Section Editor's Message: Dermatologic Perspective on Wounds

In this issue, Federman et al. discuss a fatal case of toxic epidermal necrolysis and review the literature on this difficult-to-manage and often lethal condition. The authors also critically evaluate new therapies, such as intravenous immunoglobulin and immunosuppressant agents. Brown recluse spider bite is the subject of an article by Norden and Phillips. This condition is probably over-diagnosed, and a wide differential diagnosis should be considered before a chronic skin ulcer is attributed to a spider bite. In this patient, the diagnosis of spider bite was unlikely. However, for the rare patient who does indeed have a brown recluse spider bite, early recognition is critical, as there may be life-threatening complications. Hardman and Ashcroft review the current literature on hormones and wound healing. In particular, they focus on the influence of the sex hormones, estrogens and androgens, on the healing of acute wounds. There is compelling data that systemic as well as topical estrogen treatment can accelerate the rate of healing in elderly women and that topical estrogens can accelerate healing in elderly men as well. The authors discuss their work in identifying and pursuing downstream genes and factors that mediate the effect of estrogen on healing. In contrast to estrogen, androgens appear to inhibit healing; in-vivo studies show a correlation between increased testosterone levels and delayed healing. Hardman and Ashcroft have recently demonstrated accelerated healing following topical administration of dihydroepiandrosterone, an adrenal precursor of androgens and estrogens. In preliminary studies, this molecule appears to accelerate wound healing without the adverse effect of estrogen therapy. We eagerly await further data from Ashcroft and colleagues on this interesting molecule.