Foreword: Emerging Role of Topical Immunomodulatory Therapies in Dermatology

During the last decade, advancements in the development and application of topical therapies, whether as monotherapy or adjunctive therapy, have provided dermatologists with greater options in the management of cutaneous disease. This special issue of the Journal of Cutaneous Medicine and Surgery provides readers with current and novel strategies for the treatment of several important dermatologic conditions that may present in the clinic. Articles were contributed by leading US experts in the diagnosis and management of dermatoses. These clinicians/researchers have a special interest in the topics they cover in this supplement. The supplement begins with my overview on the mechanism of action of immune response modifiers (IRMs) currently available for the treatment of a variety of common dermatologic conditions. Proinflammatory IRMs include the Toll-like receptor agonist imiquimod 5% cream, which applies a novel mechanism of action and stimulates the body s natural defenses to target diseased tissue. Immunosuppressive IRMs discussed include anti-tumor necrosis factor agents (e.g., infliximab and etanercept) and anti–T-cell agents (e.g., pimecrolimus and tacrolimus). Although IRM activity encompasses several different mechanisms of action, these immunomodulatory agents leverage the body s immune system to effectively treat numerous dermatoses. The next article, by Joseph Jorizzo, highlights a number of topical therapies currently available for the treatment of actinic keratosis. Several topical therapies are available including 5-fluorouracil, diclofenac, photodynamic therapy, and imiquimod 5% cream. The article reviews data on the newer formulation of 5-fluorouracil, 0.5%, and discusses newer treatment strategies using photodynamic therapy (e.g., shorter incubation times and various topical formulations of aminolevulinic acid). This review article also highlights exciting data on imiquimod 5% cream in the treatment of superficial actinic keratosis. With a number of dosing regimens already clinically evaluated, topical therapies such as imiquimod 5% cream will provide the opportunity for healthcare providers to tailor treatment to individual patient needs. The article by Robert Skinner provides a comprehensive overview of topical agents effective in the treatment of a number of conditions. Data are reviewed on the efficacy and safety of imiquimod 5% cream in the treatment of several dermatoses, including condyloma acuminata, basal cell carcinoma, and lentigo maligna. The efficacy and safety of pimecrolimus 1% cream and tacrolimus ointment (0.1% and 0.03%) in the treatment of atopic dermatosis in children and adults are also reviewed. Data suggest that topical immunotherapy will continue to play an important and useful role in managing dermatologic conditions during the next decade. Finally, the article by Brian Berman explores new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Although abnormal scarring represents a difficult and continuing challenge for healthcare providers, published studies suggest that several novel modalities may be effective for scarring. Discussions include the use of laser therapy for the treatment of atrophic scars, and surgical excision, in combination with topical therapies (e.g., imiquimod 5% cream), for the treatment and management of keloids and hypertrophic scars. In summary, it is my hope that you will find this special issue of Journal of Cutaneous Medicine and Surgery to be an important educational resource, providing a state-of-the-art synopsis on several important dermatologic conditions that readers may encounter in their clinical practice.