gland products whose production and secretion is regulated by the MC5-R, to examine the physiological significance of this regulation, and to determine the potential utility of MC5-R agonists and antagonists for the regulation of exocrine gland function in vivo, using the mouse as a model. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: REGULATION OF CEREBELLAR DEVELOPMENT BY RETINOIC ACID Principal Investigator & Institution: Mccaffery, Peter; Eunice Kennedy Shriver Center; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2001; Project Start 1-APR-1997; Project End 1-MAR-2003 Summary: My long-range goal is to have a successful academic research career in the field of retinoid neurobiology. This area is an extension of my post- doctoral research on the role of retinoic acid (RA) in the development of the retina. My work has provided new tools and techniques which I intend to use to elucidate new facets of retinoid metabolism. The retinoid vitamin A is an essential nutritional supplement required for growth, reproduction and sight. RA, the active metabolite of vitamin A, is increasingly used in the clinical treatment of cancers and skin diseases. Exposure to retinoid homologues may even come from insecticides such as methoprene. Potential hazards exist since RA, in excess, is neurotoxic, particularly in children, and is also one of the most teratogenic substances identified. Its pernicious actions are through the disregulation of the normal patterns of RA metabolism and the central nervous system (CNS) is particularly sensitive. The aim of this proposal is to map the pathways of retinoid metabolism in the developing CNS. I will focus on the development of a single region of the brain, the cerebellum, allowing a straightforward, coherent research program to be developed. The cerebellum is a region of the CNS in which development and function can be disrupted through disturbances in RA metabolism. Accidental exposure of embryos to the acne drug Acutane(R) has shown that human cerebellar development is vulnerable to a disruption in the normal pattern of RA distribution. A high susceptibility to systemically applied retinoic acid indicates that the developing cerebellum is naturally disposed to respond to endogenously synthesized RA. l now propose to investigate the pathways of retinoid metabolism and signal transduction in the developing cerebellum in order to determine how factors that interfere with these processes disrupt development. l will be assisted by several experts at the Shriver

Studies 21

Center in the fields of lipid analysis and molecular biology. Initially, l will use both novel and traditional techniques to study RA metabolism during normal cerebellar development, then investigate the developmental changes that result from in-vivo disturbances of such pathways. In order to facilitate future work on cerebellar abnormalities in humans l will also isolate the human homologue of the murine retinoicacid generating enzyme. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: REGULATION OF GENES BY T AND DHT IN RAT AND HUMAN PROSTA Principal Investigator & Institution: Mcphaul, Michael J. Professor; Internal Medicine; University of Texas Sw Med Ctr/Dallas Dallas, Tx 753909105 Timing: Fiscal Year 2001; Project Start 4-JUL-1997; Project End 1-MAY-2003 Summary: Although the principal androgen produced by the adult and fetal testis and circulating in the blood of males is T, many tissues such as the prostate gland, are dependent on the in situ conversion of T to DHT. Studies of patients deficient in one of the two isoenzymes that catalyze the conversion of T to DHT, as well as animal studies using specific inhibitors of 5a-reductase, have clearly demonstrated that T and DHT are not equivalent androgens, and that the formation of DHT is physiologically important for the differentiation and development of the ventral prostate gland and tissues of the male external genital tract. It is clear from studies of animals and humans with androgen resistance that both T and DHT bind to the same receptor protein within the nucleus of target cells. The objective of this project is to elucidate mechanisms by which two androgens account for the totality of androgen action during development. Two general hypotheses will be addressed in the proposed studies: 1) T and DHT elicit separate and unique androgenic responses during differentiation of the prostate gland, and 2) DHT formation is necessary to concentrate the androgenic signal in some tissues of the differentiating male urogenital tract. We do not feel that one hypothesis is mutually exclusive of the other, and in fact, have amassed preliminary data that support both. The proposed work is of enormous significance. Formation of DHT has been implicated in the pathogenesis of several human diseases, including BPH, acne, hirsutism, and male pattern baldness. The results of these studies will help define the distinct roles that T and DHT play in androgen physiology and indicate the directions that efforts to selectively interfere with the actions of T and DHT can take. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF LIPID METABOLISM IN HUMAN SEBACEOUS GLANDS Principal Investigator & Institution: Thiboutot, Diane M. Associate Professor; Medicine; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2002; Project Start 1-APR-2002; Project End 1-MAR-2007 Summary: (provided by the applicant): Acne is the most common skin disease affecting young people. In addition to psychological distress and feelings of low self-esteem, acne can lead to permanent facial scarring. The production of sebum (oil) by sebaceous glands is a key factor in the development of acne. Apart from isotretinoin and hormonal therapy, there are no drugs that effectively reduce sebum production. Unfortunately, these drugs have significant side effects, including birth defects. No recent advances have been made in our ability to therapeutically reduce sebum production in part due to our lack of knowledge regarding the mechanisms regulating human sebum production.

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The overall goal of this research is to elucidate the mechanisms that regulate human sebum production in order to identify novel therapeutic target sites whose pharmacological ligands will offer safe and effective alternatives to isotretinoin for the treatment of acne. Peroxisome proliferator-activated receptors (PPARs) and sterol response element binding proteins (SREBPs) are key transcriptional regulators of lipid metabolism in a variety of tissues. The central hypothesis to be tested is that PPARs regulate lipid metabolism in human sebaceous glands. The effects of linoleic acid and other PPAR agonists on lipid metabolism will be determined using assays of lipid transport, synthesis, and catabolism in addition to an analysis of gene expression. 13-cis retinoic acid is the most potent sebosuppressive agent. PPARs and retinoids share common DNA binding sites, and in this regard can mediate transcription of common genes. Our secondary hypothesis is that 13-cis retinoic acid reduces sebum production by altering the expression of PPAR-regulated genes. The effects of 13-cis retinoic acid on gene expression will be examined in human sebocytes and in skin from patients treated with isotretinoin. Data generated from the proposed experiments will advance our understanding of the mechanisms regulating sebum production and can lead to identification of potential additional therapeutic target sites in the treatment of acne. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: RETINOIC ACID RECEPTORS: DYNAMICS, STABILITY AND FOLDING Principal Investigator & Institution: Schimerlik, Michael I. Professor; Biochemistry and Biophysics; Oregon State University Corvallis, or 973391086 Timing: Fiscal Year 2003; Project Start 1-APR-2003; Project End 1-MAR-2007 Summary: (provided by applicant): Retinoid X receptors (RXR) act as homodimers or heterodimers with retinoic acid receptors (RAR) or other nuclear hormone receptors to regulate gene expression. Among the genes regulated by retinoids are those that mediate apoptosis, cholesterol absorption and efflux, expression of xenobiotic metabolizing enzymes and the oncogene v-Erb A. Because of the important roles that RXR and RAR play in growth, development and cellular differentiation retinoids are of interest as chemopreventative and chemotherapeutic agents. They are also used in the treatment of acne, psoriasis and precancerous lesions. Although X-ray structures of several receptors for retinoids have been determined, information concerning the dynamics and stability of these proteins and the effects of ligands on these properties is lacking. This proposal will use mass spectrometry in conjunction with hydrogen/deuterium exchange to (1) examine the dynamics of the RARgamma and RXRalpha ligand binding domains and the effects of ligands and protein quaternary structure on solvent accessibility of structural elements, (2) probe the kinetic mechanism by which these proteins fold and (3) analyze conformational changes by differential protease sensitivity. Thermodynamic and kinetic studies are also proposed to examine the energetics and mechanisms of folding. These studies give information that complements the static, structural data, forms the foundation for future work to characterize the interactions of these proteins with other components of their signal transduction pathways and provides new data that may aid in the design of more effective drugs that act on receptors for retinoids. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

Studies 23

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Project Title: INDUCTION

ROSIGLITAZONE

AND

CLOMIPHENE

FOR

OVULATION

Principal Investigator & Institution: Cataldo, Nicholas A. Assistant Professor; Gynecology and Obstetrics; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001; Project Start 1-AUG-2001; Project End 1-JUL-2003 Summary: This proposal will evaluate the effectiveness of a new drug combination, rosiglitazone and clomiphene, for the induction of ovulation in anovulatory women with polycystic ovary syndrome (PCOS). PCOS is a disorder affecting about 5% of women of reproductive age, characterized by anovulation with loss of menstrual cyclicity and hyperandrogenism, often resulting in hirsutism or acne. Anovulation leads to spontaneous infertility and poses a risk of endometrial carcinoma if untreated. A majority of women with PCOS have peripheral insulin resistance and compensatory hyperinsulinemia. These abnormalities may lead to a long-term increased rish of Type 2 diabetes mellitus, hypertension, and accelerated atherosclerosis. Induction of ovulation is necessary to restore fertility to women with PCOS. The standard initial treatment is oral clomiphene citrate, a selective estrogen-receptor modulator which increases endogenous FSH secretion. Clomiphene is successful in inducing ovulation in only about 70% of women with PCOS, and failure is associated with hyperinsulinemia. Women who fail clomiphene ovulation induction are usually treated with parenteral FSH, but this is associated with a greater risk than clomiphene of both multiple gestation and ovarian hyperstimulation syndrome, which in its severe form can be lifethreatening. This study will examine whether clomiphene can be more effective in inducing ovulation in women with PCOS when given concomitantly with rosiglitazone, an insulin sensitizer which lowers circulating insulin levels. Women with PCOS selected for previous resistance to clomiphene ovulation induction will be randomized to receive either rosiglitazone or placebo in double-bind fashion for 6 weeks, and then will undergo attempted ovulation induction with clomiphene. If unsuccessful, the clomiphene dose will be increased in up to 2 subsequent cycles in standard fashion in an effort to achieve ovulation. Spontaneous and clomiphene-induced ovulatory outcomes, assessed by serum progesterone levels, will be compared between rosiglitazone and placebo groups and correlated with changes in hyperinsulinemia, assessed on oral glucose tolerance testing (OGTT), and with changes in baseline LH, total and free testosterone, sex hormone binding globulin (SHBG), and insulin-like growth factor binding protein-1 (IGFBP-1) levels. The effects of rosiglitazone on insulin secretion on OGTT will be correlated with its effects on the levels of the above hormones and binding proteins. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen ·

Project Title: TESTOSTERONE MENOPAUSAL WOMENT

DOSE

RESPONSE

IN

SURGICALLY

Principal Investigator & Institution: Bhasin, Shalender; Professor and Chief; Charles R. Drew University of Med & Sci 1621 E 120Th St Los Angeles, Ca 90059 Timing: Fiscal Year 2003; Project Start 5-AUG-2003; Project End 1-JUL-2008 Summary: The clinical applications of testosterone in women are predicated upon the postulate that by appropriate selection of testosterone dose, clinically beneficial effects of testosterone on sexual, physical and neurocognitive functions can be dissociated from its virilizing side effects. However, we do not know whether the skin, hair, vocal cords, and clitoris differ in their testosterone sensitivity from sexual, cognitive, and physical functions. Therefore, the primary objective of this study is to establish testosterone dose-

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response relationships in surgically menopausal women with low testosterone concentrations for a range of androgen-dependent outcomes, including sexual function, fat-free mass, thigh muscle strength and leg power, and several domains of neurocognitive function. The secondary objective is to determine the range of testosterone doses and concentrations that are associated with improvements in sexual, physical and neurocognitive functions and that can be safely administered to women without adverse effects on hair growth, voice, sebum production, clitoral size, and cardiovascular risk factors. In this randomized, double-blind, parallel-group study, surgically-menopausal women with low testosterone concentrations after a run-in period of transdermal estradiol for 3 months will be randomized to one of 4 groups to receive 0, 400, 1000, or 1600 uL testosterone gel daily for 6-months. These doses are expected to be associated with total testosterone concentrations of 20, 60, 120, and 180 ng/dL. The following outcomes will be assessed before and after 24-weeks of testosterone/placebo: sexual function, assessed by Brief Index of Sexual Functioning for Women, Derogatis Sexual Function Interview-Self Report, a sexual event log diary, and a Female Sexual Distress Scale; genital blood flow and sensation; mood by Psychological General Well Being Index; whole body and regional fat-free and fat mass by DEXA, deuterium water and sodium water dilution; and MRI scans of abdomen and thigh; leg press strength and leg power; physical function by Margaria power test, 400-m walk, and load carry test; and neurocognitive function by tests of spatial memory, spatial ability, logical memory, verbal (category and phonemic) fluency, immediate and delayed recall, digit and visual memory spans, spatial orientation, selective attention measure, and executive function. We will measure serum total and free testosterone, estradiol, DHT, SHBG, and FSH. For safety, we will evaluate hematocrit, liver enzymes, periodic breast and pelvic examination, hair growth by Ferriman and Galloway scale, sebuln production by Sebu-Tape, acne by Palatsi scale, clitoris size and index, changes in voice frequency, pitch range, and video images of vocal cords and digital speech records; plasma lipids, apolipoproteins and lipoprotein particles; inflammation sensitive markers; sleep apnea using Berlin's questionnaire; and insulin sensitivity by modified FSIVGT. These dose response data are crucial for the therapeutic applications of androgens in women, and will help determine whether by appropriate selection of testosterone dose, its beneficial effects can be dissociated from virilizing side effects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information WellNet: http://www.wellnet.ca/herbsa-c.htm (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “acne” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for acne in the PubMed Central database: Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 3 4

Studies 25

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Clinical resistance to erythromycin and clindamycin in cutaneous propionibacteria isolated from acne patients is associated with mutations in 23S rRNA.. by Ross JI, Eady EA, Cove JH, Jones CE, Ratyal AH, Miller YW, Vyakrnam S, Cunliffe WJ. 1997 May; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=163871

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Induction of proinflammatory cytokines by a soluble factor of Propionibacterium acnes: implications for chronic inflammatory acne.. by Vowels BR, Yang S, Leyden JJ. 1995 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&rendertype=exter nal&artid=173431

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with acne, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “acne” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “acne” (hyperlinks lead to article summaries): ·

A case of infantile acne due to pityrosporum. Author(s): Kang SK, Jee MS, Choi JH, Sung KJ, Moon KC, Koh JK. Source: Pediatric Dermatology. 2003 January-February; 20(1): 68-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12558851&dopt=Abstract

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A community-based epidemiological study of acne vulgaris in Hong Kong adolescents. Author(s): Yeung CK, Teo LH, Xiang LH, Chan HH. Source: Acta Dermato-Venereologica. 2002; 82(2): 104-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12125936&dopt=Abstract

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A comparative trial of two retinoids commonly used in the treatment of acne vulgaris. Author(s): Nyirady J, Grossman RM, Nighland M, Berger RS, Jorizzo JL, Kim YH, Martin AG, Pandya AG, Schulz KK, Strauss JS.

PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

6

26 Acne

Source: The Journal of Dermatological Treatment. 2001 September; 12(3): 149-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12243706&dopt=Abstract ·

A comparison of the relative efficacy of antiandrogens for the treatment of acne in hyperandrogenic women. Author(s): Carmina E, Lobo RA. Source: Clinical Endocrinology. 2002 August; 57(2): 231-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12153602&dopt=Abstract

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A microbiological approach to acne vulgaris. Author(s): Loveckova Y, Havlikova I. Source: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2002 December; 146(2): 29-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12572891&dopt=Abstract

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A multicenter, double-blind, randomized comparison study of the efficacy and tolerability of once-daily tazarotene 0.1% gel and adapalene 0.1% gel for the treatment of facial acne vulgaris. Author(s): Webster GF, Guenther L, Poulin YP, Solomon BA, Loven K, Lee J. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 February; 69(2 Suppl): 4-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095066&dopt=Abstract

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A new concept for acne therapy: a pilot study with zileuton, an oral 5-lipoxygenase inhibitor. Author(s): Zouboulis CC, Nestoris S, Adler YD, Orth M, Orfanos CE, Picardo M, Camera E, Cunliffe WJ. Source: Archives of Dermatology. 2003 May; 139(5): 668-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12756111&dopt=Abstract

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A new treatment for acne vulgaris combining benzoyl peroxide with clindamycin. Author(s): Tschen E, Jones T. Source: J Drugs Dermatol. 2002 September; 1(2): 153-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12847739&dopt=Abstract

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A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris. Author(s): Rosen MP, Breitkopf DM, Nagamani M. Source: American Journal of Obstetrics and Gynecology. 2003 May; 188(5): 1158-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748463&dopt=Abstract

Studies 27

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A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris. Author(s): Am Fam Physician. 2002 Aug 1;66(3):442 Source: Clinical Therapeutics. 2002 July; 24(7): 1117-33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt= Abstract&list_uids=12182521

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A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4% in the treatment of moderate acne vulgaris of the face. A randomized, double-blind, multicenter, parallel gr Author(s): Gupta AK, Lynde CW, Kunynetz RA, Amin S, Choi K, Goldstein E. Source: Journal of Cutaneous Medicine and Surgery. 2003 January-February; 7(1): 31-7. Epub 2002 October 09. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12362264&dopt=Abstract

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A single-center study of aminolevulinic acid and 417 NM photodynamic therapy in the treatment of moderate to severe acne vulgaris. Author(s): Goldman MP, Boyce SM. Source: J Drugs Dermatol. 2003 August; 2(4): 393-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884461&dopt=Abstract

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Acne 2002. Author(s): Hirsch R, Shalita AR. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 August; 70(2): 90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234162&dopt=Abstract

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Acne and hirsuties in teenagers. Author(s): Barth JH, Clark S. Source: Best Practice & Research. Clinical Obstetrics & Gynaecology. 2003 February; 17(1): 131-48. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12758231&dopt=Abstract

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Acne and hirsutism in polycystic ovary syndrome: clinical, endocrine-metabolic and ultrasonographic differences. Author(s): Falsetti L, Gambera A, Andrico S, Sartori E. Source: Gynecological Endocrinology : the Official Journal of the International Society of Gynecological Endocrinology. 2002 August; 16(4): 275-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396556&dopt=Abstract

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Acne in Apert's syndrome: treatment with isotretinoin. Author(s): Cuerda E, del Pozo J, Rodriguez-Lozano J, Pena-Penabad C, Fonseca E.

28 Acne

Source: The Journal of Dermatological Treatment. 2003 January; 14(1): 43-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745854&dopt=Abstract ·

Acne in infancy and acne genetics. Author(s): Herane MI, Ando I. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 24-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566802&dopt=Abstract

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Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation. Author(s): Kawada A, Aragane Y, Kameyama H, Sangen Y, Tezuka T. Source: Journal of Dermatological Science. 2002 November; 30(2): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12413768&dopt=Abstract

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Acne therapy: a methodologic review. Author(s): Lehmann HP, Robinson KA, Andrews JS, Holloway V, Goodman SN. Source: Journal of the American Academy of Dermatology. 2002 August; 47(2): 231-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140469&dopt=Abstract

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Acne treatment with a 1,450 nm wavelength laser and cryogen spray cooling. Author(s): Paithankar DY, Ross EV, Saleh BA, Blair MA, Graham BS. Source: Lasers in Surgery and Medicine. 2002; 31(2): 106-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12210594&dopt=Abstract

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Acne variants. Author(s): Gebauer K. Source: American Journal of Clinical Dermatology. 2000 May-June; 1(3): 187-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12094771&dopt=Abstract

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Acne vulgaris and rosacea: evaluation and management. Author(s): Webster GF. Source: Clinical Cornerstone. 2001; 4(1): 15-22. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12739318&dopt=Abstract

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Acne vulgaris as an immune reconstitution syndrome in a patient with AIDS after initiation of antiretroviral therapy. Author(s): Kreuter A, Schlottmann R, Altmeyer P, Brockmeyer NH. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2002 November; 16(6): 638. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12482054&dopt=Abstract

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Acne vulgaris, I: pathogenesis and diagnosis. Author(s): Oberemok SS, Shalita AR. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 August; 70(2): 101-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234155&dopt=Abstract

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Acne vulgaris, II: treatment. Author(s): Oberemok SS, Shalita AR. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 August; 70(2): 111-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234157&dopt=Abstract

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Acne vulgaris. Author(s): Webster GF. Source: Bmj (Clinical Research Ed.). 2002 August 31; 325(7362): 475-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12202330&dopt=Abstract

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Acne vulgaris. Current treatment approaches. Author(s): Vernon P. Source: Adv Nurse Pract. 2003 February; 11(2): 59-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12640821&dopt=Abstract

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Acne vulgaris: a disease of Western civilization. Author(s): Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Source: Archives of Dermatology. 2002 December; 138(12): 1584-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12472346&dopt=Abstract

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Acne, isotretinoin treatment and acute depression. Author(s): Ng CH, Tam MM, Hook SJ. Source: World J Biol Psychiatry. 2001 July; 2(3): 159-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12587200&dopt=Abstract

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Acne: comparing hormonal approaches to antibiotics and isotretinoin. Author(s): Larsen TH, Jemec GB. Source: Expert Opinion on Pharmacotherapy. 2003 July; 4(7): 1097-103. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12831336&dopt=Abstract

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Acne: effect of hormones on pathogenesis and management. Author(s): Shaw JC. Source: American Journal of Clinical Dermatology. 2002; 3(8): 571-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12358558&dopt=Abstract

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Acne: evolution of the clinical practice and therapeutic management of acne between 1996 and 2000. Author(s): Dreno B, Daniel F, Allaert FA, Aube I. Source: Eur J Dermatol. 2003 March-April; 13(2): 166-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695133&dopt=Abstract

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Acneiform follicular mucinosis of the head and neck region. Author(s): Muscardin LM, Capitanio B, Concetta Fargnoli M, Maini A. Source: Eur J Dermatol. 2003 March-April; 13(2): 199-202. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695140&dopt=Abstract

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Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. Author(s): Kim J, Ochoa MT, Krutzik SR, Takeuchi O, Uematsu S, Legaspi AJ, Brightbill HD, Holland D, Cunliffe WJ, Akira S, Sieling PA, Godowski PJ, Modlin RL. Source: Journal of Immunology (Baltimore, Md. : 1950). 2002 August 1; 169(3): 1535-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12133981&dopt=Abstract

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Analysis of laboratory data in acne patients treated with isotretinoin: is there really a need to perform routine laboratory tests? Author(s): Alcalay J, Landau M, Zucker A. Source: The Journal of Dermatological Treatment. 2001 March; 12(1): 9-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171680&dopt=Abstract

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Anti-acne effects of oriental herb extracts: a novel screening method to select antiacne agents. Author(s): Nam C, Kim S, Sim Y, Chang I. Source: Skin Pharmacology and Applied Skin Physiology. 2003 March-April; 16(2): 8490. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12637783&dopt=Abstract

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Antibacterial therapy for acne: a guide to selection and use of systemic agents. Author(s): Tan HH. Source: American Journal of Clinical Dermatology. 2003; 4(5): 307-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12688836&dopt=Abstract

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Antibiotic-resistant acne: lessons from Europe. Author(s): Ross JI, Snelling AM, Carnegie E, Coates P, Cunliffe WJ, Bettoli V, Tosti G, Katsambas A, Galvan Perez Del Pulgar JI, Rollman O, Torok L, Eady EA, Cove JH. Source: The British Journal of Dermatology. 2003 March; 148(3): 467-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653738&dopt=Abstract

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Antibiotic-resistant Propionibacteria acnes may not be the major issue clinically or microbiologically in acne. Author(s): Burkhart CN, Burkhart CG. Source: The British Journal of Dermatology. 2003 February; 148(2): 365-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588399&dopt=Abstract

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Anti-inflammatory effects of erythromycin and tetracycline on Propionibacterium acnes induced production of chemotactic factors and reactive oxygen species by human neutrophils. Author(s): Jain A, Sangal L, Basal E, Kaushal GP, Agarwal SK. Source: Dermatology Online Journal [electronic Resource]. 2002 October; 8(2): 2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12546757&dopt=Abstract

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Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser. Author(s): Rogachefsky AS, Hussain M, Goldberg DJ. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 September; 29(9): 904-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930330&dopt=Abstract

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Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Author(s): Mills O Jr, Thornsberry C, Cardin CW, Smiles KA, Leyden JJ. Source: Acta Dermato-Venereologica. 2002; 82(4): 260-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12361129&dopt=Abstract

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Clindoxyl gel for the treatment of acne vulgaris. Author(s): Tan JK. Source: Skin Therapy Letter. 2002 May; 7(5): 1-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12223978&dopt=Abstract

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Clinical evaluation of Double Strength Isotrexin versus Benzamycin in the topical treatment of mild to moderate acne vulgaris. Author(s): Marazzi P, Boorman GC, Donald AE, Davies HD. Source: The Journal of Dermatological Treatment. 2002 September; 13(3): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227873&dopt=Abstract

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Clinical Evidence of the Endocrinological Influence of a Triphasic Oral Contraceptive Containing Norgestimate and Ethinyl Estradiol in Treating Women with Acne vulgaris. A Pilot Study. Author(s): Sator P, Schmidt JB, Honigsmann H.

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Source: Dermatology (Basel, Switzerland). 2003; 206(3): 241-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12673082&dopt=Abstract ·

Comedolysis by a lipohydroxyacid formulation in acne-prone subjects. Author(s): Uhoda E, Pierard-Franchimont C, Pierard GE. Source: Eur J Dermatol. 2003 January-February; 13(1): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609785&dopt=Abstract

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Commentary: A UK primary care perspective on treating acne. Author(s): Poyner T, Cunliffe B. Source: Bmj (Clinical Research Ed.). 2002 August 31; 325(7362): 475-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211228&dopt=Abstract

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Comparative efficacy of clindamycin and benzoyl peroxide for in vivo suppression of Propionibacterium acnes. Author(s): Gans EH, Kligman AM. Source: The Journal of Dermatological Treatment. 2002 September; 13(3): 107-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227872&dopt=Abstract

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Congenital adrenal hyperplasia and acne in male patients. Author(s): Degitz K, Placzek M, Arnold B, Schmidt H, Plewig G. Source: The British Journal of Dermatology. 2003 June; 148(6): 1263-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12828760&dopt=Abstract

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Current concepts in the treatment of acne: report from a clinical roundtable. Author(s): Berson DS, Chalker DK, Harper JC, Leyden JJ, Shalita AR, Webster GF. Source: Cutis; Cutaneous Medicine for the Practitioner. 2003 July; 72(1 Suppl): 5-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887172&dopt=Abstract

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Current concepts of the pathogenesis of acne: implications for drug treatment. Author(s): Gollnick H. Source: Drugs. 2003; 63(15): 1579-96. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887264&dopt=Abstract

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Demographic features and seasonal variations in patients with acne vulgaris in Saudi Arabia: a hospital-based study. Author(s): Al-Ameer AM, Al-Akloby OM. Source: International Journal of Dermatology. 2002 December; 41(12): 870-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12492972&dopt=Abstract

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Diagnostic points and possible origin of osteomyelitis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome: a radiographic study of 77 mandibular

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osteomyelitis cases. Author(s): Suei Y, Taguchi A, Tanimoto K. Source: Rheumatology (Oxford, England). 2003 July 16 [epub Ahead of Print] http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12867589&dopt=Abstract ·

Diet and acne redux. Author(s): Treloar V. Source: Archives of Dermatology. 2003 July; 139(7): 941; Author Reply 942-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873900&dopt=Abstract

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Diet and acne revisited. Author(s): Thiboutot DM, Strauss JS. Source: Archives of Dermatology. 2002 December; 138(12): 1591-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12472347&dopt=Abstract

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Differences in the use of combined oral contraceptives amongst women with and without acne. Author(s): Seaman HE, Vries CS, Farmer RD. Source: Human Reproduction (Oxford, England). 2003 March; 18(3): 515-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12615817&dopt=Abstract

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Different effectiveness of cyproterone acetate doses in treatment of acne. Author(s): De Leo V, Morgante G. Source: Clinical Endocrinology. 2003 February; 58(2): 246. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12580942&dopt=Abstract

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Drug-induced Sweet's syndrome in acne caused by different tetracyclines: case report and review of the literature. Author(s): Khan Durani B, Jappe U. Source: The British Journal of Dermatology. 2002 September; 147(3): 558-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12207601&dopt=Abstract

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Effect of antibiotics on the oropharyngeal flora in patients with acne. Author(s): Levy RM, Huang EY, Roling D, Leyden JJ, Margolis DJ. Source: Archives of Dermatology. 2003 April; 139(4): 467-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707094&dopt=Abstract

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Effect of cyclic progestin-estrogen therapy on sebum and acne in women. Author(s): Strauss JS, Pochi PE. Source: J Am Med Assoc. 1964 November 30; 190(9): 815-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12254865&dopt=Abstract

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Effect of vaccination therapy for acne, using a staphylococci antigenic complex in combination with clindamycin. Author(s): Jautova J, Dorko E, Pilipcinec E, Tkacikova L. Source: Folia Microbiol (Praha). 2003; 48(2): 249-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12800511&dopt=Abstract

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Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Author(s): Ta CN, Shine WE, McCulley JP, Pandya A, Trattler W, Norbury JW. Source: Cornea. 2003 August; 22(6): 545-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883348&dopt=Abstract

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Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Author(s): Skidmore R, Kovach R, Walker C, Thomas J, Bradshaw M, Leyden J, Powala C, Ashley R. Source: Archives of Dermatology. 2003 April; 139(4): 459-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707093&dopt=Abstract

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Efficacy and cutaneous safety of adapalene in black patients versus white patients with acne vulgaris. Author(s): Czernielewski J, Poncet M, Mizzi F. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 October; 70(4): 243-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12403317&dopt=Abstract

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Efficacy and safety of a new salicylic acid derivative as a complement of vitamin A acid in acne treatment. Author(s): Rougier A, Richard A. Source: Eur J Dermatol. 2002 July-August; 12(4): Xlix-L. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120611&dopt=Abstract

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Efficacy and safety of stabilised hydrogen peroxide cream (Crystacide) in mild-tomoderate acne vulgaris: a randomised, controlled trial versus benzoyl peroxide gel. Author(s): Milani M, Bigardi A, Zavattarelli M. Source: Current Medical Research and Opinion. 2003; 19(2): 135-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12740158&dopt=Abstract

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Efficacy of a low-dose oral contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel for the treatment of moderate acne: A randomized, placebo-controlled trial. Author(s): Leyden J, Shalita A, Hordinsky M, Swinyer L, Stanczyk FZ, Weber ME.

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Source: Journal of the American Academy of Dermatology. 2002 September; 47(3): 399409. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196750&dopt=Abstract ·

Epidemiology of acne. Author(s): Dreno B, Poli F. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566799&dopt=Abstract

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Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light. Author(s): Ashkenazi H, Malik Z, Harth Y, Nitzan Y. Source: Fems Immunology and Medical Microbiology. 2003 January 21; 35(1): 17-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12589953&dopt=Abstract

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Factors related to patient compliance in the treatment of acne vulgaris. Author(s): McEvoy B, Nydegger R, Williams G. Source: International Journal of Dermatology. 2003 April; 42(4): 274-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12694492&dopt=Abstract

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Fifty-six cases of acne treated by auricular needle-embedding. Author(s): Hou H, Wu T. Source: J Tradit Chin Med. 2002 June; 22(2): 115-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12125483&dopt=Abstract

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Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Author(s): Lee JB, Chung WG, Kwahck H, Lee KH. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2002 November; 28(11): 1017-21; Discussion 1021. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12460296&dopt=Abstract

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Guidelines for the management of acne vulgaris in adolescents. Author(s): Goulden V. Source: Paediatric Drugs. 2003; 5(5): 301-13. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716217&dopt=Abstract

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How could acne confer protection against malignant hematological disease. Author(s): Namazi MR. Source: Journal of Dermatological Science. 2003 April; 31(2): 165. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12670728&dopt=Abstract

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Improving patient satisfaction and acne severity in patients with mild to moderate acne: the BEST study. Author(s): Weiss J, Shavin J, Davis MW. Source: Cutis; Cutaneous Medicine for the Practitioner. 2003 February; 71(2 Suppl): 3-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630668&dopt=Abstract

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In vitro bactericidal effect of low-dose ultraviolet B in patients with acne. Author(s): Kalayciyan A, Oguz O, Bahar H, Torun MM, Aydemir EH. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 2002 November; 16(6): 642-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12482057&dopt=Abstract

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Increased hydrogen peroxide generation by neutrophils from patients with acne inflammation. Author(s): Akamatsu H, Horio T, Hattori K. Source: International Journal of Dermatology. 2003 May; 42(5): 366-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12755973&dopt=Abstract

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Inflammatory events are involved in acne lesion initiation. Author(s): Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Source: The Journal of Investigative Dermatology. 2003 July; 121(1): 20-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12839559&dopt=Abstract

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Inhibition of lipase activity in antibiotic-resistant propionibacterium acnes strains. Author(s): Gloor M, Wasik B, Becker A, Hoffler U. Source: Dermatology (Basel, Switzerland). 2002; 205(3): 260-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12399674&dopt=Abstract

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Inhibition of Propionibacterium acnes-induced mediators of inflammation by Indian herbs. Author(s): Jain A, Basal E. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2003 January; 10(1): 34-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622461&dopt=Abstract

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Interest of a new salicylic acid derivative in the prevention of acne relapses. Author(s): Breno B, Khammari A, Richard A, Rougier A. Source: Eur J Dermatol. 2002 July-August; 12(4): Li-Liii. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120603&dopt=Abstract

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Knowledge, beliefs and perception of youth toward acne vulgaris. Author(s): Al-Hoqail IA.

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Source: Saudi Med J. 2003 July; 24(7): 765-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12883611&dopt=Abstract ·

Lasers, light, and acne. Author(s): Hirsch RJ, Shalita AR. Source: Cutis; Cutaneous Medicine for the Practitioner. 2003 May; 71(5): 353-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12769401&dopt=Abstract

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Less common methods to treat acne. Author(s): Kaminsky A. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 68-73. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566807&dopt=Abstract

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Long-term mini-doses of isotretinoin in the treatment of relapsing acne. Author(s): Amichai B. Source: The Journal of Dermatology. 2003 July; 30(7): 572. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12928552&dopt=Abstract

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Long-term safety of spironolactone in acne: results of an 8-year followup study. Author(s): Shaw JC, White LE. Source: Journal of Cutaneous Medicine and Surgery. 2002 November-December; 6(6): 541-5. Epub 2002 September 12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12219252&dopt=Abstract

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Low-dose doxycycline moderately effective for acne. Author(s): Miller ST, Stevermer JJ. Source: The Journal of Family Practice. 2003 August; 52(8): 594, 597. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899809&dopt=Abstract

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Lymecycline in the treatment of acne: an efficacious, safe and cost-effective alternative to minocycline. Author(s): Bossuyt L, Bosschaert J, Richert B, Cromphaut P, Mitchell T, Al Abadie M, Henry I, Bewley A, Poyner T, Mann N, Czernielewski J. Source: Eur J Dermatol. 2003 March-April; 13(2): 130-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12695127&dopt=Abstract

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Management of acne. Author(s): Liao DC. Source: The Journal of Family Practice. 2003 January; 52(1): 43-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12540312&dopt=Abstract

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Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. Author(s): Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, Shalita AR, Thiboutot D; Global Alliance to Improve Outcomes in Acne. Source: Journal of the American Academy of Dermatology. 2003 July; 49(1 Suppl): S1-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12833004&dopt=Abstract

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Minocycline for acne vulgaris: efficacy and safety. Author(s): Garner SE, Eady EA, Popescu C, Newton J, Li WA. Source: Cochrane Database Syst Rev. 2003; (1): Cd002086. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12535427&dopt=Abstract

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Modelling the remission of individual acne lesions in vitro. Author(s): Downie MM, Sanders DA, Kealey T. Source: The British Journal of Dermatology. 2002 November; 147(5): 869-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410695&dopt=Abstract

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New aspects in acne inflammation. Author(s): Toyoda M, Morohashi M. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 17-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566801&dopt=Abstract

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New therapy update--A unique combination formulation in the treatment of inflammatory acne. Author(s): Fagundes DS, Fraser JM, Klauda HC. Source: Cutis; Cutaneous Medicine for the Practitioner. 2003 July; 72(1 Suppl): 16-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12887173&dopt=Abstract

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Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): a report of 22 patients. Author(s): Ruiz-Esparza J, Gomez JB. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 April; 29(4): 333-9; Discussion 339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656809&dopt=Abstract

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Nudging acne by topical beta-lipohydroxy acid (LHA), a new comedolytic agent. Author(s): Pierard GE, Rougier A. Source: Eur J Dermatol. 2002 July-August; 12(4): Xlvii-Xlviii. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12120612&dopt=Abstract

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Omega-3 fatty acids and acne. Author(s): Logan AC.

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Source: Archives of Dermatology. 2003 July; 139(7): 941-2; Author Reply 942-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873901&dopt=Abstract ·

Once-daily tazarotene 0.1 % gel versus once-daily tretinoin 0.1 % microsponge gel for the treatment of facial acne vulgaris: a double-blind randomized trial. Author(s): Leyden JJ, Tanghetti EA, Miller B, Ung M, Berson D, Lee J. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 February; 69(2 Suppl): 12-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095064&dopt=Abstract

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Optimizing the use of tazarotene for the treatment of facial acne vulgaris through combination therapy. Author(s): Draelos ZD, Tanghetti EA; Tazarotene Combination Leads to Efficacious Acne Results (CLEAR) Trial Study Group. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 February; 69(2 Suppl): 20-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095065&dopt=Abstract

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Oral contraception and the treatment of acne: where are we? Author(s): Belisle S. Source: J Obstet Gynaecol Can. 2002 July; 24(7): 550-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12365395&dopt=Abstract

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Oral contraceptives as anti-androgenic treatment of acne. Author(s): Lemay A, Poulin Y. Source: J Obstet Gynaecol Can. 2002 July; 24(7): 559-67. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12196847&dopt=Abstract

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Overall results of the BEST study following treatment of patients with mild to moderate acne. Author(s): Weiss J, Shavin J, Davis MW. Source: Cutis; Cutaneous Medicine for the Practitioner. 2003 February; 71(2 Suppl): 10-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12630670&dopt=Abstract

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Overview of treatments for acne. Author(s): Oprica C, Emtestam L, Nord CE. Source: Dermatology Nursing / Dermatology Nurses' Association. 2002 August; 14(4): 242-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12240500&dopt=Abstract

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Pathological mechanisms of acne with special emphasis on Propionibacterium acnes and related therapy. Author(s): Jappe U.

40 Acne

Source: Acta Dermato-Venereologica. 2003; 83(4): 241-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12926793&dopt=Abstract ·

Pharmacokinetics of tazarotene cream 0.1% after a single dose and after repeat topical applications at clinical or exaggerated application rates in patients with acne vulgaris or photodamaged skin. Author(s): Yu Z, Sefton J, Lew-Kaya D, Walker P, Yu D, Tang-Liu DD. Source: Clinical Pharmacokinetics. 2003; 42(10): 921-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12885265&dopt=Abstract

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Photocontact dermatitis and chloracne: two major occupational and environmental skin diseases induced by different actions of halogenated chemicals. Author(s): Yamamoto O, Tokura Y. Source: Journal of Dermatological Science. 2003 August; 32(2): 85-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850300&dopt=Abstract

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Post acne scarring: a review. Author(s): Goodman G. Source: Journal of Cosmetic and Laser Therapy : Official Publication of the European Society for Laser Dermatology. 2003 June; 5(2): 77-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850800&dopt=Abstract

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Preliminary results of a nonrandomized, multicenter, open-label study of patient satisfaction after treatment with combination benzoyl peroxide/clindamycin topical gel for mild to moderate acne. Author(s): Weiss JW, Shavin J, Davis M. Source: Clinical Therapeutics. 2002 October; 24(10): 1706-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12462298&dopt=Abstract

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Prolonged remissions of cystic acne and conglobate acne with 13-cis-retinoic acid Peck GL, Olsen TG, Yoder FW et al. Author(s): Cunliffe WJ. Source: Clinical and Experimental Dermatology. 2002 September; 27(6): 539-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12372111&dopt=Abstract

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Pronounced and early acne in Apert's syndrome: a case successfully treated with oral isotretinoin. Author(s): Campanati A, Marconi B, Penna L, Paolinelli M, Offidani A. Source: Eur J Dermatol. 2002 September-October; 12(5): 496-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370145&dopt=Abstract

Studies 41

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Propionibacterial biofilms cannot explain antibiotic resistance but might contribute to some cases of antibiotic recalcitrant acne. Author(s): Coates T, Eady A, Cove J. Source: The British Journal of Dermatology. 2003 February; 148(2): 366-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12588400&dopt=Abstract

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Propionibacterium acnes resistance: a worldwide problem. Author(s): Eady EA, Gloor M, Leyden JJ. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 54-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566805&dopt=Abstract

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Propionibacterium acnes-induced IL-8 production may be mediated by NF-kappaB activation in human monocytes. Author(s): Chen Q, Koga T, Uchi H, Hara H, Terao H, Moroi Y, Urabe K, Furue M. Source: Journal of Dermatological Science. 2002 August; 29(2): 97-103. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12088610&dopt=Abstract

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Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy. Author(s): Ng CH, Tam MM, Celi E, Tate B, Schweitzer I. Source: The Australasian Journal of Dermatology. 2002 November; 43(4): 262-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12423432&dopt=Abstract

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Pseudotumor cerebri induced by minocycline therapy for acne vulgaris. Author(s): Mochizuki K, Takahashi T, Kano M, Terajima K, Hori N. Source: Japanese Journal of Ophthalmology. 2002 November-December; 46(6): 668-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12543195&dopt=Abstract

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Pyoderma gangrenosum, acne conglobata, and IgA gammopathy. Author(s): Birnkrant MJ, Papadopoulos AJ, Schwartz RA, Lambert WC. Source: International Journal of Dermatology. 2003 March; 42(3): 213-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12653919&dopt=Abstract

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Randomised, controlled trial of the efficacy and safety of adapalene gel 0.1% and tretinoin cream 0.05% in patients with acne vulgaris. Author(s): Cunliffe WJ, Danby FW, Dunlap F, Gold MH, Gratton D, Greenspan A. Source: Eur J Dermatol. 2002 July-August; 12(4): 350-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12095880&dopt=Abstract

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Responsiveness of the Acne-Specific Quality of Life Questionnaire (Acne-QoL) to treatment for acne vulgaris in placebo-controlled clinical trials. Author(s): Fehnel SE, McLeod LD, Brandman J, Arbit DI, McLaughlin-Miley CJ, Coombs JH, Martin AR, Girman CJ.

42 Acne

Source: Quality of Life Research : an International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. 2002 December; 11(8): 809-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12482164&dopt=Abstract ·

Resurfacing of Pitted Facial Acne Scars Using Er:YAG Laser with Ablation and Coagulation Mode. Author(s): Jeong JT, Park JH, Kye YC. Source: Aesthetic Plastic Surgery. 2003 June 6 [epub Ahead of Print] http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12784154&dopt=Abstract

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Retinoic acid receptors and topical acne therapy: establishing the link between gene expression and drug efficacy. Author(s): Del Rosso JQ. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 August; 70(2): 127-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234160&dopt=Abstract

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Robust evidence is needed in treating acne. Author(s): Garner S, Eady A, Avery T. Source: Bmj (Clinical Research Ed.). 2002 December 14; 325(7377): 1422. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12480866&dopt=Abstract

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Seasonal variation in acne vulgaris--myth or reality. Author(s): Sardana K, Sharma RC, Sarkar R. Source: The Journal of Dermatology. 2002 August; 29(8): 484-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12227481&dopt=Abstract

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Sebaceous glands in acne patients express high levels of neutral endopeptidase. Author(s): Toyoda M, Nakamura M, Makino T, Kagoura M, Morohashi M. Source: Experimental Dermatology. 2002 June; 11(3): 241-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12102663&dopt=Abstract

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Seijo-bofu-to, Jumi-haidoku-to and Toki-shakuyaku-san suppress rashes and incidental symptoms in acne patients. Author(s): Higaki S, Toyomoto T, Morohashi M. Source: Drugs Exp Clin Res. 2002; 28(5): 193-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635494&dopt=Abstract

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Selective nonablative treatment of acne scarring with 585 nm flashlamp pulsed dye laser. Author(s): Patel N, Clement M.

Studies 43

Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2002 October; 28(10): 942-5; Discussion 945. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12410680&dopt=Abstract ·

Selective photothermolysis of the sebaceous glands for acne treatment. Author(s): Lloyd JR, Mirkov M. Source: Lasers in Surgery and Medicine. 2002; 31(2): 115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12210595&dopt=Abstract

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Subacute Propionibacterium acnes osteomyelitis of the spine in an adolescent. Author(s): Do TT, Strub WM, Witte D. Source: Journal of Pediatric Orthopaedics. Part B / European Paediatric Orthopaedic Society, Pediatric Orthopaedic Society of North America. 2003 July; 12(4): 284-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12821847&dopt=Abstract

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Systemic antibiotic therapy for acne: a review. Author(s): Kunynetz R. Source: Skin Therapy Letter. 2002 May; 7(5): 3-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12223979&dopt=Abstract

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Systemic isotretinoin in the treatment of a Behcet's patient with arthritic symptoms and acne lesions. Author(s): Akyol M, Dogan S, Kaptanoglu E, Ozcelik S. Source: Clin Exp Rheumatol. 2002 July-August; 20(4 Suppl 26): S-55. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12371626&dopt=Abstract

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The association between depression and isotretinoin use in acne. Author(s): Ng CH, Schweitzer I. Source: The Australian and New Zealand Journal of Psychiatry. 2003 February; 37(1): 7884. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12534661&dopt=Abstract

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The association of serum androsterone glucuronide with inflammatory lesions in women with adult acne. Author(s): Carmina E, Godwin AJ, Stanczyk FZ, Lippman JS, Lobo RA. Source: J Endocrinol Invest. 2002 October; 25(9): 765-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398233&dopt=Abstract

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The effect of 2 combined oral Contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Author(s): van Vloten WA, van Haselen CW, van Zuuren EJ, Gerlinger C, Heithecker R.

44 Acne

Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 April; 69(4 Suppl): 2-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12096825&dopt=Abstract ·

The effective treatment of acne vulgaris by a high-intensity, narrow band 405-420 nm light source. Author(s): Elman M, Slatkine M, Harth Y. Source: Journal of Cosmetic and Laser Therapy : Official Publication of the European Society for Laser Dermatology. 2003 June; 5(2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850803&dopt=Abstract

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The influence of genetics and environmental factors in the pathogenesis of acne: a twin study of acne in women. Author(s): Bataille V, Snieder H, MacGregor AJ, Sasieni P, Spector TD. Source: The Journal of Investigative Dermatology. 2002 December; 119(6): 1317-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12485434&dopt=Abstract

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The interaction between acne vulgaris and the psyche. Author(s): Baldwin HE. Source: Cutis; Cutaneous Medicine for the Practitioner. 2002 August; 70(2): 133-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12234161&dopt=Abstract

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The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics. Author(s): Ghanem VC, Mehra N, Wong S, Mannis MJ. Source: Cornea. 2003 April; 22(3): 230-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658088&dopt=Abstract

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The rationale for using a topical retinoid for inflammatory acne. Author(s): Millikan LE. Source: American Journal of Clinical Dermatology. 2003; 4(2): 75-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12553848&dopt=Abstract

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The response of skin disease to stress: changes in the severity of acne vulgaris as affected by examination stress. Author(s): Chiu A, Chon SY, Kimball AB. Source: Archives of Dermatology. 2003 July; 139(7): 897-900. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873885&dopt=Abstract

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The role of innate immunity in the pathogenesis of acne. Author(s): Koreck A, Pivarcsi A, Dobozy A, Kemeny L.

Studies 45

Source: Dermatology (Basel, Switzerland). 2003; 206(2): 96-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12592074&dopt=Abstract ·

The seroprevalence of Helicobacter pylori and nitric oxide in acne rosacea. Author(s): Gurer MA, Erel A, Erbas D, Caglar K, Atahan C. Source: International Journal of Dermatology. 2002 November; 41(11): 768-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452999&dopt=Abstract

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The unwelcome return of the acne diet. Author(s): Bershad S. Source: Archives of Dermatology. 2003 July; 139(7): 940-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873898&dopt=Abstract

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The use of low dose oral contraceptives for the management of acne. Author(s): Lemay A, Langley RG. Source: Skin Therapy Letter. 2002 December; 7(10): 1-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12658330&dopt=Abstract

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The use of lymecycline in the treatment of moderate to severe acne vulgaris: a comparison of the efficacy and safety of two dosing regimens. Author(s): Dubertret L, Alirezai M, Rostain G, Lahfa M, Forsea D, Niculae BD, Simola M, Horvath A, Mizzi F. Source: Eur J Dermatol. 2003 January-February; 13(1): 44-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12609781&dopt=Abstract

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Therapy for macular degeneration: insights from acne. Author(s): Sparrow JR. Source: Proceedings of the National Academy of Sciences of the United States of America. 2003 April 15; 100(8): 4353-4. Epub 2003 Apr 07. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12682280&dopt=Abstract

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Topical acne drugs: review of clinical properties, systemic exposure, and safety. Author(s): Akhavan A, Bershad S. Source: American Journal of Clinical Dermatology. 2003; 4(7): 473-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12814337&dopt=Abstract

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Topical adapalene gel 0.1% vs. isotretinoin gel 0.05% in the treatment of acne vulgaris: a randomized open-label clinical trial. Author(s): Ioannides D, Rigopoulos D, Katsambas A. Source: The British Journal of Dermatology. 2002 September; 147(3): 523-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12207595&dopt=Abstract

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Topical treatment in acne: current status and future aspects. Author(s): Gollnick HP, Krautheim A. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 29-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566803&dopt=Abstract

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Treatment of acne with isotretinoin: recommendations based on Australian experience. Author(s): Cooper AJ; Australian Roaccutane Advisory Board. Source: The Australasian Journal of Dermatology. 2003 May; 44(2): 97-105. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12752181&dopt=Abstract

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Treatment of atrophic facial acne scars with a dual-mode Er:YAG laser. Author(s): Tanzi EL, Alster TS. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2002 July; 28(7): 551-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12135504&dopt=Abstract

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Treatment of gram-negative folliculitis in patients with acne. Author(s): Boni R, Nehrhoff B. Source: American Journal of Clinical Dermatology. 2003; 4(4): 273-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680804&dopt=Abstract

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Update and future of hormonal therapy in acne. Author(s): Thiboutot D, Chen W. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 57-67. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566806&dopt=Abstract

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Update and future of systemic acne treatment. Author(s): Zouboulis CC, Piquero-Martin J. Source: Dermatology (Basel, Switzerland). 2003; 206(1): 37-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566804&dopt=Abstract

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Update on pathogenesis and treatment of acne. Author(s): Lee DJ, Van Dyke GS, Kim J. Source: Current Opinion in Pediatrics. 2003 August; 15(4): 405-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12891054&dopt=Abstract

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Urethral fistula caused by acne inversa (hidradenitis suppurativa): a case report. Author(s): Gronau E, Pannek J. Source: International Urology and Nephrology. 2002; 34(3): 377-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12899232&dopt=Abstract

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CHAPTER 2. NUTRITION AND ACNE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and acne.

Finding Nutrition Studies on Acne The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “acne” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

48 Acne

The following is a typical result when searching for recently indexed consumer information on acne: ·

The power of Accutane. The benefits and risks of a breakthrough acne drug. Source: Meadows, M FDA-Consum. 2001 Mar-April; 35(2): 18-23 0362-1332

The following information is typical of that found when using the “Full IBIDS Database” to search for “acne” (or a synonym): ·

A case of pyoderma vegetans associated with acne conglobata. Author(s): Department of Dermatology, School of Medicine, Chiba University, Japan. Source: Fujita, M Okamoto, S J-Dermatol. 1990 July; 17(7): 429-34 0385-2407

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A comparison of adapalene gel 0.1% vs. tretinoin gel 0.025% in the treatment of acne vulgaris in China. Author(s): Department of Dermatology, First Hospital, Peking University, Beijing, China. Source: Tu, P Li, G Q Zhu, X J Zheng, J Wong, W Z J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 31-6 0926-9959

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Acne and rosacea. New and emerging therapies. Author(s): Section of Dermatology, Pennsylvania State University, College of Medicine, Hershey, USA. [email protected] Source: Thiboutot, D M Dermatol-Clin. 2000 January; 18(1): 63-71, viii 0733-8635

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Acne as a risk factor for anorexia nervosa in Chinese. Author(s): Department of Psychiatry, Chinese University of Hong Kong, Shatin, NT. Source: Lee, S Leung, C M Wing, Y K Chiu, H F Chen, C N Aust-N-Z-J-Psychiatry. 1991 March; 25(1): 134-7 0004-8674

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Acne inversa (alias hidradenitis suppurativa). Author(s): Department of Dermatology, Ruhr-University Bochum, Germany. Source: Jansen, I Altmeyer, P Piewig, G J-Eur-Acad-Dermatol-Venereol. 2001 November; 15(6): 532-40 0926-9959

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Acne therapy. Author(s): Department of Dermatology, Southern California Permanente Medical Group, San Diego, USA. Source: White, G M Adv-Dermatol. 1999; 1429-58; discussion 59 0882-0880

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Acne therapy: clinical pearls. Author(s): Department of Dermatology & Cutaneous Surgery, Mount Sinai Medical Center, New York, NY 10029-6574, USA. Source: Stein, R H Lebwohl, M Semin-Cutan-Med-Surg. 2001 September; 20(3): 184-9 1085-5629

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Acne. Introduction. Source: Thiboutot, D Semin-Cutan-Med-Surg. 2001 September; 20(3): 137-8 1085-5629

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Acne. Myths and management issues. Author(s): [email protected] Source: Clearihan, L Aust-Fam-Physician. 2001 November; 30(11): 1039-44 0300-8495

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Adapalene biochemistry and the evolution of a new topical retinoid for treatment of acne. Author(s): Galderma Research and Development, Valbonne, France. Source: Czernielewski, J Michel, S Bouclier, M Baker, M Hensby, J C J-Eur-AcadDermatol-Venereol. 2001; 15 Suppl 3: 5-12 0926-9959

Nutrition 49

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An update of recent clinical trials examining adapalene and acne. Author(s): Department of Dermatology, Baylor College of Medicine, Houston, TX 770303411, USA. [email protected] Source: Wolf, J E J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 23-9 0926-9959

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Candidiasis of the skin and acne. Author(s): Buckinghamshire Chiltern University College, Chalfont St Giles. Source: Courtenay, Molly Butler, Michele Nurs-Times. 2002 February 28-March 6; 98(9): 55-6 0954-7762

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Clinical efficacy of Velac, a new tretinoin and clindamycin phosphate gel in acne vulgaris. Author(s): C.H.U. de Saint Etienne, Department of Dermatology, France. Source: Cambazard, F J-Eur-Acad-Dermatol-Venereol. 1998 September; 11 Suppl 1S20-7; discussion S28-9 0926-9959

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Comparative activity of the topical quinolone OPC-7251 against bacteria associated with acne vulgaris. Author(s): Institute of Medical Microbiology, Free University of Berlin, Germany. Source: Vogt, K Hermann, J Blume, U Gollnick, H Hahn, H Haustein, U F Orfanos, C E Eur-J-Clin-Microbiol-Infect-Dis. 1992 October; 11(10): 943-5 0934-9723

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Comparison of the effect on acne with a combiphasic desogestrel-containing oral contraceptive and a preparation containing cyproterone acetate. Author(s): Laakarikeskus Materna Oy, Kajaani, Finland. Source: Vartiainen, M de Gezelle, H Broekmeulen, C J Eur-J-Contracept-Reprod-HealthCare. 2001 March; 6(1): 46-53 1362-5187

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Current perspectives on the treatment of acne vulgaris and implications for future directions. Author(s): Universitatsklinik fur Dermatologie und Venereologie, Otto von Guericke Universitat, Magdeburg, Germany. Source: Gollnick, H J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 1-4 0926-9959

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Densitometric thin layer chromatographic analysis of tretinoin and erythromycin in lotions for topical use in acne treatment. Author(s): Pharmaceutical Institute, Vrije Universiteit Brussel, Brussels, Belgium. Source: Gabriels, M Brisaert, M Plaizier Vercammen, J Eur-J-Pharm-Biopharm. 1999 July; 48(1): 53-8 0939-6411

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Developments in topical retinoid therapy for acne. Author(s): Department of Dermatology, The Mount Sinai School of Medicine, New York, NY, USA. [email protected] Source: Bershad, S Semin-Cutan-Med-Surg. 2001 September; 20(3): 154-61 1085-5629

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Efficacy of the fixed 1.2% clindamycin phosphate, 0.025% tretinoin gel formulation (Velac) and a proprietary 0.025% tretinoin gel formulation (Aberela) in the topical control of facial acne. Author(s): Yamanouchi Europe B.V., Medical Department Europe, Leiderdorp, The Netherlands. Source: Richter, J R Forstrom, L R Kiistala, U O Jung, E G J-Eur-Acad-DermatolVenereol. 1998 November; 11(3): 227-33 0926-9959

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Endocrinological evaluation and hormonal therapy for women with difficult acne. Author(s): Section of Dermatology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey 17033, USA. [email protected]

50 Acne

Source: Thiboutot, D M J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 57-61 09269959 ·

Exploration of retinoid activity and the role of inflammation in acne: issues affecting future directions for acne therapy. Author(s): Department of Dermatology, University Medical Center Benjamin Franklin, The Free University of Berlin, Germany. [email protected] Source: Zouboulis, C C J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 63-7 0926-9959

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Facing up to acne. Source: Pizzorno, J.E. Jr. Veg-times. Mt. Morris, Ill. : Vegetarian Times. January 1992. (173) page 18-19. 0164-8497

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Fine-needle aspiration cytology of acne rosacea. Author(s): Outpatient Cytopathology Center, Johnson City, Tennessee 37601, USA. Source: Rollins, S D Sheets, P Diagn-Cytopathol. 2000 August; 23(2): 106-7 8755-1039

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Hormonal therapy for acne in women. Source: Anonymous J-Pediatr-Adolesc-Gynecol. 1998 August; 11(3): 157-9 1083-3188

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Is prior authorization of topical tretinoin for acne cost effective? Author(s): Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA. [email protected] Source: Feldman, S R Fleischer, A B Chen, G J Am-J-Manag-Care. 1999 April; 5(4): 457-63 1096-1860

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Low dose flutamide in the treatment of acne vulgaris in women with or without oligomenorrhea or amenorrhea. Author(s): Department of Obstetrics & Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C. Source: Wang, H S Wang, T H Soong, Y K Changgeng-Yi-Xue-Za-Zhi. 1999 September; 22(3): 423-32

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Management of adult acne and acne variants. Author(s): The Skin Research Centre, The General Infirmaty and University of Leeds, Leeds, England. Source: Cunliffe, W J J-Cutan-Med-Surg. 1998 May; 2 Suppl 37-13 1203-4754

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Medium dose isotretinoin for the treatment of acne. Author(s): Department of Dermatology, Charite-Virchow Clinic, Humboldt University, Berlin, Germany. Source: Hermes, B Praetel, C Henz, B M J-Eur-Acad-Dermatol-Venereol. 1998 September; 11(2): 117-21 0926-9959

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Minocycline for acne vulgaris: efficacy and safety. Author(s): Unit of Health-Care Epidemiology, Institute of Health Sciences, Oxford University, Old Road, Headington, Oxford, UK, OX3 7LF. [email protected] Source: Garner, S E Eady, E A Popescu, C Newton, J Li Wan Po, A Cochrane-DatabaseSyst-Revolume 2000; (2): CD002086 1469-493X

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Oral contraceptives as anti-androgenic treatment of acne. Author(s): Universite Laval, Quebec, QC, Canada. Source: Lemay, A Poulin, Y J-Obstet-Gynaecol-Can. 2002 July; 24(7): 559-67 1701-2163

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Persistent corneal opacity after oral isotretinoin therapy for acne. Author(s): Department of Ophthalmology, Hotel-Dieu de Paris Hospital, Paris, France. Source: Ellies, P Dighiero, P Legeais, J M Pouliquen, Y J Renard, G Cornea. 2000 March; 19(2): 238-9 0277-3740

Nutrition 51

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Pivotal clinical trials of adapalene in the treatment of acne. Author(s): Department of Dermatology, Tulane University, New Orleans, LA 701122699, USA. [email protected] Source: Millikan, L E J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 19-22 0926-9959

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Prospective study of depressive symptoms and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy. Author(s): Department of Psychiatry, The University of Melbourne, The Melbourne Clinic, Melbourne, Victoria, Australia. [email protected] Source: Ng, C H Tam, M M Celi, E Tate, B Schweitzer, I Australas-J-Dermatol. 2002 November; 43(4): 262-8 0004-8380

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Psychological and sympatho-adrenal status in patients with cystic acne. Author(s): Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece. Source: Schulpis, K Georgala, S Papakonstantinou, E D Michas, T J-Eur-Acad-DermatolVenereol. 1999 July; 13(1): 24-7 0926-9959

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Side effects of acne therapy and their management. Author(s): Dalhousie University, Halifax, Nova Scotia, Canada. Source: Miller, R A J-Cutan-Med-Surg. 1998 May; 2 Suppl 314-8 1203-4754

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Tear lactoferrin levels in chronic meibomitis associated with acne rosacea. Author(s): Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey. Source: Kiratli, H Irkec, M Orhan, M Eur-J-Ophthalmol. 2000 Jan-March; 10(1): 11-4 1120-6721

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The cost-effectiveness of isotretinoin in the treatment of acne. Part 1. A meta-analysis of effectiveness literature. Author(s): Outcomes Consultants, Monument Park, Pretoria. Source: Wessels, F Anderson, A N Kropman, K S-Afr-Med-J. 1999 July; 89(7 Pt 2): 780-4 0038-2469

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The cost-effectiveness of isotretinoin in the treatment of acne. Part 2. A chronic medication plan profiling study. Author(s): Outcomes Consultants, Monument Park, Pretoria. Source: Wessels, F Anderson, A N Kropman, K S-Afr-Med-J. 1999 July; 89(7 Pt 2): 785-90 0038-2469

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The cost-effectiveness of isotretinoin in the treatment of acne. Part 3. A costminimisation pharmaco-economic model. Source: Wessels, F Anderson, A N Kropman, K S-Afr-Med-J. 1999 July; 89(7 Pt 2): 791-4 0038-2469

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The inhibition of free radical generation by human neutrophils through the synergistic effects of metronidazole with palmitoleic acid: a possible mechanism of action of metronidazole in rosacea and acne. Author(s): Department of Dermatology, Kansai Medical University, Moriguchi, Japan. Source: Akamatsu, H Oguchi, M Nishijima, S Asada, Y Takahashi, M Ushijima, T Niwa, Y Arch-Dermatol-Res. 1990; 282(7): 449-54 0340-3696

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The integral role of topical and oral retinoids in the early treatment of acne. Author(s): Department of Dermatology, State University of New York Health Science Center, Brooklyn 11203, USA. Source: Shalita, A J-Eur-Acad-Dermatol-Venereol. 2001; 15 Suppl 3: 43-9 0926-9959

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The inter-relationship between isotretinoin/acne and depression. Author(s): Department of Dermatology, University of Florence, Italy.

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Source: Chu, A Cunliffe, W J J-Eur-Acad-Dermatol-Venereol. 1999 May; 12(3): 263 09269959 ·

The management of acne vulgaris. Source: White, S Practitioner. 1988 September 8; 232(1454 ( Pt 1)): 942-4, 947 0032-6518

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Topical tazarotene therapy for psoriasis, acne vulgaris, and photoaging. Author(s): Division of Dermatology, University of Western Ontario, London, Ontario, Canada. Source: Guenther, L C Skin-Therapy-Lett. 2002 March; 7(3): 1-4 1201-5989

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Topical therapy for acne vulgaris. How do you choose the best drug for each patient? Author(s): Medical College of Virginia Campus of Virginia Commonwealth University, Richmond 23298-0230, USA. [email protected] Source: Johnson, B A Nunley, J R Postgrad-Med. 2000 March; 107(3): 69-70, 73-6, 79-80 0032-5481

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Topical therapy in acne. Author(s): Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany. [email protected] Source: Gollnick, H Schramm, M J-Eur-Acad-Dermatol-Venereol. 1998 September; 11 Suppl 1S8-12; discussion S28-9 0926-9959

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Topical treatment of acne vulgaris for the nurse practitioner. Author(s): Department of Veterans Affairs, Kauai Community-Based Outpatient Clinic, Lihue, Hawaii, USA. Source: Duvauchelle, S A Clin-Excell-Nurse-Pract. 1999 May; 3(3): 141-8 1085-2360

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Transdermal absorption of clindamycin and tretinoin from topically applied antiacne formulations in man. Author(s): Clinical Pharmacology Research Department, Yamanouchi Europe B.V., Leiderdorp, The Netherlands. [email protected] Source: van Hoogdalem, E J Baven, T L Spiegel Melsen, I Terpstra, I J Biopharm-DrugDispos. 1998 December; 19(9): 563-9 0142-2782

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Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. Author(s): Clinical Pharmacology Research Department, Yamanouchi Europe B.V., Leiderdorp, Netherlands. [email protected] Source: van Hoogdalem, E J J-Eur-Acad-Dermatol-Venereol. 1998 September; 11 Suppl 1S13-9; discussion S28-9 0926-9959

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Treating acne. A practical guide. Author(s): Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. [email protected] Source: Krowchuk, D P Med-Clin-North-Am. 2000 July; 84(4): 811-28 0025-7125

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Treatment of acne and seborrhoea. Author(s): Dermatology Unit, Dept. of Medicine, Medical College, Calcutta. Source: Datta, P K Saha, S S Indian-J-Dermatol. 1990 March; 35(1): 41-8 0019-5154

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Type I collagen N-telopeptide variation in adolescents receiving oral isotretinoin for severe acne. Author(s): Department of Pediatrics, Hospital V. Buzzi, Milan, Italy. [email protected] Source: Trifiro, Giuliana Norbiato, Guido J-Pediatr-Endocrinol-Metab. 2002 January; 15(1): 35-9

Nutrition 53

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDÒHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

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The following is a specific Web list relating to acne; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): ·

Vitamins Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Pantothenic Acid Source: Healthnotes, Inc. www.healthnotes.com Riboflavin Source: Integrative Medicine Communications; www.drkoop.com Vitamin A Source: Healthnotes, Inc. www.healthnotes.com Vitamin A Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin A Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10066,00.html Vitamin B Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10067,00.html Vitamin B12 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.drkoop.com Vitamin B3 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B6 Source: Healthnotes, Inc. www.healthnotes.com Vitamin B6 Source: Prima Communications, Inc.www.personalhealthzone.com Vitamin B9 (Folic Acid) Alternative names: Folate, Folic Acid Source: Integrative Medicine Communications; www.drkoop.com Vitamin E Source: Prima Communications, Inc.www.personalhealthzone.com

Nutrition 55

Vitamin E Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,906,00.html ·

Minerals Betaine Hydrochloride Source: Healthnotes, Inc. www.healthnotes.com Chromium Source: Prima Communications, Inc.www.personalhealthzone.com Folate Source: Integrative Medicine Communications; www.drkoop.com Iodine Source: Healthnotes, Inc. www.healthnotes.com Isotretinoin Source: Healthnotes, Inc. www.healthnotes.com Retinol Source: Integrative Medicine Communications; www.drkoop.com Selenium Source: Integrative Medicine Communications; www.drkoop.com Selenium Source: Prima Communications, Inc.www.personalhealthzone.com Selenium Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10055,00.html Tretinoin Source: Healthnotes, Inc. www.healthnotes.com Vitamin A (Retinol) Source: Integrative Medicine Communications; www.drkoop.com Zinc Source: Healthnotes, Inc. www.healthnotes.com Zinc Source: Integrative Medicine Communications; www.drkoop.com Zinc Source: Prima Communications, Inc.www.personalhealthzone.com

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Zinc Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10071,00.html Zinc/copper Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,938,00.html ·

Food and Diet Burdock Alternative names: Arctium lappa Source: Healthnotes, Inc. www.healthnotes.com Burdock Source: Prima Communications, Inc.www.personalhealthzone.com Chocolate Source: Healthnotes, Inc. www.healthnotes.com Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Omega-6 fatty acids Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,1037,00.html

57

CHAPTER 3. ALTERNATIVE MEDICINE AND ACNE Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to acne. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to acne and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “acne” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to acne: ·

47 cases of acne treated by prick-bloodletting plus cupping. Author(s): Chen D, Jiang N, Cong X. Source: J Tradit Chin Med. 1993 September; 13(3): 185-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8246588&dopt=Abstract

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50 cases of acne treated by puncturing acupoint dazhui in combination with cupping. Author(s): Ding LN. Source: J Tradit Chin Med. 1985 June; 5(2): 128. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2932606&dopt=Abstract

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A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. Author(s): Bassett IB, Pannowitz DL, Barnetson RS. Source: The Medical Journal of Australia. 1990 October 15; 153(8): 455-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2145499&dopt=Abstract

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Acne, hypervitaminosis A and hypercalcaemia. A case report. Author(s): Hofman KJ, Milne FJ, Schmidt C. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1978 September 30; 54(14): 579-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=153590&dopt=Abstract

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Acne: the disease and stress. Author(s): Lawlis GF, Achterberg J. Source: Top Clin Nurs. 1983 July; 5(2): 23-31. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6223413&dopt=Abstract

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Acne--fact and folklore. Author(s): Kligman AM. Source: The Western Journal of Medicine. 1979 December; 131(6): 547-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=161829&dopt=Abstract

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Acneiform eruption due to "megadose" vitamins B6 and B12. Author(s): Sherertz EF. Source: Cutis; Cutaneous Medicine for the Practitioner. 1991 August; 48(2): 119-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1834437&dopt=Abstract

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Acneiform eruptions after facial beauty treatment. Author(s): Khanna N, Gupta SD. Source: International Journal of Dermatology. 1999 March; 38(3): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10208615&dopt=Abstract

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Activity of eleven kampo formulations and eight kampo crude drugs against Propionibacterium acnes isolated from acne patients: retrospective evaluation in 1990 and 1995. Author(s): Higaki S, Nakamura M, Morohashi M, Hasegawa Y, Yamagishi T. Source: The Journal of Dermatology. 1996 December; 23(12): 871-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9037918&dopt=Abstract

Alternative Medicine 59

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Advances in the acupuncture treatment of acne. Author(s): Dai G. Source: J Tradit Chin Med. 1997 March; 17(1): 65-72. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10437251&dopt=Abstract

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Alternative therapies for acne, aphthae, insect bites, and bullous diseases. Author(s): Coverman MH. Source: Dermatologic Clinics. 1989 January; 7(1): 71-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2522029&dopt=Abstract

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An investigation into the treatment of acne vulgaris with Grenz x-rays. Author(s): Jelliffe AM, Soutter C, Meara RH. Source: The British Journal of Dermatology. 1969 August; 81(8): 617-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4240710&dopt=Abstract

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An update on common skin diseases. Acne, psoriasis, contact dermatitis, and warts. Author(s): Millikan LE, Shrum JP. Source: Postgraduate Medicine. 1992 May 1; 91(6): 96-8, 101-4, 107-10 Passim. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1533716&dopt=Abstract

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Antimicrobial effects of tea-tree oil and its major components on Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes. Author(s): Raman A, Weir U, Bloomfield SF. Source: Letters in Applied Microbiology. 1995 October; 21(4): 242-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7576514&dopt=Abstract

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Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. Author(s): Lalla JK, Nandedkar SY, Paranjape MH, Talreja NB. Source: Journal of Ethnopharmacology. 2001 November; 78(1): 99-102. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11585696&dopt=Abstract

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Comparative efficacy of four Ayurvedic formulations in the treatment of acne vulgaris: a double-blind randomised placebo-controlled clinical evaluation. Author(s): Paranjpe P, Kulkarni PH. Source: Journal of Ethnopharmacology. 1995 December 15; 49(3): 127-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8824737&dopt=Abstract

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Dermabrasion-Loo-punch-excision technique for the treatment of acne-induced osteoma cutis. Author(s): Fulton JE Jr. Source: J Dermatol Surg Oncol. 1987 June; 13(6): 655-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2953769&dopt=Abstract

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Effect of keigai-rengyo-to, a Japanese kampo medicine, on neutrophil functions: a possible mechanism of action of keigai-rengyo-to in acne. Author(s): Akamatsu H, Asada Y, Horio T. Source: J Int Med Res. 1997 September-October; 25(5): 255-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9364288&dopt=Abstract

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Effect of lipase activities of Propionibacterium granulosum and Propionibacterium acnes. Author(s): Higaki S, Nakamura M, Kitagawa T, Morohashi M, Yamagishi T. Source: Drugs Exp Clin Res. 2001; 27(5-6): 161-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11951573&dopt=Abstract

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Fifty-six cases of acne treated by auricular needle-embedding. Author(s): Hou H, Wu T. Source: J Tradit Chin Med. 2002 June; 22(2): 115-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12125483&dopt=Abstract

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Inhibition of Propionibacterium acnes-induced mediators of inflammation by Indian herbs. Author(s): Jain A, Basal E. Source: Phytomedicine : International Journal of Phytotherapy and Phytopharmacology. 2003 January; 10(1): 34-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12622461&dopt=Abstract

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L-carnitine supplementation in patients with cystic acne on isotretinoin therapy. Author(s): Georgala S, Schulpis KH, Georgala C, Michas T. Source: Journal of the European Academy of Dermatology and Venereology : Jeadv. 1999 November; 13(3): 205-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10642057&dopt=Abstract

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Naturally occurring antiacne agents. Author(s): Kubo I, Muroi H, Kubo A. Source: Journal of Natural Products. 1994 January; 57(1): 9-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8158169&dopt=Abstract


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Nodulocystic acne: oral gugulipid versus tetracycline. Author(s): Thappa DM, Dogra J. Source: The Journal of Dermatology. 1994 October; 21(10): 729-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7798429&dopt=Abstract

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Nonablative radiofrequency for active acne vulgaris: the use of deep dermal heat in the treatment of moderate to severe active acne vulgaris (thermotherapy): a report of 22 patients. Author(s): Ruiz-Esparza J, Gomez JB. Source: Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]. 2003 April; 29(4): 333-9; Discussion 339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12656809&dopt=Abstract

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Ocimum basilicum in acne vulgaris--a controlled comparison with a standard regime. Author(s): Balambal R, Thiruvengadam KV, Kameswarant L, Janaki VR, Thambiah AS. Source: J Assoc Physicians India. 1985 August; 33(8): 507-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2932427&dopt=Abstract

·

Photocontact dermatitis and chloracne: two major occupational and environmental skin diseases induced by different actions of halogenated chemicals. Author(s): Yamamoto O, Tokura Y. Source: Journal of Dermatological Science. 2003 August; 32(2): 85-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850300&dopt=Abstract

·

Psychosomatic aspects of acne: a controlled study. Author(s): Kenyon FE. Source: Trans St Johns Hosp Dermatol Soc. 1966; 52(1): 71-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4223404&dopt=Abstract

·

Recurrent exacerbation of acne by granulocyte colony-stimulating factor administration. Author(s): Lee PK, Dover JS. Source: Journal of the American Academy of Dermatology. 1996 May; 34(5 Pt 1): 855-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8632088&dopt=Abstract

·

Relationship between Propionibacterium acnes biotypes and Jumi-haidoku-to. Author(s): Higaki S, Kitagawa T, Kagoura M, Morohashi M, Yamagishi T. Source: The Journal of Dermatology. 2000 October; 27(10): 635-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11092266&dopt=Abstract

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·

Seasonal variations in the severity of acne vulgaris. Author(s): Gfesser M, Worret WI. Source: International Journal of Dermatology. 1996 February; 35(2): 116-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8850040&dopt=Abstract

·

Seijo-bofu-to, Jumi-haidoku-to and Toki-shakuyaku-san suppress rashes and incidental symptoms in acne patients. Author(s): Higaki S, Toyomoto T, Morohashi M. Source: Drugs Exp Clin Res. 2002; 28(5): 193-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12635494&dopt=Abstract

·

Solid facial edema as a complication of acne vulgaris: treatment with isotretinoin and clofazimine. Author(s): Helander I, Aho HJ. Source: Acta Dermato-Venereologica. 1987; 67(6): 535-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2451384&dopt=Abstract

·

Susceptibility of Propionibacterium acnes, Staphylococcus aureus and Staphylococcus epidermidis to 10 Kampo formulations. Author(s): Higaki S, Morimatsu S, Morohashi M, Yamagishi T, Hasegawa Y. Source: J Int Med Res. 1997 November-December; 25(6): 318-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9427165&dopt=Abstract

·

Tanshinone in the treatment of acne. Author(s): Wang DB. Source: J Tradit Chin Med. 1983 September; 3(3): 227-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6226833&dopt=Abstract

·

Tetracycline inhibition of a lipase from Corynebacterium acnes. Author(s): Weaber K, Freedman R, Eudy WW. Source: Appl Microbiol. 1971 April; 21(4): 639-42. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4252558&dopt=Abstract

·

The anti-lipase activity of shiunko on Propionibacterium acnes. Author(s): Higaki S, Morimatsu S, Morohashi M, Yamagishi T. Source: International Journal of Antimicrobial Agents. 1998 August; 10(3): 251-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9832288&dopt=Abstract


·

The correlation of Kampo formulations and their ingredients on anti-bacterial activities against Propionibacterium acnes. Author(s): Higaki S, Hasegawa Y, Morohashi M, Takayoshi Y. Source: The Journal of Dermatology. 1995 January; 22(1): 4-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7897023&dopt=Abstract

·

Therapeutic effect in 216 cases of acne, chloasma, and flat condyloma treated with mould-like masks containing Chinese drugs. Author(s): Li X, Chen Y, Zhao L, Li Y, Li Z. Source: J Tradit Chin Med. 1992 December; 12(4): 259-62. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1291816&dopt=Abstract

·

Treatment of acne vulgaris by biofeedback relaxation and cognitive imagery. Author(s): Hughes H, Brown BW, Lawlis GF, Fulton JE Jr. Source: Journal of Psychosomatic Research. 1983; 27(3): 185-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6224928&dopt=Abstract

·

Treatment of acne with ear acupuncture--a clinical observation of 80 cases. Author(s): Xu YH. Source: J Tradit Chin Med. 1989 December; 9(4): 238-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2534318&dopt=Abstract

·

Treatment of adolescent acne with acupuncture. Author(s): Liu J. Source: J Tradit Chin Med. 1993 September; 13(3): 187-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8246589&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

·


·

Chinese Medicine: http://www.newcenturynutrition.com/

·

drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

·

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

·

Google: http://directory.google.com/Top/Health/Alternative/

·

Healthnotes: http://www.healthnotes.com/

·

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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·

Open Directory Project: http://dmoz.org/Health/Alternative/

·

HealthGate: http://www.tnp.com/

·

WebMDÒHealth: http://my.webmd.com/drugs_and_herbs

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

·

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to acne; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation (some Web sites are subscription based): ·

General Overview Acne Source: Integrative Medicine Communications; www.drkoop.com Acne Source: Integrative Medicine Communications; www.drkoop.com Acne Source: Prima Communications, Inc.www.personalhealthzone.com Acne Rosacea Source: Healthnotes, Inc. www.healthnotes.com Acne Vulgaris Source: Healthnotes, Inc. www.healthnotes.com Amenorrhea Source: Integrative Medicine Communications; www.drkoop.com Birth Defects Prevention Source: Healthnotes, Inc. www.healthnotes.com Burns Source: Integrative Medicine Communications; www.drkoop.com Cholesterol, High Source: Integrative Medicine Communications; www.drkoop.com Cutaneous Drug Reactions Source: Integrative Medicine Communications; www.drkoop.com Drug Reactions, Cutaneous Source: Integrative Medicine Communications; www.drkoop.com Female Infertility Source: Healthnotes, Inc. www.healthnotes.com


Hair Disorders Source: Integrative Medicine Communications; www.drkoop.com Hair Growth, Excessive Source: Integrative Medicine Communications; www.drkoop.com High Cholesterol Source: Integrative Medicine Communications; www.drkoop.com Hirsuitism Source: Integrative Medicine Communications; www.drkoop.com Hypercholesterolemia Source: Integrative Medicine Communications; www.drkoop.com Insulin Resistance Syndrome Source: Healthnotes, Inc. www.healthnotes.com Menopause Source: Integrative Medicine Communications; www.drkoop.com Menstruation, Absence of Source: Integrative Medicine Communications; www.drkoop.com Photodermatitis Source: Integrative Medicine Communications; www.drkoop.com Skin Disorders, Drug Reactions Source: Integrative Medicine Communications; www.drkoop.com Skin Disorders, Photodermatitis Source: Integrative Medicine Communications; www.drkoop.com Sunburn Source: Integrative Medicine Communications; www.drkoop.com Systemic Lupus Erythematosus Source: Healthnotes, Inc. www.healthnotes.com ·

Alternative Therapy Acupuncture Source: Healthnotes, Inc. www.healthnotes.com Magical herbalism Alternative names: herbal magic Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Natural Hygiene Alternative names: Hygienic Health System Life Science

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Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/n.html Raktamoksha Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Reflexology Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,730,00.html ·

Chinese Medicine Lingxiaohua Alternative names: Trumpetcreeper Flower; Flos Campsis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/

·

Homeopathy Antimonium tartaricum Source: Healthnotes, Inc. www.healthnotes.com Calcarea carbonica Source: Healthnotes, Inc. www.healthnotes.com Hepar sulphuris calcareum Source: Healthnotes, Inc. www.healthnotes.com Pulsatilla Source: Healthnotes, Inc. www.healthnotes.com Silicea (Silica) Source: Healthnotes, Inc. www.healthnotes.com Sulphur Source: Healthnotes, Inc. www.healthnotes.com

·

Herbs and Supplements Adapalene Source: Healthnotes, Inc. www.healthnotes.com Androstenedione Source: Healthnotes, Inc. www.healthnotes.com Arctium Alternative names: Burdock, Gobo; Arctium lappa L.


Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Arnica Alternative names: Arnica montana Source: Integrative Medicine Communications; www.drkoop.com Arnica montana Source: Integrative Medicine Communications; www.drkoop.com Baking soda Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,835,00.html Benzamycin Source: Healthnotes, Inc. www.healthnotes.com Brewer's Yeast Alternative names: Nutritional Yeast Source: Integrative Medicine Communications; www.drkoop.com Chamomile Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,766,00.html Chaste Tree Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Chasteberry Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,767,00.html Chickweed Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Clindamycin Topical Source: Healthnotes, Inc. www.healthnotes.com Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc. www.healthnotes.com Dehydroepiandrosterone (DHEA) Source: Integrative Medicine Communications; www.drkoop.com DHEA Source: Integrative Medicine Communications; www.drkoop.com

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DHEA Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10022,00.html DHEA (Dehydroepiandrosterone) Source: Prima Communications, Inc.www.personalhealthzone.com Digestive Enzymes Source: Healthnotes, Inc. www.healthnotes.com English Lavendar Source: Integrative Medicine Communications; www.drkoop.com French Lavendar Source: Integrative Medicine Communications; www.drkoop.com Goldenseal Alternative names: Hydrastis canadensis Source: Integrative Medicine Communications; www.drkoop.com Guggul Alternative names: Commiphora mukul Source: Healthnotes, Inc. www.healthnotes.com Hydrastis canadensis Source: Integrative Medicine Communications; www.drkoop.com Juniperus Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Lavandula angustifolia Source: Integrative Medicine Communications; www.drkoop.com Lavender Alternative names: Lavandula angustifolia, English Lavendar, French Lavendar Source: Integrative Medicine Communications; www.drkoop.com Melaleuca Alternative names: Tea Tree Oil; Melaleuca alternifolia Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Minocycline Source: Healthnotes, Inc. www.healthnotes.com Nettle Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,10048,00.html


Ocimum Alternative names: Basil, Albahaca; Ocimum basilicum Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ PMS Herbal combination Source: WholeHealthMD.com, LLC. www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,947,00.html Potentilla Alternative names: Cinquefoil, Silverweed; Potentilla sp. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Red Clover Source: Prima Communications, Inc.www.personalhealthzone.com Sandalwood Alternative names: Santalum album Source: Healthnotes, Inc. www.healthnotes.com Senna Alternative names: Cassia senna, Cassia angustifolia Source: Healthnotes, Inc. www.healthnotes.com Tea Tree Alternative names: Melaleuca alternifolia Source: Healthnotes, Inc. www.healthnotes.com Tea Tree Source: Prima Communications, Inc.www.personalhealthzone.com Tetracycline Source: Healthnotes, Inc. www.healthnotes.com Thuja plicata Alternative names: Western Red Cedar Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Verbascum Alternative names: Mullein; Verbascum thapsus L. Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/ Vitex Alternative names: Chaste; Vitex agnus-castus Source: Alternative Medicine Foundation, Inc. www.amfoundation.org Hyperlink: http://www.herbmed.org/

70 Acne

Vitex Alternative names: Vitex agnus-castus Source: Healthnotes, Inc. www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

71

CHAPTER 4. CLINICAL TRIALS AND ACNE Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning acne.

Recent Trials on Acne The following is a list of recent trials dedicated to acne.8 Further information on a trial is available at the Web site indicated. ·

Determine the Effect of Administering Periostat(R) Twice Daily on Patients with Acne Rosacea Condition(s): Acne Rosacea Study Status: This study is currently recruiting patients. Sponsor(s): CollaGenex Pharmaceuticals Purpose - Excerpt: The purpose of this study is to determine whether Periostat(R), Doxycycline Hyclate 20 mg Tablets, taken twice daily is effective in reducing the red and white heads and overall redness associated with rosacea. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00041977

·

Comparison of efficacy and safety of Azelaic Acid 15% gel with its vehicle in subjects with mild to moderate acne. Condition(s): Acne Study Status: This study is completed. Sponsor(s): Berlex Laboratories

8

These are listed at www.ClinicalTrials.gov.

72 Acne

Purpose - Excerpt: Acne is a common inflammatory skin condition characterized by skin eruptions around hair follicles. People with acne can have pustules (zits or pimples), papules, whiteheads or blackheads, nodules, and redness of the skin. Acne usually involves the face and shoulders, but can also involve the chest, arms, and legs. The purpose of this study is to evaluate the safety and effectiveness of an investigational gel containing active medication compared to the same gel without any active medication (placebo or vehicle) in subjects with mild to moderate facial acne. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00031096 ·

Study of Scaling Disorders and Other Inherited Skin Diseases Condition(s): Genetic Skin Disease; Keratosis Follicularis; Lamellar Ichthyosis Study Status: This study is completed. Sponsor(s): National Cancer Institute (NCI) Purpose - Excerpt: The purpose of this study is to identify the genes responsible for certain scaling disorders and other inherited skin diseases and to learn about the medical problems they cause. In some cases, these may include problems affecting organs other than the skin, such as the eyes, teeth and bones. Patients with inherited skin disorders, including Darier's disease (keratosis follicularis), lamellar ichthyosis, epidermolysis bullosa, cystic acne, and others, and their relatives may be eligible for this study. Patients will have a medical history, physical examination with particular emphasis on the skin, and routine blood tests. Additional procedures for patients and unaffected relatives may include: 1. Blood sample collection 2. Dental exam with X-ray of the jaw 3. Eye examination 4. X-rays of the skull, ribs, chest, hands, feet, spine, arms, or legs 5. Bone density scan 6. Photographs of the skin 7. Skin biopsies (removal of a small tissue sample under local anesthetic) 8. Buccal sample (gentle brushing inside the cheek to collect a cell sample) for gene studies Patients who request the results of their gene testing will be provided this information. Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00001292

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “acne” (or synonyms).

Clinical Trials 73

While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

·

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

·

For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

·

For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

·

For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

·

For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

·

For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

·

For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

·

For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

·

For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

·

For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

·

For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

·

For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

·

For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

·

For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 5. PATENTS ON ACNE Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “acne” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on acne, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Acne By performing a patent search focusing on acne, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will

9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

76 Acne

tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on acne: ·

Acne patch Inventor(s): Buseman; Teri (Minnetonka, MN), Rolf; David (Eden Prairie, MN), McWhorter; Daniel M. (Eagan, MN) Assignee(s): Lec Tec Corporation (Minnetonka, MN) Patent Number: 6,495,158 Date filed: January 19, 2001 Abstract: An adhesive patch is provided wherein the patch includes a flexible backing having a front side and a back side. The patch also includes a therapeutic formulation positioned on and in at least a portion of the front side of the backing such that the therapeutic formulation is partially embedded in at least a portion of the front side of the backing. At least a portion of the backing is treated with a hydrophobic sizing agent such that the portion of the backing that is treated with the hydrophobic sizing agent has a surface energy of about 20 dynes/cm.sup.2 to about 65 dynes/cm.sup.2. The therapeutic formulation includes a topical acne drug, a solvent that dissolves the topical acne drug, and a pressure sensitive adhesive. Excerpt(s): Acne vulgaris is a chronic disorder of the pilosebaceous follicles (apparatus) characterized by comedones (blackheads), papules, pustules, cysts, nodules, and often scars, that appear on the most visible areas of the skin (e.g., the face, chest, back, neck, and upper arms). The pilosebaceous apparatus is largely under the control of endogenous hormones (mainly androgens) which are present in unusually high concentrations in the blood during adolescence and puberty, giving rise to an excessive production of sebum. The condition may worsen by a simultaneous increase in the rate of keratinization of the skin's horny layer (the stratum comeum). As the horny cells proliferate, they can form an occlusive plug or comedone which coupled with the increased production of the sebum, represents an ideal medium for the proliferation of the skin resident strains, such as the Gram positive anaerobic bacterium, Propionibacterium acnes. Eventually, the plugged follicles rupture and allow the discharge of their contents, causing local swelling and inflammation. The exposed follicles may darken from the deposition of pigment from damaged cells in the deeper layer of skin. In severe cases, acne can lead to hospitalization of the patient, extensive discomfort, and long term scarring of the skin.... There are numerous treatments available for treating acne. Typically, acne is treated with topical formulations in the form of creams, gels, emulsions or lotions that contain selected agents. These agents include hormones or hormone agonists and antagonists (EP A1 0 563 813 and U.S. Pat. No. 5,439,923), antimicrobial agents (U.S. Pat. No. 4,446,145, GB 2,088,717, GB 2,090,135, GB 1,054,124, U.S. Pat. No. 5,409,917), salicylic acid (U.S. Pat. No. 4,514,385, U.S. Pat. No. 4,355,028, EP A1 0 052 705, FR-A 2,581,542, and FR-A 2,607,498). The problems associated with topical treatment of acne with creams, gels, emulsions and lotions include, e.g., the lack of precision of the application of the cream, gel, emulsion or lotions and the associated lack of control over precise doses to the target site. The application of a cream, gel, emulsion or lotion typically results in the exposure of an area considerably in excess of that covered by the acne, thereby exposing normal healthy skin to the anti-acne formulation. In addition, creams, gels, emulsions and lotions are messy and inconvenient.... Oral administration of anti-acne agents is currently provided for severe cases of acne. These are reviewed in "Acne, A Review of

Patents 77

Optimum Treatment" by Sykes N. I. and Webster G. F in Drugs 48, 59-70 (1994). Numerous side-effects have been described using oral administration of anti-acne drugs. For example, isotretinoin, which is a derivative of vitamin A has associated risks of teratogenicity and may be a risk for women of childbearing age. Oral administration of antibiotics suited for treating acne may induce the appearance of adverse effects which include abdominal cramps, black tongue, cough, diarrhea, fatigue, irritation of the mouth and other undesirable symptoms. Web site: http://www.delphion.com/details?pn=US06495158__ ·

Acne treatment composition with vasoconstrictor Inventor(s): Fried; Karen G. (Raritan Township, Hunterdon County, NJ) Assignee(s): Ideal Ideas, Inc. (Flemington, NJ) Patent Number: 5,910,312 Date filed: October 9, 1996 Abstract: The acne treatment composition of the present invention includes an effective amount of acne treatment medication selected from the group consisting of benzoyl peroxide and salicylic acid, and effective amount of a vasoconstrictor and an inert carrier. The acne treatment medication is therapeutic to acne conditions by acting as an antibacterial agent. The vasoconstrictor removes the redness normally associated with acne conditions as well as additional redness which may be caused by the benzoyl peroxide itself. The carrier is simply an inert flowing carrier to permit application of the active ingredients to the skin. In preferred embodiments about 1 to 15% of the acne treatment medication based on the total weight of the composition is included. The preferred acne treatment medication is benzoyl peroxide and the preferred vasoconstrictor is tetrahydrozoline hydrochloride or a combination of tetrahydrozoline hydrochloride and zinc sulfate. Excerpt(s): The present invention relates to an acne treatment composition which provides for the treatment of acne conditions (decreases pimple duration or incidence) while rapidly removing redness which is normally manifested with acne conditions.... U.S. Pat. No. 5,470,884 relates to anti-acne compositions having good efficacy, low skin irritation, and good physical and chemical stability. These compositions comprise a benzoyl peroxide, a wetting agent, water, a non-volatile emollient component which is a liquid at 25.degree. C. and which has a weighted arithmetic mean solubility parameter of less than or equal to about 7, and a water soluble or dispersible gelling agent.... U.S. Pat. No. 5,466,446 relates to dermatological conditions that are treated by topically applying to the affected area an effective amount of a combination benzoyl peroxide and clindamycin composition. Web site: http://www.delphion.com/details?pn=US05910312__

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Acne treatment compositions Inventor(s): Singh; Mohinder (Naperville, IL), Wojcik; Michael A. (Plainfield, IL) Assignee(s): Blistex Inc. (Oak Brook, IL) Patent Number: 6,436,417 Date filed: June 25, 2001

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Abstract: A substantially alcohol-free composition for treatment of acne contains about 0.05 to 26% by weight salicylic acid and about 0.05 to 28% by weight of a solubilizing agent for the salicylic acid, which is sodium tetraborate, sodium carbonate or sodium bicarbonate, dissolved in a cosmetically acceptable aqueous medium. Excerpt(s): The invention relates to the field of over-the-counter type acne treatment compositions.... Compositions for treatment of acne vulgaris, white heads, black heads and comedones are well known. Generally, such compositions include a keratolytic agent, such as salicylic acid, which dissolves the intracellular matrix of the treated lesion and causes the lesion to slough off the body as dead tissue.... Salicylic acid has been approved by the US Food and Drug Administration for treatment of acne in concentrations of 0.5 to 2% by weight. Such compositions may be in the form of a gel, lotion, cream or solution to be applied with pads. Web site: http://www.delphion.com/details?pn=US06436417__ ·

Acne treatment including dual-package system Inventor(s): Singh; Mohinder (Naperville, IL), Wojcik; Michael A. (Plainfield, IL) Assignee(s): Blistex Inc. (Oak Brook, IL) Patent Number: 6,544,562 Date filed: June 25, 2001 Abstract: A dual regimen acne treatment package includes an outer container, and disposed within the outer container first and second inner containers which are separate from each other. Each of the inner containers has an exposed dispensing means, the first inner container containing a solubilized salicylic acid acne treatment composition, and the second inner container containing a solubilized benzoyl peroxide acne treatment composition. Excerpt(s): The invention relates to the field of over-the-counter acne treatment compositions.... Compositions for treatment of acne vulgaris, white heads, black heads and comedones are well known. Generally, such compositions include a keratolytic agent, such as salicylic acid, which dissolves the intracellular matrix of the treated lesion and causes the lesion to slough off the body as dead tissue.... Salicylic acid has been approved by the US Food and Drug Administration for treatment of acne in concentrations of 0.5 to 2% by weight. Such compositions may be in the form of a gel, lotion, cream or solution to be applied with pads. Web site: http://www.delphion.com/details?pn=US06544562__

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Acne treatment with multifunctional enzyme Inventor(s): de Faire; Johan R. (London, GB), Franklin; Richard L. (London, GB), Kay; John (Radyr, GB), Lindblom; Ragnvald (Muang Rayong, TH) Assignee(s): Phairson Medical Inc. (London, GB) Patent Number: 5,958,406 Date filed: February 8, 1996 Abstract: The invention relates to a multifunctional enzyme that can be derived from crustaceans or fish. The enzyme has at least one of a chymotrypsin, trypsin, elastase,

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collagenase and exo peptidase activity, and a molecular weight between about 20 kd and about 40 kd as determined by SDS PAGE. Preferably, the multifunctional enzyme has substantial anti cell-cell adhesion activity. Preferably, the multifunctional enzyme has substantial homology with the krill multifunctional enzyme. These enzymes are useful for treating viral infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease and cancer. Additionally, the invention relates to a method of purifying the multifunctional enzyme, and to a preparation of essentially purified multifunctional enzyme. Excerpt(s): The present invention relates to a krill-derived multifunctional enzyme and a family of crustacean and fish derived enzymes having substantial structural similarity to the multifunctional enzyme derived from antarctic krill. The invention additionally relates to the multifunctional enzyme, to methods of purifying the multifunctional enzyme and purified multifunctional enzyme, and to pharmaceutical, cosmetic and other uses of the enzyme.... The enzymes that are substantially structurally similar to the krill-derived multifunctional enzyme have the same utility as the krill enzyme. In particular, these multifunctional enzymes are useful for treating viral infections such as herpes outbreaks, fungal, bacterial or parasitic infections, including the primary and secondary infections of leprosy, colitis, ulcers, hemorrhoids, corneal scarring, dental plaque, acne, cystic fibrosis, blood clots, wounds, immune disorders including autoimmune disease, such as lupus erythematosus and multiple sclerosis, and cancer. The entire disclosures of U.S. patent application Ser. Nos. 08/486,820, 08/338,501 (filed Nov. 22, 1994) and 08/385,540 are incorporated herein by reference.... U.S. Pat. Nos. 4,801,451 and 4,963,491 disclose a mixture of exo- and endopeptidases isolated from antarctic krill (Euphasia superba) and the use of the mixture as cleaning solutions. U.S. Pat. No. 4,801,451 discloses the use of such enzymes to remove foreign matter and dead tissue from wounds. Patent Application WO 85/04809 discloses the use of krill enzymes as a digestion promotor. European Application EP-A1-0170115 discloses the use of krill enzymes to dissolve blood clots. All of these references employ impure or poorly characterized materials. A purified multifunctional enzyme is desirable to provide a pharmaceutically useful product. Web site: http://www.delphion.com/details?pn=US05958406__ ·

Anti-acne cosmetic compositions Inventor(s): Briggs; Gillian Scott (Egham, GB), Crook; Teresa Barbara (Camberley, GB), Smith; Graeme Douglas T. (Windsor, GB) Assignee(s): The Procter & Gamble Company (Cincinnati, OH) Patent Number: 5,976,521 Date filed: February 28, 1997 Abstract: An anti-acne cosmetic composition in the form of a multiple phase water-in-oil emulsion and process for preparing thereof, wherein the composition comprises two or more aqueous phases and a coalescence inhibitor for preventing coalescence of the aqueous phases and wherein at least a first aqueous phase comprises the anti-acne active in the form of an aqueous/alcoholic solution. The composition exhibits moisturisation, anti-acne activityand skin anti-ageing benefits, together with product and colour stability.

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Excerpt(s): The present invention relates to cosmetic compositions. In particular it relates to tinted cosmetic compositions which provide excellent moisturisation, together with improved anti-acne activity and skin anti-ageing benefits and formulation and colour stability.... Skin is made up of several layers of cells which coat and protect the keratin and collagen fibrous proteins that form the skeleton of its structure. The outermost of these layers, referred to as the stratum corneum, is known to be composed of 250.ANG. protein bundles surrounded by 80.ANG. thick layers. Anionic surfactants and organic solvents typically penetrate the stratum corneum membrane and, by delipidization (i.e. removal of the lipids from the stratum corneum), destroy its integrity. This destruction of the skin surface topography leads to a rough feel and may eventually permit the surfactant or solvent to interact with the keratin, creating irritation.... It is now recognised that maintaining the proper water gradient across the statum corneum is important to its functionality. Most of this water, which is sometimes considered to be the stratum corneum's plasticizer, comes from inside the body. If the humidity is too low, such as in a cold climate, insufficient water remains in the outer layers of the stratum corneum to properly plasticize the tissue; and the skin begins to scale and becomes itchy. Skin permeability is also decreased somewhat when there is inadequate water across the stratum corneum. On the other hand, too much water on the outside of the skin causes the stratum corneum to ultimately sorb three to five times its own weight of bound water. This swells and puckers the skin and results in approximately a two to three fold increase in the permeability of the skin to water and other polar molecules. Web site: http://www.delphion.com/details?pn=US05976521__ ·

Anti-acne method and composition Inventor(s): Klein; Robert W. (Fort Washington, PA), Packman; Albert M. (Dresher, PA) Assignee(s): Dermik Laboratories Inc. (Collegeville, PA) Patent Number: 6,013,637 Date filed: June 12, 1998 Abstract: Compositions and methods for the treatment of acne including a peroxide and an antibiotic from the lincomycin family of antibiotics are disclosed. Excerpt(s): This invention relates to a method and pharmaceutical composition useful for the topical treatment of acne.... Acne is a common inflammatory disease which is very common at puberty and which occurs in skin areas where sebaceous glands are largest, most numerous, and most active. In its milder forms, acne is a superficial disorder which is evidenced by slight, spotty irritations, and which can be treated satisfactorily by ordinary skin hygiene. However, pilosebaceous follicles occurs and results in the formation of pustules, infected cysts and, in extreme cases, canalizing inflamed and infected sacs, which may become extensive and leave permanent, disfiguring scars.... Therapeutic methods for treating acne include the systemic and topical administration of anti-acne agents such as antibiotics or derivatives of Vitamin A acid. In all but the severest of cases, system c treatment of acne is not desirable because of side effects. However, systemic methods have been extensively to treat acne because there has not available a topical formulation which possess the level of therapeutic effectiveness desirable to relieve the unsightly symptoms of the acne disease condition. Web site: http://www.delphion.com/details?pn=US06013637__

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Chitosan formulation with azelaic acid and other actives for the treatment of acne Inventor(s): Oester; Dean A. (Cincinnati, OH), Wachter; Rolf (Duesseldorf, DE), Gates; Jeffrey A. (West Chester, OH) Assignee(s): Cognis Corporation (Cincinnati, OH) Patent Number: 6,451,773 Date filed: March 31, 2000 Abstract: A composition for treating acneiform eruption containing: (a) a chitosan having a molecular weight ranging from about 500,000 to about 5,000,000 g/mole and a degree of deacylation greater than 80%; (b) an acid-form active ingredient for treating acne; and (c) water. Excerpt(s): Not Applicable.... Not Applicable.... Acne is a common disease which afflicts the majority of all teenagers, along with a significant number of men and women of adult age. Acne vulgaris occurs most often on oily areas of the skin having high sebaceous gland concentration. These areas include the face, ears, behind the ears, chest, back and occasionally the neck and upper arms. Web site: http://www.delphion.com/details?pn=US06451773__

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Composition and method for treating acne Inventor(s): Barefoot; Susan F. (Liberty, SC), Ratnam; Priya (Clemson, SC) Assignee(s): Clemson University (Clemson, SC) Patent Number: 5,981,473 Date filed: September 12, 1997 Abstract: A method and composition for preventing and treating acne is disclosed. The composition contains an anti-bacterial agent that inhibits the growth of the cutaneous bacteria that are believed to cause acne. In particular, the anti-bacterial agent comprises a bacteriocin produced by Propionibacterium. For instance, in one embodiment, the bacteriocin is produced by the B1264 strain of Propionibacterium jensenii. The bacteriocins of the present invention can be contained in a topical preparation that is applied to the skin. Excerpt(s): The present invention is generally directed to a composition and method for treating acne. More particularly, the present invention is directed to the use of a protein produced by bacteria from dairy or classical propionibacteria that inhibits the growth of bacteria that cause acne.... Acne (formally known as "acne vulgaris") is a skin disease which afflicts, in some form, approximately 80 to 90 percent of all teenagers. Acne can also affect many adults and infants. The severity of acne can range from minor skin lesions called comedones to nodules and cysts which can potentially permanently scar skin tissue.... The areas of the body that are commonly affected by acne are the face, chest and upper back. These areas of the body have a high sebaceous gland concentration which causes the skin to be oily. Web site: http://www.delphion.com/details?pn=US05981473__

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Composition for treating acne Inventor(s): Waltman; Herschel (Jackson, MS) Assignee(s): Waltman Pharmaceuticals Incorporated (Jackson, MS) Patent Number: 5,811,101 Date filed: April 29, 1997 Abstract: A composition for treating acne and related skin conditions which contains salicylic acid and aloe vera which is improved by the addition of an effective amount of a methylxanthine. Preferably, the methylxanthine is derived from mate extract. A method for treating acne with the composition is also provided. Excerpt(s): The present invention relates to improved topical compositions for treating acne, psoriasis and acne related skin conditions. More particularly, there is provided a composition for treating acne which contains salicylic acid, aloe vera and a methylxanthine.... Salicylic acid has been employed in the treatment of acne and related skin conditions for over sixty years. It is classified by the U.S. Food and Drug Administration as a Category I "safe and effective" non-prescription drug for the topical treatment of acne and related seborrheic conditions. However, because salicylic acid has a tendency to cause irritation, the over-the-counter (OTC) concentration is limited to about 2% by weight. Even at a concentration of 2%, salicylic acid can cause irritation, dryness and erythema of the skin.... Aloe vera has been used in the treatment of skin irritations and has been combined with salicylic acid for the treatment of acne. However, Aloe vera alone has only slightly reduced the irritation resulting from the use of salicylic acid. The combination of salicylic acid and aloe vera has still not resulted in the ability to use a salicylic acid concentration greater than two percent (2%). Web site: http://www.delphion.com/details?pn=US05811101__

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Compositions for the treatment of acne containing clindamycin and benzoyl peroxide Inventor(s): Baroody; Lloyd J. (1940 Inverness Dr., Scotch Plains, NJ 07076), Dow; Gordon J. (4189 Chaparral Ct., Santa Rosa, CA 95409), Dow; Debra A. (Petaluma, CA), Lathrop; Robert (Novato, CA) Assignee(s): Baroody; Lloyd J. (Scotch Plains, NJ), Dow; Gordon J. (Santa Rosa, CA) Patent Number: 6,117,843 Date filed: May 13, 1997 Abstract: A pharmaceutical composition containing clindamycin and benzoyl peroxide is disclosed for the treatment of acne. The composition is stable for several months when stored at room temperature. Methods of preparing and of using the composition are disclosed. Excerpt(s): The present invention relates generally to compositions and methods for formulating compositions for treatment of acne. More particularly, the present invention relates to compositions comprising benzoyl peroxide and clindamycin for treatment of acne by topical administration.... Acne is a common skin disorder characterized by blackheads, whiteheads, papules, pustules, cysts, and various sized nodules and scars which, in the inflammatory state of the disorder, are contaminated with bacteria such as Propionibacterium acnes. The disorder effects skin areas where the sebaceous glands are most active, and bacterial infection can occur in the sebaceous follicles.... A variety of acne treatment methods have been developed, D including both systemic and topical

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administration of antibiotics, topical administration of organic peroxides, particularly benzoyl peroxide, and the like. Of particular interest to the present invention is the topical administration of antibiotic compositions and other active ingredients, such as benzoyl peroxide. Web site: http://www.delphion.com/details?pn=US06117843__ ·

Compositions of clindamycin and benzoyl peroxide for acne treatment Inventor(s): Baroody; Lloyd J. (1940 Inverness Dr., Scotch Plains, NJ 07076), Dow; Gordon J. (3868 Lanewood Way, Santa Rosa, CA 95404), Dow; Debra A. (San Rafael, CA), Lathrop; Robert (Novato, CA) Assignee(s): Baroody; Lloyd J. (Scotch Plains, NJ), Dow; Gordon J. (Santa Rosa, CA) Patent Number: 5,733,886 Date filed: April 28, 1994 Abstract: Compositions suitable for the treatment of acne by topical application comprise clindamycin and benzoyl peroxide. Kits for preparing the compositions include a solution of clindamycin in a first container and a gel suspension of benzoyl peroxide in a second container. Each component is stored at a pH which promotes stability, and the combination of the two components provides a final composition having a pH which promotes stability and enhances viscosity. Excerpt(s): The present invention relates generally to compositions and methods for formulating compositions for treatment of acne. More particularly, the present invention relates to compositions comprising benzoyl peroxide and clindamycin for treatment of acne by topical administration.... Acne is a common skin disorder characterized by blackheads, whiteheads, papules, pustules, cysts, and various sized nodules and scars which, in the inflammatory state of the disorder, are contaminated with bacteria such as Propionibacterium acnes. The disorder effects skin areas where the sebaceous glands are most active, and bacterial infection can occur in the sebaceous follicles.... A variety of acne treatment methods have been developed, including both systemic and topical administration of antibiotics, topical administration of organic peroxides, particularly benzoyl peroxide, and the like. Of particular interest to the present invention is the topical administration of antibiotic compositions and other active ingredients, such as benzoyl peroxide. Web site: http://www.delphion.com/details?pn=US05733886__

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Device for the identification of acne, microcomedones, and bacteria on human skin Inventor(s): Margosiak; Marion Louise (Mahwah, NJ), Knaggs; Helen Elizabeth (Fairview, NJ), Aronson; Michael Paul (West Nyack, NY) Assignee(s): Elizabeth Arden Co., Division of Conopco, Inc. (New York, NY) Patent Number: 5,760,407 Date filed: July 31, 1997 Abstract: The invention relates to a device and a method for the identification of fluorescing follicles that can be follicular impactions and/or microcomedones (clinically non-evident acne lesions), and/or comedones (clinically evident acne lesions) and/or bacteria on the face or other skin surface area. The inventive device allows the detection

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of both types of follicular fluorescence (yellow/green and orange/red). For safety reasons, to prevent skin burns and erythema, the filter on the ultraviolet light source removes substantially all the harmful UVB radiation (280-320 nm wavelength range). The filter used in conjunction with the detection means removes reflected and scattered light emanating from the subject's skin surface, thus increasing the sensitivity and discretion of the technique and making fluorescence detection easier and clearer. Excerpt(s): The invention relates to a device and a method for the identification of fluorescing follicles that can be follicular impactions and/or microcomedones (clinically non-evident acne lesions), and/or comedones (clinically evident acne lesions) and/or bacteria on the face or other skin surface area.... Acne affects pilosebaceous follicles within the skin. At least six types of acne are known, e.g., acne vulgaris. Four processes are thought to be involved in the pathogenesis of acne: sebum production, ductal hypercornification, bacterial colonization of a pilosebaceous follicle and inflammation. Clinically, acne is characterized by the appearance of comedones (non-inflamed lesions) and inflamed lesions (papules and pustules). Ductal hypercornification is caused by the increased proliferation of the basal ductal keratinocytes and increased adhesion between the corneocytes of the duct wall. This leads to a build-up of corneocytes in the duct lumen which becomes mixed with sebum produced by the sebaceous gland, resulting in follicular impactions. If the correct conditions prevail, the follicular impactions can develop into comedones. Microcomedones represent an intermediate stage in the development of acne. Comedones are clinically evident, but follicular impactions and microcomedones are not. Once the comedones, or follicular impactions, or microcomedones are formed, the duct lumen offers a suitable microenvironment for colonization by bacteria. The bacteria thought to be responsible for acne is P. acnes.... It is desirable to be able to detect follicular impactions and microcomedones in order to provide a timely skin treatment and to prevent the appearance of comedones. It is also desirable to distinguish between bacteria-populated and non-bacterial follicles, because the treatment may differ depending on the presence or absence of the bacteria within the follicle. Web site: http://www.delphion.com/details?pn=US05760407__ ·

Device for topical treatment of acne and its method of manufacture Inventor(s): Fotinos; Spiros (Athens, GR) Assignee(s): Lavipharm Laboratories Inc. () Patent Number: 6,280,764 Date filed: July 21, 1999 Abstract: A patch for topical application of an anti-acne formulation has in various embodiments a backing film, a release layer and at least one adhesive polymeric matrix layer located between the backing film and the release layer. The anti-acne formulation is uniformly distributed throughout one or more polymeric matrix layers and has an anti-acne effective amount of at least two agents selected from the group consisting of an anti-microbial, an antiseptic, an anti-irritant, a keratolytic agent, a hormone, a hormone agonist and a hormone antagonist. Excerpt(s): A delivery device in the form of patch, and method of its manufacture, is provided for the topical treatment of acne and acneiform diseases.... Acne afflicts 90% of all teenagers but also men and women in their twenties or thirties or may persist throughout adulthood. The process by which acne develops has been described in "New

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Approaches to Acne Treatment" by W. J. Cunliffe, ed. Martin Dunitz, London, 1989.... Acne vulgaris is a chronic disorder of the pilosebaceous follicles (apparatus) characterized by comedones (blackheads), papules, pustules, cysts, nodules, and often scars, that appear on the most visible areas of the skin particularly on the face, chest, back and occasionally neck, and upper arms. Web site: http://www.delphion.com/details?pn=US06280764__ ·

Face pimples prevention method and compositions Inventor(s): Van Moerkerken; Arthur (18761 W. Dixie Hwy., #209, North Miami Beach, FL 33180) Assignee(s): none reported Patent Number: 5,616,617 Date filed: November 27, 1995 Abstract: Disclosed is the method of determining the effectiveness of an agent for the prevention of facial pimples or acne, comprising the steps ofa) administering to a susceptible subject a quantity of a trigger substance reproducibly effective in producing within a period of four hours the appearance of at least two pimples on the face of the subject lasting for at least eight hours in the absence of treatment,b) administering to said subject having received said quantity of trigger substance a predetermined quantity of the agent whose effectiveness is to be determined,c) measuring the number of pimples on the face of the subject upon administering said agent, andd) comparing the number of pimples with and without the administration of said agent.Also disclosed are effective quantities of certain nutrient substances which can reproducibly relieve pimples produced in a susceptible subject by the administration of a trigger substance. Excerpt(s): Thus the sufferer is told that the problem may have any of a number of possible causes, and the probability of success in controlled experimentation attempting to correlate the problem with a particular food is small.... While the disease is stated to be almost universal and the prognosis for eventual healing without scars is considered good, disfiguring or even mild acne may embarass young people and lead to psychological complications, so that supportive counseling for both patients and their parents is often recommended. Specific treatments for superficial acne include cautious mechanical removal of comedones, topical clindamycin solution or other antibiotics, or 5-10% preparations of benzoyl peroxide, considered the best nonprescription topical drug (Merck Manual).... Oral isotretinoin is considered the best treatment for patients in whom treatment with antibiotics is unsuccessful or withvery severe deep acne but is subject to severe side effects and cannot be given to pregnant women because it is teratogenic. Web site: http://www.delphion.com/details?pn=US05616617__

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Formulation and method of manufacturing an acne extraction patch Inventor(s): Chen; Shu-Juan (Hsinchu, TW), Liao; Chao-Wei (Hsinchu, TW), Cheng; Chien-Hsin D. (Hsinchu Hsien, TW) Assignee(s): Caleb Pharmaceuticals, Inc. (Hsinchu, TW) Patent Number: 6,159,493 Date filed: February 11, 1998 Abstract: A formulation and a method for manufacturing an acne extraction patch. Water is added into polyvinyl alcohol and polyvinyl pyrrolidone to form an polymer solution. An adequate excipient is further added to form an optimal formulation. The formulation is coated directly onto the hydrophilic nonwovens or the nonwovens are placed over the release liner after coating the release liner with silicon coating. After the steps described above, the nonwovens are put into the dry oven for a two-step drying method at 55-90.degree. C., and 80-95.degree. C. A die-cut and package machine is used to cut an adequate patch. The patch is moistened with water and applied to the face or nose. The water solution of the formulation penetrates into the hair follicles or sebaceous glands. The lug of acne sticks to the polymer patch as the water evaporates. The acne is extracted from the hair follicle as the patch is removed. Excerpt(s): This application claims priority benefit of Taiwan application Serial no. 86117919, filed Nov. 28, 1997, the full disclosure of which is incorporated herein by reference.... The invention relates to an acne extraction patch, and more particularly to a formulation for an acne extraction patch.... People with oleaginous skin normally have oleaginous face problems, such as shadding of cosmetics, pimples, acne, etc. Skin maintenance already on the market not only decrease but inhibit steaeoexcretion, however, it is not really available so much to solve the cosmetic problem of acne as it is to inhibit stereoexcretion. In order to extract acne from the face, it is a better and direct treatment to extract acne locally. Commercially, available masks are used presently to extract acne. Web site: http://www.delphion.com/details?pn=US06159493__

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Glycolic acid and tretinoin formulation for the treatment of acne Inventor(s): Sklar; Jerald L. (9016 Green Oaks Cir., Dallas, TX 75243) Assignee(s): none reported Patent Number: 5,861,432 Date filed: January 16, 1997 Abstract: A preparation for treating acne containing as active ingredients glycolic acid and tretinoin in an emollient base. Excerpt(s): The present invention relates generally to a topical medication for treating acne and more particularly to a lotion adapted for treating acne vulgaris. This invention is based on Provisional Application No. 60/011,271, entitled "Glycolic Acid and Tretinoin Formulation For the Treatment of Acne" which was filed on Feb. 7, 1996.... Alltrans-retinoic-acid, known as tretinoin or Retin-A, is an extremely photosensitizing agent used for the treatment of normalizing skin since the 1970's. It works intracellularly, and it organizes the skin, exfoliates it and substantially changes the physiology.... Glycolic acid, an alpha-hydroxy acid, is used in many cosmetic products for improved skin appearance. There are two main theories on how glycolic acid works.

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The first theory proposes that the glycolic acid produces a mild subclinical irritation which stimulates the epidermis to produce fresh skin, while the second theory proposes that glycolic acid weakens the intercellular bonding of the corneocytes in a manner similar to both water and retinoids. Unfortunately, little objective data regarding the effectiveness of alpha-hydroxy acid has been published thereby leaving the industry to rely on anecdotal information which is difficult to quantify. It is quite clear that many of the topical cosmetics incorporating glycolic acid or other alpha-hydroxy acids have insufficient concentrations to accomplish their objectives. Web site: http://www.delphion.com/details?pn=US05861432__ ·

Individually packaged disposable single acne pad Inventor(s): Wolfe; David M. (Hollywood, FL) Assignee(s): Circle Laboratories, Inc. (Hollywood, FL) Patent Number: 5,879,693 Date filed: January 30, 1997 Abstract: Packaging an acne packet, which packet will hold just one three inch by three inch square acne pad is disclosed. The three inch square acne pad is folded in half twice to render the size of the acne pad one and one-half inches by one and one-half inches. The, folded pad is thereafter inserted by a packet forming machine utilizing MP3850 paper, foil, and poly carbonate to render the packaged pad ultimately three inches by two and three-quarters by one-eighth to one-quarter inch thick with twenty-two individual packets separated at their lateral edges and then placed in a box. The acne pad itself is 75 gram 149-189 tight waffle Novonette. Each pad is impregnated with 1.56 grams of the treatment solution. The method of forming the pads is to run the three inch ribbon of waffle Novonette through a feeding machine and thereafter dip the same in a solution having as its most active ingredient 0.5% salicylic acid. De-ionized water (75%) and SD Alcohol 40 (24%) make up the major portion of the inactive ingredient. Excerpt(s): The present invention relates to acne pads used primarily for facial cleansing with the intent of removing or reducing dirt or oil and improving the cleanliness of acne blemished skin. The invention further relates to the formation of the pad, the packaging of the pad, the selection of the pad material as well as the cleansing contents, and the proportioning of the same.... Acne pads have been known and marketed for several years. The common form is a plurality of the circular pads soaked in a cleansing solution. The circular pads are stacked on top of each other. Normally the number of pads is fifty to seventy-five. Thereafter, they are packaged in a plastic cylindrical-type jar with a screw top.... Exemplary of the prior art is the "Stridex" (registered trademark of Bayer Corp., Consumer Care Division, Myerstown, Pa.) circular acne pad which are packaged in a stack of fifty-five with a diameter of two and seven-sixteenths inches and held in a re-closable screw top plastic jar. Web site: http://www.delphion.com/details?pn=US05879693__

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Method and composition for treating acne Inventor(s): Fitzjarrell; Edwin A. (68994 N. Pine St., Sisters, OR 97759) Assignee(s): none reported Patent Number: 5,759,559 Date filed: May 5, 1997 Abstract: A method and composition for treating outbreaks of acne. Initially, the acne affected area is cleaned. A topical spray comprising about 1 to 20 grams niacinamide per 100 grams solution in an inert carrier is then applied to the area. A composition that includes lysine, selenium, chromium and zinc and any desired vitamins and minerals is then taken orally in the form of a capsule or tablet. Generally, at least two spray applications are made and two capsules are taken each day. For optimum skin cleaning, an exfoliation scrub such as a conventional apricot facial scrub is applied to the skin prior to application of the niacinamide topical spray. Excerpt(s): This invention relates to methods and compositions for treating acne.... Acne is a skin disorder that occurs most commonly among teen-agers. It consists of various kinds of blemishes on the face, upper chest and back. Severe acne can result in scarring. Acne is most likely in the facial area extending from around the nose to around the chin. This area is also most visible and acne here can be very distressing to the victim.... During early adolescence, hormone production begins that stimulates the oil glands in the skin. These sebaceous glands grow larger and produce more oil. Each sebaceous gland empties into a hair follicle and passes to the skin through a pore. Sometimes the pores become plugged and oil accumulates under the plugs. Pimples and cysts, caused by the acne bacillus, become infected resulting in redness and pus. Cysts may leave permanent scars, as may pimples if squeezed or scratched. Mild acne can be treated with diet changes, careful washing and nonprescription lotions containing benzoyl peroxide, topical creams containing salicylic acid, or other medications. Vitamin A palmitate may be applied topically for the treatment of acne and other skin disorders as described by Lerner in U.S. Pat. Nos. 5,556,887 and 5,520,919. Severe acne may be treated with tetracycline, 13-cis-retinoic acid and other prescription drugs. The skin may be treated with acid or freezing in some cases to make the skin peel. These treatments are often unsuccessful and may have significant side effects. Often, at best, these treatments reduce the intensity or frequency of acne outbreaks. Web site: http://www.delphion.com/details?pn=US05759559__

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Method and composition for treating acne Inventor(s): Sefton; John (Trabuco Canyon, CA) Assignee(s): Allergan Sales, Inc. (Irvine, CA) Patent Number: 6,262,117 Date filed: February 18, 1999 Abstract: The present invention provides a method for treating acne vulgaris by serially applying a topical composition of azelaic acid and a topical composition of benzoyl peroxide. The present invention also provides topical compositions of a peroxide of benzoyl peroxide, and azelaic acid and its derivatives, such as azelaic acid, sodium salt or methylester which are useful for treating acne vulgaris and may be used to simultaneously apply benzoyl peroxide and azelaic acid.

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Excerpt(s): This invention relates to a method and composition for treating acne vulgaris.... Acne vulgaris is an inflammatory disease of the sebaceous glands characterized by an eruption of the skin, often pustular in nature but not suppurative. Acne is a common affliction of the adolescent and affects a small but significant percentage of the adult population. Acne involvement results in unsightly lesions, particularly on the face, and in some cases results in severe scarring.... (c) a bacteriostatic activity so as to inhibit the activity of Propionibacterium acnes. Web site: http://www.delphion.com/details?pn=US06262117__ ·

Method for the treatment of acne Inventor(s): Gans; Eugene H. (Phoenix, AZ) Assignee(s): Medics Pharmaceutical Corporation (Phoenix, AZ) Patent Number: 5,908,838 Date filed: February 19, 1998 Abstract: A method for the treatment of acne is provided which results in the reduction of vestibular side effects following administration of oral tetracycline antibiotics. Excerpt(s): This invention relates to methods for the treatment of acne, and in particular to methods for the treatment of acne involving the use of oral tetracycline antibiotics.... Oral tetracycline antibiotics are frequently used in the treatment of acne. One of the most effective oral tetracycline antibiotics used in the treatment of acne it is minocycline. All tetracycline antibiotics are known to have some side effects. These side effects include vestibular symptoms such as vertigo, dizziness or blurred vision. These effects are sometimes disabling. See, Gould & Brookler, Arch. Otolarang. Vol. 96, p. 291 (1972); Williams et al., Lancet, Sep. 28, 1974, p. 144-45; Fanning & Gump, Arch. Intern. Med., Vol. 136, pp. 761-62 (1976). Headache and general malaise, along with gastro-intestinal symptoms such as the diarrhea, nausea, gas, or cramps also occur. Dry nose and dry mouth are also occasionally encountered.... Dosage forms of oral tetracycline antibiotics are typically constructed with a view towards achieving rapid dissolution rates. Rapid dissolution is believed to be essential to the effectiveness of these drugs. The driving force behind this practice is the understanding that rapid dissolution leads to rapid assimilation through the gut lining, where the antibiotics are then transmitted through the blood stream to the skin, where they are active against bacteria associated with acne. The U.S. Food and Drug Administration (FDA) has established standards for dissolution rates for various oral antibiotics. These standards set minimum dissolution rates. For example, the FDA standard for oral minocycline is that 75 percent of the stated dosage must have dissolved within 45 minutes, under standard U.S. Pharmacopea test conditions. Commercial products are typically engineered to have a dissolution rates which are substantially faster than that required by the FDA. All of this is based upon the generally accepted belief in the art that, while dissolution rates enhance the effectiveness of the antibiotic, once the FDA minimum dissolution rate is achieved, all products have equivalent safety and efficacy. Web site: http://www.delphion.com/details?pn=US05908838__

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Method for treating acne Inventor(s): Taylor; Lesli A. (3708 Sweeten Creek Rd., Chapel Hill, NC 27514), Bass; Ralph L. (3708 Sweeten Creek Rd., Chapel Hill, NC 27514) Assignee(s): none reported Patent Number: 6,350,475 Date filed: April 18, 1997 Abstract: A method for the topical treatment of skin affected with acne, rosacea, or a combination thereof. Sodium chloride in a substantially pure form is topically applied to the affected skin by gently gliding the sodium chloride over the affected skin in a manner insufficient to cause abrasion and debridement of the affected skin. A solid block of about 98% to about 100% by weight sodium chloride free of a carrier and/or free of other topical acne-treatment medicaments and/or free of other topical rosaceatreatment medicaments should be used. The applied sodium chloride is left on the skin. Preferably, the affected skin is pre-moistened with water from shaving, bathing, splashing water on the skin, and the like prior to gliding the sodium chloride thereon. Excerpt(s): The present invention relates, in general, to a method for the topical treatment of acne and/or rosacea. More particularly, the present invention relates to an improved method for the topical treatment of human skin affected with acne and/or rosacea by gently gliding over the affected skin substantially pure sodium chloride.... Acne is a skin disorder caused by bacteria that inflames skin glands and hair follicles of humans. Acne typically occurs during the teenage years due to hormonal changes, but occasionally develops as early as the age of nine and sometimes extends well into the age of the mid-twenties. On the other hand, rosacea, which used to be thought of as a type of acne, has more recently been found to be a skin disorder that, in contrast to acne, dilates facial blood vessels in severe cases in humans and typically occurs at the age of about 30 to about 50. It is not known what causes rosacea.... An excellent discussion of the problems of rosacea afflicting those in the 30 to 50 age group can be found in Stern, "You Don't Have to Live with It", Parade Magazine (Feb. 19, 1995). Stern also discloses that standard acne medications, when topically applied to rosacea-affected skin, generally irritate the skin and induce rosacea flare-ups. Similarly, agents that dilate blood vessels when ingested, for instance, ethanol (drinking alcohol) and certain medications for high blood pressure, can bring on a rosacea blush when ingested by a person affected with rosacea. Untreated, rosacea can result in swollen veins, scattered lumps, and clusters of pustules on the face. Stern concludes with a brief discussion of treatment of rosacea by ingestion of antibiotics and/or by laser beams directly on the rosacea-affected skin to destroy swollen blood vessels. Web site: http://www.delphion.com/details?pn=US06350475__

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Method for treating acne and/or rosacea Inventor(s): Taylor; Lesli A. (820 Churchill, Chapel Hill, NC 27514), Bass; Ralph L. (820 Churchill, Chapel Hill, NC 27514) Assignee(s): none reported Patent Number: 6,352,724 Date filed: March 11, 1996

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Abstract: A method for the topical treatment of skin affected with acne, rosacea, or a combination thereof. Sodium chloride in a substantially pure form is topically applied to the affected skin by gently gliding the sodium chloride over the affected skin in a manner insufficient to cause abrasion and debridement of the affected skin. A solid block of about 98% to about 100% by weight sodium chloride free of a carrier and/or free of other topical acne-treatment medicaments and/or free of other topical rosaceatreatment medicaments should be used. The applied sodium chloride is left on the skin. Preferably, the affected skin is pre-moistened with water from shaving, bathing, splashing water on the skin, and the like prior to gliding the sodium chloride thereon. Excerpt(s): The present invention relates, in general, to a method for the topical treatment of acne and/or rosacea. More particularly, the present invention relates to an improved method for the topical treatment of human skin affected with acne and/or rosacea by gently gliding over the affected skin substantially pure sodium chloride.... Acne is a skin disorder caused by bacteria that inflames skin glands and hair follicles of humans. Acne typically occurs during the teenage years due to hormonal changes, but occasionally develops as early as the age of nine and sometimes extends well into the age of the mid-twenties. On the other hand, rosacea, which used to be thought of as a type of acne, has more recently been found to be a skin disorder that, in contrast to acne, dilates facial blood vessels in severe cases in humans and typically occurs at the age of about 30 to about 50. It is not known what causes rosacea.... An excellent discussion of the problems of rosacea afflicting those in the 30 to 50 age group can be found in Stern, "You Don't Have to Live with It", Parade Magazine, pp. 8 and 10 (Feb. 19, 1995). Stern also discloses that standard acne medications, when topically applied to rosaceaaffected skin, generally irritate the skin and induce rosacea flare-ups. Similarly, agents that dilate blood vessels when ingested, for instance, ethanol (drinking alcohol) and certain medications for high blood pressure, can bring on a rosacea blush when ingested by a person affected with rosacea. Untreated, rosacea can result in swollen veins, scattered lumps, and clusters of pustules on the face. Stern concludes with a brief discussion of treatment of rosacea by ingestion of antibiotics and/or by laser beams directly on the rosacea-affected skin to destroy swollen blood vessels. Web site: http://www.delphion.com/details?pn=US06352724__ ·

Method for treating patients with acne by administering a CGMP-specific PDE inhibitor Inventor(s): Menander; Kerstin B. (Meadowbrook, PA), Mayle; Mark Jeffrey (Warrington, PA) Assignee(s): Cell Pathways, Inc. (Horsham, PA) Patent Number: 6,177,471 Date filed: August 20, 1999 Abstract: Inhibitors of cGMP-specific PDE are useful in the treatment of acne. Excerpt(s): Acne is a skin disease that often scars those afflicted, and can afflict patients at young ages--typically teen years--when their self-images are the most sensitive. The scarring is commonly permanent even if the condition is treated with medications. Some patients experience symptoms well into their adult years.... Acne is believed to be caused typically when the sebaceous glands become clogged due to skin cell debris and an excess of a specific type of skin bacteria. Sebaceous glands are located within the dermis layer of the skin along the hair shaft. Keratin and other chemicals associated

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with the skin can clog the hair shaft and the sebaceous gland. The bacteria, Propionibacterium acnes (P. acnes), which is always present, multiplies to a much greater degree when the sebaceous glands are clogged because the bacteria prefer an anaerobic environment, which is present when the glands become clogged.... P. acnes produces a lipase enzyme that hydrolyzes triglycerides of the sebaceous gland into free fatty acids. The fatty acids along with bacterial proteins and keratin can irritate the skin tissues. This may lead to an inflammatory response and the formation of an acne lesion. Web site: http://www.delphion.com/details?pn=US06177471__ ·

Method for treating patients with acne by administering substituted sulfonyl indenyl acetic acids, amides and alcohols Inventor(s): Menander; Kerstin B. (Meadowbrook, PA), Mayle; Mark Jeffrey (Warrington, PA) Assignee(s): Cell Pathways, Inc. (Horsham, PA) Patent Number: 6,025,394 Date filed: January 29, 1999 Abstract: Substituted indenyl sulfonyl acetic acids, amides, and alcohols are useful in the treatment of acne. Excerpt(s): Acne is a skin disease that often scars those afflicted, and can afflict patients at young ages--typically teen years--when their self-images are the most sensitive. The scarring is commonly permanent even if the condition is treated with medications. Some patients experience symptoms well into their adult years.... Acne is believed to be caused typically when the sebaceous glands become clogged due to skin cell debris and an excess of a specific type of skin bacteria. Sebaceous glands are located within the dermis layer of the skin along the hair shaft. Keratin and other chemicals associated with the skin can clog the hair shaft and the sebaceous gland. The bacteria, Propionibacterium acnes (P. acnes), which is always present, multiplies to a much greater degree when the sebaceous glands are clogged because the bacteria prefer an anaerobic environment, which is present when the glands become clogged.... P. acnes produces a lipase enzyme that hydrolyzes triglycerides of the sebaceous gland into free fatty acids. The fatty acids along with bacterial proteins and keratin can irritate the skin tissues. This may lead to an inflammatory response and the formation of an acne lesion. Web site: http://www.delphion.com/details?pn=US06025394__

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Method for treating skin afflicted with blemishes or acne with a composition comprising distilled wool wax acids and at least one monoglycerol monocarboxylic acid monoester Inventor(s): Traupe; Bernd (Hamburg, DE), Schonrock; Uwe (Norderstedt, DE), Wolf; Florian (Hamburg, DE) Assignee(s): Beiersdorf AG (Hamburg, DE) Patent Number: 5,759,584 Date filed: October 20, 1995

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Abstract: A method for treating skin afflicted with blemishes or acne with a composition comprising distilled wool wax acids and at least one monoglycerol monocarboxylic acid monoester is presented. Excerpt(s): The present invention relates to active compounds and formulations comprising such active compounds which are active against blemished skin.... In addition to other influences, bacterial secondary infections are of etiological importance to blemished skin. One of the most important microorganisms associated with blemished skin is Propionibacterium acnes.... Blemished skin and/or comedones impair the well-being of those affected even in mild cases. Since practically every adolescent is affected-by blemished skin to some degree, there is the need to remedy this state in many persons. Web site: http://www.delphion.com/details?pn=US05759584__ ·

Method for treatment of acne and/or the effects of ageing using HMG-coenzyme Areductase inhibitor and compositions for performing the same Inventor(s): Breton; Lionel (Versailles, FR), De Lacharriere; Olivier (Paris, FR) Assignee(s): L'Oreal (Paris, FR) Patent Number: 5,902,805 Date filed: November 19, 1997 Abstract: A method for the treatment of acne and/or the effects of ageing, by administering, to a subject in need thereof, a composition containing an effective amount of at least one HMG-Coenzyme A-reductase inhibitor in a carrier that is selected from the group consisting of dermatologically acceptable carriers, cosmetically acceptable carriers, and mixtures thereof, and the compositions for performing the method are provided. Excerpt(s): The present invention relates to the use of an HMG-Coenzyme A-reductase inhibitor as an active anti-ageing agent, in or for the manufacture of a cosmetic and/or dermatological composition, its use in order to treat the effects of ageing and acne and to a topical composition containing the same in combination with an active agent possessing desquamating properties, acting in synergy.... Ageing of the skin is the result of the effects of intrinsic and extrinsic factors on the skin. Clinically, the signs of ageing are reflected by the appearance of wrinkles and fine lines, by a slackening of cutaneous and subcutaneous tissue, by a loss of skin elasticity, by atonia of the skin texture and by yellowing of the skin, which becomes duller and lacking in radiance. On areas of skin which have been exposed to the sun throughout life--essentially the face, neckline, hands and forearms--pigmentation marks, telangiectasias and elastosis are often observed.... Some of these signs are more particularly associated with intrinsic or physiological ageing, (ageing associated with physical age), whereas others are more specific to extrinsic ageing, (ageing caused generally by the environment). Extrinsic ageing more particularly concerns photo-ageing due to exposure to the sun, to light or to any other radiation. Web site: http://www.delphion.com/details?pn=US05902805__

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Method of treating acne conditions Inventor(s): Fried; Karen G. (Raritan Township, Hunterdon County, NJ) Assignee(s): Ideal Ideas, Inc. (Flemington, NJ) Patent Number: 5,753,637 Date filed: January 8, 1997 Abstract: The acne treatment method of the present invention includes applying to skin a composition including an effective amount of acne treatment medication selected from the group consisting of benzoyl peroxide and salicylic acid, an effective amount of a vasoconstrictor and an inert carrier. The acne treatment medication is therapeutic to acne conditions by acting as an antibacterial agent. The vasoconstrictor removes the redness normally associated with acne conditions as well as additional redness which may be caused by the benzoyl peroxide itself. The carrier is simply an inert flowing carrier to permit the application of the active ingredients to the skin. In preferred embodiments about 1 to 15% of the acne treatment medication based on the total weight of the composition is included. The preferred acne treatment medication is benzoyl peroxide and the preferred vasoconstrictor is tetrahydrozoline hydrochloride or a combination of tetrahydrozoline hydrochloride and zinc sulfate. Excerpt(s): The present invention relates to a method of treating acne conditions using an acne treatment composition which provides for the treatment of acne conditions (decreases pimple duration or incidence) while rapidly removing redness which is normally manifested with acne conditions.... U.S. Pat. No. 5,470,884 relates to anti-acne compositions having good efficacy, low skin irritation, and good physical and chemical stability. These compositions comprise a benzoyl peroxide, a wetting agent, water, a non-volatile emollient component which is a liquid at 25.degree. C. and which has a weighted arithmetic mean solubility parameter of less than or equal to about 7, and a water soluble or dispersible gelling agent.... U.S. Pat. No. 5,466,446 relates to dermatological conditions that are treated by topically applying to the affected area an effective amount of a combination benzoyl peroxide and clindamycin composition. Web site: http://www.delphion.com/details?pn=US05753637__

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Method of treating acne vulgaris using avermectin compound Inventor(s): Parks; L. Dean (2420 SE. 15th St., Ocala, FL 34471) Assignee(s): none reported Patent Number: 6,399,652 Date filed: November 19, 2001 Abstract: Methods for treating acne vulgaris are disclosed. The treatment includes topical application of a dermatological composition containing an avermectin compound to the affected areas of a patient alone, or in conjunction with other conventional methods of treating acne vulgaris. The dermatological composition contains an avermectin compound in a pharmaceutically acceptable carrier, including water, glycols, alcohols, lotions, creams, gels, emulsions, sprays, soaps, body washes, facial cleansers, and facial masks. Excerpt(s): The present invention relates to methods for treating acne vulgaris, particularly with topical treatment using avermectin compound.... Acne vulgaris, known as acne by the general public, is a common and multifaceted skin disorder of the

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hair follicles and sebaceous glands. Although it affects almost 100% of adolescents to varying degrees and generally wanes as adolescence ends, the disease may persist into adulthood. Adult women, in particular, may be affected and may experience premenstrual flares. However, severe acne vulgaris tends to be more common in adolescent males than in people of other age-groups.... At least four factors contribute to the development of acne: follicular plugging, increased sebum production by the sebaceous glands, colonization of the sebaceous follicles with Propionibacterium acnes, and inflammation. Propionibacterium acnes is the most common gram-positive, nonspore forming bacteria, a common resident of the pilosebaceous glands of the human skin. It is the causative agent of acne vulgaris. Web site: http://www.delphion.com/details?pn=US06399652__ ·

Method of treating acne with 5-.alpha. reductase inhibitors Inventor(s): Gormley; Glenn J. (Westfield, NJ), Kaufman; Keith D. (Westfield, NJ), Stoner; Elizabeth (Westfield, NJ), Waldstreicher; Joanne (Scotch Plains, NJ) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 6,174,892 Date filed: November 24, 1999 Abstract: The instant invention involves a method of treating and/or reversing androgenic alopecia and promoting hair growth, and methods of treating acne vulgaris, seborrhea, and female hirsutism, by administering to a patient in need of such treatment a 5.alpha.-reductase 2 inhibitor, such as finasteride, in a dosage amount under 5 mgs/day. Excerpt(s): Certain undesirable physiological manifestations, such as acne vulgaris, seborrhea, female hirsutism, androgenic alopecia which includes female and male pattern baldness, and benign prostatic hyperplasia, are the result of hyperandrogenic stimulation caused by an excessive accumulation of testosterone ("T") or similar androgenic hormones in the metabolic system. Early attempts to provide a chemotherapeutic agent to counter the undesirable results of hyperandrogenicity resulted in the discovery of several steroidal antiandrogens having undesirable hormonal activities of their own. The estrogens, for example, not only counteract the effect of the androgens but have a feminizing effect as well. Non-steroidal antiandrogens have also been developed, for example, 4'-nitro-3'-trifluoromethylisobutyranilide. See Neri, et al., Endocrinol. 1972, 91 (2). However, these products, though devoid of hormonal effects, compete with all natural androgens for receptor sites, and hence have a tendency to feminize a male host or the male fetus of a female host and/or initiate feed-back effects which would cause hyperstimulation of the testes.... The principal mediator of androgenic activity in some target organs, e.g. the prostate, is 5.alpha.-dihydrotestosterone ("DHT"), formed locally in the target organ by the action of testosterone-5.alpha.-reductase. Inhibitors of testosterone-5.alpha.reductase will serve to prevent or lessen symptoms of hyperandrogenic stimulation in these organs. See especially U.S. Pat. No. 4,377,584 assigned to Merck & Co., Inc., issued Mar. 22, 1983. It is now known that a second 5.alpha.-reductase isozyme exists, which interacts with skin tissues, especially in scalp tissues. See, e.g., G. Harris, et al., Proc. Natl. Acad. Sci. USA, Vol. 89, pp. 10787-10791 (November 1992). The isozyme that principally interacts in skin tissues is conventionally designated as 5.alpha.-reductase 1 (or 5.alpha.-reductase type 1), while the isozyme that principally interacts within the prostatic tissues is designated as 5.alpha.-reductase 2 (or 5.alpha.-reductase type 2)....

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Finasteride (17.beta.-(N-tert-butylcarbamoyl)-4-aza-5.alpha.-androst-1-ene-3-one), which is marketed by Merck & Co., Inc. under the tradename PROSCAR.RTM., is an inhibitor of 5.alpha.-reductase 2 and is known to be useful for the treatment of hyperandrogenic conditions. See e.g., U.S. Pat. No. 4,760,071. Finasteride is currently marketed in the United States and worldwide for the treatment of benign prostatic hyperplasia. Finasteride's utility in the treatment of androgenic alopecia and prostatic carcinoma is also disclosed in the following documents: EP 0 285,382, published Oct. 5, 1988; EP 0 285 383, published Oct. 5, 1988; Canadian Patent no. 1,302,277; and Canadian Patent no. 1,302,276. The specific dosages exemplified in the above-noted disclosures varied from 5 to 2000 mg per patient per day. Web site: http://www.delphion.com/details?pn=US06174892__ ·

Non-irritating composition for treating acne and other skin conditions Inventor(s): O'Halloran; David P. (Milltown, NJ), Rudtke; Deborah (Hillsdale, NJ), Mayes-Smith; Joyce (North Brunswick, NJ) Assignee(s): Bristol-Myers Squibb Company (New York, NY) Patent Number: 6,168,798 Date filed: February 3, 1997 Abstract: The invention provides methods and compositions which are mild and nonirritating for reducing and eliminating skin disorders, particularly blemishes and redness associated with acne. The hydroalcoholic compositions of the invention contain a keratolytic compound, preferably a.beta.-hydroxy carboxylic acid, more preferably salicylic acid or pharmaceutically acceptable salt thereof; and a glycerophosphate ester or salt, formulated with pharmaceutically acceptable carriers. Preferred glycerophosphate salts for use in the methods and compositions of the invention are sodium glycerophosphate and calcium glycerophosphate. Additional anti-irritancy agents are not required in the compositions of the present invention, as the glycerophosphate salt component uniquely endows the compositions with nonirritant properties. Other components which may be formulated into the compositions of the invention include fragrances, colorants, emollients, humectants and antimicrobial agents. Excerpt(s): The invention relates generally to compositions and methods for topical application to the skin to treat conditions, such as acne, which often cause blemishes, pimples and redness.... Aging, hormonal changes, and approaching adolescence often cause unsightly and embarrassing skin conditions which take the form of pimples, blemishes, pustules and reddened areas. These skin problems take their toll not only in emotional anxiety and distress but also in physical marring of the skin, sometimes associated with pain, in both juveniles and adults. Age-related skin problems can arise either from disease or illness, or as a consequence of hormonal changes. Skin problems can be exacerbated by environmental influences such as, for example, improper diet, stress or tension, and lack of sleep. Disease conditions include dry skin, ichthyosis, eczema, palmar and plantar hyperkeratoses, dandruff, acne and warts. Skin changes associated with aging can result in such symptoms as age spots, wrinkling and related aging changes.... A number of issued patents disclose the use of.alpha.-hydroxy acids and salts such as lactic and glycolic acids, for the treatment of diseased and nondiseased skin and wrinkles (U.S. Pat. Nos. 4,105,782, 4,105,783, 4,021,572, 3,879,537, 3,920,835, 3,984,566 and 3,988,470 to Van Scott and Yu and U.S. Pat. No. 5,091,171 to Yu et al.). These patents focus primarily on.alpha.-hydroxy acids of lower molecular weight.

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Ammonium salts were found to be more effective than the free acid, and both of the aforementioned forms were said to be substantially better than the alkali metal salts. A problem with the use of these compounds is that the levels at which the.alpha.-hydroxy acids are most effective in commercial products results in a stinging sensation and even redness after application on the skin. Indeed, the stinging and redness is reputed to be an indication to the user that the product is working. However, those who use products containing.alpha.-hydroxy acids and salts and apply them to their skin would rather have performance without such side effects. Web site: http://www.delphion.com/details?pn=US06168798__ ·

Oral and topical compositions and methods related thereto in the treatment of acne Inventor(s): Mann; Morris (21669 N. 57th Ave., Glendale, AZ 85308) Assignee(s): none reported Patent Number: 6,558,656 Date filed: March 26, 2002 Abstract: Described are compositions and methods for the treatment of acne. The method and compositions comprise an orally ingested composition containing thymic peptides, vitamins, and minerals. Zinc, pantothenic acid, magnesium, pyridoxine, vitamins A and D, riboflavin, and folic acid are found to be essential to the composition. Also described is a topical composition comprising pantothenic acid that, when used in conjunction with the oral composition, resulted in a better response than either the oral or topical composition alone. Excerpt(s): The present invention generally relates to oral and topical compositions and methods for the treatment of acne. More specifically, the present invention generally relates to compositions and methods for the treatment of acne by oral treatment with a composition comprising containing thymosin fraction 5 preparation plus other beneficial ingredients, such as vitamins and the like, and concomitant use of novel topical compositions.... Acne is considered by those afflicted to be a serious problem. At some point 80% of all individuals, both male and female, experience acne. Although the vast majority of individuals afflicted with acne have spontaneous resolution of the problem over time, the effects of this skin disorder can be emotionally scarring. Some people, however, have active acne, until their mid-fifties. Likewise, in the last 20 years, for reason that are currently unknown, there has been a dramatic increase in acne affecting women over the age of 30.... Many causes have been proposed for acne. However, for a cause to have true validity, the treatment resolving the hypothesized cause must prove to be effective in the vast majority of cases. Causes that have been proposed include, but are not limited to: diet, hormonal disregulation, stress, bacterial overgrowth, heredity and environmental exposure; all of which may cause a deficiency of Coenzyme A. In no case has a treatment designed for any of the aforementioned causes proven to be uniformly effective. The only treatment that is proven effective in the vast majority of cases is the oral administration of isotretinoin (Accutane.TM.). This medication, however, has numerous side effects; the most disturbing of which being its potential to induce sever birth defects. Web site: http://www.delphion.com/details?pn=US06558656__

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Pharmaceutical compositions and methods for treating acne Inventor(s): Murad; Howard (4316 Marina City Dr., Marina del Rey, CA 90292) Assignee(s): none reported Patent Number: 5,962,517 Date filed: January 30, 1998 Abstract: This invention relates to a pharmaceutical composition for the treatment of acne having an acne reduction component in an amount sufficient to reduce the redness and blemishes associated with acne. The invention also relates to pharmaceutical compositions having, in addition to the acne reduction component, a skin cell conditioning component in an amount sufficient to properly regulate the keratin and sebum production of the skin cells, thereby inhibiting the appearance of acne. In a preferred form, the skin cell conditioning component is a chromium component. In another preferred form, the composition further includes at least one of a vitamin C source, burdock root, yellow dock root, horsetail extract, a catechin-based composition, a vitamin B.sub.1 source, a vitamin B.sub.2 source, a vitamin B.sub.3 source, a vitamin B.sub.5 source, and a vitamin E source. In a more preferred form, the invention also includes at least one amino acid component, a magnesium component, a selenium component, and biotin. The invention also relates to methods for treating acne by administering, alone or in conjunction with another composition, the pharmaceutical compositions in an amount therapeutically effective in reducing the incidence of acne and methods for additionally inhibiting the appearance of acne by conditioning skin cells. Excerpt(s): This invention relates to pharmaceutical compositions for treating acne and conditioning the skin cells in patients. The invention further relates to methods of treating acne and conditioning skin cells by administering the pharmaceutical compositions to the patient.... The mammalian skin, in particular, human skin, is a multifunctional organ. Not only does the skin provide an external covering to protect the body, but it also performs several specialized functions, such as breathing, perspiring, sensory information processing, and oil production. ›D. Mowery, The Scientific Validation of Herbal Medicine, 248 (1986)!. Oil production, essential to the protective features of the skin, works when an oily substance known as sebum is released from the sebaceous glands, which are large glands located at the base of a hair follicle. This permits the skin to moisturize and waterproof itself, thereby protecting itself from the environment. ›J. Whitaker, Dr. Whitaker's Guide to Natural Healing, 141, (1995)!.... Unfortunately, puberty adversely affects the production of sebum, which in some cases is caused by increased levels of testosterone in both males and females. For example, testosterone stimulates the sebaceous glands accompanying the hair follicles. In response, these glands become enlarged and begin to secrete more sebum than usual. Also, testosterone causes the cells lining a pore to release more keratin, an insoluble protein that is the primary constituent of the hair and the epidermis. Together, the sebum and keratin block a skin pore, resulting in a comedone, also known as a blackhead. Bacteria proliferates in clogged pores, and the body typically responds by releasing enzymes to breakdown the sebum. The enzymes cause the pore to become inflamed. This eventually may result in pustules or pimples. This condition is typically known as acne vulgaris. ›Id.!. This response is especially prevalent on the face, back, and shoulders, where a greater amount of sebaceous glands exist. Web site: http://www.delphion.com/details?pn=US05962517__

Patents 99

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Potassium-containing composition useful in the treatment of acne, psoriasis and seborrhea Inventor(s): Oge; Eray (11 Clamshell La., Northport, NY 11768), Goodwin; Gary (31 Brushwood Dr., Shirley, NY 11967-4009) Assignee(s): none reported Patent Number: 5,955,067 Date filed: July 23, 1996 Abstract: A composition is disclosed which is useful in alleviating, at least in part, symptoms of acne vulgaris, psoriasis or seborrhea, which includes a potassium-based compound a dermatologically acceptable base for the potassium-based compound, which is preferably a potassium salt, and which include potassium acetate, potassium aluminate, potassium arsenite solution, potassium bicarbonate, potassium bisulfate potassium bitartararte, potassium bromide, potassium carbonate, potassium chloride, potassium citrate, potassium gluconate, potassium glycerophosphate, potasium iodate, potassium iodide, potassium manganate, potassium permanganate, potassium phosphate monobasic potassium phosphate dibasic, potassium phosphate tribasic, potassium phosphite or a combination thereof. The composition is topically applied to the areas of a patient's skin which are afflicted with any of acne vulgaris, psoriasis or seborrhea. Excerpt(s): The present invention relates, generally to a composition containing potassium and its use for alleviating, at least in part, the symptons of acne, psoriasis and seborrhea, as well as a method for its use.... More particularly, the present invention relates to a composition containing potassium, which is applied topically to a person's skin in area afflicted with acne, psoriasis or seborrhea for the purpose of reducing the effects of such skin ailments.... Acne vulgaris is a common inflammatory pilosebaceous skin disease characterized by comedones, papules, pustules, inflamed nodules, superficial pus filled cysts and in extreme cases canalizing and deep inflamed sacks. Web site: http://www.delphion.com/details?pn=US05955067__

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Process and apparatus for the cosmetic treatment of acne vulgaris Inventor(s): Kohler; Wolfgang (Schnaittach, DE) Assignee(s): SLI Lichtsysteme GmbH (Erlangen, DE) Patent Number: 6,183,500 Date filed: December 3, 1998 Abstract: A process and an apparatus for the cosmetic treatment of acne vulgaris utilize irradiation of the affected skin areas with light characterized by a combination of two emission spectra, one in a blue region and the other in a red region. Excerpt(s): This invention discloses a process for the cosmetic treatment of acne vulgaris by irradiation of the affected skin areas with light and an apparatus for the application of the process.... A known process uses UV light for the irradiation of the face. This, however, has the possible disadvantage of erythema formation or an undesirable oxidation of skin pigments.... Also known is a treatment with a cream containing approximately 0,5% benzoyl peroxide. The disadvantage of this treatment is possible skin dryness.

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Web site: http://www.delphion.com/details?pn=US06183500__ ·

Short contact treatment for acne Inventor(s): Bershad; Susan (2 Stonebridge Rd., Montclair, NJ 07042) Assignee(s): none reported Patent Number: 6,017,938 Date filed: July 28, 1998 Abstract: The present invention relates to a method of treating acne using short-term contact with an acetylenic retinoid, preferably tazarotene and related compounds. Excerpt(s): The present invention is directed to the treatment of various chronic and acute skin conditions, particularly acne and photoaging.... There is presently in use an FDA approved treatment for acne employing tazarotene topical gel that is marketed by Allergan, Inc. under the brand name Tazorac.TM..... Tazarotene is a retinoid prodrug which is converted to its active form--the cognate carboxylic acid of tazarotene (AGN 190299)--by rapid deesterification in most biological systems. AGN 190299 binds to all three members of the retinoic acid receptor (RAR) family; RAR.sub..alpha. RAR.sub..beta. and RAR.sub..gamma., but shows relative selectivity for RAR.sub..beta. and RAR.sub..gamma., and may modify gene expression. The clinical significance of these findings is not known. Web site: http://www.delphion.com/details?pn=US06017938__

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Short contact treatment of acne with topical retinoids Inventor(s): Bershad; Susan (2 Stonebridge Rd., Montclair, NJ 07042) Assignee(s): none reported Patent Number: 6,096,765 Date filed: November 18, 1999 Abstract: The present invention relates to a method of treating acne and using shortterm contact with a topically-applied retinoid composition. Excerpt(s): The present invention is directed to the treatment of various chronic and acute skin conditions, particularly acne and photoaging using topical retinoids.... The retinoids are a family of compounds including vitamin A, retinoic acid (RA), related derivatives of these, and other compounds capable of binding to retinoic acid receptors (RAR). RA, which is a natural metabolite of vitamin A (retinol), is known as a potent modulator (i.e., an inhibitor or, to the contrary, a stimulator, depending on the nature of the cells treated) of the differentiation and proliferation of many normal or transformed cell types. All-trans-RA (tretinoin) acts on the differentiation and proliferation of cells by interacting with RARs contained in the cell nucleus. There are, to date, three identified subtypes of known RAR receptors, respectively termed RAR-.alpha., -.beta., -.gamma.. These receptors, after binding the RA ligand, interact with the promoter region of genes regulated by RA at specific response elements. To bind to the response elements, the RARs heterodimerize with another type of receptor designated as RXR. The natural ligand of RXRs is 9-cis-retinoic acid.... Many retinoids are known and have been described to date. Generally, retinoids can be identified by their ability to bind RARs, either as all the RARs or selectively to an individual RAR class. Further, retinoids exhibit

Patents 101

a diverse spectrum of activities. Among these is use as a topical therapeutic for treatment of skin conditions. Web site: http://www.delphion.com/details?pn=US06096765__ ·

Therapeutic method for treating acne or isolated pimples and adhesive patch therefor Inventor(s): Hymes; Alan C. (Mount Vernon, WA) Assignee(s): LecTec Corporation (Minnetonka, MN) Patent Number: 6,455,065 Date filed: May 18, 1999 Abstract: The skin disorder acne, as well as one or more isolated pimples, are treated by applying to the skin, over the skin disorder, a flexible moisture-containing hydrophilic hydrogel patch that includes a backing support such as paper, cloth or plastic and a water-based hydrogel layer applied to the backing. The hydrogel layer comprises a hydrophilic natural or synthetic polymer dispersed in water to provide body and can be a tacky adhesive. The polymer can comprise any high molecular weight hydrophilic carbohydrate such as karaya, cornstarch, or kelp and/or a synthetic hydrophilic polymer such as polyacrylamide or polyacrylic acid. A humectant such as an alcohol containing two or more hydroxyl groups, i.e., a polyhydric alcohol, keeps the adhesive layer moist. A solute such as salt, protein, sugar or an alcohol is dissolved in the water in a quantity sufficient to raise the osmotic pressure enough to maintain the adhesive hydrogel layer in a hypertonic state with respect to the underlying skin tissue. The hydrogel adhesive which hydrates the upper layer of skin forms a hydrophilic bridge with the patient's skin that allows fluid to be drawn by osmotic pressure from the skin disorder through the normally dry stratum corneum into the patch. Another aspect of the invention is the a hypertonic moisture-containing adhesive patch itself. Excerpt(s): This invention relates to a method and therapeutic adhesive patch product for treating pimples and/or acne.... Acne is a common inflammatory pilosebaceous disease characterized by comedones, papules, pustules, inflamed nodules, superficial pus-filled cysts, and (in extreme cases) canalizing and deep, inflamed, sometimes purulent sacs. Acne involves an interaction between hormones, keratinization, sebum, and bacteria that somehow determines the course and severity of acne. It often begins at puberty, when the increase in androgens causes an increase in the size and activity of the pilosebaceous glands. The earliest microscopic change is thought to be intrafollicular hyperkeratosis, which leads to blockage of the pilosebaceous follicle with consequent formation of the comedo, composed of sebum, keratin, and microorganisms, particularly Propionibacterium acnes. Lipases from P. acnes break down triglycerides in the sebum to form free fatty acids (FFA), which irritate the follicular wall. Retention of sebaceous secretions and dilation of the follicle may lead to cyst formation. Rupture of the follicle, with release of FFA, bacterial products and keratin constituents into the tissues, includes an inflammatory reaction that may result in abscess that heals with scars in severe cases. When the condition is less severe, it may merely involve an occasional isolated pimple. However, the underlying pathology is similar to that described above.... Current treatment begins by washing of the skin. However, even vigorous washing of the skin leaves behind billions of bacteria, yeasts and fungi that cannot be dispossessed no matter how vigorously one scrubs. Bacteria which is normally found deep in the hair follicles is harmless most of the time. However, during adolescence, when the sebaceous glands become particularly active, these bacteria can proliferate and cause an outbreak of acne. Current treatment often includes the use of

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specific follicular drugs such as benzoyl peroxide or retinoic acid; the removal of comedones; or the use of antibodies such as tetracycline, erythromycin, chlorohexidine gluconate, or oral isotretinoin. Present therapeutic methods are generally recognized as not entirely satisfactory. After treatment, many patients still continue to suffer from the symptoms of acne or pimples. Web site: http://www.delphion.com/details?pn=US06455065__ ·

Topical anti-acne composition Inventor(s): Burgess; Nelson Leon (120-8E Einstein Loop North, Bronx, NY 10475) Assignee(s): none reported Patent Number: 5,837,270 Date filed: August 26, 1996 Abstract: The present invention relates to a topical anti-acne formulation comprising, in a pharmaceutically acceptable carrier, a compound of the formula C.sub.6 H.sub.2 ClOHR.sup.1 R.sup.2, wherein R.sup.1 and R.sup.2 are each independently C1 to C7 alkyl, C3 to C7 cycloalkyl or C3 to C7 aryl, and zinc oxide. The preferred formulation contains 4-chloro-3,5-dimethylphenol and zinc oxide. Excerpt(s): The present invention relates to the field of treating the skin condition known as acne. More specifically, the present invention is concerned with the prophylactic or therapeutic topical treatment of acne. Even more specifically, the present invention is concerned with the topical treatment of such skin disorders as acne vulgaris, other acneiform dermal disorders, e.g. preadolescent acne, acne rosacea (now known as rosacea), premenstrual acne, acne venenata, acne cosmetica, acne detergicans, acne cosmetica, acne excoriee, gram negative acne, steroid acne, acne conglobata, or nodulocystic acne. The present invention can also be used for topically treating certain other types of acneiform dermal disorders, e.g. perioral dermatitis, seborrheic dermatitis in the presence of acne, gram negative folliculitis, sebaceous gland dysfunction, hiddradenitis suppurativa, pseudo-folliculitis barbae, or folliculitis.... The present invention relates to topically applied medicinal compositions and more particularly refers to such compositions having, as active topical medicinal ingredients, zinc oxide and a compound of the formula C.sub.6 H.sub.2 ClOHR.sup.1 R.sup.2, wherein R.sup.1 and R.sup.2 are each independently C1 to C7 alkyl or C3 to C7 cycloalkyl or aryl.... Acne vulgaris is a common disease which afflicts approximately 90% of all teenagers and, not uncommonly, affects men and women in their twenties or thirties or may persist in adults for many years. Acne vulgaris most commonly occurs on oily areas of the skin with high sebaceous gland concentration. The areas of high sebaceous gland concentration are the face, ears, retroauricular areas (e.g. behind the ears), chest, back and occasionally the neck and upper arms. Web site: http://www.delphion.com/details?pn=US05837270__

Patents 103

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Topical anti-acne composition Inventor(s): Popp; Karl F. (1775 Duck Pond Rd., Schodack Landing, NY 12156), Stiefel; Brent D. (8400 School House Rd., Miami, FL 33143) Assignee(s): none reported Patent Number: 6,433,024 Date filed: May 8, 2000 Abstract: The present invention is directed towards a topical composition for the treatment of acne comprising water, an organic peroxide, an alpha hydroxy acid, a moisturizer, an isosorbide and a detergent. This invention also is directed to a method of making the composition of this invention. The method involves (1) heating water to between 60.degree. C. and 70.degree. C. (2) adding a detergent base to the water and mixing the solution; (3) cooling the solution and adding an alpha hydroxy acid, an isosorbide and sodium pyrollidone carboxylate; (4) continuing to cool the solution to between 25.degree. C. and 35.degree. C. and then adding benzoyl peroxide and a preservative to the solution; (5) mixing and milling the product until smooth; and (6) adjusting the pH of the product to a pH of 3-5 with a base. This invention also is directed towards a method for treating a patient afflicted with acne by applying the composition of this invention to the affected areas of the patient's skin. Excerpt(s): This invention relates to topical compositions for the treatment of acne.... Acne and seborrhea are conditions of the skin characterized by an excessive flow of sebum from the sebaceous glands. Sebum reaches the skin surface through the duct of the hair follicle. The presence of excessive amounts of sebum in the duct and in the skin acts to block the continuous flow of sebum from the follicular duct. This produces a thickening of the sebum which becomes a comedone. Comedone formation is followed by hyperkeratinization of the follicular opening, completely closing the duct. The usual result is a papule, a pustule, or a cyst, often contaminated with bacteria which cause secondary infections.... Many topical therapeutic agents are used in the treatment of acne and seborrhea to prevent the blocking of the follicular duct, to reopen the duct once it has become blocked, to act against the infecting bacteria or the thickened sebum, or to provide combinations of each of these actions. Therapeutic agents which act to prevent the blocking of the follicular duct by promoting the removal or scuffing off of excess keratin are known as keratolytic agents. For example, the use of sulfur as a mild irritant to remove the horny layer of skin, and with it the debris clogging the follicular openings, is well known. Web site: http://www.delphion.com/details?pn=US06433024__

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Topical application of muscarinic agents such as neostigmine for treatment of acne and other inflammatory conditions Inventor(s): El Khoury; Georges F. (1561 Ramillo Ave., Long Beach, CA 90815) Assignee(s): none reported Patent Number: 5,994,330 Date filed: November 9, 1998 Abstract: Treatment of acne through topical administration is an aspect of the present invention. Specifically, muscarinic agents may be applied in any therapeutically acceptable carrier including gels, creams, lotions, and sprays. Therapeutic effects

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observed with the present invention include decrease in redness, swelling, and inflammation. Treatment of other inflammatory conditions is also disclosed. Treatment of suitable conditions in accordance with the present invention results in significant improvements in healing of those conditions. Excerpt(s): The present invention is direction to the treatment of acne and other inflammatory conditions. More specifically, in some embodiments this invention relates to methods for treating acne which methods comprise the topical application of muscarinic agents such as neostigmine. Treatment in accordance with the present invention results in improved healing in the treated area.... Acne is one example of inflammatory conditions which may be treated in accordance with the present invention.... Acne is a multi factorial disease affecting the sebaceous follicle and characterized by papules, pustules, and scars. Acne affects nearly 90% of 16-year old boys and girls but is clearly no longer a problem confined to teenagers. Recently for this condition, referral for specialists' opinions have significantly increased among people over the age of 20. It has been realized that simple attention to hygiene is no longer sufficient, and antiseptic washes so popular some years ago are now perceived as ineffective by many sufferers and most clinicians. Web site: http://www.delphion.com/details?pn=US05994330__ ·

Topical application of opioids for treatment of acne and sebaceous gland disorders Inventor(s): Elkhoury; George F. (1561 Ramillo Beach Ave., Long Beach, CA 90815) Assignee(s): none reported Patent Number: 5,834,480 Date filed: June 13, 1997 Abstract: Treatment of acne through topical administration is an aspect of the present invention. Specifically, opioids may be applied in any therapeutically acceptable carrier including gels, creams, lotions, and sprays. Therapeutic effects observed with the present invention include decrease in redness, swelling, and inflammation. Treatment of other inflammatory conditions is also disclosed. Treatment of suitable conditions in accordance with the present invention results in significant improvements in healing of those conditions. Excerpt(s): The present invention is directed to the treatment of acne and other inflammatory conditions. More specifically, in some embodiments this invention relates to methods for treating acne which methods comprise the topical application of opioids. Treatment in accordance with the present invention results in improved healing in the treated area.... Acne is one example of inflammatory conditions which may be treated in accordance with the present invention.... Acne is a multifactorial disease affecting the sebaceous follicle and characterized by papules, pustules, and scars. Acne affects nearly 90% of 16-year old boys and girls but is clearly no longer a problem confined to teenagers. Recently for this condition, referral for specialists' opinions have significantly increased among people over the age of 20. It has been realized that simple attention to hygiene is no longer sufficient, and antiseptic washes so popular some years ago are now perceived as ineffective by many sufferers and most clinicians. Web site: http://www.delphion.com/details?pn=US05834480__

Patents 105

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Topical spray for treating acne containing niacinamide and NaPCA Inventor(s): Fitzjarrell; Edwin A. (68994 N. Pine St., Sisters, OR 97759) Assignee(s): none reported Patent Number: 5,989,523 Date filed: March 20, 1998 Abstract: A method and composition for treating outbreaks of acne. Initially, the acne affected area is cleaned. A topical spray comprising about 1 to 10 wt % niacinamide, about 0.1 to 1 wt % Aloe Vera extract and about 0.1 to 1 wt % NaPCA in a water carrier is then applied to the area. Generally, at least two spray applications are made each day. For optimum skin cleaning, an exfoliation scrub such as a conventional apricot facial scrub is preferably applied to the skin prior to application of the combination topical spray. Excerpt(s): This invention relates to topical spray for application to the skin for the treatment of acne.... Acne is a skin disorder that occurs most commonly among teenagers. It consists of various kinds of blemishes on the face, upper chest and back. Severe acne can result in scarring. Acne is most likely in the facial area extending from around the nose to around the chin. This area is also most visible and acne here can be very distressing to the victim.... During early adolescence, hormone production begins that stimulates the oil glands in the skin. These sebaceous glands grow larger and produce more oil. Each sebaceous gland empties into a hair follicle and passes to the skin through a pore. Sometimes the pores become plugged and oil accumulates under the plugs. Pimples and cysts, caused by the acne bacillus, become infected resulting in redness and pus. Cysts may leave permanent scars, as may pimples if squeezed or scratched. Mild acne can be treated with diet changes, careful washing and nonprescription lotions containing benzoyl peroxide, topical creams containing salicylic acid, or other medications. Vitamin A palmitate may be applied topically for the treatment of acne and other skin disorders as described by Lerner in U.S. Pat. Nos. 5,556,887 and 5,520,919. Severe acne may be treated with tetracycline, 13-cis-retinoic acid and other prescription drugs. The skin may be treated with acid or freezing in some cases to make the skin peel. These treatments are often unsuccessful and may have significant side effects. Often, at best, these treatments reduce the intensity or frequency of acne outbreaks. Web site: http://www.delphion.com/details?pn=US05989523__

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Treatment of acne using lipoic acid Inventor(s): Perricone; Nicholas V. (27 Coginchaug Ct., Guilford, CT 06437) Assignee(s): none reported Patent Number: 6,365,623 Date filed: December 30, 1999 Abstract: Active acne and acneiform scars are treated by topical application of a composition containing lipoic acid and/or a lipoic acid derivative such as dihydrolipoic acid, a lipoic or dihydrolipoic acid ester, a lipoic or dihydrolipoic acid amide, a lipoic or dihydrolipoic acid salt, and mixtures of any of these to reduce erythema, pore size, and scarring. Topical application of lipoic acid and/or a lipoic acid derivatives are advantageously used with at least one adjunct ingredient such as a retinoid, an

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antibiotic, or benzoyl peroxide conventionally used for acne, alone or in combination with dimethylaminoalcohol, an.alpha.-hydroxy acid such as glycolic acid, a tyrosine, tocotrienol, and/or a fatty acid ester of ascorbic acid. One preferred embodiment contains a combination of lipoic acid, an.alpha.-hydroxy acid, and dimethylaminoalcohol. Excerpt(s): This invention relates primarily to methods and compositions for the treatment of acne vulgaris. Acne is the most common pustular condition of the skin, disfiguring afflicted persons with inflammatory and noninflammatory lesions (including pustules, papules and comedones) during the active phase, and with atrophic scars afterwards. It occurs most commonly in teenagers, but is not confined to adolescents, as increasing numbers of persons aged >20 years are seeking advice on treatment for acne (Brogden, R. N., and Goa, K. L., Drugs, 1997, 53: 511-519; this reference and others cited below are hereby incorporated herein in their entireties by reference). Although acne is generally considered to be self-limiting, its social effects can be substantial, and it may have its most severe effects on the psyche (ibid.). In about 60% of teenagers, disease severity is sufficient for them to self-medicate with proprietary preparations, or seek medical advice.... Acne is a multifactorial disease affecting the pilosebaceous units of the skin. Each unit consists of a large, multilobed sebaceous gland, a rudimentary hair and a wide follicular canal lined with stratefied squamous epithelium. They are found over most of the body surface but are largest and most numerous on the face, chest, and upper back. Normally, desquamated follicular cells are carried to the surface by the flow of sebum. Under the abnormal circumstances of acne vulgaris, an abnormal desquamination process provokes increased sloughing of the epithelium, which becomes more cohesive because of defective keratinization. This process causes blockage of the follicular orifice with accumulation of dead cells. Androgen stimulates the undifferentiated hormonally responsive cells making up the outer layer of the sebaceous gland lobule to divide and differentiate. Sebum production favors proliferation of the anaerobe Propionibacterium acnes, which is a normal commensal to the pilosebaceous unit, which can elicit hypersensitivity responses in acne.... The basic lesion of acne is the microcomedo. Accumulation of sebum and keratinous debris results in a visible closed comedo, or whitehead, and its continued distension causes an open comedo, or blackhead. The dark color of blackheads is due to oxidized melanin. Blackheads and microcysts are noninflammatory lesions of acne, but some comedones evolve into inflammatory papules, pustules, or nodules, and can become chronic granulomatous lesions. The initial inflammatory cell in an acute acne papule is the CD4+T lumphocyte. Duct rupture is not a prerequisite for inflammation, which is due to the release of pro-inflammatory substances from the duct. When inflammation develops, neutrophil chemotaxis occurs. These neutrophils secrete hydrolytic enzymes that cause further damage and increased permeability of the follicular wall. In pustules, neutrophils are present much earlier. More persistent lesions exhibit granulomatous histology that can lead to scarring. Web site: http://www.delphion.com/details?pn=US06365623__

Patents 107

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Treatment of acne, seborrheic dermatitis and other skin diseases with salt solution containing NACL Inventor(s): Biener; Hans F. (Munich, DE) Assignee(s): Bio.Life International AG (Zug, CH) Patent Number: 6,287,548 Date filed: November 21, 1994 Abstract: The present invention provides a composition of matter which has been demonstrated to be a very effective treatment for acne, seborrheic dermatitis and related skin diseases when applied to and contacted with affected skin areas, while avoiding the disadvantages and complications attendant to more established treatments. The composition comprises a synthetic mixture of salts which, when dissolved in a solvent such as water, is ionically composed primarily of a mixture of sodium and magnesium cations and chloride and sulfate anions, and which is preferably free of added zinc. More specifically, the salt mixture according to the present invention comprises the following range of composition in grams/kilogram of salt mixture in the ionic state, the balance being water of hydration: Excerpt(s): The invention concerns a topical skin preparation for the treatment of acne, seborrheic dermatitis and other skin diseases.... Since acne generally is not life endangering and is regarded by some as a kind of pubertary consequence, only a small part of the people with acne have regular medical treatment. Yet a significant percentage of the population is plagued by this disease. Both disregarding it, as well as excessive and improper treatment, can lead to irreversible scars and changes of the skin, and consequent adverse effects to quality of life.... To a large extent, the aforementioned is also true for seborrheic dermatitis and other skin diseases in their different forms such as herpes, from simple irritations of the skin up to severe and irreversible changes of epidermis. For distinguishing of these diseases and in order to define their grade, dermatology uses defined terms which can be measured or counted to a high degree. Acne in its different forms such as acne aestivalis, fulminans, necroticans, cosmetica etc. is mostly defined by papules, pustules, blackheads and whiteheads, while seborrheic dermatitis and related skin diseases are generally characterized by itching, scales and erythema. Web site: http://www.delphion.com/details?pn=US06287548__

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Use of plant extracts for treatment of acne and furuncle Inventor(s): Ren; Kaijun (1211 Spinnaker Way, Sugar Land, TX 77478) Assignee(s): Ren; Kaijun (Sugar Land, TX) Patent Number: 6,379,718 Date filed: December 21, 2000 Abstract: Novel herbal extracts provide potent efficacy in the treatment of acne and furuncle. The formulated extracts of Momordica charantia L. are from either the whole plant or parts of the plant. The extracts have been formulated into aqueous solution, pads, and/or lotion. These formulations have been provided to treat acne and furuncle 2 to 3 times a day. It has demonstrated the ability to manage various grades of acne, from mild, moderate to severe, which include comedos, papules, pustules and nodules.

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Significant improvement is visible within five days. There are no observed either longterm or short-term side reactions. Excerpt(s): This invention relates to the use of the extract from the whole plant or a part of the plant as a novel potent agent for the treatments of acne and furuncle.... Acne is the result of the hypercornification of sebaceous follicles that are found over most of the body surface, but is the largest and most numerous on the face, chest, and upper back. In normal conditions, the cornified layer of the follicle remains thin. When the persistent cohesion between cells retards desquamation, it causes the thickening of the ductal epithelium to narrow the ductal lumen. The process of ductal hypercornification causes the formation of a micromedo that may evolve into either a comedo or an inflammatory lesion.... Androgen is one of most important factors to cause an increased production of sebum. From the age of puberty period and up, the adrenal glands mature and secrete an increased amount of androgen to increase the activity of sebaceous glands and produce more sebum. Males produce 10 times as much androgen as females, so it is not surprising that more males develop severe cases of acne. Web site: http://www.delphion.com/details?pn=US06379718__ ·

Use of plant Momordica charactia extracts for treatment of acne acid Inventor(s): Ren; Kaijun (1211 Spinnaker Way, Sugar Land, TX 77478) Assignee(s): none reported Patent Number: 6,183,747 Date filed: July 14, 1999 Abstract: Novel herbal extracts provide potent efficacy in the treatment of acne and furuncle. The formulated extracts of Momordica charantia L. are from either the whole plant or parts of the plant. The extracts have been formulated into aqueous solution, pads, and/or lotion. These formulations have been provided to treat acne and furuncle 2 to 3 times a day. It has demonstrated the ability to manage various grades of acne, from mild, moderate to severe, which include comedos, papules, pustules and nodules. Significant improvement is visible within five days. There are no observed either longterm or short-term side reactions. Excerpt(s): This invention relates to the use of the extract from the whole plant or a part of the plant, Momordica charantia L., as a novel potent agent for the treatments of acne and furuncle.... Acne is the result of the hypercornification of sebaceous follicles that are found over most of the body surface, but are largest and most numerous on the face, chest, and upper back. In normal conditions, the cornified layer of the follicle remains thin. When the persistent cohesion between cells retards desquamation, it causes the thickening of the ductal epithelium to narrow the ductal lumen. The process of ductal hypercornification causes the formation of a micromedo that may evolve into either a comedo or an inflammatory lesion.... A resident anaerobic organism, Propionibacterium acnes, proliferates in the environment created by the mixture of the excessive sebum and follicular cells and produces chemotatic factors and inflammatory mediators that may lead to inflammation. Web site: http://www.delphion.com/details?pn=US06183747__

Patents 109

Patent Applications on Acne As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to acne: ·

Acne treating composition Inventor(s): Manetta, Vincent E. (Bordentown, NJ), Mahoney, Linda M. (Phoenixville, PA), Nordsiek, Michael T. (Berwyn, PA), Balaji, Kodumudi S. (Lansdale, PA), Dorrell, Jay; (Vicksburg, MI) Correspondence: H Eric Fischer; Synnestvedt & Lechner; 2600 Aramark Tower; 1101 Market Street; Philadelphia; PA; 19107-2950; US Patent Application Number: 20030044432 Date filed: August 21, 2002 Abstract: A package comprising components which, upon being mixed, are capable of forming a pharmaceutical composition that is effective in treating acne, the composition tending to degrade prematurely, one of the components comprising an oxidizing agent and another of the components comprising an antibiotic which is effective against acneassociated bacterial species, the components separated one from the other in the package, one component having a viscosity within about 50% of the viscosity of the other component. In addition, a package comprising: (A) components which, upon being mixed, are capable of forming a pharmaceutical composition that is effective in treating acne, one of the components comprising a benzoyl peroxide gel and another of the components comprising a gel of erythromycin and hydroxypropylcellulose; and (B) containers for holding the components in the package separated one from the other; the components having viscosities such that, upon the application of a uniform forces to the components, substantially equal volumes of the components are capable of being dispensed simultaneously from the containers. Excerpt(s): The present invention relates to a pharmaceutical composition that tends to lose its effectiveness prematurely and to improved means for the effective use of such a composition. More particularly, the present invention relates to the packaging of constituents comprising such a composition and to an improved form of such composition, including, for example, a composition for topical application, such as a topical composition for the treatment of acne.... Acne is a common inflammatory disease which is very common at puberty and may continue for many years. It occurs in facial skin areas where sebaceous glands are the largest, most numerous, and most active. In its milder forms, acne is a superficial disorder which is evidenced by slight, spotty irritations and which can be treated satisfactorily by ordinary skin hygiene. However, in the more inflammatory types of acne, bacterial invasion of or about the pilosebaceous follicles occurs and results in the formation of pustules, infected cysts, and, in extreme cases, canalizing inflamed and infected sacs appear. These lesions may become extensive and leave permanent, disfiguring scars.... Therapeutic methods for treating acne are designed to prevent formation of new lesions and facilitate the healing of old lesions. Treatments include the systemic and topical administration of anti-acne agents such as antibiotics or synthetic Vitamin A analogs. In most cases, systemic treatment of

10

This has been a common practice outside the United States prior to December 2000.

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acne is not desirable because of the risks of adverse side effects that are experienced by the user. For this reason, topical acne treatment compositions have been preferred. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Acne treatment including dual-package system Inventor(s): Singh, Mohinder; (Naperville, IL), Wojcik, Michael A. (Plainfield, IL) Correspondence: BREZINA & EHRLICH; Suite 333; 47 West Polk Street; Chicago; IL; 60605-2092; US Patent Application Number: 20030008851 Date filed: June 25, 2001 Abstract: A dual regimen acne treatment package includes an outer container, and disposed within the outer container first and second inner containers which are separate from each other. Each of the inner containers has an exposed dispensing means, the first inner container containing a solubilized salicylic acid acne treatment composition, and the second inner container containing a solubilized benzoyl peroxide acne treatment composition. Excerpt(s): The invention relates to the field of over-the-counter acne treatment compositions.... Compositions for treatment of acne vulgaris, white heads, black heads and comedones are well known. Generally, such compositions include a keratolytic agent, such as salicylic acid, which dissolves the intracellular matrix of the treated lesion and causes the lesion to slough off the body as dead tissue.... Salicylic acid has been approved by the US Food and Drug Administration for treatment of acne in concentrations of 0.5 to 2% by weight. Such compositions may be in the form of a gel, lotion, cream or solution to be applied with pads. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Acne vaccine Inventor(s): Gauldie, Jack; (Hamilton, CA), Braciak, Todd; (Hamilton, CA) Correspondence: VAN DYKE & ASSOCIATES, P.A. 1630 HILLCREST STREET; ORLANDO; FL; 32803; US Patent Application Number: 20020086837 Date filed: December 21, 2000 Abstract: Disclosed herein are vectors and methods for use in the prevention and treatment of acne. Specifically exemplified are adenovirus vectors or plasmid DNA that encode a variety of target antigens from proprionibacterium acnes with or without cytokines, chemokines or co-stimulatory receptors. These vectors in both viral and DNA vector form are prolific molecular adjuvants and can be used in combination with vectors and DNA encoding the lipase, hyaluronidase, phosphatase and other genes on the same operon, to elicit protective immune responses against colonization of the bacterium in the skin follicles. Excerpt(s): Acne vulgaris is a multifactorial skin disease which is generally characterized by the presence of a variety of inflamed and noninflamed lesions on the face and upper trunk. Although the disease occurs mainly during adolescence, it should

Patents 111

now no longer be solely viewed as a condition of pubescence. A considerable number of patients have persistent cases of acne into their 30's and even into their 50's. While the precise role of bacterial colonization, sebum production, immune factors, genetics and hormonal changes are not yet entirely clarified, the skin bacterium Propionibacterium acnes has been increasingly implicated in the pathogenesis of inflammatory acne (whiteheads).... It has been demonstrated that chemical agents including antibiotics, which reduce the numbers of this organism are therapeutic. In fact, it has been shown in patients failing to respond to erythromycin antibiotic therapy that P. acnes bacterium isolated from lesions of the skin acquired antibiotic resistance. Another agent benzoyl peroxide, the active ingredient in many of the over-the-counter acne products, has also been directly correlated with its effects on P. acnes colonization in the skin. Thus, it appears that in inflammatory acne, interference with colonization of skin follicles by the P. acnes bacterial species can prevent the most common form of inflammatory acne (whiteheads). This process of bacterial colonization of the skin follicle may provide a target for the acne gene therapy and vaccine.... The underlying basis of acne appears to be associated with the presence of larger than normal sebaceous follicles coupled with an increased level of sebum production from enlarged sebaceous glands (i.e. the response of the skin to the presence of the bacteria). In addition, keratinization (the process of skin formation) in the follicle is abnormal and leads to the generation of `sticky` cells which can occlude the follicle. This blockage in combination with excess sebum production can facilitate the colonization of the follicle by Propionibacterium acnes. P. acnes organisms are able to metabolize the readily abundant triglycerides (fats) present in the sebum, and fatty acid by-products from this metabolism can contribute to the inflammatory acne condition in at least two ways. First, the metabolic breakdown products of the fatty acids have been shown to facilitate the colonization and survival of the P. acnes bacterium in the follicle. Secondly, these fatty acid molecules can be converted into chemoattractants (molecules which attract and recruit immune and inflammatory cells of the body) producing inflammation. It is dependent on the degree and intensity of this process that the more severe superficial pustules and papules of acne may form resulting in skin destruction and scarring. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Anti-acne chrono patch Inventor(s): Fotinos, Spiros; (Athens, GR), O'Halloran, David P. (Milltown, NJ) Correspondence: ALLEN BLOOM; C/O DECHERT; PRINCETON PIKE CORPORATION CENTER; P.O. BOX 5218; PRINCETON; NJ; 08543-5218; US Patent Application Number: 20010019722 Date filed: January 9, 2001 Abstract: Multi-layer, time release, anti-acne patches and multi-layer, anti-acne patches for the topical application of an anti-acne effective combination of active agents are provided along with a method for making the same. The multi-layer, anti-acne patches contain an anti-acne effective combination of at least two agents selected from the group of an antimicrobial agent, an antiseptic agent, an anti-irritant, a keratolytic agent, a hormone, a hormone agonist and a hormone antagonist. The individual layers of adhesive polymeric matrix material contained in the multi-layer, anti-acne patches provided, may contain identical or disparate combinations of agents constituting the anti-acne effective combination. The multi-layer, anti-acne patches may further contain

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enhancing agents which improve the efficacy of the anti-acne effective combination present therein. Excerpt(s): This Application is a continuation-in-part of U.S. patent application Ser. No. 09/358,209 filed Jul. 21, 1999, which is a continuation of U.S. patent application Ser. No. 08/880,099 filed Jun. 20, 1997 (now U.S. Pat. No. 5,976,565).... The present invention relates to multi-layer, time release, anti-acne patches and multi-layer, anti-acne patches for the topical application of an anti-acne effective combination of active agents and a method of making the same.... Acne afflicts 90% of all teenagers. Acne also can afflict men and women in their twenties or thirties and in some cases may persist throughout adulthood. The process by which acne develops has been described in "New Approaches to Acne Treatment" by W. J. Cunliffe, ed. Martin Dunitz, London, 1989. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Apparatus and method for high energy photodynamic therapy of acne vulgaris and seborrhea Inventor(s): Harth, Yoram; (Haifa, IL), Korman, Avner; (Herzlia, IL) Correspondence: Eitan, Pearl, Latzer & Cohen-Zedek; One Crystal Park, Suite 210; 2011 Crystal Drive; Arlington; VA; 22202-3708; US Patent Application Number: 20020128695 Date filed: December 10, 2001 Abstract: An apparatus and method for the phototherapy of different skin conditions, particularly acne vulgaris and seborrhea. The invention transporting compounds, and/or a methylene blue solution. The apparatus includes at least one narrow spectral band light source with spectral emittance concentrated in the violet/blue spectral band and an optical system for controlling spectra and beam parameters of said light source and a mechanical fixture for holding the said light source at an adjustable distance and direction related to the skin treated area, and an electonic unit to control the duration and power and spectral bands of the emitted radiation. Excerpt(s): This application is a continuation in part application of U.S. application Ser. No. 09/756,130, filed Jan. 9, 2001, which is a continuation in part application of PCT Application No: PCT/IL99/00374, filed Jul. 7, 1999.... The present invention relates to an apparatus and method for the photodynamic therapy treatment of acne vulgaris and seborrhea and, more so particularly, to a violet/blue light radiating system that illuminates a collimated narrow bandwidth beam on the treated skin area. The method relates to the combined photodynamic skin treatment including narrow band violet/blue light radiation and topical application of oxidative and/or keratolytic agents.... The enlargement and obstruction of sebaceous glands cause acne vulgaris. Due to the accumulation of seburn in the glands, bacteria, mainly propionibacterium acnes (p. acnes), proliferate in the glands. These bacteria cause inflammation and later the formation of pustular lesions and acne cysts, which heal by scarring. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Apparatus and method for high energy photodynamic therapy of acne vulgaris, seborrhea and other skin disorders Inventor(s): Korman, Avner; (Herzelia, IL), Harth, Yoram; (Haifa, IL) Correspondence: DANIEL J SWIRSKY; PO BOX 2345; BEIT SHEMESH; 99544; IL Patent Application Number: 20020173833 Date filed: March 18, 2002 Abstract: An apparatus and method for the phototherapy of different skin conditions, particularly acne vulgaris seborrhea and inflammation. The invention consists of a multiple session treatment method by a violet/blue light source with a spectral emission in the range of 400-450 nanometer and possible additional spectral bands in the green and red part of the spectrum and possibly with the topical application of oxygen transporting compounds, and/or a methylene blue solution. The apparatus includes at least one narrow spectral band light source with spectral emittance concentrated in the violet/blue spectral band. The apparatus use the radiation to reduce the level of extra cellular pro inflammatory cytokines related to inflammation and to significantly reduce the acne bacteria population by a photodynamic effect. Excerpt(s): This application is a continuation in part application of U.S. application Ser. No: 10/007,702, filed Dec. 10, 2001, which is a continuation in part application of U.S. application Ser. No: 09/756130, filed Jan.9, 2001, which is a continuation in part application of PCT Application No: PCT/IL99/00374, filed Jul. 7, 1999.... The present invention relates to an apparatus and method for the photodynamic treatment of acne vulgaris and seborrhea and, more particularly, to a violet/blue light radiating system that illuminates a collimated narrow bandwidth beam on the treated skin area. The method relates to the combined photodynamic skin treatment including narrow band violet/blue light radiation and topical application of oxidative and/or keratolytic agents.... The present invention also relates to the phototherapy of inflammation and particularly to the phototherapy of inflammation using narrow band high intensity light source in the spectral range of 400-450 nm. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Combinatorial anti-acne compositions Inventor(s): Maes, Daniel H. (Huntington, NY), Schnittger, Steven F. (Huntington Station, NY), Chen, Chia Wen; (Bronxville, NY), Matsui, Mary Steidl; (Teaneck, NJ), Marenus, Kenneth D. (Dix Hills, NY) Correspondence: KAREN A. LOWNEY, ESQ; ESTEE LAUDER COMPANIES; 125 PINELAWN ROAD; MELVILLE,; NY; 11747; US Patent Application Number: 20030072777 Date filed: October 5, 2001 Abstract: The present invention provides a composition containing an anti-acne effective amount of a combination of five components that work combinatorially to combat the acne condition as a whole. The compositions contain an anti-irritant component, an antiinflammatory component, an adhesion inhibiting component, an sebum reducing component, and a sclareolide component. Both inflamed and non-inflamed lesions associated with the acne condition are reduced with a combination of the anti-irritant component, the anti-inflammatory component comprising at least a hoelen mushroom

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extract, the adhesion inhibiting component comprising at least a polysaccharide, the sebum reducing component comprising at least a pygeum extract, and the sclareolide component. The methods of the present invention treating the acne condition in a holistic manner. In addition, therefore, the methods of the present invention also include treating and preventing the irritation and inflammation frequently experienced when applying an acne treatment regimen. By applying to the skin an effective amount of the composition of the present invention the appearance of comedones are prevented. The compositions of the present invention protect against and prevent the damaging effects of the acne condition and the appearance of comedones and pustules associated with the acne condition. Excerpt(s): The present invention relates to cosmetic or pharmaceutical compositions for treating acne with specific combinatorial components active against the various aspects of the acne condition. More specifically, the invention relates to substantially nonirritating topical compositions free of benzoyl peroxide for the treatment of acne.... The ravages of the acne condition can range from the minor unsightly presence of comedones and scattered papules or pustules to the major disfiguring draining sinuses, scarring and pitting of the skin. As a disease, acne is characterized by a multifactorial pathogenesis including factors of increased sebum production, follicular keratinization, Propionibacterium acnes (P. acnes) proliferation, and inflammation. In general, acne is an androgen dependent disorder. Endocrinological factors effect the secretory activity of sebaceous glands. For example, 5.alpha.-reductase catalyzes testosterone to 5.alpha.dihydrotestosterone (DHT), a large amount of which is found in sebaceous glands. Thus, 5.alpha.-reductase is considered to be the principal mediator of local androgenic activity. However, the role of 5.alpha.-reductase, and in particular, 5.alpha.-reductase inhibitors in being able to treat acne is uncertain. A recent report suggests, based on studies, that 5.alpha.-reductase inhibitors may not be valuable in acne therapy. Webster, G. F., "Acne Vulgaris: State of the Science", Arch Dermatol, vol. 135 (September 1999). Still, one element that is far less disputed, if disputed at all, is the role of sebum in causing acne.... Sebum is one of the major factors contributing to the development of the acne condition. Other contributors include colonization by P. acnes, and abnormal keratinization of the follicular epithelium. P. acnes, the major organism responsible for acne, is a gram-positive microaerophilic diphtheroid and it is dominant in the sebaceous follicles. The nutritional needs of P. acnes are provided by the triglyceride fraction of sebum. The glycerol moiety of sebaceous triglycerides are necessary for nutrition and P. acnes gains access to it by an extracellular lipase. As a result of deesterification, the free fatty acids remain in the sebum and the concentration of free fatty acids, in sebum, is directly proportional to the density of P. acnes population. The most common sign of this activity is the presence of the inflammatory response, the comedonal epithelium. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Composition based on etyl ester of linoleic acid and triethyl ester of citric acid for topical use in the treatment of seborrhea and acne Inventor(s): de Paoli Ambrosi, Gianfranco; (Salo, IT) Correspondence: MCGLEW & TUTTLE, PC; SCARBOROUGH STATION; SCARBOROUGH; NY; 10510; US Patent Application Number: 20030118623 Date filed: December 16, 2002

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Abstract: The present invention relates to a composition for topical use for treating and improving the aesthetic conditions of the skin, which comprises, as an active ingredient, a mixture of ethyllinoleate and triethylcitrate. This composition is active in the treatment of seborrhea and acne. Excerpt(s): This invention concerns a new product for pharmaceutical and/or cosmetic use in the treatment of acne, acne rosacea and seborrhoea.... A very large number of people suffer from acne which has a pathological cutaneous picture characterised by a morphological and functional alteration of the pilosebaceous organ with appearance of whiteheads (closed comedo), blackheads (open comedo), papules and in the more serious forms, pustules, nodules, cysts and scars.... Acne affects about 80% of the population between the ages of 12 and 30 and, above all in women, may persist even to a more advanced age. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Compositions and methods for use against acne-induced inflammation and dermal matrix-degrading enzymes Inventor(s): Kang, Sewon; (Ann Arbor, MI), Voorhees, John J. (Ann Arbor, MI), Fisher, Gary J. (Ypsilanti, MI) Correspondence: Bradley N. Ruben, PC; 463 First St., Suite 5A; Hoboken; NJ; 07030; US Patent Application Number: 20030021816 Date filed: June 6, 2002 Abstract: Acne-affected skin has been found to be accompanied by the presence of matrix-degrading enzymes such as MMPs and neutrophil elastase, induction of neutrophils, and a reduction in procollagen biosynthesis. This invention treats scarring and inflammation accompanying acne by administering, topically or systemically, at least one of (i) an inhibitor of the matrix degrading enzymes and (ii) a cytokine inhibitor that alleviates inflammation and thus also alleviate neutrophil infiltration. Alleviating the matrix degradation and renormalizing procollagen biosynthesis allows for reduced inflammation and better natural repair of acne-affected skin. Inhibiting cytokines alleviates induction of MMPs in resident skin cells, and also alleviates inflammation with its concommitant induction of neutrophils from the blood stream bringing MMPs and elastase into the acne lesion. Dimishing the presence of matrix-degrading enzymes in the acne lesion reduces imperfect repair of the skin and thus decreases scarring in acne-affected skin. Excerpt(s): This application is based on provisional application 60/296394, filed Jun. 6, 2001.... This invention involves protecting human skin from some of the effects of acne, especially acne vulgaris, through the use of the topically and/or systemically applied non-retinoid and non-steriod compounds that diminish inflammation and matrixdegrading enzymes in acne-affected skin.... Acne is a multifactorial disease, developing in the sebaceous follicles. At least one agent thought responsible is the anaerobe Propionibacterium acnes (P. acnes); in younger individuals, practically no P. acnes is found in the follicles of those without acne. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Irradiation device and method for the treatment of acne and acne scars Inventor(s): Wilkens, Jan Hennrik; (Homburg, DE), Stirner, Rolf; (Berlin, DE) Correspondence: Harding, Earley, Follmer & Frailey; 86 The Commons At Valley For. E. 1288 Valley Forge RD. P. O. Box 750; Valley Forge; PA; 19482; US Patent Application Number: 20030004501 Date filed: March 8, 2002 Abstract: The invention relates to an irradiation device (1) and a method for the treatment of acne and acne scars, comprising at least one source of radiation (2), the source of radiation emitting at least one broadband spectrum in the wavelength range of 320-at least 540 nm and the radiation source (2) being pulse-operable and/or movable relatively to the area to be irradiated, the pulse energy being between 0.05-10 J/cM.sup.2 and the peak irradiation intensity being between 0.5 W/cm.sup.2 and 100 kW/cm.sup.2. Excerpt(s): The invention relates to an irradiation device and a method for the treatment of acne.... It is known to treat acne, which is a skin disease caused by proliferation of bacteria in blocked follicles of areas of the skin that are rich in sebaceous glands together with keratosis, with blue light in the range of 400-440 nm without significant proportions of UVA, with limited success.... Here we refer to the article of V. Sigurdsson et al., "Phototherapy of Acne Vulgaris with visible Light, Dermatologie 1997, 194; iss. 3, 256-260" which includes further literature references. This form of therapy started by using red fluorescence of acne follicle as part of the dermatological examination using a woodlamp. The source determined for the flouorescence was the storage of large quantities of porphyrins in the propionbacterium acne. McGinley et al., Facial follicular porphyrin fluorscence. Correlation with age and density of propionibacterium acnes, Br. J. Dermatol. 1980, Vol. 102, Iss. 3, 437-441). Since the principal absorption (Soret-band) of porphyrins is around 420 nm, it was obvious for Meffert et al. to treat acne follicles with blue light. The longest-wave absorption band of porphyrins is 630 nm, with a penetration depth of 4 mm, which is most favorable for photodynamic follicle treatment and is used for this purpose. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Kit for treating acne vulgaris using avermectin compound Inventor(s): Parks, L. Dean; (Ocala, FL) Correspondence: MELVIN K. SILVERMAN; SUITE 440; 4901 NORTH FEDERAL HIGHWAY; FORT LAUDERDALE; FL; 33308; US Patent Application Number: 20030064940 Date filed: June 3, 2002 Abstract: A kit for treating acne vulgaris are disclosed. The treatment includes topical application of a dermatological composition containing an avermectin compound to the affected areas of a patient alone, or in conjunction with other conventional methods of treating acne vulgaris. The dermatological composition of the kit contains an avermectin compound in a pharmaceutically acceptable carrier, including water, glycols, alcohols, lotions, creams, gels, emulsions, sprays, soaps, body washes, facial cleansers, and facial masks.

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Excerpt(s): This application is a continuation of co-pending application Ser. No. 09/988,914 filed Nov. 19, 2001, which is herein incorporated by reference in its entirety. Said application is a continuation-in-part of co-pending patent application Ser. No. 09/967,915 filed Oct. 12, 2001.... The present invention relates to methods for treating acne vulgaris, particularly with topical treatment using avermectin compound.... Acne vulgaris, known as acne by the general public, is a common and multifaceted skin disorder of the hair follicles and sebaceous glands. Although it affects almost 100% of adolescents to varying degrees and generally wanes as adolescence ends, the disease may persist into adulthood. Adult women, in particular, may be affected and may experience premenstrual flares. However, severe acne vulgaris tends to be more common in adolescent males than in people of other age-groups. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method for reducing acne or improving skin tone Inventor(s): Wiegand, Benjamin; (Newtown, PA), McCulloch, Laura; (Cedar Knolls, NJ), Grossman, Rachel; (Princeton, NJ), Halas, Lynn; (Ewing, NJ) Correspondence: AUDLEY A. CIAMPORCERO JR. JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US Patent Application Number: 20020151527 Date filed: December 7, 2001 Abstract: The present invention relates to methods for (1) reducing the number and severity of acne lesions on the skin of a mammal; (2) ameliorating the inflammation of acne lesions on the skin of a mammal; (3) improving the skin tone of a mammal, (4) treating skin disorders; (5) treating stress related skin diseases; (6) reducing stress and improving the emotional well being of an acne sufferer; (7) reducing sebaceous gland output; and (8) increasing compliance of the administration of anti-acne products. The method comprises the administration of a sensory regimen in an amount effective to downregulate the activity of the hypothalamus-pituitary-adrenal (HPA) axis in combination with the administration of an anti-acne composition. Excerpt(s): This application is a continuation-in-part of U.S. patent application Ser. No. ______, entitled "Methods For Reducing Chronic Stress In Mammals" filed concurrently herewith (Attorney Docket No. JBP 570), and which claims priority to U.S. Patent Application Serial No. 60/256,813, filed Dec. 20, 2000, the disclosures of which are hereby incorporated by reference.... The present invention relates to methods for (1) reducing the number and severity of acne lesions on the skin of a mammal; (2) ameliorating the inflammation of acne lesions on the skin of a mammal, (3) improving the skin tone of a mammal, (4) treating skin disorders; (5) treating stress related skin diseases; (6) reducing stress and improving the emotional well being of an acne sufferer; (7) reducing sebaceous gland output; and (8) increasins compliance of the administration of anti-acne products. The method comprises the administration of a sensory regimen in an amount effective to downregulate the activity of the hypothalamus-pituitary-adrenal (HPA) axis in combination with the administration of an anti-acne composition.... Advances in technology in the last century have brought benefits to society bat have resulted in greater prevalence of stress in the daily lives of people at all levels of society. Our stress response mechanisms have not adapted at the same pace as advancing technology. The effect of stress on health and well being is well documented in "Why Zebra's Don't Get Ulcers--An Updated Guide to Stress, Stress Related Diseases and Coping" by Robert M. Sapolsky, ISBN 0-7167-3210-6, Chapter 1,

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(5.sup.th Edition 2000) and in "The Concepts of Stress and Stress System Disorders-Overview of Physical and Behavioral Homeostasis", JAMA, March 4, 1992, Vol. 267, No. 9. For example, it is known that chronic stress (an accumulation of acute stresses) can cause or aggravate many conditions including immunosuppression and vulnerability to infectious diseases, gastric conditions, sleep problems, depression, premature birth in expectant mothers, low birth weight, degeneration of brain neurons leading to memory and learning problems, elevated blood pressure, heart complications and stroke due to elevated blood lipid levels and other health complications. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Method of treating acne Inventor(s): Sierra, Rafael A. (Palmer, MA), Mirkov, Mirko; (Chelmsford, MA), McMillan, Kathleen I. (Concord, MA), Lloyd, Jennifer R. (Poland, OH) Correspondence: John P. Iwanicki; BANNER & WITCOFF, LTD. 28th Floor; 28 State Street; Boston; MA; 02109; US Patent Application Number: 20030050678 Date filed: August 7, 2001 Abstract: A method of selectively enhancing photothermal sebaceous gland disruption and treatment of acne is disclosed. The method provides for alleviation of the acne symptoms as well as preventing acne recurrence and new acne from occurring. Excerpt(s): Embodiments of the present invention relate in general to the combined use of laser therapy and laser light absorbing agents in the treatment of skin conditions associated with the production of sebum by sebaceous glands. More particularly, embodiments of the present invention relate to methods of preventing, reducing, eliminating, or otherwise treating unwanted skin conditions, such as acne, using laser light and one or more exogenous chromophores to disrupt production of sebum without significant harm to surrounding normal tissue.... Unwanted skin conditions associated with the production or overproduction of sebum are well known. One example of such an unwanted skin condition includes common acne which is a major treatment concern of many dermatologists. It is estimated that as many as 32 million Americans exhibit some form of unwanted acne.... The treatment of acne is of major concern to dermatologists. Acne accounts for more than four million visits to dermatologists each year. Typically, acne arises in the early teen years and subsides by the mid twenties. In many cases, particularly in women, acne remains a chronic problem well into the adult years. It is estimated that as many as 32 million Americans suffer from acne. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Method of treating acne vulgaris using avermectin compound Inventor(s): Parks, L. Dean; (Ocala, FL) Correspondence: Melvin K. Silverman; Suite 440; 4901 North federal Highway; Fort Lauderdale; FL; 33308; US Patent Application Number: 20020061855 Date filed: November 19, 2001

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Abstract: Methods for treating acne vulgaris are disclosed. The treatment includes topical application of a dermatological composition containing an avermectin compound to the affected areas of a patient alone, or in conjunction with other conventional methods of treating acne vulgaris. The dermatological composition contains an avermectin compound in a pharmaceutically acceptable carrier, including water, glycols, alcohols, lotions, creams, gels, emulsions, sprays, soaps, body washes, facial cleansers, and facial masks. Excerpt(s): This application is a continuation-in-part of co-pending patent application Ser. No. 09/976,915 entitled "Method of Treating Dermatoses Using Avermectin Compound" filed on Oct. 12, 2001, which is a continuation-in-part of co-pending application Ser. No. 09/605,747 filed on Jun. 29, 2000, both of which are herein incorporated by reference in their entirety.... The present invention relates to methods for treating acne vulgaris, particularly with topical treatment using avermectin compound.... Acne vulgaris, known as acne by the general public, is a common and multifaceted skin disorder of the hair follicles and sebaceous glands. Although it affects almost 100% of adolescents to varying degrees and generally wanes as adolescence ends, the disease may persist into adulthood. Adult women, in particular, may be affected and may experience premenstrual flares. However, severe acne vulgaris tends to be more common in adolescent males than in people of other age-groups. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Methods of treating acne Inventor(s): Ashley, Robert A. (Newtown, PA) Correspondence: HOFFMANN & BARON, LLP; 6900 JERICHO TURNPIKE; SYOSSET; NY; 11791; US Patent Application Number: 20030130240 Date filed: April 5, 2002 Abstract: A method of treating acne in a human in need thereof comprising administering systemically to said human a tetracycline compound in an amount that is effective to treat acne but has substantially no antibiotic activity, without administering a bisphosphonate compound. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/281,916, filed Apr. 5, 2001, and U.S. Provisional Application No. 60/325,489, filed Sep. 26, 2001, both of which are incorporated herein by reference.... Acne is a common disease characterized by various types of lesions. The areas affected typically are areas of the skin where sebaceous glands are largest, most numerous, and most active. The lesions associated with acne are usually categorized as either non-inflammatory or inflammatory.... Non-inflammatory lesions include comedones. Comedones appear in two forms, open and closed. Comedones are thought to arise from abnormal follicular differentiation. Instead of undergoing shedding and discharge through the follicular orifice, abnormal desquamated cells (keratinocytes) become unusually cohesive, forming a microcomedo or a microscopic hyperkeratotic plug in the follicular canal. The progressive accumulation of these microcomedones lead to visible comedones. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Oral and topical compositions and methods related thereto in the treatment of acne Inventor(s): Mann, Morris; (Glendale, AZ) Correspondence: The Halvorson Law Firm; Ste 1; 405 W. Southern Ave. Tempe; AZ; 85282; US Patent Application Number: 20020155171 Date filed: March 26, 2002 Abstract: Described are compositions and methods for the treatment of acne. The method and compositions comprise an orally ingested composition containing thymic peptides, vitamins, and minerals. Zinc, pantothenic acid, magnesium, pyridoxine, vitamins A and D, riboflavin, and folic acid are found to be essential to the composition. Also described is a topical composition comprising pantothenic acid that, when used in conjunction with the oral composition, resulted in a better response than either the oral or topical composition alone. Excerpt(s): The present invention generally relates to oral and topical compositions and methods for the treatment of acne. More specifically, the present invention generally relates to compositions and methods for the treatment of acne by oral treatment with a composition comprising containing thymosin fraction 5 preparation plus other beneficial ingredients, such as vitamins and the like, and concomitant use of novel topical compositions.... Acne is considered by those afflicted to be a serious problem. At some point 80% of all individuals, both male and female, experience acne. Although the vast majority of individuals afflicted with acne have spontaneous resolution of the problem over time, the effects of this skin disorder can be emotionally scarring. Some people, however, have active acne, until their mid-fifties. Likewise, in the last 20 years, for reason that are currently unknown, there has been a dramatic increase in acne affecting women over the age of 30.... Many causes have been proposed for acne. However, for a cause to have true validity, the treatment resolving the hypothesized cause must prove to be effective in the vast majority of cases. Causes that have been proposed include, but are not limited to: diet, hormonal disregulation, stress, bacterial overgrowth, heredity and environmental exposure; all of which may cause a deficiency of Coenzyme A. In no case has a treatment designed for any of the aforementioned causes proven to be uniformly effective. The only treatment that is proven effective in the vast majority of cases is the oral administration of isotretinoin (Accutane.TM.). This medication, however, has numerous side effects; the most disturbing of which being its potential to induce sever birth defects. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Serine protease and topical retinoid compositions useful for treatment of acne vulgaris and production of anti-aging effects Inventor(s): Seiberg, Miri; (Princeton, NJ), Wisniewski, Stephen J. (Doylestown, PA), Cauwenbergh, Gerard F. (Plainsboro, NJ), Shapiro, Stanley S. (Livingston, NJ) Correspondence: AUDLEY A. CIAMPORCERO JR. JOHNSON & JOHNSON; ONE JOHNSON & JOHNSON PLAZA; NEW BRUNSWICK; NJ; 08933-7003; US Patent Application Number: 20020172672 Date filed: December 17, 2001

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Abstract: This invention is related to methods for treating Acne Vulgaris and/or for producing anti-aging effects on the skin of a mammal, and compositions effective for the same. More specifically, the present invention is directed to the use of serine proteases, as the sole active in a composition effective for the treatment of Acne Vulgaris and/or for producing anti-aging effects on the skin of a mammal, or in combination with a retinoid compound in a composition effective for the same. Excerpt(s): This Application claims the benefit of U.S. Provisional Application No. 60/037,605 filed on Feb. 12, 1997, which is incorporated herein by reference in its entirety.... This invention is related to methods for treating Acne Vulgaris and/or for producing anti-aging effects on the skin of a mammal, and compositions effective for the same. More specifically, the present invention is directed to the use of serine proteases, either alone or in combination with a retinoid compound in a pharmaceutical or cosmetic composition.... Acne Vulgaris is a disorder of the pilosebaceous unit that affects nearly all adolescents to some degree, as well as many adults. The initial lesion of the disease is believed to be due to hypercornification and hyperkeratinization of the infundibulum, a process that helps to transform the sebaceous follicle into a comedone. This disorganization of the epithelium may give rise to inflammatory lesions, as the infundibulum ruptures and sebum is introduced into the dermis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Topical aminolevulinic acid-photodynamic therapy for the treatment of acne vulgaris Inventor(s): Anderson, Richard Rox; (Lexington, MA) Correspondence: NUTTER MCCLENNEN & FISH LLP; ONE INTERNATIONAL PLACE; BOSTON; MA; 02110; US Patent Application Number: 20020099094 Date filed: August 14, 2001 Abstract: Light treatments of sebaceous gland disorders with 5-aminolevulinic acid and photodynamic therapy are disclosed. A preferred treatment includes topical application of 5-aminolevulinic acid to the skin followed by light exposures with repeated treatment at various intervals. At low doses of ALA and photodynamic therapy (PDT) in single or multiple treatments, improvement in the sebaceous gland disorder, e.g., acne, provides the discovery that diminishment in sebum secretion and the eradication of bacteria occurs. At high doses of ALA and a single high energy PDT treatment, permanent changes to the sebaceous gland and sebum secretion have been discovered. Excerpt(s): This application is related to and claims the priority under 35 USC.sctn. 119 (e) of U.S. Provisional Application No. 60/225,691, filed Aug. 16, 2000.... This application is also related to International Application filed with the same application title on Aug. 13, 2001 in the United States Receiving Office using Express Mail Label No. EL835838321 and identified as Attorney Docket No. 101537-29.... Skin disorders, such as acne, can be irritating and embarrassing. The major disease of skin associated with sebaceous follicles, is acne vulgaris. This is also the most common reason for visiting a dermatologist in the United States. There are many treatments, but no cures for acne. These include antibiotics (which inhibit growth of p. acnes bacteria which play a role in acne), retinoids such as Accutane.RTM. (isotetinoin, which reduces sebaceous gland output of sebum), and antimicrobials such as benzoyl peroxide. Acne lesions result from the rupture of a sebaceous follicle, followed by inflammation and pus (a "whitehead"), or by accumulation of plugged material in the sebaceous follicle (a "blackhead"). This

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pathophysiology has two major requirements: (1) plugging of the upper portion of the follicle, and (2) an increase in sebum production. The upper portion of the follicle, i.e., the "pore" into which sebum is secreted and which is directly in communication with the skin surface, is called the infundibulum. A plug forms in the infundibulum from cells, sebum, bacteria, and other debris. The sebaceous gland continues to produce sebum (an oily fluid), stretching the infundibulum until either it or some lower portion of the follicles ruptures. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Topical dapsone for the treatment of acne Inventor(s): Osborne, David W. (Fort Collins, CO) Correspondence: Lisa A. Amii; Morrison & Foerster LLP; 755 Page Mill Road; Palo Alto; CA; 94304-1018; US Patent Application Number: 20030157036 Date filed: February 20, 2002 Abstract: The present invention relates to a method of treating acne by topically applying a dermatological composition comprising dapsone. In addition to inflammatory lesions, the composition also treats non-inflammatory acne. The composition is formulated to include dapsone in a both a dissolved and microparticulate state. Excerpt(s): The present invention relates to the field of dermatology. In particular, the invention is a novel method for treating primary non-inflammatory acne or closed comedones by topically administering dapsone.... Sebaceous glands are associated with hair follicles and secrete an oily substance called sebum into the upper part of the follicles. These glands are found everywhere on the human skin, except for the soles and dorsa of the feet and the palms. In each gland, a common excretory duct is supplied by smaller ducts that originate in the acini of the gland. As the sebaceous cells move toward the center of the gland, lipid synthesis within the cells continues until there is a 100 to 150 fold increase in cell volume. The cells then rupture and lipid is expelled into the excretory stream of the gland, passing through the follicular canal and into the upper third of the hair follicle. On the skin of the face, the sebaceous glands are the predominant portion of the follicles and are called sebaceous follicles.... The follicular canal contains keratinous material, i.e., dead skin cells, from the wall of the canal, sebum from the sebaceous glands, and bacteria, predominately Propionibacterium acnes. In the follicular canal of patients with acne, these dead skin cells clump together to form a keratin plug. This altered pattern of keratinization is the primary structural change in the follicular canal that leads to an acne lesion. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Topical preparation for treating acne and hirsutism Inventor(s): Goodman, David S. (Naples, FL) Correspondence: Riker, Danzig, Scherer, Hyland & Perretti LLP; Headquarters Plaza; One Speedwell Avenue; Morristown; NJ; 07962; US Patent Application Number: 20030147977 Date filed: January 16, 2003 Abstract: An improved method and preparation for the treatment of acne and hirsutism comprises topically applying an effective amount of a saw palmetto berry extract, in combination with two classes of low irritability penetrating agents that enhance penetration of the extract into hair follicles and sebaceous glands. The low irritability penetration agents are selected from the group (A) comedolytics consisting of adapalene, tretinoin, tretinoin gel microsponges, retinaldehyde, retinol, and tazarotene, and (B) keratinolytics consisting of the beta hydroxy acid, salicylic acid, and the alpha hydroxy acid, glycolic acid. Polyolprepolymer-2 may be incorporated into the preparation as well. Excerpt(s): This application is a Continuation-in-Part of U.S. Ser. No. 10/097,001 filed Mar. 13, 2002 which in turn is a continuation in part of Ser. No. 09/563,555 filed May 3, 2000 both or the instant inventor.... This invention relates to an improved preparation and method for treating both acne and hirsutism, or unwanted facial and body hair in women; and more particularly to a preparation comprising a topically active extract of saw palmetto berries, in combination with two classes of penetration enhancing agents included to enhance penetration of the extract into hair follicles and sebaceous glands.... Acne is caused by a complex interaction of excessive sebum production, colonization of hair follicles by Proprionibacterium acnes, and follicular plugging or comedone formation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Treatment of acne Inventor(s): Burrell, Robert Edward; (Sherwood Park, CA), Yin, Hua Qing; (Sherwood Park, CA) Correspondence: GREENLEE WINNER AND SULLIVAN P C; 5370 MANHATTAN CIRCLE; SUITE 201; BOULDER; CO; 80303; US Patent Application Number: 20020192298 Date filed: April 23, 2001 Abstract: The invention relates to the use of one or more antimicrobial metals selected from silver, gold, platinum, and palladium but most preferably silver, preferably formed with atomic disorder, and preferably in a nanocrystalline form, for the treatment of a acne. The nanocrystalline antimicrobial metal of choice may be used in the form of a nanocrystalline coating of one or more antimicrobial metals, a nanocrystalline powder of one or more antimicrobial metals, or a solution containing dissolved species from a nanocrystalline powder or coating of one or more antimicrobial metals. Excerpt(s): The invention relates to the use of antimicrobial metals for the treatment of acne.... Acne is a group of diseases whose initial pathology is the comedo and includes acne vulgaris, neonatal acne, infantile acne, and pomade acne. There are approximately 45 million people who suffer from acne in America alone. The disease is so common in

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youth at their puberty that it often has been termed physiological. Although acne stops appearing for most people by the age of 25, some people, the majority of them are women, experience the disease well into their adult life. This "adult acne" differs from teenage acne in location and that it tends to be more inflammatory with fewer comedones. It has received a great deal of attention recently.... Acne is a chronic inflammatory disease affecting the sebaceous glands. Acne lesions primarily involve the sebaceous glands located on the face, neck, chest and back. Both closed comedones (blackheads) and open comedones (whiteheads) are caused by hyperkeratinization of the infundibulum of the sebaceous duct. These keritinous plugs block the flow of sebum. These dilated ducts abound with the colonies of Priopionibacterium acnes and other fat splitting organisms. The clinically evident open and closed comedones and the microscopic microcomedo are the signal lesions of acne. The acne process results from a cascade of events. First, at puberty a spike in androgen production heralds an increase in sebum production and begins the hyperkeratinization process causing microcomedones and sebum blockade. With this blockage, the number of resident follicular flora increases dramatically. These bacteria produce inflammatory products, which permeate through thin walls of dilated sebum-filled duct. Once in the perifollicular dermis, they trigger the body's own immune defenses (both acute and granulaomatous) to produce the characteristic inflammatory papules, pustules and nodules characteristic of inflammatory acne. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Treatment of acne using alkanolamine compositions Inventor(s): Perricone, Nicholas V. (Guilford, CT) Correspondence: MARY M. KRINSKY, Ph. D., J.D. PATENT ATTORNEY; 79 TRUMBULL STREET; NEW HAVEN; CT; 06511; US Patent Application Number: 20030021855 Date filed: February 27, 2002 Abstract: Acne is treated or prevented by the topical application of compositions containing an alkanolamine such as dimethylaminoethanol, tyrosine, and a sulfur ingredient such as lipoic acid or glutathione. Adjunct ingredients such as fatty acid esters of ascorbic acid, e.g., ascorbyl palmitate and.alpha.-hydroxy acids may be included in the formulations. Compositions of the invention may be used alone, or, in many preferable embodiments, in combination with conventional acne medications such as anti-acne products containing salicylic acid, benzoyl peroxide, or a retinoid. In these embodiments, alkanolamine compositions of the invention are applied to affected skin areas first, and then a conventional acne medication is applied. This maximizes the efficacy of the treatment while minimizing skin irritation caused by conventional medications. Excerpt(s): This is a continuation-in-part of co-pending U.S. patent application Ser. No. 09/900,680, filed Jul. 6, 2001.... This invention relates to improved compositions and methods for the treatment and prevention of acne, and the promotion of clear skin.... This invention relates primarily to methods and compositions for the treatment of acne vulgaris. Acne is the most common pustular condition of the skin, disfiguring afflicted persons with inflammatory and noninflammatory lesions (including pustules, papules and comedones) during the active phase, and with atrophic scars afterwards. It occurs most commonly in teenagers, but is not confined to adolescents, as increasing numbers of persons aged >20 years are seeking advice on treatment for acne (Brogden, R. N.,

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and Goa, K. L., Drugs, 1997, 53: 511-519; this reference and others cited below are hereby incorporated herein in their entireties by reference). Although acne is generally considered to be self-limiting, its social effects can be substantial, and it may have its most severe effects on the psyche (ibid.). In about 60% of teenagers, disease severity and embarrassment are sufficient for them to self-medicate with proprietary preparations and/or seek medical advice. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·

Use of plant extracts for treatment of acne and furuncle Inventor(s): Ren, Kaijun; (Sugar Land, TX) Correspondence: Joseph M. Jong; THOMASON, MOSER & PATTERSON, L.L.P. Suite 1500; 3040 Post Oak Blvd. Houston; TX; 77056; US Patent Application Number: 20010053390 Date filed: December 21, 2000 Abstract: Novel herbal extracts provide potent efficacy in the treatment of acne and furuncle. The formulated extracts of Momordica charantia L. are from either the whole plant or parts of the plant. The extracts have been formulated into aqueous solution, pads, and/or lotion. These formulations have been provided to treat acne and furuncle 2 to 3 times a day. It has demonstrated the ability to manage various grades of acne, from mild, moderate to severe, which include comedos, papules, pustules and nodules. Significant improvement is visible within five days. There are no observed either longterm or short-term side reactions. Excerpt(s): This invention relates to the use of the extract from the whole plant or a part of the plant as a novel potent agent for the treatments of acne and furuncle.... Acne is the result of the hypercomification of sebaceous follicles that are found over most of the body surface, but are largest and most numerous on the face, chest, and upper back. In normal conditions, the cornified layer of the follicle remains thin. When the persistent cohesion between cells retards desquamation, it causes the thickening of the ductal epithelium to narrow the ductal lumen. The process of ductal hypercornification causes the formation of a micromedo that may evolve into either a comedo or an inflammatory lesion.... A resident anaerobic organism, propionibacterium acnes, proliferates in the environment created by the mixture of the excessive sebum and follicular cells and produces chemotatic factors and inflammatory mediators that may lead to inflammation. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Use of resveratrol for the treatment of exfoliative eczema, acne and psoriasis Inventor(s): Pelliccia, Maria Teresa; (Avellino, IT), Giannella, Attilio; (Codogno, IT), Giannella, Jenny; (Codogno, IT) Correspondence: YOUNG & THOMPSON; 745 SOUTH 23RD STREET 2ND FLOOR; ARLINGTON; VA; 22202 Patent Application Number: 20010056071 Date filed: March 22, 2001

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Abstract: The use of resveratrol (3,4',5-trihydroxy-trans-stilbene) and derivatives thereof, for the preparation of medicaments for the treatment of exfoliative eczema, acne and psoriasis, topical pharmaceutical formulations containing resveratrol or derivatives thereof in combination with other active principles. Treatment consists in topical administrations of resveratrol at concentrations of 0.01 to 20%, in the form of lotions, creams or ointments, optionally in combination with other active principles such as melatonin, vitamins D, E and A and derivatives thereof, hormones, vegetable and/or animal extracts. Contrary to current therapies, the use of resveratrol has neither systemic nor topical effects during and after therapy. Excerpt(s): The present invention relates to the use of resveratrol (3,4',5-trihydroxytrans-stilbene) and derivatives thereof (esters, glycosides, 3'-oxyresveratrol), for the preparation of medicaments for the treatment of exfoliative eczema, acne and psoriasis.... Resveratrol (3,4',5-trihydroxy-trans-stilbene), a phytoalexin produced by a number of vegetables under stress conditions, is one of the natural substances of vegetable origin at present arousing great interest in the pharmaceutical, cosmetic and nutritional fields, due to the important, established effects this molecule exerts in humans.... In vitro and in vivo studies on resveratrol proved that the molecule: a) exerts protective action on the cardiovascular system, (Clin. Chim. Acta, 235:207, 1995) and decreases arteriosclerosis risks (Clin. Chim. Acta, 246:163, 1996); b) has vasal relaxing effect on the arteries (Gen. Pharm. 27:363, 1996); c) has antioxidant action which inhibits LDL cholesterol peroxidation (The Lancet, 341:1103, 1993); reduces oxidative stress (Neuroreport 8:1499, 1997); protects from the radical damage in cerebral ischemia (Chin. Pharm. Bull. 12:128, 1996); prevents the propagation of free radicals responsible for the molecular damage of the biological systems and for cell aging; d) modulates lipid synthesis, preventing the accumulation of cholesterol and fats in the liver, decreases the concentrations of blood triglycerids and of cholesterol in low-density LDL lipoproteins and reduces the atherogenic index (Chem Pharm. Bull. 30:1766, 1982); e) inhibits platelet aggregation, preventing the formation of thrombi (Int. J. Tiss. Reac. XVIII, 1, 1995; Thrombosis and Haemostasis, 76:818, 1996); f) inhibits the production of proatherogenic eicosanoids by platelets and neutrophils, exerting anti-inflammatory action (Biochem. Biophys. Acta, 834:275, 1985); g) inhibits protein-tyrosine kinase which modulates cell proliferation and differentiation and the signaling processes in the immune system cells, biological processes involved in the inflammatory response and in severe pathologies such as cancer, arteriosclerosis and psoriasis (J. Natural Products, 56:1805, 1993, Science 267:1782, 1995); h) has marked antimutagenic action, inhibiting the cell events connected with the initiation, promotion and progression of the tumor (Science 275:218, 1997, Anal. Biochem, 169:328, 1988, Proc. Natl. Acad. Sci USA, 91:3147, 1994, Proc. Natl. Acad. USA, 72:1848, 1975, Carcinogenesis, 8:541, 1987). The presence of resveratrol traces in red wines is believed to be the main cause of the beneficial nutritional effects thereof (Am, J. Enol. Vitic. 46:159, 1996, Clin. Chim. Acta, 246:183, 1996, Amer. J. Clin. Nutr., 55:1012, 1992). The poor concentrations of resveratrol in wine and in wine industry by-products have, until some time ago, remarkably restricted a wide use of this molecule in the pharmaceutical and nutritional fields. Recently, rhizomes of the Chinese plant Poligonum cuspidatum have been found to contain high amounts of resveratrol (more than about 400 times those in wine) thus inducing a strong commercial development of this molecule as alimentary supplement, in particular on the U.S. market. Lately, the actions of resveratrol for pharmacological or cosmetic use have been claimed (WO9959561; WO9958119; EP0773020; FR2766176; WO9904747). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with acne, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “acne” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on acne. You can also use this procedure to view pending patent applications concerning acne. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON ACNE Overview This chapter provides bibliographic book references relating to acne. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on acne include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical books that use the generic term “acne” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on acne, we have included nonmedical books in this bibliography. The following has been recently listed with online booksellers as relating to acne (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

A Pocket Guide to Acne by William J. Cunliffe; ISBN: 1870026500; http://www.amazon.com/exec/obidos/ASIN/1870026500/icongroupinterna

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Acne by Ronald Marks; ISBN: 0668056592; http://www.amazon.com/exec/obidos/ASIN/0668056592/icongroupinterna

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Acne - the 'at Your Fingertips' Guide (At Your Fingertips) by Tim Mitchell; ISBN: 185959073X; http://www.amazon.com/exec/obidos/ASIN/185959073X/icongroupinterna

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Acne & Related Disorders by Gerd Plewig, Marks (1989); ISBN: 0948269944; http://www.amazon.com/exec/obidos/ASIN/0948269944/icongroupinterna

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Acne (Liz Earle's Quick Guides) by Liz Earle; ISBN: 0752216317; http://www.amazon.com/exec/obidos/ASIN/0752216317/icongroupinterna

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Acne (Natural Way) by Elizabeth Holmes; ISBN: 1843337126; http://www.amazon.com/exec/obidos/ASIN/1843337126/icongroupinterna

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Acne (Overcoming Common Problems) by Paul Van Riel; ISBN: 0859694534; http://www.amazon.com/exec/obidos/ASIN/0859694534/icongroupinterna

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Acne : morphogenesis and treatment by Gerd Plewig; ISBN: 0387072128; http://www.amazon.com/exec/obidos/ASIN/0387072128/icongroupinterna

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Acne : update for the practitioner; ISBN: 0914316168; http://www.amazon.com/exec/obidos/ASIN/0914316168/icongroupinterna

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Acne and Related Disorders of Complexion and Scalp by A. Bobroff; ISBN: 0398001839; http://www.amazon.com/exec/obidos/ASIN/0398001839/icongroupinterna

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Acne and Rosacea by A.M. Lligman, et al; ISBN: 3540667512; http://www.amazon.com/exec/obidos/ASIN/3540667512/icongroupinterna

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Acne and the Mature Woman by N.B. Simpson MD FRCP; ISBN: 187002608X; http://www.amazon.com/exec/obidos/ASIN/187002608X/icongroupinterna

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Acne Can Be Cured by Gustave H. Hoehn; ISBN: 0668041137; http://www.amazon.com/exec/obidos/ASIN/0668041137/icongroupinterna

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Acne Fast Facts Series by Cunliffe, et al; ISBN: 189954173X; http://www.amazon.com/exec/obidos/ASIN/189954173X/icongroupinterna

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Acne Festival by Legor Gran (2001); ISBN: 8489618593; http://www.amazon.com/exec/obidos/ASIN/8489618593/icongroupinterna

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Acne Free Skin the Bma Way by Carl Wuco (1985); ISBN: 9995013002; http://www.amazon.com/exec/obidos/ASIN/9995013002/icongroupinterna

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Acne in Black Women by N., Dr Persadsingh (1998); ISBN: 9768138866; http://www.amazon.com/exec/obidos/ASIN/9768138866/icongroupinterna

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Acne RX by James E., Jr., MD Fulton, James E. Fulton Jr. ISBN: 0971281009; http://www.amazon.com/exec/obidos/ASIN/0971281009/icongroupinterna

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Acne Try Nature's Remedy by Stephen T. MacHutta (1988); ISBN: 0962148903; http://www.amazon.com/exec/obidos/ASIN/0962148903/icongroupinterna

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ACNE: ADVICE ON CLEARING SKIN; ISBN: 0906348536; http://www.amazon.com/exec/obidos/ASIN/0906348536/icongroupinterna

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Acne: Advice on Clearing Your Skin by Ronald Marks; ISBN: 0668056606; http://www.amazon.com/exec/obidos/ASIN/0668056606/icongroupinterna

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Acne: Clearing and Control for Everyone: The Complete Easy to Use Self Help Guide to Clear and Control Your Acne by Scott Tourtellotte; ISBN: 9990277516; http://www.amazon.com/exec/obidos/ASIN/9990277516/icongroupinterna

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Acne: Diagnosis & Management by William J. Cunliffe, et al; ISBN: 1853172065; http://www.amazon.com/exec/obidos/ASIN/1853172065/icongroupinterna

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Acne: Symposium at the World Congress of Dermatology, Paris, July 2002 by C. C. Zouboulis (Editor), et al (2003); ISBN: 3805575483; http://www.amazon.com/exec/obidos/ASIN/3805575483/icongroupinterna

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Acne: UN Tratamiento Naturista by Abel, Dr Cruz (2001); ISBN: 9706434461; http://www.amazon.com/exec/obidos/ASIN/9706434461/icongroupinterna

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All You Wanted to Know About Acne by Poonam Jain; ISBN: 812072335X; http://www.amazon.com/exec/obidos/ASIN/812072335X/icongroupinterna

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Androgenization in women : acne, seborrhoea, androgenetic alopecia and hirsutism : lectures and discussions of a symposium, Berlin, 23rd-24th February 1979; ISBN: 0444901426; http://www.amazon.com/exec/obidos/ASIN/0444901426/icongroupinterna

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Answers to Acne by Gillian Murphy (Author); ISBN: 0356124347; http://www.amazon.com/exec/obidos/ASIN/0356124347/icongroupinterna

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ANTI-ACNE BOOK; ISBN: 0851402828; http://www.amazon.com/exec/obidos/ASIN/0851402828/icongroupinterna

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Clear Skin: A Step-By-Step Program to Stop Pimples, Blackheads, Acne by Kenneth L. Flandermeyer; ISBN: 0316285463; http://www.amazon.com/exec/obidos/ASIN/0316285463/icongroupinterna

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Die Behandlung Der Acne Vulgaris Bei Frauen by Herausgegeben Von F. Nurnberger (1989); ISBN: 3110118068; http://www.amazon.com/exec/obidos/ASIN/3110118068/icongroupinterna

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Diets to help acne by Alan Moyle; ISBN: 0722502257; http://www.amazon.com/exec/obidos/ASIN/0722502257/icongroupinterna

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Dr. Fulton's Step-By-Step Program for Clearing Acne by James E. Fulton; ISBN: 0060380209; http://www.amazon.com/exec/obidos/ASIN/0060380209/icongroupinterna

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Evening Primrose Oil: How Its Amazing Nutrients Promote Health Relief from Problems Including Acne, Arthritis and Heart Disease by Richard A. Passwater (1982); ISBN: 0879832630; http://www.amazon.com/exec/obidos/ASIN/0879832630/icongroupinterna

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Everything You Need to Know About Acne: A Helping Book for Teens (Need to Know Library) by Jennifer Ceaser; ISBN: 0823932222; http://www.amazon.com/exec/obidos/ASIN/0823932222/icongroupinterna

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Focus on acne vulgaris by S. I. Cullen (Author); ISBN: 0905958225; http://www.amazon.com/exec/obidos/ASIN/0905958225/icongroupinterna

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Freedom from Acne (Health Series); ISBN: 0870823205; http://www.amazon.com/exec/obidos/ASIN/0870823205/icongroupinterna

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Herbs for Healthy Skin, Hair & Nails: Banish Eczema, Acne and Psoriasis With Healing Herbs That Cleanse and Tone to Body Inside and Out (Keats Good Herb Guide) by Brigitte Mars; ISBN: 0879838388; http://www.amazon.com/exec/obidos/ASIN/0879838388/icongroupinterna

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Hormone Therapy of Acne: Clinical and Experimental Principles by Doris Fanta (1980); ISBN: 0387815864; http://www.amazon.com/exec/obidos/ASIN/0387815864/icongroupinterna

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How Do We Manage: ACNE by Tom Pyner (1999); ISBN: 1873839561; http://www.amazon.com/exec/obidos/ASIN/1873839561/icongroupinterna

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Natural Way: Acne by Elizabeth Holmes; ISBN: 1862047464; http://www.amazon.com/exec/obidos/ASIN/1862047464/icongroupinterna

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New Approaches to Acne Treatment (Medical Pocketbooks) by W.J. Cunliffe MD FRCP; ISBN: 1853171484; http://www.amazon.com/exec/obidos/ASIN/1853171484/icongroupinterna

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Overcoming Acne: The How and Why of Healthy Skin Care by Alvin Silverstein, et al; ISBN: 0688083447; http://www.amazon.com/exec/obidos/ASIN/0688083447/icongroupinterna

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Pocket Guide to Acne by Amrit Darvay, Tony Chu (2000); ISBN: 0632054379; http://www.amazon.com/exec/obidos/ASIN/0632054379/icongroupinterna

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Quasi-experimentelle Überprüfung der Veränderung psychischer und physiologischer Reaktionen von Acne vulgaris-Patienten im Verlauf von dermatologisch induzierten Hautbildverbesserungen by Barbara Grothgar; ISBN: 363143488X; http://www.amazon.com/exec/obidos/ASIN/363143488X/icongroupinterna

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Rapid Resolutions in the Primary Care Management of Acne (Round Table Series (RTS)) by W.J. Cunliffe (Editor); ISBN: 1853153753; http://www.amazon.com/exec/obidos/ASIN/1853153753/icongroupinterna

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Sebaceous Glands, Acne and Related Disorders: Basic and Clinical Research, Clinical Entities and Treatment (Dermatology) by Ch. C. Zouboulis (Editor) (1998); ISBN: 3805566484; http://www.amazon.com/exec/obidos/ASIN/3805566484/icongroupinterna

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Skin conditions of youths 12-17 years, United States : prevalence of facial acne and other skin conditions of youths in the United States by age, sex, race, geographic region, and socioeconomic background as well as in relation to other selected findings from the Health Examination Survey of 1966-70 by Jean Roberts; ISBN: 0840600607; http://www.amazon.com/exec/obidos/ASIN/0840600607/icongroupinterna

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The 2002 Official Patient's Sourcebook on Acne by James N. Parker (Editor), Philip M. Parker (Editor) (2002); ISBN: 0597832080; http://www.amazon.com/exec/obidos/ASIN/0597832080/icongroupinterna

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The Acne Cure by Terry Dubrow (Author), Brenda Adderly (Author); ISBN: 1579547427; http://www.amazon.com/exec/obidos/ASIN/1579547427/icongroupinterna

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The Acne Prescription : The Perricone Program for Clear and Healthy Skin at Every Age by Nicholas Perricone (Author) (2003); ISBN: 0060188782; http://www.amazon.com/exec/obidos/ASIN/0060188782/icongroupinterna

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The Acne Prescription CD : The Perricone Program for Clear and Healthy Skin at Every Age [ABRIDGED] by Nicholas Perricone (Author) (2003); ISBN: 0060572523; http://www.amazon.com/exec/obidos/ASIN/0060572523/icongroupinterna

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The acnes : clinical features, pathogenesis, and treatment by W. J. Cunliffe; ISBN: 0721627854; http://www.amazon.com/exec/obidos/ASIN/0721627854/icongroupinterna

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The Beauty Bible: From Acne to Wrinkles and Everything in Between by Paula Begoun; ISBN: 1877988227; http://www.amazon.com/exec/obidos/ASIN/1877988227/icongroupinterna

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The Good Skin Doctor: A Dermatologist's Survival Guide to Beating Acne by Tony C. Chu, Anne Lovell (1999); ISBN: 0722536755; http://www.amazon.com/exec/obidos/ASIN/0722536755/icongroupinterna

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The Official Patient's Sourcebook on Acne Rosacea by James N. Parker (Editor), Philip M. Parker (Editor) (2002); ISBN: 0597832129; http://www.amazon.com/exec/obidos/ASIN/0597832129/icongroupinterna

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Treating Acne by Richard A. Walzer, Consumer Reports Books; ISBN: 0890434492; http://www.amazon.com/exec/obidos/ASIN/0890434492/icongroupinterna

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Understanding Skin Problems: Acne, Eczema, Psoriasis and Related Conditions by Linda Papadopoulos (Author), Carl Walker (Author); ISBN: 047084518X; http://www.amazon.com/exec/obidos/ASIN/047084518X/icongroupinterna

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US ACNE TREATMENTS REPORT 2002 [DOWNLOAD: PDF] by Snapshots International Ltd (Author); ISBN: B00006SLEB; http://www.amazon.com/exec/obidos/ASIN/B00006SLEB/icongroupinterna

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Your Skin: From Acne to Zits by Jerome Z., M.D. Litt (1989); ISBN: 0942637135; http://www.amazon.com/exec/obidos/ASIN/0942637135/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “acne” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 ·

Acne Author: Cunliffe, W. J. (William James); Year: 1977; London: M. Dunitz, 1989; ISBN: 0948269391 http://www.amazon.com/exec/obidos/ASIN/0948269391/icongroupinterna

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Acne Author: Juhlin, Lennart; Year: 1940; [S.l.: s.n.]: Stockholm: distributed by Almqvist; Wiksell, 1980

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Acne Author: Brook, Robert H. (Robert Henry); Year: 1949; [Santa Monica, Calif.]: Rand Corporation, c1980; ISBN: 0833002201

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Acne: update for the practitioner Author: Frank, Samuel B.; Year: 1965; New York: Yorke Medical Books, c1979; ISBN: 0914316168 http://www.amazon.com/exec/obidos/ASIN/0914316168/icongroupinterna

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Acne and related disorders: proceedings of an international symposium, Cardiff, 1988 Author: Marks, Ronald; Year: 1975; London: M. Dunitz, 1989; ISBN: 0948269944 http://www.amazon.com/exec/obidos/ASIN/0948269944/icongroupinterna

11 In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Acne and related disorders of complexion and scalp. Author: Bobroff, Arthur; Year: 1953; Springfield, Ill., Thomas [c1964]

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Acne and rosacea Author: Plewig, Gerd; Year: 1989; Berlin; New York: Springer-Verlag, c1993; ISBN: 3540522778

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Acne can be cured Author: Hoehn, Gustave H.; Year: 1964; New York: Arco Pub. Co., c1977; ISBN: 0668041137 http://www.amazon.com/exec/obidos/ASIN/0668041137/icongroupinterna

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Acne vulgaris. Author: Frank, Samuel B.; Year: 1971; Springfield, Ill., Thomas [c1971]

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Acne, an approach to therapy for the pediatrician Author: Tunnessen, Walter W.; Year: 1955; Chicago: Year Book Medical Publishers, c1984

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Acne: morphogenesis and treatment [by] Gerd Plewig [and] Albert M. Kligman. Author: Plewig, Gerd; Year: 1873; Berlin, New York, Springer-Verlag, 1975; ISBN: 3540072128

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Comparative clinical evaluation of isotretinoin and tetracycline in the management of severe nodulocystic acne Author: Lester, Robert S; Year: 1957; Mississauga, Ont.: MES Medical Education Services (Canada), c1984; ISBN: 0886610109

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Diets to help acne. Author: Moyle, Alan; Year: 1973; Wellingborough [Eng.] Thorsons [c1973]; ISBN: 0722502257 http://www.amazon.com/exec/obidos/ASIN/0722502257/icongroupinterna

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Focus on acne vulgaris Author: Cullen, S. I. (Stanley I.); Year: 1974; London: Royal Society of Medicine Services Ltd. Oxford; New York: Distributed by Oxford University Press, 1985; ISBN: 0905958225 http://www.amazon.com/exec/obidos/ASIN/0905958225/icongroupinterna

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Health care guideline: acne management Author: Institute for Clinical Systems Improvement; Year: 1972; Bloomington, MN: ICSI, c2002

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Hormone therapy of acne: clinical and experimental principles Author: Fanta, Doris; Year: 1958; Wien; New York: Springer-Verlag, c1980; ISBN: 3211815864

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Management of patients with severe acne using isotretinoin Author: Raymond, Giles P; Year: 1953; Mississauga, Ont.: MES Medical Education Services (Canada), c1984; ISBN: 0886610087

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Mechanisms of inflammation in acne vulgaris Author: Tucker, Stephen Brent; Year: 1949; [Minneapolis?: s.n.], 1983

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On acne and its treatment. Author: Fox, Tilbury; Year: 1972; Edinburgh: Oliver; Boyd, 1873

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Special issue on sebaceous glands and acne vulgaris; proceedings. Guest editors: William Montagna, Mary Bell, and John S. Strauss. Author: Bell, Mary; Year: 1974; [Baltimore, Williams; Wilkins, 1974]

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The acnes: clinical features, pathogenesis, and treatment Author: Cunliffe, W. J. (William James); Year: 2002; Philadelphia: Saunders, c1975; ISBN: 0721627854 http://www.amazon.com/exec/obidos/ASIN/0721627854/icongroupinterna

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The basal metabolic rate in acne vulgaris; an analysis of 353 determinations [by] C. Jack Young and Stewart C. Smith. Author: Young, Charles Jackson; Year: 1978; Charlottesville, Univ. of Virginia School of Medicine and Hospital, Dept. of Dermatology and Syphilology [1949?]

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The cause and cure of acne eruptions, including pimples and spots, by Richard A. Marshall and Charles R. Stewart. Author: Marshall, Richard A; Year: 1984; Hayward, Calif., Hayward Pub. Co., c1953

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Chapters on Acne In order to find chapters that specifically relate to acne, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and acne using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “acne” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on acne: ·

Chapter 199: Sebaceous Gland Disorders Source: in Berkow, R., ed. The Merck Manual of Medical Information: Home Edition (online version). Rahway, NJ: Merck and Company, Inc. 2000. 5 p. Contact: Available online from Merck and Company, Inc. (800) 819-9456. Website: www.merck.com/pubs/mmanual_home/contents.htm. Also available from your local book store. PRICE: $29.95 plus shipping. Summary: This chapter provides the general public and people who have sebaceous gland disorders with information on the symptoms and treatment of acne, rosacea, perioral dermatitis, and sebaceous cysts. acne is a common skin condition in which dried sebum, flaked skin, and bacteria collect in skin pores, forming a comedo, which blocks sebum from flowing from hair follicles up through the pores. acne is often worse in the winter and better in the summer. Diet has little or no effect. acne may also appear with each menstrual period in young women and may clear up or worsen during pregnancy. Certain cosmetics may aggravate acne. Superficial acne can be made worse by squeezing pimples or trying to open them in other ways. It can be treated by applying the antibiotic clindamycin or erythromycin to the skin. Certain oral antibiotics can reduce or prevent superficial acne. Sunlight can help because it dries the skin and causes slight scaling. Other helpful topical agents are benzoyl peroxide and preparations containing sulfur resorcinol. Deep acne is treated with an oral antibiotic or oral isotretinoin if antibiotics are ineffective. Although isotretinoin is very effective, it can have serious side effects, so a person taking this drug must be monitored. Rosacea is a persistent skin disorder of unknown etiology that produces redness, tiny pimples, and broken blood vessels, usually on the central area of the face. Treatment involves avoiding foods that cause blood vessels to dilate, taking oral antibiotics, and applying topical antibiotics. Perioral dermatitis, a red, often bumpy rash around the mouth and on the chin, can be caused by corticosteroids and by some oily cosmetics. Oral tetracyclines are usually the best treatment. Sebaceous cysts are yellowish or flesh colored bumps that contain dead skin, skin excretions, and other skin particles. These cysts are treated by either puncturing the top with a needle or cutting the top off with a scalpel, then squeezing out the contents. 1 figure.

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Chapter 78: Follicular Syndromes with Inflammation and Atrophy Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 818-822. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 759-3749 or (614) 759-3641. E-

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mail: [email protected]. PRICE: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on the classification, historical aspects, epidemiology, etiology, pathogenesis, clinical features, pathology, differential diagnosis, treatment, course, and prognosis of follicular syndromes with inflammation and atrophy. Keratosis pilaris atrophicans (KPA) is the term suggested for a group of phenotypically related rare disorders that have several common features, including keratotic follicular papules, nonpurulent inflammation of variable degree, and atrophic end stages characterized by irreversible hair loss or atrophic depressions similar to pitted scars. Categories of KPA include localized entities of keratosis pilaris atrophicans faciei (KPAF) and atrophoderma vermiculatum (AV) and the generalized keratosis follicularis spinulosa decalvans (KFSD) of Siemens. KPAF is the most common form of KPA, but AV and KSFD are very rare. The etiology of the disorders that make up KPA are genodermatoses of unknown origin, and the pathogenesis is not well understood. Both KPAF and KPSD begin in infancy, but AV usually does not occur until between 5 and 12 years of age. In addition, AV is morphologically different from KPAF and KPSD in that it causes scarlike atrophic pits of the cheeks. The histologic picture depends on the stage of the process. Differential diagnosis of these three follicular syndromes involves distinguishing KPAF from seborrheic dermatitis, KPSD from atopic dermatitis and the KID syndrome, and AV from acne infantum. In addition, there are several other disorders that may appear similar to these three syndromes. There is no effective therapy for reversing the course of the syndromes, but some emollients and topical drugs may relieve symptoms. 3 figures and 57 references. ·

Chapter 73: Diseases of the Sebaceous Glands Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 769-784. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 759-3749 or (614) 759-3641. Email: [email protected]. PRICE: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on acne vulgaris, its epidemiology, etiology, pathogenesis, clinical manifestations, laboratory findings, pathology, diagnosis, and treatment. This self limited disease, seen mainly in adolescents, involves the sebaceous follicles. acne is often an early manifestation of puberty, and most cases are seen during the middle to late adolescent period. The disease seems to be familial. Although the basic cause of acne is unknown, there is considerable information on the various factors involved in its pathogenesis. The primary site is the face, but the back, chest, and shoulders may also be affected. acne is characterized by various noninflammatory or inflammatory clinical lesions. Laboratory studies are not usually indicated for patients who have acne unless hyperandrogenism is suspected. The diagnosis of acne vulgaris is usually made from the finding of a mixture of comedones, pustules, papules, and nodules on the face, back, or chest. Therapeutic options include local, physical, or systemic therapy. Local therapy involves cleansing and applying topical agents such as vitamin A acid, benzoyl peroxide, and azelaic acid. Physical therapy includes superficial x ray therapy, ultraviolet light therapy, cryotherapy, surgery, and intralesional injection of glucocorticoids. The major systemic modalities that are currently being used include antibiotics and antibacterial agents; hormones such as estrogens, oral contraceptives, glucocorticoids, gonadotropin

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releasing hormone agonists, and antiandrogens; and the oral synthetic retinoid isotretinoin. The prognosis vulgaris is favorable, with scarring being the only physical sequela. The article also describes miscellaneous types of acne, including neonatal acne; excoriated acne; acne induced by steroids, iodides, bromides, and other drugs; occupational acne; tropical acne; acne aestivalis; acne cosmetica; pomade acne; acne detergicans; acne mechanica; acne with facial edema; acne conglobata; acne fulminans; and steatocystoma multiplex. 10 figures and 114 references. ·

Chapter 75: Perioral Dermatitis Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 794-799. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 759-3749 or (614) 759-3641. Email: [email protected]. PRICE: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on the epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of perioral dermatitis. This facial dermatosis predominantly affecting women of childbearing age is characterized by an erythematous, micropapular, fine scaling eruption classically affecting the nasolabial folds, chin, and upper lip. Factors implicated in causing perioral dermatitis include ultraviolet light, infective agents, demodectic infections, skin irritants, hormones, and glucocorticoids. Laboratory investigations that have been reported include patch testing, bacteriology, mycology for Candida, and a search for Demodex. Although diagnosis should be no problem in classic perioral dermatitis, when the clinical picture is not so distinctive, differential diagnosis should include rosacea, seborrheic dermatitis, contact dermatitis, acne, and papular sarcoid. Treatment involves the use of oral tetracycline. Prevention involves determining the cause, but many factors have been implicated in the etiology of perioral dermatitis, and none have been proven or confirmed. However, there is no doubt that the condition is precipitated or aggravated in many patients by using topical glucocorticoids. Untreated, the disease usually persists over several years, and the condition can resolve spontaneously. Prognosis is excellent with appropriate therapy. 3 figures and 72 references.

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Chapter 136: Abnormal Responses to Ultraviolet Radiation: Idiopathic Source: in Freedberg, I.M., et al., eds. Fitzpatrick's Dermatology in General Medicine. 5th ed., Vol. 1. New York, NY: McGraw-Hill. 1999. p. 1573-1589. Contact: Available from McGraw-Hill Customer Services. P.O. Box 548, Blacklick, OH 43004-0548. (800) 262-4729 or (877) 833-5524. Fax (614) 759-3749 or (614) 759-3641. Email: [email protected]. PRICE: $395.00 plus shipping and handling. ISBN: 0070219435. Summary: This chapter provides health professionals with information on abnormal responses to exposure to ultraviolet (UV) radiation (UVR), focusing on acquired idiopathic photodermatoses. The chapter discusses the etiology, clinical features, diagnosis, and treatment of polymorphic light eruption (PMLE), actinic prurigo (AP), hydroa vacciniforme (HV), solar urticaria (SU), and chronic actinic dermatitis (CAD). PMLE, the most common photodermatosis, occurs mainly in fair skinned people and is characterized by nonscarring, pruritic, erythematous papules, vesicles, or plaques on light exposed skin. The etiology of PMLE is unclear. Diagnosis is based mainly on the

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time course for the evolution and morphology of the lesions. Mild cases may be controlled by moderating sun exposure at times of high UV light intensity and applying a broad spectrum sunscreen with a high protection factor. More severe cases may be treated with prophylactic low dose photochemotherapy. AP, which is more common in females, is characterized by a persistent, pruritic, excoriated papular or nodular eruption mainly of sun exposed areas. Data suggest that AP is immunologically mediated. Although restricting sun exposure and using broad spectrum, high protection sunscreens may occasionally help milder cases, intermittent courses of low dose thalidomide are very effective for most patients. HV, a very rare idiopathic disorder occurring mainly in childhood, is characterized by recurrent crops of vesicles on some or all sun exposed skin. HV is often controlled by the regular use of high protection sunscreens against UVA and UVB radiation. SU is an uncommon condition in which UV or visible irradiation leads to itching, erythema, and patchy or confluent whealing on some or all exposed skin. Diagnosis is confirmed with phototesting with an irradiation monochromator or broad spectrum source of irradiation. Nonsedating H1 antihistamines may be an effective treatment. CAD, which occurs mainly in middle aged or elderly men, is an eczematous eruption possibly associated with infiltrated papules and plaques on sun exposed skin. Diagnosis is confirmed by phototesting the skin. Restricting sun exposure and using broad spectrum, high protection sunscreens are important aspects of treatment, but they are rarely adequate as sole measures. Azathioprine may be used to achieve remission in many resistant patients. The chapter also describes dermatoses exacerbated by UVR, including acne, dermatomyositis, disseminated superficial actinic porokeratosis, lichen planus actinicus, eczema, lupus erythematous, mycosis fungoides, pellagra, pemphigus, and psoriasis. The chapter concludes by presenting the process for assessing a photosensitive patient, focusing on taking a medical history, conducting laboratory studies, phototesting, and performing patch and photopatch tests. 7 figures, 4 tables, and 156 references. ·

Skin Disorders Source: in Mosby 's Patient Teaching Guides. St. Louis, MO: Mosby -Year Book, Inc. 1995. p. 113-33. Contact: Mosby -Year Book, Inc. 11830 Westline Industrial Drive, St. Louis, MO. 63146. ISBN: 0815158629. Summary: This section of Mosby 's Patient Teaching Guides examines the following skin disorders: acne; cystic acne; rosacea; the prevention of skin cancers such as basal cell carcinoma; malignant melanoma; contact dermatitis; atopic dermatitis; psoriasis and etretinate treatment; and scabies. Burn injuries and postoperative wound care at home are also addressed. Each section, where applicable, provides an explanation of the ailment, risk factors, diagnosis and treatment, and prevention tips.

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Cushing's Disease and Syndrome Source: in Graham, S.D., Jr., et al., eds. Glenn's Urologic Surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins. 1998. p. 3-7. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-3030 or (301) 714-2300. Fax (301) 824-7390. Website: lww.com. PRICE: $199.00 plus shipping and handling. ISBN: 0397587376. Summary: Cushing's disease and syndrome are characterized by the association of pituitary lesions in patients with hirsutism, proximal muscle weakness, round plethoric faces, increased supraclavicular and infrascapular fat pads, thin skin, and other less

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frequent signs such as acne, purple abdominal striae, and psychiatric symptoms. This chapter on Cushing's disease and syndrome is from an exhaustive textbook on urologic surgery. There are numerous etiologies of Cushing's syndrome, most involving the production of excessive ACTH from pituitary adenomas or from ectopic sources, benign adrenal tumors, and adrenal hyperplasia (overgrowth). The criteria for a diagnosis of Cushing's syndrome is excessive ACTH. The diagnosis may also be based on an abnormality of the plasma or urinary cortisol. Indications for surgery of the adrenal gland in patients with Cushing's syndrome include adrenal adenoma, adrenal hyperplasia, and adrenal carcinoma. The author then describes the posterior approach to the adrenal glands. Surgical complications following adrenal surgery for Cushing's syndrome include not only those that pertain to routine retroperitoneal surgery (e.g., blood loss and infection) but also those complications specific to patients with hormonal imbalances. Postoperative wound healing may be impaired, and the infection rate has been described to be between 4 and 21 percent. 6 figures. 6 references. ·

Skin Source: in Daugirdas, J.T. and Ing, T.S., eds. Handbook of Dialysis. 2nd ed. Boston, MA: Little, Brown and Company. 1994. p. 583-589. Contact: Available from Lippincott-Raven Publishers. 12107 Insurance Way, Hagerstown, MD 21740. (800) 777-2295. Fax (301) 824-7390. E-mail: [email protected]. Website: http://www.lrpub.com. PRICE: $37.95. ISBN: 0316173835. Summary: This chapter on skin disorders is from a handbook that outlines all aspects of dialysis therapy, emphasizing the management of dialysis patients. Topics include skin disorders relating to the uremic syndrome, including pruritus, dry skin, hyperkeratosis penetrans, changes in skin pigmentation, purpura, uremic frost, bullous dermatosis and porphyria cutanea tarda, calciphylaxis, skin necrosis, and nail changes; drug-induced skin disorders, including hypertrichosis, acne, and allergic skin reactions; and skin lesions related to the primary renal disease. The author presents information in outline form, for easy reference. 2 tables. 16 references.

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Sexual Activity Source: in Epilepsy and the Family: A New Guide. Lechtenberg, R. Cambridge, MA, Harvard University Press, pp. 73-83, 1999. Contact: Harvard University Press, Cambridge, MA. INTERNET/EMAIL: www.hup.harvard.edu. Summary: Sexual Activity, a chapter in Epilepsy and the Family: A New Guide, discusses the risks of and remedies for sexual dysfunction in persons with epilepsy. Persons with epilepsy have the same sexual problems as the general population, but possibly at a slightly higher frequency. Lack of interest and fear that sexual intercourse will cause a seizure are the main problems. Other problems include (1) hyposexuality, (2) transvestitism, (3) fetishism, (4) exhibitionism, and (5) drug-related impotence. Controlling seizures will not eliminate all sexual problems associated with epilepsy and may add to them. Reduced sex drive is often a side effect of antiepileptic drugs (AED's), but sexual inhibitions and anxieties develop mainly when seizure control is poor. Decreased sexual activity due to impaired libido is common in men and women with complex partial seizures. The sexual interest of a partner with this type of seizure disorder does not usually return, although good seizure control may help. People with complex partial seizures have a greater incidence of eccentric sexual behavior than

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people in the general population. A small portion of persons with complex partial seizures, mostly women, have orgasms as part of their seizures. It is not known whether changes in sexual activity are transient events of if they are permanent side effects of complex partial seizures. Deviant sexual behavior is seen more often in patients with temporal lobe epilepsy. Sexual dysfunction in persons with epilepsy is not always caused by the seizure disorder. Other types of sexual dysfunction should be considered. Couples must be patient and committed to overcoming the sexual inhibitions that develop when epilepsy is poorly controlled. AED's can cause unattractive cosmetic changes that contribute to the social and sexual problems in persons with epilepsy. These include (1) acne, (2) coarsening of facial skin and darkening of facial hair, (3) periodontal problems, and (4) rashes. Sexual dysfunction in a person with epilepsy is usually not permanent, and a sex therapist or physician can help improve sexual activity.

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CHAPTER 7. MULTIMEDIA ON ACNE Overview In this chapter, we show you how to keep current on multimedia sources of information on acne. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Acne The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in acne (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on acne (for more information, follow the hyperlink indicated): ·

Acne: pathogenesis and treatment [slide] Source: American Academy of Dermatology; Year: 1977; Format: Slide; Evanston, Ill.: The Academy, [1977]

·

Acne vulgaris [motion picture]: its pathogenesis Source: a National Medical Audiovisual Center production; [presented by] the U.S. Department of Health, Education, and Welfare, Public Health Service; produced in cooperation with the Institute forDermatologic; Year: 1968; Format: Motion picture; United States: Public Health Service, 1968

·

Acne vulgaris [videorecording] Source: Academy of Health Sciences, Health Sciences Media Division; produced and distributed by the Institute for Dermatologic Communication and Education; Year: 1979; Format: Videorecording; San Francisco, Calif.: The Institute, c1979

·

Acne, eczema, and vesicular diseases of children [sound recording] Source: American Academy of Pediatrics; Year: 1989; Format: Sound recording; Chicago, IL: Teach'em, [1989]

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·

Acne, perioral dermatitis and rosacea; Contact dermatitis; Infestations [videorecording] Source: produced for the Canadian Association of Professors of Dermatology by Roberta Ongley; Biomedical Communications, University of British Columbia; Year: 1993; Format: Videorecording; [Vancouver, B.C.]: The University, c1993

·

Advances in acne therapy [videorecording] Source: with Robert S. Gilgor; Year: 1988; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1988

·

Clinical management of acne [videorecording] Source: [presented by] the American Academy of Family Physicians; produced by Gardiner-Caldwell SynerMed; Year: 1991; Format: Videorecording; Kansas City, Mo.: The Academy, c1991

·

Pediatric and adolescent wellness. Pt. 3, Acne [videorecording] Source: [HSTN]; Year: 1998; Format: Videorecording; Carrollton, TX: PRIMEDIA Workplace Learning, c1998

·

Plastic planing of the skin [motion picture]: a method for the repair of acne scars and other skin defects Source: [production company unknown]; by Abner A. Kurtin; Year: 1953; Format: Motion picture; [S.l.: s.n., 1953]

·

The facts about acne [videorecording] Source: presented by the American Academy of Dermatology; produced by Edward Stecki Communications for Management, Inc., International and the Dept. of Communications, American Academy of Dermatology; Year: 1988; Format: Videorecording; Schaumberg, IL: The Academy, c1988

·

Treatment of acne [slide] Source: Postgraduate Medicine and Health Media Production Unit, University Slide; Ann Arbor: The University: Library], c1978

University of Michigan Medical Center, Dept. of Professions Education; [produced by] Biomedical of Michigan Medical Center; Year: 1978; Format: [for loan and sale by its Medical Center Media

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CHAPTER 8. PERIODICALS AND NEWS ON ACNE Overview In this chapter, we suggest a number of news sources and present various periodicals that cover acne.

News Services and Press Releases One of the simplest ways of tracking press releases on acne is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.

PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “acne” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance.

Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to acne. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “acne” (or synonyms). The following was recently listed in this archive for acne: ·

Emotional stress may influence acne severity Source: Reuters Medical News Date: July 22, 2003 http://www.reutershealth.com/archive/2003/07/22/professional/links/20030722clin 009.html

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·

FDA tells Mylan to pull acne/self-esteem statement Source: Reuters Industry Breifing Date: June 20, 2003

·

Vicuron acne antibiotic shows promise in phase I Source: Reuters Industry Breifing Date: June 18, 2003

·

CoolTouch laser wins U.S. nod for acne treatment Source: Reuters Industry Breifing Date: May 28, 2003

·

Candela earns FDA okay to market laser for acne scars Source: Reuters Industry Breifing Date: January 30, 2003

·

Connetics starts phase III studies of combination acne gel Source: Reuters Industry Breifing Date: January 06, 2003

·

Access acne drug cleared in eight new European markets Source: Reuters Industry Breifing Date: December 19, 2002

·

Novactyl begins phase IIa trial of topical acne drug Source: Reuters Industry Breifing Date: November 26, 2002

·

Roche acne drug's US label to cite violence risk Source: Reuters Industry Breifing Date: November 04, 2002

·

FDA approves Allergan's tazarotene acne therapy for treatment of facial wrinkles Source: Reuters Medical News Date: October 01, 2002

·

Allergan acne drug cleared for treatment of facial wrinkles Source: Reuters Industry Breifing Date: October 01, 2002

·

Low-dose oral contraceptive safe and effective treatment for acne Source: Reuters Industry Breifing Date: September 10, 2002

Periodicals and News 145

·

FDA approves Stiefel Labs acne gel Source: Reuters Industry Breifing Date: August 28, 2002

·

Lumenis shares up on FDA clearance of laser device for acne Source: Reuters Industry Breifing Date: August 20, 2002

·

FDA approves laser device for acne Source: Reuters Medical News Date: August 20, 2002

·

Radiancy cleared to sell acne laser treatment in Japan Source: Reuters Industry Breifing Date: July 23, 2002

·

Adding retinoid improves lymecycline therapy for acne vulgaris Source: Reuters Industry Breifing Date: July 02, 2002

·

Connetics launches phase III testing of second acne drug Source: Reuters Industry Breifing Date: June 26, 2002

·

European authorities to harmonise on pregnancy prevention measures for acne drug Source: Reuters Industry Breifing Date: May 31, 2002

·

Connetics licenses acne gel from Yamanouchi Source: Reuters Industry Breifing Date: May 14, 2002

·

Lumenis to provide FDA with more data on acne lesion treatment Source: Reuters Industry Breifing Date: April 30, 2002

·

Short-contact tazarotene therapy safe and effective treatment for acne Source: Reuters Industry Breifing Date: April 23, 2002

·

Atrix says acne drug successful in phase III trial Source: Reuters Industry Breifing Date: March 28, 2002

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·

Biosearch starts phase I studies of topical acne treatment Source: Reuters Industry Breifing Date: March 21, 2002

·

Micrologix stock drops on phase II plans for acne drug Source: Reuters Industry Breifing Date: November 30, 2001

·

FDA announces new restrictions on Hoffman-La Roche acne drug Source: Reuters Industry Breifing Date: October 31, 2001

·

Atrix licenses acne treatment to Fujisawa Source: Reuters Industry Breifing Date: October 17, 2001

·

Allergan's Tazorac cream approved by FDA for acne Source: Reuters Industry Breifing Date: October 16, 2001

·

FDA approves storage of Dermik acne gel at room temperature Source: Reuters Industry Breifing Date: September 13, 2001

·

New laser therapy device shows promise in treating acne scars Source: Reuters Industry Breifing Date: July 30, 2001

·

FDA approves Pfizer Inc.'s Estrostep oral contraceptive for the treatment of acne Source: Reuters Industry Breifing Date: July 06, 2001

·

Antibiotics losing their power against acne Source: Reuters Medical News Date: May 25, 2001

·

Antibiotics losing their power against acne, study finds Source: Reuters Industry Breifing Date: May 24, 2001

·

Low-dose oral contraceptive may improve moderate acne Source: Reuters Industry Breifing Date: May 04, 2001


·

Berlex's Finevin gets FDA approval as acne treatment Source: Reuters Industry Breifing Date: May 03, 2001

·

Atrix starts phase III trial of acne cream Source: Reuters Industry Breifing Date: April 18, 2001

·

Corixa deciphers genome important to acne, plans vaccine Source: Reuters Industry Breifing Date: April 06, 2001

·

Antibiotic-resistant acne vulgaris becoming problematic Source: Reuters Industry Breifing Date: April 03, 2001

·

Wyeth-Ayerst seeks acne indication for Alesse oral contraceptive Source: Reuters Industry Breifing Date: January 19, 2001

·

Atrix to initiate phase III trials of Atrisone topical acne treatment Source: Reuters Industry Breifing Date: January 02, 2001

·

Dermik wins FDA approval of topical acne treatment Source: Reuters Industry Breifing Date: December 26, 2000

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name.

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Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “acne” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests.

Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “acne” (or synonyms). If you know the name of a company that is relevant to acne, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “acne” (or synonyms).

Newsletters on Acne Find newsletters on acne using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “acne.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “acne” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: ·

Drug-Induced Rheumatic Syndromes Source: Bulletin on the Rheumatic Diseases. 51(4): 1-4. 2002. Contact: Available from Arthritis Foundation. 1330 West Peachtree Street, Atlanta, GA 30309. (800) 268-6942 or (404) 872-7100. Fax (404) 872-9559. Website: www.arthritis.org. Summary: This newsletter provides health professionals with information on drug induced rheumatic syndromes. Categories of drug induced rheumatic diseases are drug induced lupus (DIL), drug induced myopathy/myositis (DIM), and drug induced vasculitis (DIV). Although more than 100 drugs have been implicated in DIL, the drugs most studied have been procainamide and hydralazine. However, these drugs are not commonly prescribed today, and the illness they produce is often different from those


recently implicated in DIL. Minocycline is a treatment used for acne and rheumatoid arthritis that has caused immune and autoimmune phenomena. Several of the new recombinant biologics have been implicated in DIL, including interferon alpha, interferon gamma, and antitumor necrosis factor therapies. It is not possible to predict who will develop DIL, so patients with idiopathic lupus should be allowed to take potentially lupus inducing drugs but with careful monitoring. Drugs associated with the development of DIV include hematopoietic growth factors such as G-CSF and GM-CSF; vaccines for hepatitis B, influenza, and others; and leukotriene inhibitors. The article concludes that the number of drugs that are capable of inducing rheumatic syndromes is growing. Elements in the assessment of a possible association between exposure and the development of a rheumatic disorder include temporal association, lack of likely alternative explanations, rechallenge, and biological plausibility. 1 table and 23 references.

Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “acne” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on acne: ·

Prepubertal Acne Predicts Severe Acne Later Source: Skin and Allergy News. 28(5):8; May 1997. Summary: This newsletter article for health professionals reports on a study that found that prepubertal acne predicts severe acne later. A study of 623 fourth- and fifth-grade girls found that 78 percent had some acne. Data from a follow-up study 5 years later revealed that girls who had more acne as 9- or 10-year-olds were more likely to develop severe acne. Throughout the 5-year span, these girls also had higher serum levels of the hormone dehydroepiandrosterone sulfate than girls with less severe or no acne. The study found no racial differences for the development of acne. The article stresses the need for physicians to take preteen acne development very seriously.

Academic Periodicals covering Acne Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to acne. In addition to these sources, you can search for articles covering acne that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles.

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At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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APPENDICES

153

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

·

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

·

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

·

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

·

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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·

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

·

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

·

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

·

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

·

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

·

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

·

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

·

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

·

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

·

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

·

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

·

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

·

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

·

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

·

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

·

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

·

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

·

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources 155

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 ·

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

·

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

·

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

·

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

·

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

·

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

·

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

·

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

·

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

·

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

·

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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·

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

·

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The NLM Gateway15

The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “acne” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 8761 196 164 4 1 9126

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “acne” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 The HSTAT URL is http://hstat.nlm.nih.gov/. 19 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 15 16


Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Acne In the following section, we will discuss databases and references which relate to the Genome Project and acne.

Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information.

20 Adapted

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 23 Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease. 21

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To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “acne” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for acne: ·

Acne, Adult Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?604324

·

Pyogenic Sterile Arthritis, Pyoderma Gangrenosum, and Acne Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?604416

Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to revisit it from time to time. The following systems and associated disorders are addressed: ·

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

·

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

·

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html


·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

·

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

·

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then

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select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “acne” (or synonyms) into the search box and click “Go.”

Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “acne” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

24 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 25 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on acne can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to acne. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.

The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below.

Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to acne. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “acne”:

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·

Guides on acne Acne http://www.nlm.nih.gov/medlineplus/acne.html

·

Other guides Acne http://www.nlm.nih.gov/medlineplus/acne.html Dermatitis http://www.nlm.nih.gov/medlineplus/dermatitis.html Plastic & Cosmetic Surgery http://www.nlm.nih.gov/medlineplus/plasticcosmeticsurgery.html Rosacea http://www.nlm.nih.gov/medlineplus/rosacea.html Scars http://www.nlm.nih.gov/medlineplus/scars.html Skin Diseases http://www.nlm.nih.gov/medlineplus/skindiseasesgeneral.html

Within the health topic page dedicated to acne, the following was listed: ·

General/Overviews Acne http://www.nlm.nih.gov/medlineplus/tutorials/acneloader.html

·

Diagnosis/Symptoms Skin Rashes and Other Changes: Self-Care Flowcharts Source: American Academy of Family Physicians http://familydoctor.org/flowcharts/545.html

·

Treatment Accutane Capsules (Isotretinoin) Source: Center for Drug Evaluation and Research http://www.fda.gov/cder/drug/infopage/accutane/medicationguide.htm Acne and Isotretinoin: Using Isotretinoin the Right Way Source: American Academy of Family Physicians http://familydoctor.org/handouts/631.html Combination Therapies Offer New Management Options for Acne and Rosacea Source: American Academy of Dermatology http://www.aad.org/PressReleases/combination.html Over-the-Counter Products Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/overthecounter.html

Patient Resources 163

Prescription Medications Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/precriptmeds.html Treating Acne Source: American Academy of Pediatrics http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZKRFFG L5C.html&soc=AAP&srch_typ=NAV_SERCH ·

Specific Conditions/Aspects Acne Myths and Misconceptions Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/myths.html Acne Scarring Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/scarring.html Cosmetics & Acne Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/cosmetics.html Hidradenitis Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00837 Why Acne Forms and How Accutane Knocks It Out Source: Food and Drug Administration http://www.fda.gov/fdac/features/2001/sideacne.html

·

Children Acne: Help Is Here! Source: American Academy of Dermatology http://www.aad.org/Kids/acne.html Your Baby's Skin: Not Always Flawless Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=PR00049

·

From the National Institutes of Health Questions and Answers about Acne Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/hi/topics/acne/acne.htm

·

Organizations AcneNet Source: American Academy of Dermatology http://www.derm-infonet.com/acnenet/ American Academy of Dermatology http://www.aad.org/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/ ·

Research Unusual "Side Effect" of an Acne Drug http://www.annals.org/issues/v136n8/fpdf/200204160-00003.pdf

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Teenagers Acne in Teens: Ways to Control It Source: American Academy of Family Physicians http://familydoctor.org/healthfacts/001/index.html Can Acne Scars Be Removed? Source: Nemours Foundation http://kidshealth.org/teen/your_body/skin_stuff/acne_scars.html Why Do I Get Acne? Source: Nemours Foundation http://kidshealth.org/teen/your_body/skin_stuff/acne.html

·

Women Women and Acne: The Hormonal Connection Source: American Academy of Dermatology http://www.aad.org/PressReleases/hormone.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on acne. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

FAQs About Acne, The Source: Newport News, VA: Inflammatory Skin Disease Institute (ISDI). 2002. 4 p. Contact: Available from Inflammatory Skin Disease Institute. P.O. Box 1074, Newport News, VA 23601. (757) 223-0795. Fax (757) 595-1842. E-mail: [email protected]. Website: www.isdionline.org. PRICE: Contact organization for pricing information.


Summary: This pamphlet uses a question and answer format to provide people who have acne with information on the causes and treatment of this chronic inflammatory skin disease associated with increased activity of the sebaceous glands. Acne usually occurs near the onset of puberty as androgen hormone production affects the sebaceous glands in both genders. Although the frequency of acne peaks during adolescence, adults may have acne. Foods, personal hygiene habits, and stress do not cause acne. However, it has been speculated that postadolescent acne in women is related to chronic stress leading to enhanced secretion of adrenal androgen hormone, causing increased sebaceous gland activity. Treatments vary with the type of acne. Nonprescription treatments for mild acne may be used to unplug pores and reduce bacteria. Prescription drugs, which may used for more stubborn forms of acne, include antibiotics, vitamin derivatives, and hormones. The duration of acne and response to treatment vary. Treatment generally prevents new acne but existing blemishes must heal gradually. ·

Questions and Answers About Acne Source: Bethesda, MD: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 2001. 24 p. Contact: Available from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse. 1 AMS Circle, Bethesda, MD 20892-3675. (877) 226-4267 or (301) 495-4484. Fax (301) 718-6366. TTY (301) 565-2966. E-mail: [email protected]. Website: www.niams.nih.gov. PRICE: 1 to 25 copies free. Order Number: AR-80 QA (booklet), or AR-80L QA (large print). Summary: This booklet uses a question and answer format to provide people who have acne with information about its causes and treatment. Acne is a disorder of the sebaceous glands that results in plugged pores and outbreaks of lesions called pimples. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring. Acne occurs when a change in the inner lining of the follicle prevents sebum from passing through the surface of the skin. Bacteria that normally live on the skin grow in the plugged follicle and produce chemicals and enzymes that can cause inflammation. The basic acne lesion, which is known as a comedo or comedone, is an enlarged hair follicle plugged with oil and bacteria. Other acne lesions include papules, pustules, nodules, and cysts. Although the exact cause of acne is unknown, doctors believe that both androgens and heredity play a role in its etiology. People of all ages get acne, but it is most common among adolescents. Treatment involves using one of several over the counter or prescription topical medications or a prescription systemic medication. Severe inflammatory acne that does not improve with other medications may be treated with isotretinoin. Skin care for people who have acne involves washing the skin gently with a mild cleanser twice per day, avoiding frequent handling of the skin, shaving carefully, avoiding suntanning, and choosing cosmetics carefully. Researchers are working to develop new topical antibiotics for treating acne and to determine the factors present in girls during early puberty that might predict the development of severe acne later. The fact sheet includes a list of additional sources of information. 2 figures.

·

Acne Source: Schaumburg, IL: American Academy of Dermatology. 1996. 6 p. Contact: Available from American Academy of Dermatology. P.O. Box 681069, Schaumburg, IL 60168-1069. (888) 462-3376 or (847) 330-0230. http://www.aad.org/index.html. PRICE: Single copy free; bulk prices available.

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Summary: This brochure for people with acne presents an overview of this skin condition. Acne is the term for plugged pores, pimples, and cysts or nodules that occur on the face, neck, chest, back, shoulders, and upper arms. Although the condition affects most adolescents to some extent, it is not restricted to any age group. The brochure explains how a pimple forms, what constitutes normal care of the skin, and the differing opinions dermatologists have on the importance of diet in acne management. It discusses benefits and problems in tanning the skin to mask acne, what cosmetics should be used, and the various topical and oral treatments available. 3 photographs. ·

Acne Keloidalis Nuchae Source: Kirksville, MO: American Osteopathic College of Dermatology (AOCD). 2001. 1 p. Contact: Available online from American Osteopathic College of Dermatology. 1501 East Illinois Street, P.O. Box 7525, Kirksville, MO 63501. (800) 449-2623 or (660) 665-2184. Fax (660) 627-2623. E-mail: [email protected]. Website: www.aocd.org/skin/dermatologic_diseases/ index.html. Summary: This fact sheet provides people who have acne keloidalis nuchae (AKN) with information on this condition. AKN occurs primarily among people with stiff or curly hair and those with darker skin. Hairs on the back of the head and neck grow into the skin, become inflamed, and cause scar tissue. Treatment options include suppression of the inflammation with antibiotics and steroid gels or intralesional steroid injections. Surgery is used to remove larger lumps of AKN that have been present for a while or have not responded to treatment. Hair removal lasers may be a useful tool in early AKN. 2 figures.

·

Using Isotretinoin the Right Way for Acne Source: American Family Physician. 62(8): 1835-1836. October 15, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides people who have acne with information on the use of isotretinoin to treat this skin condition. Isotretinoin is used for severe acne that has not responded to other treatment methods. The drug should be taken with food, and vitamin A pills or multivitamins with vitamin A should not be taken in conjunction with isotretinoin. Acne may initially worsen when treatment begins. Dosage is individualized and may be changed during treatment. Serious side effects may occur during treatment, but they usually go away once therapy ends. A person who experiences any of these side effects should stop taking isotretinoin immediately and check with his or her doctor. Girls and women who are pregnant or might get pregnant should not take the drug because it causes severe birth defects.

·

Acne and Isotretinoin: Using Isotretinoin the Right Way Source: American Academy of Family Physicians. 2000. 3 p. Contact: Available from American Academy of Family Physicians. Website: www.familydoctor.org. Summary: This fact sheet discusses precautions when using isotretinoin (Accutane) to treat acne. Isotretinoin is used to treat bad acne and acne that is resistant to other forms


of treatment. The initial treatment lasts from 15 to 20 weeks. During this time, patients may not give blood, take vitamin A, have any cosmetic procedures, or take antibiotics. Women need to use two forms of birth control while taking isotretinoin as severe birth defects may occur in a developing fetus. Isotretinoin has many side effects including dry skin and lips, bleeding gums, muscular pain, thinning hair, increased sensitivity to the sun, nosebleeds, headache, nausea, yellow or red eyes, severe stomach pain, and diarrhea. These side effects usually go away after stopping the medication. ·

Acne: Six Rules To Live By Source: Patient Care. 33(11): 278. June 15, 1999. Summary: This patient information sheet provides people who have acne with information on guidelines for caring for their skin. Although acne is not caused by greasy foods and treats like chocolate, people who notice that certain foods seem to make acne worse should avoid them. Skin should be washed with gentle cleaners in the morning and in the evening. Astringents should be avoided unless the skin is very oily, and then, they should be used only on oily spots. Squeezing pimples will not improve a person's skin. Medications should be used according to their directions. Doctors and pharmacists may be helpful in answering questions about medications or other concerns. Remaining with the program recommended by one's physician is important because it may take more than a month for noticeable improvement.

·

Treatment of Acne Scars Source: Schaumburg, IL: American Society for Dermatologic Surgery (ASDS). 1998. 2 p. Contact: Available from American Society for Dermatologic Surgery. 930 North Meacham Road, Schaumburg, IL 60173-6016. (800) 441-2737 or (847) 330-9830. Fax (847) 330-0050. Website: www.asds-net.org. PRICE: Call '800' number or access website for single free copy. Summary: This fact sheet provides the general public with information on the treatment of acne scars. Acne can result in icepick or pitting scars and depressed, crater-like scars. Various dermatologic surgical techniques can be used to remove these scars, including dermabrasion, excision and punch replacement graft, soft tissue augmentation, laser therapy, and chemical peeling. The fact sheet provides information on the American Society for Dermatologic Surgery and presents a source for further information.

·

What Can I Do About Pimples? Source: American Family Physician. 61(2): 366. January 15, 2000. Contact: American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article uses a question and answer format to provide people who have acne with information on the causes and treatment of this skin condition. Acne causes skin blemishes called pimples. Acne often begins in adolescence when the skin makes too much oil, the pores become blocked, and bacteria grow more easily. Some medicines can also cause pimples. Skin care tips include washing one's face twice a day with mild soap and warm water; avoiding picking or squeezing pimples; avoiding the use of oil based makeup, hair products, or suntan lotions; and using over the counter acne medications. If acne does not improve after using a nonprescription medication for

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a few weeks, a physician can provide prescription medicines such as stronger benzoyl peroxide, topical antibiotics, and vitamin A related products.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “acne” (or synonyms). The following was recently posted: ·

Acne Source: Finnish Medical Society Duodecim - Professional Association; 2001 April 30; Various pagings http://www.guideline.gov/summary/summary.aspx?doc_id=3389&nbr=2615&a mp;string=acne

Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Acne Scar Correction Summary: Thanks to the refinement of a number of dermatologic surgical techniques, acne scars can be treated with a variety of safe, effective procedures that improve the appearance of a patient's skin and Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6733

·

Acne: Help is Here Summary: Offers a general overview of acne and acne treatment and skin care for teens. Face washing techniques and products are described. Source: American Academy of Dermatology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=5776

·

AcneNet Summary: Links to basic facts about acne and its social impact and treatment. Includes a glossary. Source: American Academy of Dermatology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6396


·

Dermabrasion Summary: During dermabrasion, or surgical skin planing, the dermatologic surgeon freezes the patient's skin, scarred from acne, chicken pox or other causes. Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6738

·

Laser Resurfacing Summary: Laser resurfacing to improve cosmetic flaws, such as wrinkles, acne scars, and aging and sun-damaged skin, is the latest scientific breakthrough in skin rejuvenation. Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6744

·

Questions & Answers About Acne Summary: General information about acne that includes a description of what acne is and how it develops, the causes of acne, and the treatment options for various forms of acne. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=4799

·

Questions and Answers about Rosacea Summary: Rosacea, previously called acne rosacea, is a chronic skin disease that affects both the skin and the eyes. Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6731

·

Retinoids Summary: In recent years new synthetic derivatives of Vitamin A (retinoids) have been developed for the treatment of various skin conditions, such as severe acne, sun spots, wrinkles, and psoriasis. Source: American Society For Dermatologic Surgery http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6748

·

Skincarephysicians.com Summary: An index to Web pages on psoriasis, eczema, aging skin, acne, melanoma, and actinic keratoses. Source: American Academy of Dermatology http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6380

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·

The Power of Accutane Summary: The Benefits and Risks of a Breakthrough Acne Drug Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=7544 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to acne. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources

A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: ·


·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDÒHealth: http://my.webmd.com/health_topics

Finding Associations There are a number of Internet directories that provide lists of medical associations with information on or resources relating to acne. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with acne.

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about acne. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.


Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “acne” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “acne”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “acne” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “acne” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for acne. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with acne. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following

174 Acne

drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to acne: Adapalene ·

Topical - U.S. Brands: Differin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/209425.html

Azelaic Acid ·

Topical - U.S. Brands: Azelex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202783.html

Benzoyl Peroxide ·

Topical - U.S. Brands: Triaz http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202086.html

Clindamycin ·

Systemic - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202145.html

·

Topical - U.S. Brands: Clinda-Derm http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202146.html

·

Vaginal - U.S. Brands: Cleocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202700.html

Erythromycin ·

Ophthalmic - U.S. Brands: Ilotycin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202220.html

Erythromycin and Benzoyl Peroxide ·

Topical - U.S. Brands: Benzamycin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202222.html

Erythromycins ·

Systemic - U.S. Brands: E.E.S. E-Base; E-Mycin; ERYC; EryPed; Ery-Tab; Erythro; Erythrocin; Erythrocot; Ilosone; Ilotycin; My-E; PCE; Wintrocin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202223.html

Estrogens and Progestins Oral Contraceptives ·

Systemic - U.S. Brands: Alesse; Brevicon; Demulen 1/35; Demulen 1/50; Desogen; Estrostep; Estrostep Fe; Genora 0.5/35; Genora 1/35; Genora 1/50; Intercon 0.5/35; Intercon 1/35; Intercon 1/50; Jenest; Levlen; Levlite; Levora 0.15/30; Lo/Ovral; Loestrin 1.5/30; Loestrin 1/20; Lo http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202228.html

Isotretinoin ·

Systemic - U.S. Brands: Accutane http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202309.html

Researching Medications 175

Niacin (Vitamin B 3 ) ·

Systemic - U.S. Brands: Endur-Acin; Nia-Bid; Niac; Niacels; Niacor; Nico-400; Nicobid Tempules; Nicolar; Nicotinex Elixir; Slo-Niacin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202405.html

Pyridoxine (Vitamin B 6 ) ·

Systemic - U.S. Brands: Beesix; Doxine; Nestrex; Pyri; Rodex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202493.html

Resorcinol ·

Topical - U.S. Brands: RA http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202507.html

Resorcinol and Sulfur ·

Topical - U.S. Brands: Sulforcin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202508.html

Salicylic Acid ·

Topical - U.S. Brands: Antinea; Duofilm; Freezone; Gordofilm; Hydrisalic; Keralyt; Lactisol; Mediplast; P&S; Paplex; Salac; Salacid; Saligel; Salonil; Sebucare; Trans-Plantar; Trans-Ver-Sal; Viranol; X-Seb http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202516.html

Salicylic Acid and Sulfur ·

Topical - U.S. Brands: Meted; Sebex http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202517.html

Sulfur ·

Topical - U.S. Brands: Finac; Sulpho-Lac http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202543.html

Tazarotene ·

Topical - U.S. Brands: Tazorac http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203118.html

Tetracyclines ·

Systemic - U.S. Brands: Achromycin V; Declomycin; Doryx; Dynacin; Minocin; Monodox; Terramycin; Vibramycin; Vibra-Tabs http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202552.html

·

Topical - U.S. Brands: Achromycin; Aureomycin; Meclan; Topicycline http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202553.html

Tretinoin ·

Systemic - U.S. Brands: Vesanoid http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/203663.html

·

Topical - U.S. Brands: Avita; Renova; Retin-A http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202574.html

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Vitamin A ·

Topical - U.S. Brands: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202574.html

Vitamin E ·

Systemic - U.S. Brands: Amino-Opti-E; E-Complex-600; Liqui-E; Pheryl-E http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202598.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug ConsultÔ Mosby’s Drug ConsultÔ database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html.

Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to acne by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “acne” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact

Researching Medications 177

information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for acne: ·

Metronidazole (topical) (trade name: Metrogel) http://www.rarediseases.org/nord/search/nodd_full?code=65

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDIX D. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.26

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National

26

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)27: ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

·

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

·

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

27

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries 181

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

·

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

·

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

182 Acne

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries 183

·

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

184 Acne

·

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

185

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

·

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on acne: ·

Basic Guidelines for Acne Acne Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000873.htm

·

Signs & Symptoms for Acne Blackheads Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003238.htm Cysts Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003240.htm Erythema Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Nodules Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003230.htm

186 Acne

Pustules Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003234.htm Skin lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin lesions Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Skin rash or lesion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003220.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm ·

Diagnostics and Tests for Acne Cyst Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003240.htm Cysts Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003240.htm Testosterone Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003707.htm

·

Nutrition for Acne Vitamin A Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002400.htm

·

Surgery and Procedures for Acne Dermabrasion Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002987.htm

·

Background Topics for Acne Blackheads Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003238.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Comedones Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003236.htm Endocrine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm

Online Glossaries 187

Oily skin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002043.htm Skin pigment Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002256.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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ACNE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 5-alpha: Enzyme converting testosterone to dihydrotestosterone. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Cramps: Abdominal pain due to spasmodic contractions of the bowel. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abrasion: 1. the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. an area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Abscess: Accumulation of purulent material in tissues, organs, or circumscribed spaces, usually associated with signs of infection. [NIH] Acantholysis: Separation of the prickle cells of the stratum spinosum of the epidermis, resulting in atrophy of the prickle cell layer. It is seen in diseases such as pemphigus vulgaris (see pemphigus) and keratosis follicularis. [NIH] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetic Acids: Acetic acid and its derivatives which may be formed by substitution reactions. Mono- and di-substituted, as well as halogenated compounds have been synthesized. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acne: A disorder of the skin marked by inflammation of oil glands and hair glands. [NIH] Acne Keloid: A type of acneiform disorder in which secondary pyogenic infection in and around pilosebaceous structures ends in keloidal scarring. It manifests as persistent folliculitis of the back of the neck associated with occlusion of the follicular orifices. It is most often encountered in black or Asian men. [NIH] Acne Rosacea: An acneiform eruption occurring mostly in middle-aged adults and appearing generally on the forehead, cheeks, nose, and chin. Three types are recognized: granulomatous, glandular hyperplastic with rhinophyma, and ocular. [NIH] Adenoma: A benign epithelial tumor with a glandular organization. [NIH] Adenovirus: A group of viruses that cause respiratory tract and eye infections. Adenoviruses used in gene therapy are altered to carry a specific tumor-fighting gene. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually

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referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adverse effect: An unwanted side effect of treatment. [NIH] Affinity: 1. inherent likeness or relationship. 2. a special attraction for a specific element, organ, or structure. 3. chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. the strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. in immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. the reciprocal of the dissociation constant. [EU] Ageing: A physiological or morphological change in the life of an organism or its parts, generally irreversible and typically associated with a decline in growth and reproductive vigor. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Allergen: A antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Allograft: An organ or tissue transplant between two humans. [NIH] Alloys: A mixture of metallic elements or compounds with other metallic or metalloid elements in varying proportions. [NIH] Aloe: A genus of the family Liliaceae containing anthraquinone glycosides such as aloinemodin or aloe-emodin (emodin). [NIH] Alopecia: Absence of hair from areas where it is normally present. [NIH] Alpha-Defensins: Defensins found in azurophilic granules of neutrophils and in the secretory granules of intestinal paneth cells. [NIH] Alpha-helix: One of the secondary element of protein. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Amebiasis: Infection with any of various amebae. It is an asymptomatic carrier state in most individuals, but diseases ranging from chronic, mild diarrhea to fulminant dysentery may occur. [NIH]

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Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Aminolevulinic Acid: A compound produced from succinyl-CoA and glycine as an intermediate in heme synthesis. [NIH] Amino-terminal: The end of a protein or polypeptide chain that contains a free amino group (-NH2). [NIH] Anaerobic: 1. lacking molecular oxygen. 2. growing, living, or occurring in the absence of molecular oxygen; pertaining to an anaerobe. [EU] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Androgenic: Producing masculine characteristics. [EU] Androgens: A class of sex hormones associated with the development and maintenance of the secondary male sex characteristics, sperm induction, and sexual differentiation. In addition to increasing virility and libido, they also increase nitrogen and water retention and stimulate skeletal growth. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anode: Electrode held at a positive potential with respect to a cathode. [NIH]

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Anomalies: Birth defects; abnormalities. [NIH] Anovulation: Suspension or cessation of ovulation in animals and humans. [NIH] Antiandrogens: Drugs used to block the production or interfere with the action of male sex hormones. [NIH] Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antiepileptic: An agent that combats epilepsy. [EU] Antifungal: Destructive to fungi, or suppressing their reproduction or growth; effective against fungal infections. [EU] Antifungal Agents: Substances that destroy fungi by suppressing their ability to grow or reproduce. They differ from fungicides, industrial because they defend against fungi present in human or animal tissues. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-infective: An agent that so acts. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apocrine Glands: Large, branched, specialized sweat glands that empty into the upper portion of a hair follicle instead of directly onto the skin. [NIH] Apolipoproteins: The protein components of lipoproteins which remain after the lipids to which the proteins are bound have been removed. They play an important role in lipid

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transport and metabolism. [NIH] Apolipoproteins A: Lipoproteins found in human blood serum in the high-density and very-high-density lipoprotein fraction (HDL, VHDL). They consist of several different polypeptides, the most important of which are apolipoprotein A-I and A-II. They maintain the structural integrity of the HDL particles and are activators of lecithin:cholesterol acyltransferase (LCAT). Atherosclerotic patients show low apolipoprotein A levels and these apolipoproteins are either absent or present in extremely low plasma concentration in Tangier disease. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonate 12-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 12-hydroperoxyarachidonate (12-HPETE) which is itself rapidly converted by a peroxidase to 12-hydroxy-5,8,10,14-eicosatetraenoate (12-HETE). The 12-hydroperoxides are preferentially formed in platelets. EC 1.13.11.31. [NIH] Arachidonate 15-Lipoxygenase: An enzyme that catalyzes the oxidation of arachidonic acid to yield 15-hydroperoxyarachidonate (15-HPETE) which is rapidly converted to 15-hydroxy5,8,11,13-eicosatetraenoate (15-HETE). The 15-hydroperoxides are preferentially formed in neutrophils and lymphocytes. EC 1.13.11.33. [NIH] Arachidonate Lipoxygenases: Enzymes catalyzing the oxidation of arachidonic acid to hydroperoxyarachidonates (HPETES). These products are then rapidly converted by a peroxidase to hydroxyeicosatetraenoic acids (HETES). The positional specificity of the enzyme reaction varies from tissue to tissue. The final lipoxygenase pathway leads to the leukotrienes. EC 1.13.11.- . [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arterioles: The smallest divisions of the arteries located between the muscular arteries and the capillaries. [NIH] Arteriolosclerosis: Sclerosis and thickening of the walls of the smaller arteries (arterioles). Hyaline arteriolosclerosis, in which there is homogeneous pink hyaline thickening of the arteriolar walls, is associated with benign nephrosclerosis. Hyperplastic arteriolosclerosis, in which there is a concentric thickening with progressive narrowing of the lumina may be associated with malignant hypertension, nephrosclerosis, and scleroderma. [EU] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the

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intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Ascites: Accumulation or retention of free fluid within the peritoneal cavity. [NIH] Ascorbic Acid: A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant. [NIH] Aspartic: The naturally occurring substance is L-aspartic acid. One of the acidic-aminoacids is obtained by the hydrolysis of proteins. [NIH] Aspartic Endopeptidases: A sub-subclass of endopeptidases that depend on an aspartic acid residue for their activity. EC 3.4.23. [NIH] Astringent: Causing contraction, usually locally after topical application. [EU] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. [NIH] Atherogenic: Causing the formation of plaque in the lining of the arteries. [NIH] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Attenuated: Strain with weakened or reduced virulence. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autologous: Taken from an individual's own tissues, cells, or DNA. [NIH] Bacillus: A genus of Bacillaceae that are spore-forming, rod-shaped cells. Most species are saprophytic soil forms with only a few species being pathogenic. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Proteins: Proteins found in any species of bacterium. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Bacteriocins: Substances elaborated by specific strains of bacteria that are lethal against other strains of the same or related species. They are protein or lipopolysaccharide-protein complexes used in taxonomy studies of bacteria. [NIH] Bacteriostatic: 1. inhibiting the growth or multiplication of bacteria. 2. an agent that inhibits the growth or multiplication of bacteria. [EU] Bacterium: Microscopic organism which may have a spherical, rod-like, or spiral unicellular or non-cellular body. Bacteria usually reproduce through asexual processes. [NIH] Bandages: Material used for wrapping or binding any part of the body. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with

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epilepsy. [NIH] Basal cell carcinoma: A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Basal metabolic rate: Represents the minimum energy expenditure required for the maintenance of vital functions; normally the amount of energy expended, measured in calories, per unit of time at rest; measured after 14-18 hours of rest. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Beauty: Characteristics or attributes of persons or things which elicit pleasurable feelings. [NIH]

Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign prostatic hyperplasia: A benign (noncancerous) condition in which an overgrowth of prostate tissue pushes against the urethra and the bladder, blocking the flow of urine. Also called benign prostatic hypertrophy or BPH. [NIH] Beta-Defensins: Defensins found mainly in epithelial cells. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the LIVER and secreted into the DUODENUM. Its composition includes BILE ACIDS AND SALTS, CHOLESTEROL, and ELECTROLYTES. It aids DIGESTION of fats in the duodenum. [NIH] Bile duct: A tube through which bile passes in and out of the liver. [NIH] Binding Sites: The reactive parts of a macromolecule that directly participate in its specific combination with another molecule. [NIH] Biofilms: Films of bacteria or other microbial organisms, usually embedded in extracellular polymers such as implanted medical devices, which adhere to surfaces submerged in, or subjected to, aquatic environments (From Singleton & Sainsbury, Dictionary of Microbiology and Molecular Biology, 2d ed). Biofilms consist of multilayers of microbial cells glued together to form microbial communities which are highly resistant to both phagocytes and antibiotics. [NIH] Biological response modifier: BRM. A substance that stimulates the body's response to infection and disease. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biosynthesis: The building up of a chemical compound in the physiologic processes of a

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living organism. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotin: Hexahydro-2-oxo-1H-thieno(3,4-d)imidazole-4-pentanoic acid. Growth factor present in minute amounts in every living cell. It occurs mainly bound to proteins or polypeptides and is abundant in liver, kidney, pancreas, yeast, and milk.The biotin content of cancerous tissue is higher than that of normal tissue. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Biotypes: Causes septicemic and pneumonic pasteurellosis in cattle and sheep, usually in conjunction with a virus infection such as parainfluenza 3. Also recorded as a cause of acute mastitis in cattle. [NIH] Bladder: The organ that stores urine. [NIH] Blepharitis: Inflammation of the eyelids. [NIH] Blister: Visible accumulations of fluid within or beneath the epidermis. [NIH] Blood Cell Count: A count of the number of leukocytes and erythrocytes per unit volume in a sample of venous blood. A complete blood count (CBC) also includes measurement of the hemoglobin, hematocrit, and erythrocyte indices. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bone scan: A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner. [NIH]

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Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breakdown: A physical, metal, or nervous collapse. [NIH] Broadband: A wide frequency range. Sound whose energy is distributed over a broad range of frequency (generally, more than one octave). [NIH] Broad-spectrum: Effective against a wide range of microorganisms; said of an antibiotic. [EU]

Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Bullous: Pertaining to or characterized by bullae. [EU] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Calcification: Deposits of calcium in the tissues of the breast. Calcification in the breast can be seen on a mammogram, but cannot be detected by touch. There are two types of breast calcification, macrocalcification and microcalcification. Macrocalcifications are large deposits and are usually not related to cancer. Microcalcifications are specks of calcium that may be found in an area of rapidly dividing cells. Many microcalcifications clustered together may be a sign of cancer. [NIH] Calciphylaxis: Condition of induced systemic hypersensitivity in which tissues respond to appropriate challenging agents with a sudden local calcification. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]

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Capillary Fragility: The lack of resistance, or susceptibility, of capillaries to damage or disruption under conditions of increased stress. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular System: The heart and the blood vessels by which blood is pumped and circulated through the body. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catabolism: Any destructive metabolic process by which organisms convert substances into excreted compounds. [EU] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH] Cathode: An electrode, usually an incandescent filament of tungsten, which emits electrons in an X-ray tube. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Caustic: An escharotic or corrosive agent. Called also cauterant. [EU] Cefadroxil: Long-acting, broad-spectrum, water-soluble, cephalexin derivative. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Aggregation: The phenomenon by which dissociated cells intermixed in vitro tend to group themselves with cells of their own type. [NIH] Cell Aging: The decrease in the cell's ability to proliferate with the passing of time. Each cell is programmed for a certain number of cell divisions and at the end of that time

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proliferation halts. The cell enters a quiescent state after which it experiences cell death via the process of apoptosis. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH] Cell Division: The fission of a cell. [NIH] Cell Physiology: Characteristics and physiological processes of cells from cell division to cell death. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cephalexin: A semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. It is effective against both gram-positive and gram-negative organisms. [NIH] Cephaloridine: A cephalosporin antibiotic. [NIH] Cephalothin: A cephalosporin antibiotic. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Chemokines: Class of pro-inflammatory cytokines that have the ability to attract and activate leukocytes. They can be divided into at least three structural branches: C (chemokines, C), CC (chemokines, CC), and CXC (chemokines, CXC), according to variations in a shared cysteine motif. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH]

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Chemotaxis: The movement of cells or organisms toward or away from a substance in response to its concentration gradient. [NIH] Chemotherapeutic agent: A drug used to treat cancer. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. [NIH] Chloasma: Melasma c. hepaticum a term formerly used to refer to circumscribed facial hyperpigmentation resembling melasma that may occur as a cutaneous manifestation of chronic liver disease. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholesterol Esters: Fatty acid esters of cholesterol which constitute about two-thirds of the cholesterol in the plasma. The accumulation of cholesterol esters in the arterial intima is a characteristic feature of atherosclerosis. [NIH] Choroid: The thin, highly vascular membrane covering most of the posterior of the eye between the retina and sclera. [NIH] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH]

Chromium: A trace element that plays a role in glucose metabolism. It has the atomic symbol Cr, atomic number 24, and atomic weight 52. According to the Fourth Annual Report on Carcinogens (NTP85-002,1985), chromium and some of its compounds have been listed as known carcinogens. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Chylomicrons: A class of lipoproteins that carry dietary cholesterol and triglycerides from the small intestines to the tissues. [NIH] Chymotrypsin: A serine endopeptidase secreted by the pancreas as its zymogen, chymotrypsinogen and carried in the pancreatic juice to the duodenum where it is activated by trypsin. It selectively cleaves aromatic amino acids on the carboxyl side. [NIH] Cicatricial: Ectropion due to scar tissue on the margins or the surrounding surfaces of the eyelids. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by

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calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citric Acid: A key intermediate in metabolism. It is an acid compound found in citrus fruits. The salts of citric acid (citrates) can be used as anticoagulants due to their calcium chelating ability. [NIH] Citrus: Any tree or shrub of the Rue family or the fruit of these plants. [NIH] Civilization: The distinctly human attributes and attainments of a particular society. [NIH] Clavicle: A long bone of the shoulder girdle. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clitoral: Pertaining to the clitoris. [EU] Clomiphene: A stilbene derivative that functions both as a partial estrogen agonist and complete estrogen antagonist depending on the target tissue. It antagonizes the estrogen receptor thereby initiating or augmenting ovulation in anovulatory women. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cod Liver Oil: Oil obtained from fresh livers of the cod family, Gadidae. It is a source of vitamins A and D. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. a state of extreme prostration and depression, with failure of circulation. 2. abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Colony-Stimulating Factors: Glycoproteins found in a subfraction of normal mammalian plasma and urine. They stimulate the proliferation of bone marrow cells in agar cultures and the formation of colonies of granulocytes and/or macrophages. The factors include interleukin-3 (IL-3), granulocyte colony-stimulating factor (G-CSF), macrophage colonystimulating factor (M-CSF), and granulocyte-macrophage colony-stimulating factor (GM-

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CSF). [NIH] Combination Therapy: Association of 3 drugs to treat AIDS (AZT + DDC or DDI + protease inhibitor). [NIH] Combinatorial: A cut-and-paste process that churns out thousands of potentially valuable compounds at once. [NIH] Comedo: A plug of keratin and sebum within the dilated orifice of a hair follicle, frequently containing the bacteria Propionibacterium acnes, Staphylococcus albus, and Pityrosporon ovale; called also blackhead. [EU] Commensal: 1. living on or within another organism, and deriving benefit without injuring or benefiting the other individual. 2. an organism living on or within another, but not causing injury to the host. [EU] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques

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for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Condyloma: C. acuminatum; a papilloma with a central core of connective tissue in a treelike structure covered with epithelium, usually occurring on the mucous membrane or skin of the external genitals or in the perianal region. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constriction: The act of constricting. [NIH] Contact dermatitis: Inflammation of the skin with varying degrees of erythema, edema and vesinculation resulting from cutaneous contact with a foreign substance or other exposure. [NIH]

Contraception: Use of agents, devices, methods, or procedures which diminish the likelihood of or prevent conception. [NIH] Contraceptive: An agent that diminishes the likelihood of or prevents conception. [EU] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Contralateral: Having to do with the opposite side of the body. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Corneum: The superficial layer of the epidermis containing keratinized cells. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Thrombosis:

Presence of a thrombus in a coronary artery, often causing a

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myocardial infarction. [NIH] Corpus: The body of the uterus. [NIH] Corpus Luteum: The yellow glandular mass formed in the ovary by an ovarian follicle that has ruptured and discharged its ovum. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticosteroids: Hormones that have antitumor activity in lymphomas and lymphoid leukemias; in addition, corticosteroids (steroids) may be used for hormone replacement and for the management of some of the complications of cancer and its treatment. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Cryotherapy: Any method that uses cold temperature to treat disease. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyanide: An extremely toxic class of compounds that can be lethal on inhaling of ingesting in minute quantities. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cyproterone: An anti-androgen that, in the form of its acetate, also has progestational properties. It is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females. [NIH] Cyproterone Acetate: An agent with anti-androgen and progestational properties. It shows competitive binding with dihydrotestosterone at androgen receptor sites. [NIH] Cyst: A sac or capsule filled with fluid. [NIH] Cysteine: A thiol-containing non-essential amino acid that is oxidized to form cystine. [NIH] Cysteine Endopeptidases: Endopeptidases which have a cysteine involved in the catalytic process. This group of enzymes is inactivated by sulfhydryl reagents. EC 3.4.22. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytosine: A pyrimidine base that is a fundamental unit of nucleic acids. [NIH] Cytotoxic: Cell-killing. [NIH] Dairy Products: Raw and processed or manufactured milk and milk-derived products. These are usually from cows (bovine) but are also from goats, sheep, reindeer, and water

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buffalo. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Decubitus: An act of lying down; also the position assumed in lying down. [EU] Decubitus Ulcer: An ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time. The bony prominences of the body are the most frequently affected sites. The ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. [NIH] Defense Mechanisms: Unconscious process used by an individual or a group of individuals in order to cope with impulses, feelings or ideas which are not acceptable at their conscious level; various types include reaction formation, projection and self reversal. [NIH]

Defensins: Family of antimicrobial peptides that have been identified in humans, animals, and plants. They are thought to play a role in host defenses against infections, inflammation, wound repair, and acquired immunity. Based on the disulfide pairing of their characteristic six cysteine residues, they are divided into alpha-defensins and beta-defensins. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dehydroepiandrosterone: DHEA. A substance that is being studied as a cancer prevention drug. It belongs to the family of drugs called steroids. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dendritic: 1. branched like a tree. 2. pertaining to or possessing dendrites. [EU] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental Plaque: A film that attaches to teeth, often causing dental caries and gingivitis. It is composed of mucins, secreted from salivary glands, and microorganisms. [NIH] Dermal: Pertaining to or coming from the skin. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Dermatitis, Contact: A type of acute or chronic skin reaction in which sensitivity is manifested by reactivity to materials or substances coming in contact with the skin. It may

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involve allergic or non-allergic mechanisms. [NIH] Dermatitis, Seborrheic: A chronic inflammatory disease of the skin of unknown etiology. It is characterized by moderate erythema, dry, moist, or greasy scaling, and yellow crusted patches on various areas, especially the scalp. On the scalp, it generally appears first as small patches of scales, progressing to involve the entire scalp with exfoliation of excessive amounts of dry scales (dandruff). [NIH] Dermatologist: A doctor who specializes in the diagnosis and treatment of skin problems. [NIH]

Dermatology: A medical specialty concerned with the skin, its structure, functions, diseases, and treatment. [NIH] Dermatosis: Any skin disease, especially one not characterized by inflammation. [EU] Dermis: A layer of vascular connective tissue underneath the epidermis. The surface of the dermis contains sensitive papillae. Embedded in or beneath the dermis are sweat glands, hair follicles, and sebaceous glands. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Desquamation: The shedding of epithelial elements, chiefly of the skin, in scales or small sheets; exfoliation. [EU] Detergents: Purifying or cleansing agents, usually salts of long-chain aliphatic bases or acids, that exert cleansing (oil-dissolving) and antimicrobial effects through a surface action that depends on possessing both hydrophilic and hydrophobic properties. [NIH] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Dietary Fats: Fats present in food, especially in animal products such as meat, meat products, butter, ghee. They are present in lower amounts in nuts, seeds, and avocados. [NIH]

Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dihydrotestosterone: Anabolic agent. [NIH] Dilatation: The act of dilating. [NIH]

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Dilate: Relax; expand. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Dilution: A diluted or attenuated medicine; in homeopathy, the diffusion of a given quantity of a medicinal agent in ten or one hundred times the same quantity of water. [NIH] Discrete: Made up of separate parts or characterized by lesions which do not become blended; not running together; separate. [NIH] Disease Vectors: Invertebrates or non-human vertebrates which transmit infective organisms from one host to another. [NIH] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuretic: A drug that increases the production of urine. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Doxycycline: A synthetic tetracycline derivative with a range of antimicrobial activity and mode of action similar to that of tetracycline, but more effective against many species. Animal studies suggest that it may cause less tooth staining than other tetracyclines. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Dry Eye Syndrome: A common condition that occurs when the eyes do not produce enough tears to keep the eye moist and comfortable. Common symptoms of dry eye include pain, stinging, burning, scratchiness, and intermittent blurring of vision. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystrophic: Pertaining to toxic habitats low in nutrients. [NIH] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Ectopic: Pertaining to or characterized by ectopia. [EU] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH]

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Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Eicosanoids: A class of oxygenated, endogenous, unsaturated fatty acids derived from arachidonic acid. They include prostaglandins, leukotrienes, thromboxanes, and hydroxyeicosatetraenoic acid compounds (HETE). They are hormone-like substances that act near the site of synthesis without altering functions throughout the body. [NIH] Elastic: Susceptible of resisting and recovering from stretching, compression or distortion applied by a force. [EU] Elasticity: Resistance and recovery from distortion of shape. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolysis: Destruction by passage of a galvanic electric current, as in disintegration of a chemical compound in solution. [NIH] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emodin: Purgative anthraquinone found in several plants, especially Rhamnus frangula. It was formerly used as a laxative, but is now used mainly as tool in toxicity studies. [NIH] Emollient: Softening or soothing; called also malactic. [EU] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Encapsulated: Confined to a specific, localized area and surrounded by a thin layer of tissue. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

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Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity. [NIH] Endometrium: The layer of tissue that lines the uterus. [NIH] Endopeptidases: A subclass of peptide hydrolases. They are classified primarily by their catalytic mechanism. Specificity is used only for identification of individual enzymes. They comprise the serine endopeptidases, EC 3.4.21; cysteine endopeptidases, EC 3.4.22; aspartic endopeptidases, EC 3.4.23, metalloendopeptidases, EC 3.4.24; and a group of enzymes yet to be assigned to any of the above sub-classes, EC 3.4.99. EC 3.4.-. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxic: Of, relating to, or acting as an endotoxin (= a heat-stable toxin, associated with the outer membranes of certain gram-negative bacteria. Endotoxins are not secreted and are released only when the cells are disrupted). [EU] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enhancer: Transcriptional element in the virus genome. [NIH] Enteropeptidase: A specialized proteolytic enzyme secreted by intestinal cells. It converts trypsinogen into its active form trypsin by removing the N-terminal peptide. EC 3.4.21.9. [NIH]

Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU]

Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidermolysis Bullosa: Group of genetically determined disorders characterized by the blistering of skin and mucosae. There are four major forms: acquired, simple, junctional, and dystrophic. Each of the latter three has several varieties. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic

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vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythromycin: A bacteriostatic antibiotic substance produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estradiol: The most potent mammalian estrogenic hormone. It is produced in the ovary, placenta, testis, and possibly the adrenal cortex. [NIH] Estrogen: One of the two female sex hormones. [NIH] Estrogen receptor: ER. Protein found on some cancer cells to which estrogen will attach. [NIH]

Ethinyl Estradiol: A semisynthetic estrogen with high oral estrogenic potency. It is often used as the estrogenic component in oral contraceptives. [NIH] Etretinate: An oral retinoid used in the treatment of keratotic genodermatosis, lichen planus, and psoriasis. Beneficial effects have also been claimed in the prophylaxis of epithelial neoplasia. The compound may be teratogenic. [NIH] Excipient: Any more or less inert substance added to a prescription in order to confer a suitable consistency or form to the drug; a vehicle. [EU] Exfoliation: A falling off in scales or layers. [EU] Exhibitionism: A disorder in which fantasies about or the act of exposing the genitals to an unsuspecting stranger produces sexual excitement with no attempt at further sexual activity with the stranger. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expectorant: 1. promoting the ejection, by spitting, of mucus or other fluids from the lungs and trachea. 2. an agent that promotes the ejection of mucus or exudate from the lungs, bronchi, and trachea; sometimes extended to all remedies that quiet cough (antitussives). [EU]

External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Eye Infections: Infection, moderate to severe, caused by bacteria, fungi, or viruses, which

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occurs either on the external surface of the eye or intraocularly with probable inflammation, visual impairment, or blindness. [NIH] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The feeling of weariness of mind and body. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Finasteride: An orally active testosterone 5-alpha-reductase inhibitor. It is used as a surgical alternative for treatment of benign prostatic hyperplasia. [NIH] Fistula: Abnormal communication most commonly seen between two internal organs, or between an internal organ and the surface of the body. [NIH] Fixation: 1. the act or operation of holding, suturing, or fastening in a fixed position. 2. the condition of being held in a fixed position. 3. in psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. the use of a fixative (q.v.) to preserve histological or cytological specimens. 5. in chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. in ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. in film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flatus: Gas passed through the rectum. [NIH] Flexor: Muscles which flex a joint. [NIH] Fluorescence: The property of emitting radiation while being irradiated. The radiation emitted is usually of longer wavelength than that incident or absorbed, e.g., a substance can be irradiated with invisible radiation and emit visible light. X-ray fluorescence is used in diagnosis. [NIH] Folate: A B-complex vitamin that is being studied as a cancer prevention agent. Also called folic acid. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Folic Acid: N-(4-(((2-Amino-1,4-dihydro-4-oxo-6-pteridinyl)methyl)amino)benzoyl)-Lglutamic acid. A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses. Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [NIH] Folklore: The common orally transmitted traditions, myths, festivals, songs, superstitions,

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and stories of all peoples. [NIH] Follicles: Shafts through which hair grows. [NIH] Folliculitis: Inflammation of follicles, primarily hair follicles. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Formulary: A book containing a list of pharmaceutical products with their formulas and means of preparation. [NIH] Fossa: A cavity, depression, or pit. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Friction: Surface resistance to the relative motion of one body against the rubbing, sliding, rolling, or flowing of another with which it is in contact. [NIH] Fungi: A kingdom of eukaryotic, heterotrophic organisms that live as saprobes or parasites, including mushrooms, yeasts, smuts, molds, etc. They reproduce either sexually or asexually, and have life cycles that range from simple to complex. Filamentous fungi refer to those that grow as multicelluar colonies (mushrooms and molds). [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gels: Colloids with a solid continuous phase and liquid as the dispersed phase; gels may be unstable when, due to temperature or other cause, the solid phase liquifies; the resulting colloid is called a sol. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Gene Therapy: The introduction of new genes into cells for the purpose of treating disease by restoring or adding gene expression. Techniques include insertion of retroviral vectors,

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transfection, homologous recombination, and injection of new genes into the nuclei of single cell embryos. The entire gene therapy process may consist of multiple steps. The new genes may be introduced into proliferating cells in vivo (e.g., bone marrow) or in vitro (e.g., fibroblast cultures) and the modified cells transferred to the site where the gene expression is required. Gene therapy may be particularly useful for treating enzyme deficiency diseases, hemoglobinopathies, and leukemias and may also prove useful in restoring drug sensitivity, particularly Genetic transcription: The process by which the genetic information encoded in the gene, represented as a linear sequence of deoxyribonucleotides, is copied into an exactly complementary sequence of ribonucleotides known as messenger RNA. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genital: Pertaining to the genitalia. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Germ Cells: The reproductive cells in multicellular organisms. [NIH] Gestation: The period of development of the young in viviparous animals, from the time of fertilization of the ovum until birth. [EU] Giardiasis: An infection of the small intestine caused by the flagellated protozoan Giardia lamblia. It is spread via contaminated food and water and by direct person-to-person contact. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucocorticoid: A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs). [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glucose tolerance: The power of the normal liver to absorb and store large quantities of glucose and the effectiveness of intestinal absorption of glucose. The glucose tolerance test is a metabolic test of carbohydrate tolerance that measures active insulin, a hepatic function based on the ability of the liver to absorb glucose. The test consists of ingesting 100 grams of glucose into a fasting stomach; blood sugar should return to normal in 2 to 21 hours after ingestion. [NIH] Glucose Tolerance Test: Determination of whole blood or plasma sugar in a fasting state before and at prescribed intervals (usually 1/2 hr, 1 hr, 3 hr, 4 hr) after taking a specified amount (usually 100 gm orally) of glucose. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous

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system. [NIH] Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycols: A generic grouping for dihydric alcohols with the hydroxy groups (-OH) located on different carbon atoms. They are viscous liquids with high boiling points for their molecular weights. [NIH] Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Gonad: A sex organ, such as an ovary or a testicle, which produces the gametes in most multicellular animals. [NIH] Gonadal: Pertaining to a gonad. [EU] Gonadotropin: The water-soluble follicle stimulating substance, by some believed to originate in chorionic tissue, obtained from the serum of pregnant mares. It is used to supplement the action of estrogens. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Grading: A system for classifying cancer cells in terms of how abnormal they appear when examined under a microscope. The objective of a grading system is to provide information about the probable growth rate of the tumor and its tendency to spread. The systems used to grade tumors vary with each type of cancer. Grading plays a role in treatment decisions. [NIH]

Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Grafting: The operation of transfer of tissue from one site to another. [NIH] Gram-negative: Losing the stain or decolorized by alcohol in Gram's method of staining, a primary characteristic of bacteria having a cell wall composed of a thin layer of peptidoglycan covered by an outer membrane of lipoprotein and lipopolysaccharide. [EU] Gram-positive: Retaining the stain or resisting decolorization by alcohol in Gram's method of staining, a primary characteristic of bacteria whose cell wall is composed of a thick layer of peptidologlycan with attached teichoic acids. [EU] Granulocyte: A type of white blood cell that fights bacterial infection. Neutrophils, eosinophils, and basophils are granulocytes. [NIH] Granulocyte Colony-Stimulating Factor: A glycoprotein of MW 25 kDa containing internal disulfide bonds. It induces the survival, proliferation, and differentiation of neutrophilic granulocyte precursor cells and functionally activates mature blood neutrophils. Among the family of colony-stimulating factors, G-CSF is the most potent inducer of terminal differentiation to granulocytes and macrophages of leukemic myeloid cell lines. [NIH] Grasses: A large family, Gramineae, of narrow-leaved herbaceous monocots. Many grasses

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produce highly allergenic pollens and are hosts to cattle parasites and toxic fungi. [NIH] Gravis: Eruption of watery blisters on the skin among those handling animals and animal products. [NIH] Groin: The external junctural region between the lower part of the abdomen and the thigh. [NIH]

Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Growth factors: Substances made by the body that function to regulate cell division and cell survival. Some growth factors are also produced in the laboratory and used in biological therapy. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Hair follicles: Shafts or openings on the surface of the skin through which hair grows. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Hematocrit: Measurement of the volume of packed red cells in a blood specimen by centrifugation. The procedure is performed using a tube with graduated markings or with automated blood cell counters. It is used as an indicator of erythrocyte status in disease. For example, anemia shows a low hematocrit, polycythemia, high values. [NIH] Hematopoietic growth factors: A group of proteins that cause blood cells to grow and mature. [NIH] Heme: The color-furnishing portion of hemoglobin. It is found free in tissues and as the prosthetic group in many hemeproteins. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobin A: Normal adult human hemoglobin. The globin moiety consists of two alpha and two beta chains. [NIH] Hemoglobinopathies: A group of inherited disorders characterized by structural alterations within the hemoglobin molecule. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]

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Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Hepatic: Refers to the liver. [NIH] Hepatitis: Inflammation of the liver and liver disease involving degenerative or necrotic alterations of hepatocytes. [NIH] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. the genetic transmission of a particular quality or trait from parent to offspring. 2. the genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Heterodimers: Zippered pair of nonidentical proteins. [NIH] Heterotrophic: Pertaining to organisms that are consumers and dependent on other organisms for their source of energy (food). [NIH] Hidradenitis: The inflammation of a sweat gland (usually of the apocrine type). The condition can be idiopathic or occur as a result of or in association with another underlying condition. Neutrophilic eccrine hidradenitis is a relatively rare variant that has been reported in patients undergoing chemotherapy, usually for non-Hodgkin lymphomas or leukemic conditions. [NIH] Hidradenitis Suppurativa: A chronic suppurative and cicatricial disease of the apocrine glands occurring chiefly in the axillae in women and in the groin and anal regions in men. It is characterized by poral occlusion with secondary bacterial infection, evolving into abscesses which eventually rupture. As the disease becomes chronic, ulcers appear, sinus tracts enlarge, fistulas develop, and fibrosis and scarring become evident. Hormonal mechanisms are expected in its pathogenesis. [NIH] Hirsutism: Excess hair in females and children with an adult male pattern of distribution. The concept does not include hypertrichosis, which is localized or generalized excess hair. [NIH]

Histology: The study of tissues and cells under a microscope. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormonal therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called hormone therapy or endocrine therapy. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones. Also called endocrine therapy. [NIH] Horny layer: The superficial layer of the epidermis containing keratinized cells. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour - now often used

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of endocrine factors as opposed to neural or somatic. [EU] Humour: 1. a normal functioning fluid or semifluid of the body (as the blood, lymph or bile) especially of vertebrates. 2. a secretion that is itself an excitant of activity (as certain hormones). [EU] Hyaluronidase: An enzyme that splits hyaluronic acid and thus lowers the viscosity of the acid and facilitates the spreading of fluids through tissues either advantageously or disadvantageously. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hydration: Combining with water. [NIH] Hydroalcoholic: Of or relating to water and alcohol. [EU] Hydrocephalus: Excessive accumulation of cerebrospinal fluid within the cranium which may be associated with dilation of cerebral ventricles, intracranial hypertension; headache; lethargy; urinary incontinence; and ataxia (and in infants macrocephaly). This condition may be caused by obstruction of cerebrospinal fluid pathways due to neurologic abnormalities, intracranial hemorrhages; central nervous system infections; brain neoplasms; craniocerebral trauma; and other conditions. Impaired resorption of cerebrospinal fluid from the arachnoid villi results in a communicating form of hydrocephalus. Hydrocephalus ex-vacuo refers to ventricular dilation that occurs as a result of brain substance loss from cerebral infarction and other conditions. Hydrogel: A network of cross-linked hydrophilic macromolecules used in biomedical applications. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolases: Any member of the class of enzymes that catalyze the cleavage of the substrate and the addition of water to the resulting molecules, e.g., esterases, glycosidases (glycoside hydrolases), lipases, nucleotidases, peptidases (peptide hydrolases), and phosphatases (phosphoric monoester hydrolases). EC 3. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hydroxy Acids: Organic compounds containing both the hydroxyl and carboxyl radicals. [NIH]

Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU]

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Hyperandrogenism: A state characterized or caused by an excessive secretion of androgens by the adrenal cortex, ovaries, or testes. The clinical significance in males is negligible, so the term is used most commonly with reference to the female. The common manifestations in women are hirsutism and virilism. It is often caused by ovarian disease (particularly the polycystic ovary syndrome) and by adrenal diseases (particularly adrenal gland hyperfunction). [NIH] Hyperkeratosis: 1. hypertrophy of the corneous layer of the skin. 2a. any of various conditions marked by hyperkeratosis. 2b. a disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperostosis: Increase in the mass of bone per unit volume. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hyperstimulation: Excessive stimulation. [EU] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrichosis: Localized or generalized excess hair. The concept does not include hirsutism, which is excess hair in females and children with an adult male pattern of distribution. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hypervitaminosis: A condition due to ingestion of an excess of one or more vitamins; called also supervitaminosis. [EU] Hypnotic: A drug that acts to induce sleep. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxic: Having too little oxygen. [NIH] Ichthyosis: Any of several generalized skin disorders characterized by dryness, roughness, and scaliness, due to hypertrophy of the stratum corneum epidermis. Most are genetic, but some are acquired, developing in association with other systemic disease or genetic syndrome. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Imidazole: C3H4N2. The ring is present in polybenzimidazoles. [NIH]

Glossary 219

Immune response: (antigens). [NIH]

The activity of the immune system against foreign substances

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunogenic: Producing immunity; evoking an immune response. [EU] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Immunosuppression: Deliberate prevention or diminution of the host's immune response. It may be nonspecific as in the administration of immunosuppressive agents (drugs or radiation) or by lymphocyte depletion or may be specific as in desensitization or the simultaneous administration of antigen and immunosuppressive drugs. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive Agents: Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of suppressor T-cell populations or by inhibiting the activation of helper cells. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of interleukins and other cytokines are emerging. [NIH] Impaction: The trapping of an object in a body passage. Examples are stones in the bile duct or hardened stool in the colon. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incidental: 1. small and relatively unimportant, minor; 2. accompanying, but not a major part of something; 3. (to something) liable to occur because of something or in connection with something (said of risks, responsibilities, ...) [EU] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU]

Indolent: A type of cancer that grows slowly. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a

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specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. an infectious disease. Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Ingestion: Taking into the body by mouth [NIH] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Insecticides: Pesticides designed to control insects that are harmful to man. The insects may be directly harmful, as those acting as disease vectors, or indirectly harmful, as destroyers of crops, food products, or textile fabrics. [NIH] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Insulin-like: Muscular growth factor. [NIH] Interferon: A biological response modifier (a substance that can improve the body's natural response to disease). Interferons interfere with the division of cancer cells and can slow tumor growth. There are several types of interferons, including interferon-alpha, -beta, and gamma. These substances are normally produced by the body. They are also made in the laboratory for use in treating cancer and other diseases. [NIH] Interferon-alpha: One of the type I interferons produced by peripheral blood leukocytes or lymphoblastoid cells when exposed to live or inactivated virus, double-stranded RNA, or bacterial products. It is the major interferon produced by virus-induced leukocyte cultures

Glossary 221

and, in addition to its pronounced antiviral activity, it causes activation of NK cells. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-10: Factor that is a coregulator of mast cell growth. It is produced by T-cells and B-cells and shows extensive homology with the Epstein-Barr virus BCRFI gene. [NIH] Interleukin-2: Soluble substances elaborated by antigen- or mitogen-stimulated Tlymphocytes which induce DNA synthesis in naive lymphocytes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestinal: Having to do with the intestines. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intravascular: Within a vessel or vessels. [EU] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Involuntary: Reaction occurring without intention or volition. [NIH] Iodides: Inorganic binary compounds of iodine or the I- ion. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Irritants: Drugs that act locally on cutaneous or mucosal surfaces to produce inflammation; those that cause redness due to hyperemia are rubefacients; those that raise blisters are vesicants and those that penetrate sebaceous glands and cause abscesses are pustulants; tear gases and mustard gases are also irritants. [NIH]

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Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoenzymes: One of various structurally related forms of an enzyme, each having the same mechanism but with differing chemical, physical, or immunological characteristics. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Isotretinoin: A topical dermatologic agent that is used in the treatment of acne vulgaris and several other skin diseases. The drug has teratogenic and other adverse effects. [NIH] IV: Intravenous (in-tra-VEE-nus). Injected into a blood vessel. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Keratolytic Agents: Agents that soften, separate, and cause desquamation of the cornified epithelium or horny layer of skin. They are used to expose mycelia of infecting fungi or to treat corns, warts, and certain other skin diseases. [NIH] Keratosis: Any horny growth such as a wart or callus. [NIH] Keratosis Follicularis: A slowly progressive autosomal dominant disorder of keratinization characterized by pinkish-to-tan papules that coalesce to form plaques. These lesions become darker over time and commonly fuse, forming papillomatous and warty malodorous growths. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. gliding; moving from point to point over the surface; unstable; fluctuating. 2. chemically unstable. [EU] Lacrimal: Pertaining to the tears. [EU] Lacrimal gland: The small almond-shaped structure that produces tears; located just above the outer corner of the eye. [NIH] Lactation: The period of the secretion of milk. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH]

Glossary 223

Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Laser: A device that concentrates light into an intense, narrow beam used to cut or destroy tissue. It is used in microsurgery, photodynamic therapy, and for a variety of diagnostic purposes. [NIH] Laser therapy: The use of an intensely powerful beam of light to kill cancer cells. [NIH] Leisure Activities: Voluntary use of free time for activities outside the daily routine. [NIH] Lens: The transparent, double convex (outward curve on both sides) structure suspended between the aqueous and vitreous; helps to focus light on the retina. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Leukotrienes: A family of biologically active compounds derived from arachidonic acid by oxidative metabolism through the 5-lipoxygenase pathway. They participate in host defense reactions and pathophysiological conditions such as immediate hypersensitivity and inflammation. They have potent actions on many essential organs and systems, including the cardiovascular, pulmonary, and central nervous system as well as the gastrointestinal tract and the immune system. [NIH] Levonorgestrel: A progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). It is used for contraception, control of menstrual disorders, and treatment of endometriosis. [NIH] Libido: The psychic drive or energy associated with sexual instinct in the broad sense (pleasure and love-object seeking). It may also connote the psychic energy associated with instincts in general that motivate behavior. [NIH] Library Services: circulation. [NIH]

Services offered to the library user. They include reference and

Lichen Planus: An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flattopped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown. [NIH] Life cycle: The successive stages through which an organism passes from fertilized ovum or spore to the fertilized ovum or spore of the next generation. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Ligands: A RNA simulation method developed by the MIT. [NIH] Lincomycin: (2S-trans)-Methyl 6,8-dideoxy-6-(((1-methyl-4-propyl-2pyrrolidinyl)carbonyl)amino)-1-thio-D-erythro-alpha-D-galacto-octopyranoside. An antibiotic produced by Streptomyces lincolnensis var. lincolnensis. It has been used in the treatment of staphylococcal, streptococcal, and Bacteroides fragilis infections. [NIH]

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Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipase: An enzyme of the hydrolase class that catalyzes the reaction of triacylglycerol and water to yield diacylglycerol and a fatty acid anion. It is produced by glands on the tongue and by the pancreas and initiates the digestion of dietary fats. (From Dorland, 27th ed) EC 3.1.1.3. [NIH] Lipid: Fat. [NIH] Lipid A: Lipid A is the biologically active component of lipopolysaccharides. It shows strong endotoxic activity and exhibits immunogenic properties. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Lipoprotein: Any of the lipid-protein complexes in which lipids are transported in the blood; lipoprotein particles consist of a spherical hydrophobic core of triglycerides or cholesterol esters surrounded by an amphipathic monolayer of phospholipids, cholesterol, and apolipoproteins; the four principal classes are high-density, low-density, and very-lowdensity lipoproteins and chylomicrons. [EU] Liposomal: A drug preparation that contains the active drug in very tiny fat particles. This fat-encapsulated drug is absorbed better, and its distribution to the tumor site is improved. [NIH]

Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Lipoxygenase: An enzyme of the oxidoreductase class that catalyzes reactions between linoleate and other fatty acids and oxygen to form hydroperoxy-fatty acid derivatives. Related enzymes in this class include the arachidonate lipoxygenases, arachidonate 5lipoxygenase, arachidonate 12-lipoxygenase, and arachidonate 15-lipoxygenase. EC 1.13.11.12. [NIH] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Liver scan: An image of the liver created on a computer screen or on film. A radioactive substance is injected into a blood vessel and travels through the bloodstream. It collects in the liver, especially in abnormal areas, and can be detected by the scanner. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Lobule: A small lobe or subdivision of a lobe. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Low-density lipoprotein: Lipoprotein that contains most of the cholesterol in the blood. LDL carries cholesterol to the tissues of the body, including the arteries. A high level of LDL increases the risk of heart disease. LDL typically contains 60 to 70 percent of the total serum cholesterol and both are directly correlated with CHD risk. [NIH] Lumen: The cavity or channel within a tube or tubular organ. [EU] Lupus: A form of cutaneous tuberculosis. It is seen predominantly in women and typically involves the nasal, buccal, and conjunctival mucosa. [NIH]

Glossary 225

Luteal Phase: The period of the menstrual cycle that begins with ovulation and ends with menstruation. [NIH] Lymecycline: (4S-(4 alpha,4a alpha,5a alpha,6 beta,12a alpha-N(6)-((((4-(Dimethylamino)1,4,4a,5,5a,6,11,12a-octahydro-3,6,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-2naphthacenyl)carbonyl)amino)methyl)-L-lysine. A semisynthetic antibiotic related to tetracycline. It is more readily absorbed than tetracycline and can therefore be given in lower doses; it is also reported to have fewer gastrointestinal side effects. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphocyte Depletion: Immunosuppression by reduction of circulating lymphocytes or by T-cell depletion of bone marrow. The former may be accomplished in vivo by thoracic duct drainage or administration of antilymphocyte serum. The latter is performed ex vivo on bone marrow before its transplantation. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macula: A stain, spot, or thickening. Often used alone to refer to the macula retinae. [EU] Macula Lutea: An oval area in the retina, 3 to 5 mm in diameter, usually located temporal to the superior pole of the eye and slightly below the level of the optic disk. [NIH] Macular Degeneration: Degenerative changes in the macula lutea of the retina. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mastitis: Inflammatory disease of the breast, or mammary gland. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen

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with antibody or by the action of antigen with a sensitized lymphocyte. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Megaloblastic: anaemia. [EU]

A large abnormal red blood cell appearing in the blood in pernicious

Melanin: The substance that gives the skin its color. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metalloendopeptidases: Endopeptidases which use a metal, normally zinc, in the catalytic mechanism. This group of enzymes is inactivated by metal chelators. EC 3.4.24. [NIH] Metamorphosis: The ontogeny of insects, i. e. the series of changes undergone from egg, through larva and pupa, or through nymph, to adult. [NIH] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methoprene: Juvenile hormone analog and insect growth regulator used to control insects by disrupting metamorphosis. Has been effective in controlling mosquito larvae. [NIH] Methylene Blue: A compound consisting of dark green crystals or crystalline powder, having a bronze-like luster. Solutions in water or alcohol have a deep blue color. Methylene blue is used as a bacteriologic stain and as an indicator. It inhibits Guanylate cyclase, and has been used to treat cyanide poisoning and to lower levels of methemoglobin. [NIH] Metronidazole:

Antiprotozoal used in amebiasis, trichomoniasis, giardiasis, and as

Glossary 227

treponemacide in livestock. It has also been proposed as a radiation sensitizer for hypoxic cells. According to the Fourth Annual Report on Carcinogens (NTP 85-002, 1985, p133), this substance may reasonably be anticipated to be a carcinogen (Merck, 11th ed). [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiological: Pertaining to microbiology : the science that deals with microorganisms, including algae, bacteria, fungi, protozoa and viruses. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Microsurgery: Surgical procedures on the cellular level; a light microscope and miniaturized instruments are used. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Minocycline: A semisynthetic staphylococcus infections. [NIH]

antibiotic

effective

against

tetracycline-resistant

Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Modulator: A specific inductor that brings out characteristics peculiar to a definite region. [EU]

Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Mononuclear: A cell with one nucleus. [NIH] Monotherapy: A therapy which uses only one drug. [EU]

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Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH]

Morphological: Relating to the configuration or the structure of live organs. [NIH] Morphology: The science of the form and structure of organisms (plants, animals, and other forms of life). [NIH] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucositis: A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth. [NIH] Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mustard Gas: Severe irritant and vesicant of skin, eyes, and lungs. It may cause blindness and lethal lung edema and was formerly used as a war gas. The substance has been proposed as a cytostatic and for treatment of psoriasis. It has been listed as a known carcinogen in the Fourth Annual Report on Carcinogens (NTP-85-002, 1985) (Merck, 11th ed). [NIH] Myalgia: Pain in a muscle or muscles. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Mycosis: Any disease caused by a fungus. [EU] Mycosis Fungoides: A chronic malignant T-cell lymphoma of the skin. In the late stages the lymph nodes and viscera are affected. [NIH] Mydriatic: 1. dilating the pupil. 2. any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myoglobin: A conjugated protein which is the oxygen-transporting pigment of muscle. It is made up of one globin polypeptide chain and one heme group. [NIH] Myopathy: Any disease of a muscle. [EU]

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Myositis: Inflammation of a voluntary muscle. [EU] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Neostigmine: A cholinesterase inhibitor used in the treatment of myasthenia gravis and to reverse the effects of muscle relaxants such as gallamine and tubocurarine. Neostigmine, unlike physostigmine, does not cross the blood-brain barrier. [NIH] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH]

Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurologic Manifestations: Clinical signs and symptoms caused by nervous system injury or dysfunction. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neurotoxic: Poisonous or destructive to nerve tissue. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the

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axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Neutrophil: A type of white blood cell. [NIH] Neutrophil Infiltration: The diffusion or accumulation of neutrophils in tissues or cells in response to a wide variety of substances released at the sites of inflammatory reactions. [NIH] Niacinamide: An important compound functioning as a component of the coenzyme NAD. Its primary significance is in the prevention and/or cure of blacktongue and pellagra. Most animals cannot manufacture this compound in amounts sufficient to prevent nutritional deficiency and it therefore must be supplemented through dietary intake. [NIH] Nimodipine: A calcium channel blockader with preferential cerebrovascular activity. It has marked cerebrovascular dilating effects and lowers blood pressure. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Norethindrone: A synthetic progestational hormone with actions similar to those of progesterone but functioning as a more potent inhibitor of ovulation. It has weak estrogenic and androgenic properties. The hormone has been used in treating amenorrhea, functional uterine bleeding, endometriosis, and for contraception. [NIH] Norgestrel: (+-)-13-Ethyl-17-hydroxy-18,19-dinorpregn-4-en-20-yn-3-one. A progestational agent with actions similar to those of progesterone. This racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). Norgestrel is used as a contraceptive and ovulation inhibitor and for the control of menstrual disorders and endometriosis. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Occupational Groups: Members of the various professions (e.g., physicians) or occupations (e.g., police). [NIH]

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Ocular: 1. of, pertaining to, or affecting the eye. 2. eyepiece. [EU] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oligo: Chemical and mineral elements that exist in minimal (oligo) quantities in the body, in foods, in the air, in soil; name applied to any element observed as a microconstituent of plant or animal tissue and of beneficial, harmful, or even doubtful significance. [NIH] Oligomenorrhea: Abnormally infrequent menstruation. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Operon: The genetic unit consisting of a feedback system under the control of an operator gene, in which a structural gene transcribes its message in the form of mRNA upon blockade of a repressor produced by a regulator gene. Included here is the attenuator site of bacterial operons where transcription termination is regulated. [NIH] Ophthalmic: Pertaining to the eye. [EU] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Opsin: A visual pigment protein found in the retinal rods. It combines with retinaldehyde to form rhodopsin. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Optic Nerve: The 2nd cranial nerve. The optic nerve conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other important targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. [NIH] Organelles: Specific particles of membrane-bound organized living substances present in eukaryotic cells, such as the mitochondria; the golgi apparatus; endoplasmic reticulum; lysomomes; plastids; and vacuoles. [NIH] Osmosis: Tendency of fluids (e.g., water) to move from the less concentrated to the more concentrated side of a semipermeable membrane. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteomyelitis: Inflammation of bone caused by a pyogenic organism. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH]

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Ovarian Follicle: Spheroidal cell aggregation in the ovary containing an ovum. It consists of an external fibro-vascular coat, an internal coat of nucleated cells, and a transparent, albuminous fluid in which the ovum is suspended. [NIH] Ovarian Hyperstimulation Syndrome: Syndrome composed of a combination of ovarian enlargement and an acute fluid shift out of the intravascular space. The enlargement is caused by ovarian cyst formation and the fluid shift may result in ascites, hydrothorax, or generalized edema. The syndrome is most usually seen as a complication of ovulation induction, a treatment for infertility. [NIH] Ovaries: The pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus. [NIH] Ovary: Either of the paired glands in the female that produce the female germ cells and secrete some of the female sex hormones. [NIH] Ovulation: The discharge of a secondary oocyte from a ruptured graafian follicle. [NIH] Ovulation Induction: Techniques for the artifical induction of ovulation. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] Palladium: A chemical element having an atomic weight of 106.4, atomic number of 46, and the symbol Pd. It is a white, ductile metal resembling platinum, and following it in abundance and importance of applications. It is used in dentistry in the form of gold, silver, and copper alloys. [NIH] Palliative: 1. affording relief, but not cure. 2. an alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Pancreatic Juice: The fluid containing digestive enzymes secreted by the pancreas in response to food in the duodenum. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Papilloma: A benign epithelial neoplasm which may arise from the skin, mucous membranes or glandular ducts. [NIH] Papule: A small circumscribed, superficial, solid elevation of the skin. [EU] Parasite: An animal or a plant that lives on or in an organism of another species and gets at least some of its nutrition from that other organism. [NIH] Parasitic: Having to do with or being a parasite. A parasite is an animal or a plant that lives on or in an organism of another species and gets at least some of its nutrients from it. [NIH]

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Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Particle: A tiny mass of material. [EU] Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Compliance: regimen. [NIH]

Voluntary cooperation of the patient in following a prescribed

Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pelvis: The lower part of the abdomen, located between the hip bones. [NIH] Pemphigus: Group of chronic blistering diseases characterized histologically by acantholysis and blister formation within the epidermis. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perianal: Located around the anus. [EU] Perioral: Situated or occurring around the mouth. [EU] Peripheral Neuropathy: Nerve damage, usually affecting the feet and legs; causing pain, numbness, or a tingling feeling. Also called "somatic neuropathy" or "distal sensory polyneuropathy." [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pernicious: Tending to a fatal issue. [EU] Peroxide: Chemical compound which contains an atom group with two oxygen atoms tied

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to each other. [NIH] Petrolatum: A colloidal system of semisolid hydrocarbons obtained from petroleum. It is used as an ointment base, topical protectant, and lubricant. [NIH] Pharmacists: Those persons legally qualified by education and training to engage in the practice of pharmacy. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenolphthalein: An acid-base indicator which is colorless in acid solution, but turns pink to red as the solution becomes alkaline. It is used medicinally as a cathartic. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylated: Attached to a phosphate group. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Photoallergy: Sensitization of the skin to light usually due to the action of certain substances or drugs, may occur shortly after exposure to a substance or after a latent period of from days to months. [NIH] Photochemotherapy: Therapy using oral or topical photosensitizing agents with subsequent exposure to light. [NIH] Photodynamic therapy: Treatment with drugs that become active when exposed to light. These drugs kill cancer cells. [NIH] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280400 mm. There are two main types : photoallergy and photoxicity. [EU] Photosensitizing Agents: Drugs that are pharmacologically inactive but when exposed to ultraviolet radiation or sunlight are converted to their active metabolite to produce a beneficial reaction affecting the diseased tissue. These compounds can be administered topically or systemically and have been used therapeutically to treat psoriasis and various types of neoplasms. [NIH]

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Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pigmentation: Coloration or discoloration of a part by a pigment. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pitch: The subjective awareness of the frequency or spectral distribution of a sound. [NIH] Placenta: A highly vascular fetal organ through which the fetus absorbs oxygen and other nutrients and excretes carbon dioxide and other wastes. It begins to form about the eighth day of gestation when the blastocyst adheres to the decidua. [NIH] Plant Oils: Oils derived from plants or plant products. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasmid: An autonomously replicating, extra-chromosomal DNA molecule found in many bacteria. Plasmids are widely used as carriers of cloned genes. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Platinum: Platinum. A heavy, soft, whitish metal, resembling tin, atomic number 78, atomic weight 195.09, symbol Pt. (From Dorland, 28th ed) It is used in manufacturing equipment for laboratory and industrial use. It occurs as a black powder (platinum black) and as a

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spongy substance (spongy platinum) and may have been known in Pliny's time as "alutiae". [NIH]

Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Poly C: A group of cytosine ribonucleotides in which the phosphate residues of each cytosine ribonucleotide act as bridges in forming diester linkages between the ribose moieties. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polycystic Ovary Syndrome: Clinical symptom complex characterized by oligomenorrhea or amenorrhea, anovulation, and regularly associated with bilateral polycystic ovaries. [NIH] Polymerase: An enzyme which catalyses the synthesis of DNA using a single DNA strand as a template. The polymerase copies the template in the 5'-3'direction provided that sufficient quantities of free nucleotides, dATP and dTTP are present. [NIH] Polymers: Compounds formed by the joining of smaller, usually repeating, units linked by covalent bonds. These compounds often form large macromolecules (e.g., polypeptides, proteins, plastics). [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polyvinyl Alcohol: A polymer prepared from polyvinyl acetates by replacement of the acetate groups with hydroxyl groups. It is used as a pharmaceutic aid and ophthalmic lubricant as well as in the manufacture of surface coatings artificial sponges, cosmetics, and other products. [NIH] Porokeratosis: A rare, chronic, progressive autosomal dominant disorder seen most often in males and usually appearing in early childhood. It is characterized by the formation of slightly atrophic patches surrounded by an elevated, keratotic border. [NIH] Porphyria Cutanea Tarda: A form of hepatic porphyria (porphyria, hepatic) characterized by photosensitivity resulting in bullae that rupture easily to form shallow ulcers. This condition occurs in two forms: a sporadic, nonfamilial form that begins in middle age and has normal amounts of uroporphyrinogen decarboxylase with diminished activity in the liver; and a familial form in which there is an autosomal dominant inherited deficiency of uroporphyrinogen decarboxylase in the liver and red blood cells. [NIH] Porphyria, Hepatic: Porphyria in which the liver is the site where excess formation of porphyrin or its precursors is found. Acute intermittent porphyria and porphyria cutanea tarda are types of hepatic porphyria. [NIH] Porphyrins: A group of compounds containing the porphin structure, four pyrrole rings connected by methine bridges in a cyclic configuration to which a variety of side chains are attached. The nature of the side chain is indicated by a prefix, as uroporphyrin, hematoporphyrin, etc. The porphyrins, in combination with iron, form the heme component in biologically significant compounds such as hemoglobin and myoglobin. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH]

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Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potassium Citrate: A powder that dissolves in water, which is administered orally, and is used as a diuretic, expectorant, systemic alkalizer, and electrolyte replenisher. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Premenstrual: Occurring before menstruation. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Procainamide: A derivative of procaine with less CNS action. [NIH] Procaine: A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016). [NIH] Procollagen: A biosynthetic precursor of collagen containing additional amino acid sequences at the amino-terminal ends of the three polypeptide chains. Protocollagen, a precursor of procollagen consists of procollagen peptide chains in which proline and lysine have not yet been hydroxylated. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an

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antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Promotor: In an operon, a nucleotide sequence located at the operator end which contains all the signals for the correct initiation of genetic transcription by the RNA polymerase holoenzyme and determines the maximal rate of RNA synthesis. [NIH] Promyelocytic leukemia: A type of acute myeloid leukemia, a quickly progressing disease in which too many immature blood-forming cells are found in the blood and bone marrow. [NIH]

Prone: Having the front portion of the body downwards. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propionibacterium: A genus of gram-positive, rod-shaped bacteria whose cells occur singly, in pairs or short chains, in V or Y configurations, or in clumps resembling letters of the Chinese alphabet. Its organisms are found in cheese and dairy products as well as on human skin and can occasionally cause soft tissue infections. [NIH] Propionibacterium acnes: A bacteria isolated from normal skin, intestinal contents, wounds, blood, pus, and soft tissue abscesses. It is a common contaminant of clinical specimens, presumably from the skin of patients or attendants. [NIH] Proportional: Being in proportion : corresponding in size, degree, or intensity, having the same or a constant ratio; of, relating to, or used in determining proportions. [EU] Prostaglandins: A group of compounds derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway. They are extremely potent mediators of a diverse group of physiological processes. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Prostate gland: A gland in the male reproductive system just below the bladder. It surrounds part of the urethra, the canal that empties the bladder, and produces a fluid that forms part of semen. [NIH] Prostatic Hyperplasia: Enlargement or overgrowth of the prostate gland as a result of an increase in the number of its constituent cells. [NIH] Prosthesis: An artificial replacement of a part of the body. [NIH] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein

Glossary 239

C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protein-Tyrosine Kinase: An enzyme that catalyzes the phosphorylation of tyrosine residues in proteins with ATP or other nucleotides as phosphate donors. EC 2.7.1.112. [NIH] Proteolytic: 1. pertaining to, characterized by, or promoting proteolysis. 2. an enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Protozoa: A subkingdom consisting of unicellular organisms that are the simplest in the animal kingdom. Most are free living. They range in size from submicroscopic to macroscopic. Protozoa are divided into seven phyla: Sarcomastigophora, Labyrinthomorpha, Apicomplexa, Microspora, Ascetospora, Myxozoa, and Ciliophora. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Pruritus: An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Puberty: The period during which the secondary sex characteristics begin to develop and the capability of sexual reproduction is attained. [EU] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Purines: A series of heterocyclic compounds that are variously substituted in nature and are known also as purine bases. They include adenine and guanine, constituents of nucleic acids, as well as many alkaloids such as caffeine and theophylline. Uric acid is the metabolic end product of purine metabolism. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH]

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Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pustular: Pertaining to or of the nature of a pustule; consisting of pustules (= a visible collection of pus within or beneath the epidermis). [EU] Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Pyrimidines: A family of 6-membered heterocyclic compounds occurring in nature in a wide variety of forms. They include several nucleic acid constituents (cytosine, thymine, and uracil) and form the basic structure of the barbiturates. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Quaternary: 1. fourth in order. 2. containing four elements or groups. [EU] Quiescent: Marked by a state of inactivity or repose. [EU] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioactivity: The quality of emitting or the emission of corpuscular or electromagnetic radiations consequent to nuclear disintegration, a natural property of all chemical elements of atomic number above 83, and possible of induction in all other known elements. [EU] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in

Glossary 241

crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Reconstitution: 1. a type of regeneration in which a new organ forms by the rearrangement of tissues rather than from new formation at an injured surface. 2. the restoration to original form of a substance previously altered for preservation and storage, as the restoration to a liquid state of blood serum or plasma that has been dried and stored. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red blood cells: RBCs. Cells that carry oxygen to all parts of the body. Also called erythrocytes. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Reductase: Enzyme converting testosterone to dihydrotestosterone. [NIH] Redux: Appetite suppressant. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Repressor: Any of the specific allosteric protein molecules, products of regulator genes, which bind to the operator of operons and prevent RNA polymerase from proceeding into the operon to transcribe messenger RNA. [NIH] Reproductive system: In women, this system includes the ovaries, the fallopian tubes, the uterus (womb), the cervix, and the vagina (birth canal). The reproductive system in men includes the prostate, the testes, and the penis. [NIH] Resolving: The ability of the eye or of a lens to make small objects that are close together, separately visible; thus revealing the structure of an object. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Response Elements: Nucleotide sequences, usually upstream, which are recognized by specific regulatory transcription factors, thereby causing gene response to various regulatory agents. These elements may be found in both promotor and enhancer regions. [NIH]

Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retina: The ten-layered nervous tissue membrane of the eye. It is continuous with the optic

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nerve and receives images of external objects and transmits visual impulses to the brain. Its outer surface is in contact with the choroid and the inner surface with the vitreous body. The outer-most layer is pigmented, whereas the inner nine layers are transparent. [NIH] Retinal: 1. pertaining to the retina. 2. the aldehyde of retinol, derived by the oxidative enzymatic splitting of absorbed dietary carotene, and having vitamin A activity. In the retina, retinal combines with opsins to form visual pigments. One isomer, 11-cis retinal combines with opsin in the rods (scotopsin) to form rhodopsin, or visual purple. Another, all-trans retinal (trans-r.); visual yellow; xanthopsin) results from the bleaching of rhodopsin by light, in which the 11-cis form is converted to the all-trans form. Retinal also combines with opsins in the cones (photopsins) to form the three pigments responsible for colour vision. Called also retinal, and retinene1. [EU] Retinaldehyde: A carotenoid constituent of visual pigments. It is the oxidized form of retinol which functions as the active component of the visual cycle. It is bound to the protein opsin forming the complex rhodopsin. When stimulated by visible light, the retinal component of the rhodopsin complex undergoes isomerization at the 11-position of the double bond to the cis-form; this is reversed in "dark" reactions to return to the native transconfiguration. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Retinoid: Vitamin A or a vitamin A-like compound. [NIH] Retinol: Vitamin A. It is essential for proper vision and healthy skin and mucous membranes. Retinol is being studied for cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Retroperitoneal: Having to do with the area outside or behind the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retroviral vector: RNA from a virus that is used to insert genetic material into cells. [NIH] Rheumatic Diseases: Disorders of connective tissue, especially the joints and related structures, characterized by inflammation, degeneration, or metabolic derangement. [NIH] Rheumatism: A group of disorders marked by inflammation or pain in the connective tissue structures of the body. These structures include bone, cartilage, and fat. [NIH] Rheumatoid: Resembling rheumatism. [EU] Rheumatoid arthritis: A form of arthritis, the cause of which is unknown, although infection, hypersensitivity, hormone imbalance and psychologic stress have been suggested as possible causes. [NIH] Rhinophyma: A manifestation of severe Acne rosacea resulting in significant enlargement of the nose and occurring primarily in men. It is caused by hypertrophy of the sebaceous glands and surrounding connective tissue. The nose is reddened and marked with numerous telangiectasias. [NIH] Rhodopsin: A photoreceptor protein found in retinal rods. It is a complex formed by the binding of retinal, the oxidized form of retinol, to the protein opsin and undergoes a series of complex reactions in response to visible light resulting in the transmission of nerve impulses to the brain. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH]

Glossary 243

Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rickets: A condition caused by deficiency of vitamin D, especially in infancy and childhood, with disturbance of normal ossification. The disease is marked by bending and distortion of the bones under muscular action, by the formation of nodular enlargements on the ends and sides of the bones, by delayed closure of the fontanelles, pain in the muscles, and sweating of the head. Vitamin D and sunlight together with an adequate diet are curative, provided that the parathyroid glands are functioning properly. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Rod: A reception for vision, located in the retina. [NIH] Rosiglitazone: A drug taken to help reduce the amount of sugar in the blood. Rosiglitazone helps make insulin more effective and improves regulation of blood sugar. It belongs to the family of drugs called thiazolidinediones. [NIH] Salicylamides: Amides of salicylic acid. [NIH] Salicylanilides: 2-Hydroxy-N-phenylbenzamides. N-phenyl substituted salicylamides. Derivatives have been used as fungicides, anti-mildew agents and topical antifungal agents. In concentrated form may cause irritation of skin and mucous membranes. [NIH] Salicylic: A tuberculosis drug. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoid: A cutaneus lesion occurring as a manifestation of sarcoidosis. [NIH] Sarcoidosis: An idiopathic systemic inflammatory granulomatous disorder comprised of epithelioid and multinucleated giant cells with little necrosis. It usually invades the lungs with fibrosis and may also involve lymph nodes, skin, liver, spleen, eyes, phalangeal bones, and parotid glands. [NIH] Scabies: A contagious cutaneous inflammation caused by the bite of the mite Sarcoptes scabiei. It is characterized by pruritic papular eruptions and burrows and affects primarily the axillae, elbows, wrists, and genitalia, although it can spread to cover the entire body. [NIH]

Scalpel: A small pointed knife with a convex edge. [NIH] Scans: Pictures of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body. [NIH] Scatter: The extent to which relative success and failure are divergently manifested in qualitatively different tests. [NIH]

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Scleroproteins: Simple proteins characterized by their insolubility and fibrous structure. Within the body, they perform a supportive or protective function. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebaceous gland: Gland that secretes sebum. [NIH] Seborrhea: Hypersecretion of sebum with excessive oily secretion from the sweat glands. [NIH]

Seborrhoea: 1. excessive secretion of sebum; called also hypersteatosis 2. seborrhoeic dermatitis. [EU] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Sensitization: 1. administration of antigen to induce a primary immune response; priming; immunization. 2. exposure to allergen that results in the development of hypersensitivity. 3. the coating of erythrocytes with antibody so that they are subject to lysis by complement in the presence of homologous antigen, the first stage of a complement fixation test. [EU] Sequela: Any lesion or affection following or caused by an attack of disease. [EU] Serine: A non-essential amino acid occurring in natural form as the L-isomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Serine Endopeptidases: Any member of the group of endopeptidases containing at the active site a serine residue involved in catalysis. EC 3.4.21. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics:

Those characteristics that distinguish one sex from the other. The

Glossary 245

primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Determination: female or male. [NIH]

The biological characteristics which distinguish human beings as

Shedding: Release of infectious particles (e. g., bacteria, viruses) into the environment, for example by sneezing, by fecal excretion, or from an open lesion. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Silicon: A trace element that constitutes about 27.6% of the earth's crust in the form of silicon dioxide. It does not occur free in nature. Silicon has the atomic symbol Si, atomic number 14, and atomic weight 28.09. [NIH] Silicon Dioxide: Silica. Transparent, tasteless crystals found in nature as agate, amethyst, chalcedony, cristobalite, flint, sand, quartz, and tridymite. The compound is insoluble in water or acids except hydrofluoric acid. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skin Care: Maintenance of the hygienic state of the skin under optimal conditions of cleanliness and comfort. Effective in skin care are proper washing, bathing, cleansing, and the use of soaps, detergents, oils, etc. In various disease states, therapeutic and protective solutions and ointments are useful. The care of the skin is particularly important in various occupations, in exposure to sunlight, in neonates, and in decubitus ulcer. [NIH] Skin Pigmentation: Coloration of the skin. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH]

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Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Soaps: Sodium or potassium salts of long chain fatty acids. These detergent substances are obtained by boiling natural oils or fats with caustic alkali. Sodium soaps are harder and are used as topical anti-infectives and vehicles in pills and liniments; potassium soaps are soft, used as vehicles for ointments and also as topical antimicrobials. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Bicarbonate: A white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. dissolving; effecting a solution. 2. a liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Spasmodic: Of the nature of a spasm. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spike: The activation of synapses causes changes in the permeability of the dendritic membrane leading to changes in the membrane potential. This difference of the potential travels along the axon of the neuron and is called spike. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated

Glossary 247

manner. [EU] Squamous: Scaly, or platelike. [EU] Squamous Epithelium: Tissue in an organ such as the esophagus. Consists of layers of flat, scaly cells. [NIH] Staging: Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. [NIH]

Staphylococcus: A genus of gram-positive, facultatively anaerobic, coccoid bacteria. Its organisms occur singly, in pairs, and in tetrads and characteristically divide in more than one plane to form irregular clusters. Natural populations of Staphylococcus are membranes of warm-blooded animals. Some species are opportunistic pathogens of humans and animals. [NIH] Steady state: Dynamic equilibrium. [EU] Sterility: 1. the inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. the state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH]

Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Streptococcal: Caused by infection due to any species of streptococcus. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH]

Stromal: Large, veil-like cell in the bone marrow. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Subcutaneous: Beneath the skin. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses.

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[NIH]

Sulfacetamide: An anti-infective agent that is used topically to treat skin infections and orally for urinary tract infections. [NIH] Sulfur: An element that is a member of the chalcogen family. It has an atomic symbol S, atomic number 16, and atomic weight 32.066. It is found in the amino acids cysteine and methionine. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Superstitions: A belief or practice which lacks adequate basis for proof; an embodiment of fear of the unknown, magic, and ignorance. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Suppurative: Consisting of, containing, associated with, or identified by the formation of pus. [NIH] Supraclavicular: The depression above the clavicle and lateral to the sternomastoid muscle. [NIH]

Surfactant: A fat-containing protein in the respiratory passages which reduces the surface tension of pulmonary fluids and contributes to the elastic properties of pulmonary tissue. [NIH]

Sweat: The fluid excreted by the sweat glands. It consists of water containing sodium chloride, phosphate, urea, ammonia, and other waste products. [NIH] Sweat Glands: Sweat-producing structures that are embedded in the dermis. Each gland consists of a single tube, a coiled body, and a superficial duct. [NIH] Symphysis: A secondary cartilaginous joint. [NIH] Synapses: Specialized junctions at which a neuron communicates with a target cell. At classical synapses, a neuron's presynaptic terminal releases a chemical transmitter stored in synaptic vesicles which diffuses across a narrow synaptic cleft and activates receptors on the postsynaptic membrane of the target cell. The target may be a dendrite, cell body, or axon of another neuron, or a specialized region of a muscle or secretory cell. Neurons may also communicate through direct electrical connections which are sometimes called electrical synapses; these are not included here but rather in gap junctions. Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synovial: Of pertaining to, or secreting synovia. [EU] Synovial Membrane: The inner membrane of a joint capsule surrounding a freely movable joint. It is loosely attached to the external fibrous capsule and secretes synovial fluid. [NIH] Synovitis: Inflammation of a synovial membrane. It is usually painful, particularly on motion, and is characterized by a fluctuating swelling due to effusion within a synovial sac. Synovitis is qualified as fibrinous, gonorrhoeal, hyperplastic, lipomatous, metritic, puerperal, rheumatic, scarlatinal, syphilitic, tuberculous, urethral, etc. [EU] Synthetic retinoid: A substance related to vitamin A that is produced in a laboratory. [NIH] Systemic: Affecting the entire body. [NIH]

Glossary 249

Systemic disease: Disease that affects the whole body. [NIH] Systemic therapy: Treatment that uses substances that travel through the bloodstream, reaching and affecting cells all over the body. [NIH] Tear Gases: Gases that irritate the eyes, throat, or skin. Severe lacrimation develops upon irritation of the eyes. [NIH] Teichoic Acids: Bacterial polysaccharides that are rich in phosphodiester linkages. They are the major components of the cell walls and membranes of many bacteria. [NIH] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Teratogen: A substance which, through immediate, prolonged or repeated contact with the skin may involve a risk of subsequent non-hereditable birth defects in offspring. [NIH] Teratogenic: Tending to produce anomalies of formation, or teratism (= anomaly of formation or development : condition of a monster). [EU] Teratogenicity: The power to cause abnormal development. [NIH] Testis: Either of the paired male reproductive glands that produce the male germ cells and the male hormones. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Thalidomide: A pharmaceutical agent originally introduced as a non-barbiturate hypnotic, but withdrawn from the market because of its known tetratogenic effects. It has been reintroduced and used for a number of immunological and inflammatory disorders. Thalidomide displays immunosuppresive and anti-angiogenic activity. It inhibits release of tumor necrosis factor alpha from monocytes, and modulates other cytokine action. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Thermoregulation: Heat regulation. [EU] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by

250 Acne

the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thromboxanes: Physiologically active compounds found in many organs of the body. They are formed in vivo from the prostaglandin endoperoxides and cause platelet aggregation, contraction of arteries, and other biological effects. Thromboxanes are important mediators of the actions of polyunsaturated fatty acids transformed by cyclooxygenase. [NIH] Thrombus: An aggregation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of its formation. Some authorities thus differentiate thrombus formation from simple coagulation or clot formation. [EU] Thymidine: A chemical compound found in DNA. Also used as treatment for mucositis. [NIH]

Thymosin: A family of heat-stable, polypeptide hormones secreted by the thymus gland. Their biological activities include lymphocytopoiesis, restoration of immunological competence and enhancement of expression of T-cell characteristics and function. They have therapeutic potential in patients having primary or secondary immunodeficiency diseases, cancer or diseases related to aging. [NIH] Thymus: An organ that is part of the lymphatic system, in which T lymphocytes grow and multiply. The thymus is in the chest behind the breastbone. [NIH] Thymus Gland: A single, unpaired primary lymphoid organ situated in the mediastinum, extending superiorly into the neck to the lower edge of the thyroid gland and inferiorly to the fourth costal cartilage. It is necessary for normal development of immunologic function early in life. By puberty, it begins to involute and much of the tissue is replaced by fat. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tone: 1. the normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. a particular quality of sound or of voice. 3. to make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU]

Glossary 251

Tonus: A state of slight tension usually present in muscles even when they are not undergoing active contraction. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxin: A poison; frequently used to refer specifically to a protein produced by some higher plants, certain animals, and pathogenic bacteria, which is highly toxic for other living organisms. Such substances are differentiated from the simple chemical poisons and the vegetable alkaloids by their high molecular weight and antigenicity. [EU] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transcription Factors: Endogenous substances, usually proteins, which are effective in the initiation, stimulation, or termination of the genetic transcription process. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Translocation: The movement of material in solution inside the body of the plant. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tretinoin: An important regulator of gene expression, particularly during growth and development and in neoplasms. Retinoic acid derived from maternal vitamin A is essential for normal gene expression during embryonic development and either a deficiency or an excess can be teratogenic. It is also a topical dermatologic agent which is used in the treatment of psoriasis, acne vulgaris, and several other skin diseases. It has also been approved for use in promyelocytic leukemia. [NIH] Trichloroacetic Acid: A strong acid used as a protein precipitant in clinical chemistry and also as a caustic for removing warts. [NIH] Trichomoniasis: An infection with the protozoan parasite Trichomonas vaginalis. [NIH] Triglyceride: A lipid carried through the blood stream to tissues. Most of the body's fat tissue is in the form of triglycerides, stored for use as energy. Triglycerides are obtained

252 Acne

primarily from fat in foods. [NIH] Trophic: Of or pertaining to nutrition. [EU] Trypsin: A serine endopeptidase that is formed from trypsinogen in the pancreas. It is converted into its active form by enteropeptidase in the small intestine. It catalyzes hydrolysis of the carboxyl group of either arginine or lysine. EC 3.4.21.4. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tubocurarine: A neuromuscular blocker and active ingredient in curare; plant based alkaloid of Menispermaceae. [NIH] Tumor Necrosis Factor: Serum glycoprotein produced by activated macrophages and other mammalian mononuclear leukocytes which has necrotizing activity against tumor cell lines and increases ability to reject tumor transplants. It mimics the action of endotoxin but differs from it. It has a molecular weight of less than 70,000 kDa. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ultraviolet radiation: Invisible rays that are part of the energy that comes from the sun. UV radiation can damage the skin and cause melanoma and other types of skin cancer. UV radiation that reaches the earth's surface is made up of two types of rays, called UVA and UVB rays. UVB rays are more likely than UVA rays to cause sunburn, but UVA rays pass deeper into the skin. Scientists have long thought that UVB radiation can cause melanoma and other types of skin cancer. They now think that UVA radiation also may add to skin damage that can lead to skin cancer and cause premature aging. For this reason, skin specialists recommend that people use sunscreens that reflect, absorb, or scatter both kinds of UV radiation. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urinary tract: The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra. [NIH] Urinary tract infection: An illness caused by harmful bacteria growing in the urinary tract. [NIH]

Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uroporphyrinogen Decarboxylase: One of the enzymes active in heme biosynthesis. It catalyzes the decarboxylation of uroporphyrinogen III to coproporphyrinogen III by the conversion of four acetic acid groups to four methyl groups. EC 4.1.1.37. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH]

Glossary 253

Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasculitis: Inflammation of a blood vessel. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Venter: Belly. [NIH] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Venules: The minute vessels that collect blood from the capillary plexuses and join together to form veins. [NIH] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral vector: A type of virus used in cancer therapy. The virus is changed in the laboratory and cannot cause disease. Viral vectors produce tumor antigens (proteins found on a tumor cell) and can stimulate an antitumor immune response in the body. Viral vectors may also be used to carry genes that can change cancer cells back to normal cells. [NIH] Virilism: Development of masculine traits in the female. [NIH] Virilization: The induction or development of male secondary sec characters, especially the induction of such changes in the female, including enlargement of the clitoris, growth of

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facial and body hair, development of a hairline typical of the male forehead, stimulation of secretion and proliferation of the sebaceous glands (often with acne), and deepening of the voice. Called also masculinization) [EU] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] Viscosity: A physical property of fluids that determines the internal resistance to shear forces. [EU] Vitamin D: The vitamin that mediates intestinal calcium absorption, bone calcium metabolism, and probably muscle activity. It usually acts as a hormone precursor, requiring 2 stages of metabolism before reaching actual hormonal form. It is isolated from fish liver oils and used in the treatment and prevention of rickets. [NIH] Vitreous Body: The transparent, semigelatinous substance that fills the cavity behind the crystalline lens of the eye and in front of the retina. It is contained in a thin hyoid membrane and forms about four fifths of the optic globe. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Vocal cord: The vocal folds of the larynx. [NIH] Vulgaris: An affection of the skin, especially of the face, the back and the chest, due to chronic inflammation of the sebaceous glands and the hair follicles. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Wound: Any interruption, by violence or by surgery, in the continuity of the external surface of the body or of the surface of any internal organ. [NIH] Wound Healing: Restoration of integrity to traumatized tissue. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Zinc Oxide: A mild astringent and topical protectant with some antiseptic action. It is also

Glossary 255

used in bandages, pastes, ointments, dental cements, and as a sunblock. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

256

INDEX 5 5-alpha ......................................... 13, 189, 211 A Abdomen .... 24, 189, 197, 215, 224, 232, 233, 242, 247, 250, 254 Abdominal ........... 77, 139, 189, 232, 233, 242 Abdominal Cramps.............................. 77, 189 Aberrant................................................. 4, 189 Abortion..................................................... 218 Abrasion ........................................ 90, 91, 189 Abscess .............................................. 101, 189 Acantholysis ...................................... 189, 233 Acceptor .................................... 189, 224, 232 Acetic Acids ........................................ 92, 189 Acetylcholine..................................... 189, 230 Acne Keloid....................................... 166, 189 Acne Rosacea . 34, 44, 45, 50, 51, 64, 71, 102, 115, 133, 169, 189 Adenoma............................................ 139, 189 Adenovirus ........................................ 110, 189 Adolescence.. 6, 76, 88, 95, 96, 101, 105, 110, 117, 119, 165, 167, 189 Adrenal Cortex .......... 190, 204, 210, 218, 237 Adrenal Glands .......................... 108, 139, 190 Adverse effect6, 10, 11, 24, 77, 107, 190, 222, 245 Affinity ...................................... 190, 224, 246 Ageing ..................................... 79, 80, 93, 190 Agonist ................................ 84, 111, 190, 201 Airway ............................................... 190, 246 Alimentary......................... 126, 190, 221, 233 Alkaline ..................................... 190, 197, 234 Allergen ..................................... 190, 206, 244 Allograft ................................................ 6, 190 Alloys ................................................ 190, 232 Aloe ............................................. 82, 105, 190 Alopecia................................. 13, 95, 131, 190 Alpha-Defensins ................................ 190, 205 Alpha-helix ........................................ 190, 222 Alternative medicine.......................... 148, 190 Amebiasis .......................................... 190, 226 Ameliorating...................................... 117, 191 Amenorrhea ............. 15, 50, 64, 191, 230, 236 Amino Acid Sequence ....................... 191, 237 Aminolevulinic Acid ................... 27, 121, 191 Amino-terminal ................................. 191, 237 Anaerobic .......... 4, 76, 92, 108, 125, 191, 247 Anaesthesia........................................ 191, 220 Anal ................................... 126, 191, 211, 216 Analog ....................................... 191, 201, 226 Anaphylatoxins.................................. 191, 202 Anatomical ................ 191, 200, 208, 219, 244

Androgenic.. 13, 21, 39, 50, 95, 114, 191, 230 Androgens .... 12, 19, 21, 24, 76, 95, 101, 165, 190, 191, 218 Anemia .............................. 159, 191, 211, 215 Animal model................................ 13, 14, 191 Anions ....................................... 107, 191, 221 Anode ........................................................ 191 Anomalies ......................................... 192, 249 Anorexia...................................................... 48 Anorexia Nervosa........................................ 48 Anovulation........................... 16, 23, 192, 236 Antiandrogens ................... 9, 26, 95, 137, 192 Antibacterial..... 5, 7, 12, 30, 77, 94, 136, 192, 201, 246 Antibiotic .................................................... 51 Antibody... 190, 192, 202, 216, 219, 220, 221, 226, 227, 240, 244, 254 Antiepileptic...................................... 139, 192 Antifungal ......................................... 192, 243 Antifungal Agents ............................. 192, 243 Antigen..... 190, 192, 202, 216, 218, 219, 220, 221, 225, 244 Antigen-Antibody Complex .............. 192, 202 Antihypertensive ............................... 192, 217 Anti-infective ............ 192, 217, 221, 246, 248 Anti-inflammatory.... 7, 14, 31, 113, 126, 192, 213 Antimicrobial ..... 7, 10, 14, 17, 59, 62, 76, 96, 111, 123, 192, 199, 200, 205, 206, 207 Antioxidant........................ 126, 192, 194, 232 Antiseptic .................... 84, 104, 111, 192, 254 Anus .................. 191, 192, 197, 201, 221, 233 Anxiety................................................ 96, 192 Apnea ........................................................ 192 Apocrine Glands................................ 192, 216 Apolipoproteins................... 24, 192, 193, 224 Apolipoproteins A............................... 24, 193 Apoptosis .............................. 13, 22, 193, 199 Aqueous ..... 78, 79, 107, 108, 125, 193, 195, 204, 208, 217, 223, 224 Arachidonate 12-Lipoxygenase......... 193, 224 Arachidonate 15-Lipoxygenase......... 193, 224 Arachidonate Lipoxygenases ............ 193, 224 Arachidonic Acid .............. 193, 208, 223, 238 Arginine ............................ 191, 193, 230, 252 Aromatic.................................... 193, 200, 234 Arterial .............................. 193, 200, 218, 239 Arteries..... 126, 193, 194, 196, 203, 224, 227, 250 Arterioles........................... 193, 194, 196, 197 Arteriolosclerosis .............................. 193, 194 Arteriosclerosis ................................. 126, 193

Index 257

Artery........................... 16, 193, 194, 203, 239 Ascites ............................................... 194, 232 Ascorbic Acid .................... 106, 124, 194, 217 Aspartic.............................................. 194, 209 Aspartic Endopeptidases.................... 194, 209 Aspiration .................................................... 50 Astringent .......................................... 194, 254 Ataxia ........................ 158, 159, 194, 217, 249 Atherogenic ....................................... 126, 194 Atopic ........................................ 136, 138, 194 Attenuated.......................................... 194, 207 Autoimmune disease.................... 79, 194, 228 Autologous ............................................ 6, 194 B Bacillus ........................................ 88, 105, 194 Bacterial Proteins................................. 92, 194 Bactericidal.......................................... 36, 194 Bacteriocins ......................................... 81, 194 Bacteriostatic ............................... 89, 194, 210 Bacterium ........................ 8, 76, 110, 111, 194 Bandages............................................ 194, 255 Barbiturate ......................................... 194, 249 Basal cell carcinoma .......................... 138, 195 Basal Ganglia..................................... 194, 195 Basal Ganglia Diseases...................... 194, 195 Basal metabolic rate........................... 134, 195 Base 86, 98, 99, 103, 174, 195, 204, 205, 222, 234, 249 Basophils ................................... 195, 214, 223 Beauty.................................. 7, 8, 58, 132, 195 Benign 95, 139, 189, 193, 195, 211, 215, 229, 232, 240 Benign prostatic hyperplasia........ 95, 195, 211 Beta-Defensins .................................. 195, 205 Bilateral ............................................. 195, 236 Bile .................... 195, 212, 217, 219, 224, 247 Bile duct............................................. 195, 219 Binding Sites ....................................... 22, 195 Biofilms ............................................... 41, 195 Biological response modifier ............. 195, 220 Biopsy.......................................... 6, 8, 18, 195 Biosynthesis............... 115, 193, 195, 244, 252 Biotechnology...... 24, 25, 133, 148, 155, 157, 158, 159, 196 Biotin ................................................... 98, 196 Biotransformation...................................... 196 Biotypes............................................... 61, 196 Bladder .............. 195, 196, 202, 228, 238, 252 Blepharitis...................................... 20, 34, 196 Blister ................................................ 196, 233 Blood Cell Count ............................... 196, 215 Blood Coagulation............................. 196, 197 Blood pressure ...... 90, 91, 118, 192, 196, 218, 227, 230, 246 Blood vessel.. 90, 91, 135, 196, 198, 199, 200, 209, 222, 224, 246, 247, 249, 250, 253

Blood-Brain Barrier .................. 196, 229, 235 Body Fluids ............................... 196, 207, 246 Bone Marrow ... 196, 201, 213, 219, 225, 227, 238, 247 Bone scan .......................................... 196, 243 Bowel ................ 189, 191, 197, 206, 233, 247 Bowel Movement ...................... 197, 206, 247 Brachytherapy ................... 197, 221, 240, 254 Bradykinin......................................... 197, 230 Brain Stem......................................... 197, 199 Branch ....................... 183, 197, 233, 246, 249 Breakdown .................. 98, 111, 197, 206, 212 Bridge................................................ 101, 241 Broadband ......................................... 116, 197 Broad-spectrum ................................. 197, 198 Buccal.................................. 72, 197, 218, 224 Bullous ........................................ 59, 139, 197 Burns ....................................... 19, 64, 84, 197 Burns, Electric........................................... 197 C Calcification ...................................... 194, 197 Calciphylaxis..................................... 139, 197 Calcium ....... 96, 197, 201, 202, 230, 245, 254 Callus ................................................ 197, 222 Capillary.................................... 197, 198, 253 Capillary Fragility ..................................... 198 Capsules ...................................... 88, 162, 198 Carbohydrate ..................... 101, 198, 213, 214 Carcinogen ................................ 198, 227, 228 Carcinogenic ..................... 198, 220, 238, 247 Carcinoma ..................... 23, 96, 139, 198, 204 Cardiac ...................... 198, 208, 210, 228, 247 Cardiovascular..................... 24, 126, 198, 223 Cardiovascular System...................... 126, 198 Carnitine.............................................. 60, 198 Case report ...................... 33, 46, 58, 198, 201 Case series......................................... 198, 201 Catabolism .......................................... 22, 198 Catechin .............................................. 98, 198 Cathode ..................................... 191, 198, 208 Cations ...................................... 107, 198, 221 Caudal ............................... 198, 206, 218, 236 Caustic....................................... 198, 246, 251 Cefadroxil.............................................. 7, 198 Cell Aggregation ............................... 198, 232 Cell Aging ......................................... 126, 198 Cell Death ................................. 193, 199, 229 Cell Differentiation ........................... 199, 245 Cell Division .... 158, 194, 198, 199, 215, 227, 235 Cell Physiology ................................... 18, 199 Cell proliferation ......... 19, 126, 194, 199, 245 Central Nervous System...... 15, 20, 189, 199, 212, 214, 215, 217, 223, 228, 231, 235 Central Nervous System Infections.. 199, 215, 217

258 Acne

Centrifugation.................................... 199, 215 Cephalexin..................................... 7, 198, 199 Cephaloridine ............................................ 199 Cephalothin................................................ 199 Cerebellar ...................... 15, 20, 194, 199, 241 Cerebellum ............................ 15, 20, 199, 241 Cerebral .... 126, 194, 195, 196, 197, 199, 210, 217, 249, 250 Cerebral Cortex ................................. 194, 199 Cerebrovascular ................. 195, 199, 230, 249 Cerebrum ........................................... 199, 252 Chemokines ....................................... 110, 199 Chemotactic Factors ............................ 31, 199 Chemotaxis ........................................ 106, 200 Chemotherapeutic agent ................ 22, 95, 200 Chemotherapy.................................... 200, 216 Chin .... 8, 35, 57, 59, 60, 62, 63, 88, 105, 126, 135, 137, 189, 200, 226 Chloasma ............................................. 63, 200 Cholesterol22, 64, 65, 126, 193, 200, 224, 247 Cholesterol Esters .............................. 200, 224 Choroid .............................................. 200, 242 Chromatin .......................................... 193, 200 Chromium................................ 55, 88, 98, 200 Chromosomal .................................... 200, 235 Chromosome...................................... 200, 224 Chronic renal ..................................... 200, 236 Chylomicrons .................................... 200, 224 Chymotrypsin ...................................... 78, 200 Cicatricial .......................................... 200, 216 Ciprofloxacin ..................................... 5, 7, 200 CIS................... 22, 40, 88, 100, 105, 200, 242 Citric Acid ......................................... 114, 201 Citrus ................................................. 194, 201 Civilization .......................................... 29, 201 Clavicle.............................................. 201, 248 Clindamycin ... 7, 8, 25, 26, 27, 32, 34, 40, 49, 52, 67, 77, 82, 83, 85, 94, 135, 174, 201 Clinical study............................... 12, 201, 203 Clinical trial ...... 11, 13, 45, 49, 51, 59, 71, 73, 155, 201, 207, 240 Clitoral................................................. 24, 201 Clomiphene.......................................... 23, 201 Cloning .............................................. 196, 201 Cod Liver Oil..................................... 201, 208 Coenzyme .............. 93, 97, 120, 194, 201, 230 Cofactor ............................................. 201, 238 Colitis .................................................. 79, 201 Collagen.... 6, 52, 80, 191, 198, 201, 235, 237, 238 Collapse ..................................... 197, 201, 246 Colon ................................. 158, 201, 219, 222 Colony-Stimulating Factors............... 201, 214 Combination Therapy ...................... 4, 39, 202 Combinatorial ............................ 113, 114, 202

Comedo 4, 101, 106, 108, 115, 123, 125, 135, 165, 202 Commensal........................................ 106, 202 Complement ........................ 34, 191, 202, 244 Complementary and alternative medicine .. 57, 70, 202 Complementary medicine ................... 57, 202 Complete remission........................... 202, 241 Compliance ........................... 11, 18, 117, 202 Computational Biology ............. 155, 157, 202 Computed tomography...................... 203, 243 Computerized axial tomography ....... 203, 243 Conception ................................ 203, 211, 247 Concomitant ................................ 97, 120, 203 Condyloma .......................................... 63, 203 Congestion ........................................ 203, 210 Conjunctiva ............................... 203, 220, 235 Connective Tissue .... 194, 196, 201, 203, 206, 211, 212, 225, 242 Consciousness ................................... 203, 205 Constriction ....................................... 203, 222 Contact dermatitis ........... 4, 59, 138, 142, 203 Contraception ................ 18, 39, 203, 223, 230 Contraceptive ..... 12, 18, 31, 34, 49, 144, 146, 147, 203, 230 Contraindications .................................. ii, 203 Contralateral........................ 13, 203, 231, 241 Controlled clinical trial ....................... 41, 203 Coordination........................ 17, 199, 203, 228 Cornea ......................................................... 50 Corneal Opacity .......................................... 50 Corneum...................... 80, 101, 203, 209, 218 Coronary...................................... 16, 203, 227 Coronary Thrombosis........................ 203, 227 Corpus ....................................... 204, 237, 249 Corpus Luteum.................................. 204, 237 Cortex........................................ 204, 231, 241 Cortical...................................... 204, 244, 249 Corticosteroids .......................... 135, 204, 213 Cortisol.............................................. 139, 204 Cranial............................... 199, 204, 215, 231 Craniocerebral Trauma..... 195, 204, 215, 217, 249 Cryotherapy....................................... 136, 204 Curative..................................... 204, 243, 249 Cutaneous.................................................... 48 Cyanide ............................................. 204, 226 Cyclic .......................... 33, 204, 215, 230, 236 Cyproterone............................. 33, 43, 49, 204 Cyproterone Acetate................ 33, 43, 49, 204 Cyst ........................... 101, 103, 186, 204, 232 Cysteine..................... 199, 204, 205, 209, 248 Cysteine Endopeptidases................... 204, 209 Cytokine .............................. 30, 115, 204, 249 Cytoplasm ................. 193, 195, 204, 209, 227 Cytosine .................................... 204, 236, 240

Index 259

Cytotoxic ........................... 204, 219, 240, 245 D Dairy Products ................................... 204, 238 Databases, Bibliographic ................... 155, 205 Decubitus........................................... 205, 245 Decubitus Ulcer ................................. 205, 245 Defense Mechanisms ........................... 14, 205 Defensins ............................. 12, 190, 195, 205 Degenerative.............................. 205, 216, 225 Dehydroepiandrosterone........ 67, 68, 149, 205 Deletion ............................................. 193, 205 Dementia.................................................... 205 Dendrites............................................ 205, 229 Dendritic .................................... 205, 226, 246 Density 72, 114, 116, 126, 193, 199, 205, 224, 231 Dental Caries ............................................. 205 Dental Plaque....................................... 79, 205 Dermal ........... 6, 8, 38, 61, 102, 115, 205, 223 Dermatitis . 5, 40, 61, 102, 107, 135, 136, 137, 138, 142, 162, 205, 206, 207, 244 Dermatitis, Contact............................ 137, 205 Dermatitis, Seborrheic ....................... 102, 206 Dermatologist ........................ 8, 121, 133, 206 Dermatosis................................. 137, 139, 206 Dermis . 6, 13, 91, 92, 121, 124, 206, 248, 251 Desensitization .................................. 206, 219 Desogestrel .................................................. 49 Desquamation .... 4, 5, 8, 9, 108, 125, 206, 222 Detergents.......................................... 206, 245 Deuterium .............................. 22, 24, 206, 217 Diabetes Mellitus................. 23, 206, 213, 215 Diagnostic procedure................... 75, 148, 206 Diarrhea ......................... 77, 89, 167, 190, 206 Diarrhoea ........................................... 206, 218 Diastolic............................................. 206, 218 Diencephalon ............................. 206, 218, 249 Dietary Fats ....................................... 206, 224 Diffusion.................................... 206, 207, 230 Digestion.............. 79, 190, 197, 206, 224, 247 Digestive system.......................... 73, 206, 228 Dihydrotestosterone...... 13, 95, 114, 189, 204, 206, 241 Dilatation ........................................... 206, 237 Dilate ..................................... 90, 91, 135, 207 Dilation .............................. 101, 197, 207, 217 Dilution................................................ 24, 207 Discrete.............................................. 207, 223 Disease Vectors ................................. 207, 220 Distal ................................. 207, 208, 233, 239 Diuretic ...................................... 207, 222, 237 Dizziness...................................... 89, 207, 253 Dorsal ................................................ 207, 236 Double-blind................ 24, 26, 27, 39, 59, 207 Doxycycline..................... 6, 8, 34, 37, 71, 207 Drive ..........ii, vii, 47, 112, 138, 139, 207, 223

Drug Interactions............................... 176, 207 Dry Eye Syndrome .............................. 20, 207 Duct...... 12, 84, 103, 106, 122, 124, 207, 210, 225, 232, 243, 248 Duodenum................. 195, 200, 207, 232, 247 Dysmenorrhea ..................................... 18, 207 Dysplasia........................................... 159, 207 Dyspnea..................................................... 207 Dystrophic ......................................... 207, 209 Dystrophy.......................................... 158, 207 E Ectopic .............................................. 139, 207 Eczema 96, 125, 126, 131, 133, 138, 141, 169, 207 Edema.................. 62, 137, 203, 207, 228, 232 Effector...................................... 189, 202, 208 Efficacy 10, 11, 13, 14, 18, 26, 27, 32, 34, 38, 41, 42, 45, 49, 50, 59, 71, 77, 89, 94, 107, 108, 112, 124, 125, 208 Effusion............................................. 208, 248 Eicosanoids ....................................... 126, 208 Elastic................................................ 208, 248 Elasticity...................................... 93, 193, 208 Elastin................................................ 201, 208 Elective.......................................... 42, 43, 208 Electrode ................................... 191, 198, 208 Electrolysis................................ 191, 198, 208 Electrons.... 192, 195, 198, 208, 221, 232, 240 Embryo...................................... 199, 208, 220 Emodin .............................................. 190, 208 Emollient................. 77, 86, 94, 208, 214, 231 Emulsion ............................... 76, 79, 208, 211 Enamel ...................................... 205, 208, 222 Encapsulated ..................................... 208, 224 Endogenous ............. 12, 23, 76, 207, 208, 251 Endometrial ........................... 18, 23, 208, 209 Endometriosis...................... 18, 209, 223, 230 Endometrium............................. 208, 209, 226 Endopeptidases.... 79, 194, 204, 209, 226, 244 Endothelium ...................................... 209, 230 Endothelium-derived......................... 209, 230 Endotoxic .......................................... 209, 224 Endotoxins ........................................ 202, 209 End-stage renal.......................... 200, 209, 236 Enhancer............................................ 209, 241 Enteropeptidase ................................. 209, 252 Environmental Exposure ..... 97, 120, 209, 231 Environmental Health ............... 154, 156, 209 Enzymatic.......... 191, 197, 202, 205, 209, 242 Epidemiological .................................. 25, 209 Epidermal .......................... 209, 222, 223, 226 Epidermis 13, 87, 98, 107, 189, 195, 196, 203, 206, 209, 216, 218, 222, 223, 233, 237, 239, 240 Epidermolysis Bullosa ........................ 72, 209 Epinephrine ............................... 209, 230, 252

260 Acne

Epithelial........ 9, 189, 195, 206, 210, 216, 232 Epithelium .... 5, 106, 108, 114, 121, 125, 203, 209, 210, 222 Erythema. 82, 84, 99, 105, 107, 138, 185, 203, 206, 210, 248, 252 Erythrocytes............... 191, 196, 210, 241, 244 Erythromycin ...... 5, 6, 7, 8, 9, 10, 25, 31, 102, 109, 111, 135, 174, 210 Esophagus.......................... 206, 210, 234, 247 Essential Tremor................................ 158, 210 Estradiol............................................... 24, 210 Estrogen..................... 8, 23, 33, 201, 204, 210 Estrogen receptor............................... 201, 210 Ethinyl Estradiol ................ 12, 18, 31, 34, 210 Etretinate............................................ 138, 210 Excipient.............................................. 86, 210 Exfoliation ........................... 88, 105, 206, 210 Exhibitionism .................................... 139, 210 Exocrine....................................... 20, 210, 232 Exogenous ........... 12, 118, 196, 207, 208, 210 Expectorant........................................ 210, 237 External-beam radiation .... 210, 221, 240, 254 Extracellular .............. 114, 195, 203, 210, 246 Eye Infections .................................... 189, 210 F Facial ........................................................... 49 Family Planning................................. 155, 211 Fat... 6, 24, 124, 138, 193, 196, 205, 211, 224, 228, 242, 244, 246, 248, 250, 251 Fatigue ................................................. 77, 211 Fatty acids ...... 38, 56, 92, 101, 111, 114, 208, 211, 224, 238, 246, 250 Fetus ............................ 95, 167, 211, 235, 253 Fibrosis ................ 79, 159, 211, 216, 243, 244 Finasteride ..................................... 95, 96, 211 Fistula .................................................. 46, 211 Fixation.............................................. 211, 244 Flatus ................................................. 211, 212 Flexor................................................. 211, 223 Fluorescence ................................ 84, 116, 211 Flutamide..................................................... 50 Folate ............................................. 54, 55, 211 Fold........................................ 22, 80, 122, 211 Folic Acid .............................. 54, 97, 120, 211 Folklore................................................ 58, 211 Folliculitis........................ 5, 46, 102, 189, 212 Foramen............................................. 200, 212 Forearm.............................................. 196, 212 Formulary ............................................ 17, 212 Fossa .................................................. 199, 212 Free Radicals ............................. 126, 192, 212 Friction ................................................ 10, 212 Fungi.. 101, 192, 210, 212, 215, 222, 227, 254 Fungus ............................................... 212, 228 G Gallbladder ................................ 189, 206, 212

Ganglia .............................. 189, 195, 212, 229 Gas .............. 89, 206, 211, 212, 217, 228, 230 Gastric ....................................... 118, 198, 212 Gastrin............................................... 212, 216 Gastrointestinal .... 7, 197, 200, 210, 212, 223, 225, 247 Gels .... 5, 14, 76, 94, 103, 104, 116, 119, 166, 212 Gene ... 15, 19, 22, 42, 72, 100, 111, 133, 159, 160, 189, 196, 212, 221, 231, 241, 251 Gene Expression..... 19, 22, 42, 100, 159, 212, 251 Gene Therapy ............................ 111, 189, 212 Genetic transcription ................. 213, 238, 251 Genetics................................. 28, 44, 111, 213 Genital................................... 21, 24, 200, 213 Genotype ............................................. 16, 213 Germ Cells ................................ 213, 232, 249 Gestation ..................................... 23, 213, 235 Giardiasis .......................................... 213, 226 Gingivitis........................................... 205, 213 Glucocorticoid..................................... 19, 213 Glucose ...... 23, 158, 194, 200, 206, 213, 215, 220, 243 Glucose Intolerance........................... 206, 213 Glucose tolerance ................................ 23, 213 Glucose Tolerance Test....................... 23, 213 Glutamic Acid ................... 211, 213, 230, 238 Glutathione Peroxidase ..................... 214, 244 Glycerol..................................... 114, 214, 234 Glycine .............................. 191, 214, 230, 244 Glycols ................................ 94, 116, 119, 214 Glycoprotein...................................... 214, 252 Gonad ........................................................ 214 Gonadal ....................................... 16, 214, 247 Gonadotropin .............................. 16, 136, 214 Governing Board............................... 214, 237 Grade..................................... 8, 107, 149, 214 Grading.................................................. 4, 214 Graft ...................................... 6, 167, 214, 216 Grafting ............................................. 214, 219 Gram-negative..................... 46, 199, 209, 214 Gram-positive...... 95, 114, 199, 214, 238, 247 Granulocyte ................................. 61, 201, 214 Granulocyte Colony-Stimulating Factor .... 61, 201, 214 Grasses .............................................. 211, 214 Gravis ................................................ 215, 229 Groin ................................................. 215, 216 Growth factors........................................... 215 Guanylate Cyclase............................. 215, 230 H Hair follicles...... 5, 13, 72, 86, 90, 91, 95, 98, 101, 117, 119, 122, 123, 135, 206, 212, 215, 254 Headache..................... 89, 167, 215, 217, 220

Index 261

Headache Disorders................................... 215 Hematocrit ................................... 24, 196, 215 Hematopoietic growth factors............ 149, 215 Heme ......................... 191, 215, 228, 236, 252 Hemoglobin ............... 191, 196, 210, 215, 236 Hemoglobin A ................................... 215, 236 Hemoglobinopathies .......................... 213, 215 Hemoglobinuria ................................. 158, 215 Hemorrhage ....................... 204, 215, 239, 247 Hemorrhoids ........................................ 79, 216 Hepatic....................................... 213, 216, 236 Hepatitis............................................. 149, 216 Hepatocytes ............................................... 216 Hereditary .......................................... 216, 242 Heredity ............... 97, 120, 165, 212, 213, 216 Herpes.......................................... 79, 107, 216 Herpes Zoster............................................. 216 Heterodimers ................................. 19, 22, 216 Heterotrophic..................................... 212, 216 Hidradenitis ........................... 46, 48, 163, 216 Hidradenitis Suppurativa ............... 46, 48, 216 Hirsutism ...... 15, 18, 21, 23, 27, 95, 123, 131, 138, 204, 216, 218 Histology ................................. 3, 18, 106, 216 Homologous ...................... 213, 216, 244, 248 Hormonal.. 4, 7, 10, 12, 16, 21, 29, 46, 49, 50, 90, 91, 95, 96, 97, 111, 120, 139, 164, 216, 254 Hormonal therapy .............. 21, 46, 49, 50, 216 Hormone therapy ......................... 10, 134, 216 Horny layer .................. 76, 103, 209, 216, 222 Host 14, 95, 202, 205, 207, 216, 219, 223, 253 Humoral................................................. 4, 216 Humour.............................................. 216, 217 Hunger ....................................................... 207 Hyaluronidase.................................... 110, 217 Hydralazine........................................ 148, 217 Hydration........................................... 107, 217 Hydroalcoholic .................................... 96, 217 Hydrocephalus ................................... 217, 222 Hydrogel ............................................ 101, 217 Hydrogen 22, 34, 36, 189, 195, 198, 206, 214, 217, 224, 227, 230, 232, 239 Hydrogen Peroxide ........ 34, 36, 214, 217, 224 Hydrolases ......................................... 209, 217 Hydrolysis.. 194, 196, 217, 234, 236, 239, 252 Hydrophilic.......................... 86, 101, 206, 217 Hydrophobic ........................ 76, 206, 217, 224 Hydroxy Acids............. 8, 11, 87, 96, 124, 217 Hydroxylysine ................................... 201, 217 Hydroxyproline.......................... 191, 201, 217 Hygienic ...................................... 65, 217, 245 Hyperandrogenism................. 15, 23, 136, 218 Hyperkeratosis ....................... 7, 101, 139, 218 Hyperostosis ........................................ 32, 218 Hyperpigmentation .................... 4, 8, 200, 218

Hyperplasia ......................... 32, 139, 218, 223 Hypersensitivity ..... 106, 190, 197, 206, 218, 223, 242, 244 Hyperstimulation................................. 95, 218 Hypertension ............... 23, 193, 215, 217, 218 Hypertrichosis ........................... 139, 216, 218 Hypertrophy .............................. 195, 218, 242 Hypervitaminosis ................................ 58, 218 Hypnotic.................................... 194, 218, 249 Hypothalamus ................... 117, 206, 218, 249 Hypoxic............................................. 218, 227 I Ichthyosis ...................................... 72, 96, 218 Id …. 53, 63, 98, 163, 168, 170, 182, 184, 218 Idiopathic .................. 137, 149, 216, 218, 243 Illusion .............................................. 218, 253 Imidazole........................................... 196, 218 Immune response ..... 110, 192, 194, 219, 244, 247, 253, 254 Immune system .... 12, 14, 126, 219, 223, 225, 228, 253, 254 Immunization .................................... 219, 244 Immunodeficiency..................... 158, 219, 250 Immunogenic .................................... 219, 224 Immunologic ............... 14, 199, 219, 240, 250 Immunosuppression .................. 118, 219, 225 Immunosuppressive........................... 213, 219 Immunosuppressive Agents ...................... 219 Impaction ...................................... 83, 84, 219 Impairment ........................ 194, 211, 219, 226 Implant radiation ............... 219, 221, 240, 254 Implantation .................................. 6, 203, 219 Impotence.......................................... 139, 219 In situ .................................................. 21, 219 In vitro....... 14, 28, 36, 38, 126, 198, 213, 219 In vivo ..... 16, 20, 32, 126, 213, 219, 225, 250 Incidental....................................... 42, 62, 219 Indicative................................... 219, 233, 253 Indolent ................................................. 8, 219 Induction .... 23, 25, 115, 191, 219, 232, 240, 253 Infancy ................................ 28, 136, 220, 243 Infantile ....................................... 25, 123, 220 Infarction........................... 204, 217, 220, 227 Infertility ......................... 16, 23, 64, 220, 232 Influenza............................................ 149, 220 Ingestion................ 90, 91, 213, 218, 220, 236 Initiation ................ 28, 36, 126, 220, 238, 251 Insecticides.......................................... 20, 220 Insight ................................................. 14, 220 Insulator ............................................ 220, 228 Insulin ......... 16, 19, 23, 24, 65, 213, 220, 243 Insulin-dependent diabetes mellitus .......... 220 Insulin-like .......................................... 23, 220 Interferon........................................... 149, 220 Interferon-alpha......................................... 220

262 Acne

Interleukin-1 ........................................ 16, 221 Interleukin-10 ...................................... 16, 221 Interleukin-2 .............................................. 221 Intermittent ........................ 138, 207, 221, 236 Internal radiation........................ 221, 240, 254 Interstitial................................... 197, 221, 254 Intestinal ..... 89, 190, 209, 213, 221, 225, 238, 254 Intestines.................................... 189, 212, 221 Intracellular. 78, 110, 220, 221, 230, 237, 244, 245 Intravascular ...................................... 221, 232 Intravenous ................................ 221, 222, 233 Intrinsic.................................... 6, 93, 190, 221 Involuntary ................ 195, 210, 221, 228, 246 Iodides ............................................... 137, 221 Iodine................................................... 55, 221 Ionizing...................................... 209, 221, 240 Ions ............................................ 195, 217, 221 Irradiation .................... 99, 116, 138, 221, 254 Irritants .............................................. 137, 221 Ischemia..................................... 126, 205, 222 Isoenzymes .......................................... 21, 222 Isosorbide .......................................... 103, 222 IV................................. 17, 155, 197, 221, 222 J Joint ................................... 200, 211, 222, 248 K Kb ...................................................... 154, 222 Keratin ...... 80, 91, 92, 98, 101, 103, 122, 202, 222, 244 Keratinocytes ............................... 84, 119, 222 Keratolytic ...... 78, 84, 96, 103, 110, 111, 112, 113, 205, 222 Keratolytic Agents............. 103, 112, 113, 222 Keratosis ...................... 72, 116, 136, 189, 222 Keratosis Follicularis ........... 72, 136, 189, 222 Kidney Disease .................... 73, 154, 159, 222 Kinetic ......................................... 22, 221, 222 L Labile................................................. 202, 222 Lacrimal............................................... 20, 222 Lacrimal gland..................................... 20, 222 Lactation ................................................ 7, 222 Large Intestine ........... 206, 221, 222, 241, 246 Larynx ............................................... 223, 254 Laser therapy ................. 6, 118, 146, 167, 223 Leisure Activities................................... 7, 223 Lens ........................................... 223, 241, 254 Lesion ... 8, 11, 36, 78, 92, 106, 108, 110, 115, 121, 122, 125, 145, 165, 186, 223, 243, 244, 245 Lethal................................. 194, 204, 223, 228 Leukemia ............................. 15, 158, 223, 238 Leukocytes.. 14, 195, 196, 199, 220, 223, 227, 252

Leukotrienes.............................. 193, 208, 223 Levonorgestrel............................. 34, 223, 230 Libido ........................................ 139, 191, 223 Library Services ................................ 182, 223 Lichen Planus ............................ 138, 210, 223 Life cycle........................................... 212, 223 Ligament ........................................... 223, 238 Ligands.......................................... 19, 22, 223 Lincomycin ................................. 80, 201, 223 Linkage................................................ 17, 224 Lip ..................................................... 137, 224 Lipase ................ 36, 60, 62, 92, 110, 114, 224 Lipid ..... 19, 21, 22, 118, 122, 126, 192, 193, 214, 220, 224, 228, 232, 251 Lipid A ................................................ 21, 224 Lipid Peroxidation............................. 224, 232 Lipophilic ............................................ 14, 224 Lipopolysaccharide ................... 194, 214, 224 Lipoprotein.......................... 24, 193, 214, 224 Liposomal............................................ 13, 224 Liposome............................................. 13, 224 Lipoxygenase ...................... 26, 193, 223, 224 Liver scan .......................................... 224, 243 Lobe .......................................................... 224 Lobule ............................................... 106, 224 Localized .. 136, 205, 208, 211, 216, 218, 220, 223, 224, 231, 235, 252 Low-density lipoprotein ............................ 224 Lumen ................................. 84, 108, 125, 224 Lupus............................. 65, 79, 138, 148, 224 Luteal Phase ........................................ 10, 225 Lymecycline.......................... 37, 45, 145, 225 Lymph ....................... 209, 217, 225, 228, 243 Lymph node .............................. 225, 228, 243 Lymphocyte ...................... 192, 219, 225, 226 Lymphocyte Depletion...................... 219, 225 Lymphoid .................................. 204, 225, 250 Lymphoma ................................ 158, 225, 228 Lysine.......................... 88, 217, 225, 237, 252 M Macula....................................................... 225 Macula Lutea............................................. 225 Macular Degeneration ......................... 45, 225 Magnetic Resonance Imaging ........... 225, 243 Malabsorption ................................... 158, 225 Malaise ................................................ 89, 225 Malignant ... 35, 138, 158, 193, 225, 228, 229, 240 Malnutrition ...................................... 225, 228 Mandible ........................................... 200, 225 Mastitis.............................................. 196, 225 Mediate................................................ 22, 225 Mediator ...................................... 95, 114, 225 MEDLINE......................... 155, 157, 159, 226 Megaloblastic .................................... 211, 226 Mel ............................................................ 187

Index 263

Melanin.............................. 106, 226, 234, 252 Melanocytes....................................... 218, 226 Melanoma .................. 138, 158, 169, 226, 252 Memory ............................... 24, 118, 205, 226 Meninges ................................... 199, 204, 226 Menopause..................................... 10, 65, 226 Menstrual Cycle............. 10, 12, 225, 226, 238 Menstruation. 15, 65, 191, 207, 225, 226, 231, 237 Mentalv, 11, 73, 154, 156, 160, 199, 200, 205, 226, 239 Mental Disorders ......................... 73, 226, 239 Meta-Analysis................................ 17, 51, 226 Metabolite............ 20, 100, 196, 226, 234, 237 Metalloendopeptidases ...................... 209, 226 Metamorphosis .......................................... 226 Methionine......................................... 226, 248 Methoprene.......................................... 20, 226 Methylene Blue ......................... 112, 113, 226 Metronidazole.......................... 5, 51, 177, 226 MI ................................ 28, 109, 115, 187, 227 Microbe........................................ 14, 227, 251 Microbiological ................................... 26, 227 Microbiology ......................... 35, 59, 195, 227 Microorganism .......................... 201, 227, 254 Microsurgery ..................................... 223, 227 Migration ............................................. 15, 227 Minocycline 8, 34, 37, 38, 41, 50, 68, 89, 149, 227 Mitochondrial Swelling ..................... 227, 229 Mitosis ............................................... 193, 227 Modification .............................. 191, 227, 240 Modulator .................................... 23, 100, 227 Molecular...... 16, 17, 21, 79, 81, 96, 101, 110, 126, 155, 157, 191, 195, 196, 203, 214, 227, 251, 252 Molecule ... 126, 192, 195, 201, 202, 208, 209, 215, 217, 227, 232, 235, 240, 245, 253 Monitor ........................................ 18, 227, 230 Monoclonal........................ 221, 227, 240, 254 Monocytes ................... 41, 221, 223, 227, 249 Mononuclear...................................... 227, 252 Monotherapy.......................................... 7, 227 Morphogenesis .......................... 130, 134, 228 Morphological ... 115, 190, 208, 212, 226, 228 Morphology ....................................... 138, 228 Motion Sickness ................................ 228, 229 Mucins ............................................... 205, 228 Mucosa .............................................. 224, 228 Mucositis ........................................... 228, 250 Multiple sclerosis................................. 79, 228 Muscle Fibers ............................................ 228 Muscle relaxant ................................. 228, 229 Muscular Atrophy.............................. 158, 228 Muscular Dystrophies........................ 207, 228 Mustard Gas....................................... 221, 228

Myalgia ............................................. 220, 228 Myasthenia ........................................ 228, 229 Mycosis ............................................. 138, 228 Mycosis Fungoides............................ 138, 228 Mydriatic........................................... 207, 228 Myelin ....................................................... 228 Myocardium ...................................... 227, 228 Myoglobin ......................................... 228, 236 Myopathy .......................................... 148, 228 Myositis............................................. 148, 229 Myotonic Dystrophy ......................... 158, 229 N Nasal Mucosa .................................... 220, 229 Nausea......................................... 89, 167, 229 NCI............................ 1, 72, 73, 153, 201, 229 Necrosis..... 139, 149, 193, 220, 227, 229, 243 Need . 3, 5, 13, 30, 93, 95, 119, 131, 135, 148, 149, 167, 171, 177, 200, 229, 250 Neonatal .................................... 123, 137, 229 Neoplasia................................... 158, 210, 229 Neoplasms ......... 217, 229, 234, 240, 249, 251 Neoplastic.......................................... 225, 229 Neostigmine .............................. 103, 104, 229 Nephropathy...................................... 222, 229 Nerve 194, 200, 205, 225, 228, 229, 231, 233, 237, 242, 244, 247, 251 Nervous System 158, 199, 225, 229, 230, 247 Neural................................................ 217, 229 Neurologic......................................... 217, 229 Neurologic Manifestations ........................ 229 Neurons ............. 118, 205, 212, 228, 229, 248 Neuropathy........................................ 229, 233 Neurotoxic........................................... 20, 229 Neurotransmitter ..... 189, 191, 197, 213, 214, 229, 245, 247 Neutrons .................................... 221, 230, 240 Neutrophil ........................... 60, 106, 115, 230 Neutrophil Infiltration ....................... 115, 230 Niacinamide ................................ 88, 105, 230 Nimodipine................................................ 230 Nitric Oxide......................................... 45, 230 Nitrogen ............................ 191, 211, 230, 252 Norethindrone ............................... 12, 18, 230 Norgestrel.......................................... 223, 230 Nuclear ................ 22, 195, 208, 229, 230, 240 Nuclei ........ 208, 213, 225, 227, 230, 231, 239 Nucleus...... 21, 100, 193, 195, 200, 204, 206, 227, 230, 239, 249 O Occult .................................................... 4, 230 Occupational Groups................................. 230 Ocular.................................... 34, 44, 189, 231 Ointments .................. 126, 231, 245, 246, 255 Oligo ................................................... 15, 231 Oligomenorrhea........................... 50, 231, 236 Oncogene .................................... 22, 158, 231

264 Acne

Opacity .............................................. 205, 231 Operon ............................... 110, 231, 238, 241 Ophthalmic ................................ 174, 231, 236 Ophthalmology ...................... 41, 44, 211, 231 Opsin ................................................. 231, 242 Optic Chiasm ..................................... 218, 231 Optic Nerve ....................................... 231, 242 Organelles.................. 199, 204, 226, 227, 231 Osmosis ..................................................... 231 Osmotic.............................. 101, 222, 227, 231 Osteomyelitis ................................. 32, 43, 231 Outpatient ................................ 17, 50, 52, 231 Ovarian Follicle ........................... 18, 204, 232 Ovarian Hyperstimulation Syndrome .. 23, 232 Ovaries....................... 218, 232, 236, 241, 245 Ovary ................................. 204, 210, 214, 232 Ovulation . 12, 16, 23, 192, 201, 225, 230, 232 Ovulation Induction............................. 23, 232 Ovum ......................... 204, 213, 223, 232, 237 Oxidation .... 99, 189, 192, 193, 196, 214, 224, 232 Oxidative Stress................................. 126, 232 P Palladium........................................... 123, 232 Palliative .................................... 204, 232, 249 Pancreas.... 189, 196, 200, 206, 220, 224, 232, 252 Pancreatic .......................... 158, 198, 200, 232 Pancreatic cancer ............................... 158, 232 Pancreatic Juice ................................. 200, 232 Papillary............................................. 218, 232 Papilloma........................................... 203, 232 Papule ........................................ 103, 106, 232 Parasite .............................................. 232, 251 Parasitic ............................................... 79, 232 Parenteral............................................. 23, 233 Paroxysmal ................................ 158, 215, 233 Partial remission ................................ 233, 241 Particle....................................... 224, 233, 251 Patch ..... 76, 84, 86, 101, 111, 137, 138, 233, 251 Pathogenesis .............................................. 141 Pathologic .................. 193, 195, 203, 218, 233 Pathologic Processes.......................... 193, 233 Pathologies ........................................ 126, 233 Pathophysiology ................ 5, 6, 8, 9, 122, 233 Patient Compliance.............................. 35, 233 Patient Education....... 164, 180, 182, 187, 233 Patient Satisfaction .................. 18, 36, 40, 233 Pelvic ................................... 24, 209, 233, 238 Pelvis ................................. 189, 232, 233, 253 Pemphigus ................................. 138, 189, 233 Peptide ...... 191, 209, 217, 222, 233, 236, 237, 238, 239 Perception ............................................ 36, 233 Perianal .............................................. 203, 233

Perioral.................. 5, 102, 135, 137, 142, 233 Peripheral Neuropathy .............................. 233 Peritoneum ........................................ 233, 242 Pernicious.................................... 20, 226, 233 Persons ................ 93, 106, 124, 139, 195, 234 Petrolatum ......................................... 208, 234 Pharmacists ................................. 17, 167, 234 Pharmacodynamic ............................... 12, 234 Pharmacokinetic............................ 12, 52, 234 Pharmacologic............................. 19, 234, 251 Pharynx ............................................. 220, 234 Phenolphthalein................................. 208, 234 Phenyl ............................................... 234, 243 Phenylalanine .................................... 234, 252 Phospholipases .................................. 234, 245 Phospholipids ............................ 211, 224, 234 Phosphorus ........................................ 197, 234 Phosphorylated.................................. 201, 234 Phosphorylation................................. 234, 239 Photoallergy .............................................. 234 Photochemotherapy........................... 138, 234 Photodynamic therapy ...... 27, 112, 113, 121, 223, 234 Photosensitivity ............................. 7, 234, 236 Photosensitizing Agents ............................ 234 Phototherapy ............... 28, 112, 113, 116, 235 Physical Examination.......................... 72, 235 Physiologic................ 190, 195, 226, 235, 240 Physiology............................... 21, 30, 86, 235 Physostigmine ................................... 229, 235 Pigment ............... 76, 187, 226, 228, 231, 235 Pigmentation ............................... 93, 218, 235 Pilot study ........................................... 26, 235 Pitch .................................................... 24, 235 Placenta ..................................... 210, 235, 237 Plant Oils........................................... 231, 235 Plants...... 198, 201, 205, 208, 213, 228, 235, 243, 251 Plaque................................................ 194, 235 Plasma ..... 24, 139, 193, 200, 201, 213, 215, 235, 241, 244 Plasmid...................................... 110, 235, 253 Platelet Activation............................. 235, 245 Platelet Aggregation.. 126, 191, 230, 235, 250 Platelets ..................... 126, 193, 230, 235, 250 Platinum .................................... 123, 232, 235 Pneumonia................................... 17, 203, 236 Poisoning................................... 226, 229, 236 Pole ................................... 190, 191, 198, 225 Poly C.................................................. 87, 236 Polycystic ...................... 23, 27, 159, 218, 236 Polycystic Ovary Syndrome.. 23, 27, 218, 236 Polymerase ................................ 236, 238, 241 Polymers.................................... 195, 236, 239 Polymorphic .................................. 8, 137, 236

Index 265

Polypeptide ..... 191, 201, 228, 236, 237, 250, 255 Polyvinyl Alcohol................................ 86, 236 Porokeratosis ..................................... 138, 236 Porphyria Cutanea Tarda ................... 139, 236 Porphyria, Hepatic ..................................... 236 Porphyrins.............................. 20, 35, 116, 236 Posterior.... 139, 191, 194, 199, 200, 207, 232, 236 Postoperative ......................... 6, 138, 139, 236 Postsynaptic ............................... 237, 245, 248 Potassium..................................... 99, 237, 246 Potassium Citrate................................. 99, 237 Potentiates.......................................... 221, 237 Potentiation........................................ 237, 245 Practice Guidelines .................... 156, 168, 237 Precancerous........................................ 22, 237 Precursor... 193, 208, 209, 214, 234, 237, 252, 254 Premalignant.............................................. 237 Premenstrual ................ 95, 102, 117, 119, 237 Prevalence...................... 10, 44, 117, 132, 237 Prickle........................................ 189, 222, 237 Probe.................................................... 22, 237 Procainamide ..................................... 148, 237 Procaine ..................................................... 237 Procollagen ........................................ 115, 237 Prodrug .............................................. 100, 237 Progesterone .......... 10, 23, 223, 230, 237, 247 Progression ............................ 9, 126, 191, 238 Progressive ..... 119, 193, 199, 200, 205, 215, 222, 228, 229, 235, 236, 238 Projection........................... 205, 231, 238, 241 Proline ............................... 201, 217, 237, 238 Promoter ............................................ 100, 238 Promotor ...................................... 79, 238, 241 Promyelocytic leukemia .................... 238, 251 Prone................................................ 7, 32, 238 Prophylaxis ................................ 210, 238, 253 Proportional ....................................... 114, 238 Prostaglandins............................ 193, 208, 238 Prostate ............ 13, 21, 95, 158, 195, 238, 241 Prostate gland ...................................... 21, 238 Prostatic Hyperplasia ........................... 96, 238 Prosthesis................................................... 238 Protease................................ 22, 120, 202, 238 Protein C............ 191, 192, 194, 222, 224, 238 Protein S ...... 20, 133, 159, 196, 210, 238, 249 Protein-Tyrosine Kinase .................... 126, 239 Proteolytic.................................. 202, 209, 239 Protons....................................... 217, 221, 239 Protozoa............................................. 227, 239 Proximal .................................... 138, 207, 239 Pruritic ....................... 137, 207, 223, 239, 243 Pruritus .......................................... 9, 139, 239 Psoriasis....................................................... 52

Psychiatric ................................. 139, 226, 239 Psychiatry.................. 29, 43, 48, 51, 211, 239 Psychic .............................. 223, 226, 239, 244 Puberty ... 76, 80, 98, 101, 108, 109, 124, 136, 165, 239, 250 Public Policy ..................................... 155, 239 Publishing............................................ 24, 239 Pulmonary ................. 196, 223, 239, 248, 253 Pulmonary Artery...................... 196, 239, 253 Pulse .......................................... 116, 227, 239 Pupil .......................................... 207, 228, 239 Purines............................................... 239, 244 Purpura .............................................. 139, 239 Purulent ..................................... 101, 189, 240 Pustular.................... 4, 89, 106, 112, 124, 240 Pyoderma .................................................... 48 Pyogenic............................ 158, 189, 231, 240 Pyrimidines ....................................... 240, 244 Q Quality of Life................. 41, 42, 51, 107, 240 Quaternary........................................... 22, 240 Quiescent........................................... 199, 240 R Race........................... 132, 223, 227, 230, 240 Racemic..................................... 223, 230, 240 Radiation therapy .............. 210, 221, 240, 254 Radioactive196, 217, 219, 221, 224, 230, 240, 243, 254 Radioactivity ............................................. 240 Radiolabeled.............................. 221, 240, 254 Radiotherapy ..................... 197, 221, 240, 254 Randomized ..... 18, 23, 24, 26, 27, 34, 39, 45, 208, 240 Reactive Oxygen Species .................... 31, 240 Receptor ... 14, 15, 19, 20, 21, 23, 30, 95, 100, 192, 204, 240, 245 Recombinant ............................. 149, 240, 253 Recombination .................................. 213, 240 Reconstitution ..................................... 28, 241 Rectum ..... 192, 197, 201, 206, 211, 212, 222, 238, 241 Recurrence ........................................ 118, 241 Red blood cells.................. 210, 236, 241, 243 Red Nucleus ...................................... 194, 241 Reductase .......... 13, 21, 93, 95, 114, 211, 241 Redux .................................................. 33, 241 Refer..... 1, 116, 197, 200, 202, 207, 211, 212, 216, 225, 230, 241, 251, 253 Refraction.......................................... 241, 246 Regeneration ............................................. 241 Regimen ... 4, 5, 7, 18, 78, 110, 114, 117, 208, 233, 241 Remission.................................... 38, 138, 241 Repressor........................................... 231, 241 Reproductive system ......................... 238, 241 Resolving .................................... 97, 120, 241

266 Acne

Respiration................................. 192, 227, 241 Response Elements ............................ 100, 241 Restoration................................. 241, 250, 254 Retina.. 20, 200, 223, 225, 231, 241, 242, 243, 254 Retinal ............................................... 231, 242 Retinaldehyde ............................ 123, 231, 242 Retinoblastoma .................................. 158, 242 Retinoid ...... 4, 7, 9, 19, 20, 22, 44, 48, 49, 50, 100, 105, 115, 120, 121, 124, 145, 210, 242 Retinol ................................. 55, 100, 123, 242 Retroperitoneal .......................... 139, 190, 242 Retrospective ....................................... 58, 242 Retroviral vector ................................ 212, 242 Rheumatic Diseases ........................... 148, 242 Rheumatism ............................................... 242 Rheumatoid........................................ 149, 242 Rheumatoid arthritis .......................... 149, 242 Rhinophyma ...................................... 189, 242 Rhodopsin.......................................... 231, 242 Riboflavin .............................. 54, 97, 120, 242 Ribose ................................................ 236, 243 Rickets ............................................... 243, 254 Risk factor ....................... 16, 24, 48, 138, 243 Rod ............................................ 194, 238, 243 Rosiglitazone ....................................... 23, 243 S Salicylamides............................................. 243 Salicylanilides...................................... 14, 243 Salicylic .... 5, 7, 9, 34, 36, 76, 77, 78, 82, 87, 88, 94, 96, 105, 110, 123, 124, 175, 243 Salivary.............................. 205, 206, 232, 243 Salivary glands .......................... 205, 206, 243 Saponins ............................................ 243, 247 Sarcoid............................................... 137, 243 Sarcoidosis................................................. 243 Scabies............................................... 138, 243 Scalpel ............................................... 135, 243 Scans.................................................... 24, 243 Scatter ................................................ 243, 252 Scleroproteins .................................... 222, 244 Sclerosis..................... 158, 193, 194, 228, 244 Screening ............................... 12, 30, 201, 244 Seborrhea 43, 95, 99, 103, 112, 113, 114, 115, 244 Seborrhoea........................... 52, 115, 131, 244 Sebum ... 4, 5, 6, 7, 8, 9, 10, 12, 18, 21, 24, 33, 76, 84, 95, 98, 101, 103, 106, 108, 111, 113, 114, 118, 121, 122, 123, 124, 125, 135, 165, 202, 244 Secretion ..... 4, 16, 20, 23, 121, 165, 217, 218, 220, 222, 228, 244, 254 Secretory............................ 114, 190, 244, 248 Seizures...................................... 139, 233, 244 Selenium .................................. 55, 88, 98, 244 Semen ................................................ 238, 244

Semisynthetic .... 199, 201, 210, 225, 227, 244 Senna................................................... 69, 244 Sensitization .......................... 11, 14, 234, 244 Sequela .............................................. 137, 244 Serine ................ 120, 121, 200, 209, 244, 252 Serine Endopeptidases ...................... 209, 244 Serum ..... 18, 23, 24, 43, 149, 191, 193, 202, 214, 224, 225, 241, 244, 252 Sex Characteristics .... 189, 191, 239, 244, 249 Sex Determination............................. 159, 245 Shedding.................................... 119, 206, 245 Shock................................................. 245, 251 Side effect ................................................... 51 Signal Transduction ...................... 20, 22, 245 Signs and Symptoms ................. 229, 241, 245 Silicon ................................................. 86, 245 Silicon Dioxide.......................................... 245 Skeletal...................................... 191, 228, 245 Skeleton....................................... 80, 222, 245 Skin Care............................... 7, 132, 168, 245 Skin Pigmentation ............................. 139, 245 Skull .................................... 72, 204, 245, 249 Sleep apnea ......................................... 24, 246 Small intestine.. 200, 207, 213, 216, 221, 246, 252 Sneezing ............................................ 245, 246 Soaps ........................... 94, 116, 119, 245, 246 Social Environment ........................... 240, 246 Sodium . 5, 9, 24, 78, 88, 90, 91, 96, 103, 107, 246, 248 Sodium Bicarbonate ............................ 78, 246 Soft tissue.................. 167, 196, 238, 245, 246 Solvent ............ 22, 76, 80, 107, 214, 231, 246 Spasmodic ......................................... 189, 246 Spatial disorientation......................... 207, 246 Specialist ................................... 170, 207, 246 Species ..... 17, 109, 111, 123, 194, 207, 209, 227, 232, 240, 246, 247, 252, 254 Spectrum ............. 17, 101, 113, 116, 138, 246 Sperm ........................................ 191, 200, 246 Spike ................................................. 124, 246 Spinal cord ........ 197, 199, 200, 226, 229, 246 Spinous...................................... 209, 222, 246 Sporadic .................................... 236, 242, 246 Squamous .......................................... 106, 247 Squamous Epithelium ....................... 106, 247 Staging .............................................. 243, 247 Staphylococcus........ 10, 59, 62, 202, 227, 247 Steady state ......................................... 12, 247 Sterility.............................................. 220, 247 Steroid . 5, 16, 18, 19, 102, 166, 204, 243, 247 Stimulus ............................ 207, 208, 247, 250 Stomach.... 167, 189, 206, 210, 212, 213, 216, 221, 229, 234, 246, 247 Stool .................................. 201, 219, 222, 247 Streptococcal..................................... 223, 247

Index 267

Stress ..... 44, 58, 96, 97, 117, 120, 126, 143, 165, 186, 198, 204, 229, 232, 242, 247, 252 Stroke................................... 73, 118, 154, 247 Stromal .............................................. 209, 247 Subacute ...................................... 43, 220, 247 Subarachnoid ..................................... 215, 247 Subclinical ........................... 87, 220, 244, 247 Subcutaneous ....................... 93, 207, 233, 247 Subspecies ......................................... 246, 247 Substance P................ 210, 226, 241, 244, 247 Sulfacetamide .................................... 5, 9, 248 Sulfur ......... 5, 7, 103, 124, 135, 175, 226, 248 Sunburn........................................ 65, 248, 252 Sunscreen............................................... 4, 138 Superstitions ...................................... 211, 248 Supplementation .................................. 60, 248 Suppression........................ 7, 18, 32, 166, 248 Suppurative.................................. 89, 216, 248 Supraclavicular .................................. 138, 248 Surfactant............................................. 80, 248 Sweat ......................... 192, 206, 216, 244, 248 Sweat Glands ..................... 192, 206, 244, 248 Symphysis.................................. 200, 238, 248 Synapses ............................................ 246, 248 Synaptic ..................................... 230, 245, 248 Synergistic ................................................... 51 Synovial..................................................... 248 Synovial Membrane................................... 248 Synovitis .............................................. 32, 248 Synthetic retinoid............................... 137, 248 Systemic disease ................................ 218, 249 Systemic therapy............................ 5, 136, 249 T Tear Gases ......................................... 221, 249 Teichoic Acids................................... 214, 249 Telangiectasia .................................... 159, 249 Temporal.................... 140, 149, 215, 225, 249 Temporal Lobe .................................. 140, 249 Teratogen............................................... 7, 249 Teratogenic ...... 15, 20, 85, 210, 222, 249, 251 Teratogenicity................................ 15, 77, 249 Testis ........................................... 21, 210, 249 Testosterone.... 23, 95, 98, 114, 186, 189, 211, 241, 249 Tetracycline .... 6, 7, 17, 31, 61, 62, 69, 88, 89, 102, 105, 119, 134, 137, 207, 225, 227, 249 Thalamic ............................................ 194, 249 Thalamic Diseases ............................. 194, 249 Thalidomide....................................... 138, 249 Therapeutics .............. 16, 17, 27, 40, 176, 249 Thermal........................................ 13, 230, 249 Thermoregulation ................................ 20, 249 Thigh ........................................... 24, 215, 249 Third Ventricle .................................. 218, 249 Thorax ............................................... 189, 250 Threonine........................................... 244, 250

Threshold .................................... 16, 218, 250 Thrombin................................... 235, 238, 250 Thrombocytes.................................... 235, 250 Thrombosis........................ 126, 239, 247, 250 Thromboxanes........................... 193, 208, 250 Thrombus .......................... 203, 220, 235, 250 Thymidine ........................................... 18, 250 Thymosin .................................... 97, 120, 250 Thymus.............................................. 219, 250 Thymus Gland........................................... 250 Thyroid...................................... 221, 250, 252 Tin ............................................. 233, 235, 250 Tolerance........................................... 213, 250 Tone .......................................... 117, 131, 250 Tonus................................................. 250, 251 Topical ................................ 48, 49, 50, 51, 52 Toxic .v, 13, 15, 204, 207, 209, 215, 229, 244, 251 Toxicity ............................. 207, 208, 235, 251 Toxicokinetics ........................................... 251 Toxicology ........................................ 156, 251 Toxin ................................... 15, 209, 250, 251 Trace element .................... 200, 245, 250, 251 Transcription Factors ........................ 241, 251 Transdermal ........................................ 24, 251 Transduction...................................... 245, 251 Transfection .............................. 196, 213, 251 Translation ................................ 191, 210, 251 Translocation..................................... 210, 251 Transmitter ........................ 189, 225, 248, 251 Trauma .......................................... 9, 229, 251 Tretinoin.... 4, 5, 6, 7, 8, 9, 10, 11, 39, 41, 48, 49, 50, 52, 55, 86, 100, 123, 175, 251 Trichloroacetic Acid............................ 35, 251 Trichomoniasis.................................. 226, 251 Triglyceride ....................................... 114, 251 Trophic ................................................ 31, 252 Trypsin ........................ 78, 200, 209, 252, 255 Tryptophan ........................................ 201, 252 Tuberculosis .............................. 224, 243, 252 Tuberous Sclerosis ............................ 159, 252 Tubocurarine ..................................... 229, 252 Tumor Necrosis Factor...................... 249, 252 Tyrosine ............................ 106, 124, 239, 252 U Ultraviolet radiation .............. 9, 234, 248, 252 Unconscious .............................. 205, 218, 252 Urethra ...................................... 195, 238, 252 Urinary ................ 18, 139, 200, 217, 248, 252 Urinary tract ...................................... 248, 252 Urinary tract infection ....................... 248, 252 Urine ......... 195, 196, 201, 207, 215, 242, 252 Uroporphyrinogen Decarboxylase .... 236, 252 Urticaria ............................................ 137, 252 Uterus 204, 208, 209, 226, 232, 237, 241, 253

268 Acne

V Vaccination.......................................... 34, 253 Vaccine .............................. 110, 111, 147, 253 Vagina ....................................... 226, 241, 253 Vascular ...... 5, 200, 206, 209, 215, 220, 230, 232, 235, 250, 252, 253 Vasculitis ........................................... 148, 253 Vasodilator ................................ 197, 217, 253 Vector ........................................ 110, 251, 253 Vein ........................................... 221, 230, 253 Venous............................... 196, 216, 239, 253 Venter ........................................................ 253 Ventral ......................................... 21, 218, 253 Ventricle .................................... 239, 249, 253 Venules ...................................... 196, 197, 253 Vertebrae ........................................... 246, 253 Vertigo................................................. 89, 253 Vesicular.................................... 141, 216, 253 Vestibular ............................................ 89, 253 Vestibule.................................................... 253 Veterinary Medicine .......................... 155, 253 Viral....................... 15, 79, 110, 220, 251, 253 Viral vector .......................................... 15, 253 Virilism.............................................. 218, 253 Virilization........................................... 16, 253 Virus . 196, 199, 209, 220, 221, 235, 242, 251, 253, 254

Viscera .............................................. 228, 254 Viscosity.............................. 83, 109, 217, 254 Vitamin D.................................. 165, 243, 254 Vitreous Body ................................... 242, 254 Vitro .......................................................... 254 Vivo....................................... 13, 21, 225, 254 Vocal cord ........................................... 23, 254 Vulgaris....................... 48, 49, 50, 51, 52, 141 W Wart................................................... 222, 254 Weight Gain ........................................ 13, 254 White blood cell .... 192, 214, 223, 225, 230, 254 Wound............... 138, 139, 205, 233, 251, 254 Wound Healing ................................. 139, 254 X Xenograft .......................................... 191, 254 X-ray22, 59, 72, 198, 203, 211, 221, 230, 240, 243, 254 X-ray therapy .................................... 221, 254 Y Yeasts ........................................ 101, 212, 254 Z Zinc Oxide......................................... 102, 254 Zymogen ................................... 200, 238, 255

Index 269

270 Acne

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