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Many of the modern therapies that evolved during the last 25 years are new, more patient-friendly twists on old therapies. Harsh treatments with unpleasant odors that fail to diminish the most severe forms of acne and rosacea are no longer the main tools in the dermatologists' arsenal.

Five years ago, we marveled at the incredible advances in both medical and surgical dermatology. These included systemic retinoids for acne and keratinizing disorders, superpotent topical corticosteroids for even steroid-unresponsive dermatoses, photochemotherapy and narrow-band UVB phototherapy for psoriasis, and mycosis fungoides. They also included other difficult-to-treat skin problems, and sophisticated surgical modalities to improve photo-damaged skin and to help turn back the clock on skin aging in general. Five years ago, we celebrated, in these pages, 20 years of change in dermatology as reflected on the subjects that Dermatology Times covered for its readers.

National report - Trends in the treatment of melanoma continue to focus on early detection and include experimentation with vaccines that might someday stop the cancer from spreading or prevent it entirely. Despite progress in early detection, survival rates for late-stage patients continue to be a concern.

National Report -- In the past 25 years, dermatologists have witnessed a host of innovations that have made their specialty more vital than ever. During that same period, it has become increasingly evident that for the specialty to thrive in 2004 and beyond, two intertwined challenges must be addressed. They are the pervasive impact of managed care and the troubling trend for younger doctors to succumb to the allure of performing cosmetic procedures at the expense of clinical ones.

Microsoft Word, Excel and PowerPoint documents can (and usually do) contain a wide variety of information known as metadata (information that you might not want to share with others when you distribute the document electronically) in "hidden" fields that can easily be viewed by simple text editing programs and by sophisticated software designed for the purpose of extracting this hidden information.

Waikoloa, Hawaii - Examine the scalps of women who report excessive hair shedding because early intervention is the key to successful treatment of female pattern hair loss.

Waikoloa, Hawaii - The Galaxy, a new machine from Syneron, achieves optimal skin rejuvenation by combining high fluence radio frequency energy with optical light and laser, according to R. Stephen Mulholland, MD.

Waikoloa, Hawaii- Since the advent of botulinum toxin type A (Botox) for cosmetic purposes, its use has been guided by two primary sources: clinical study and practice.

Panama City, Fla.-The suture material of choice for skin closure of reconstructive surgery wounds of the face and neck in adult patients is coated irradiated polyglactin 910 (Vicryl Rapide, Ethicon) for G. Joseph Parell, M.D. He reports it achieves solid cosmetic results that won't need further repair.

Las Vegas - Suspect infection in any patient who presents with painful erosions after resurfacing procedures because early treatment is key for achieving a good outcome, said Christopher B. Harmon, M.D., at the Fall Clinical Dermatology Conference.

Las Vegas - Suspect infection in any patient who presents with painful erosions after resurfacing procedures because early treatment is key for achieving a good outcome, said Christopher B. Harmon, M.D., at the Fall Clinical Dermatology Conference.

San Diego - Health care and public health workers vaccinated against smallpox have had few of the adverse events historically associated with smallpox vaccine, though unexpected cardiac events have occurred and continue to be investigated, according to Raymond A. Strikas, M.D.

Washington - When it comes to sun protection methods, there are some new options on the horizon. While many have yet to be approved for use in the U.S., they are showing promise as future preventive methods, according to Darrell S. Rigel, M.D., a dermatologist, clinical professor of dermatology at New York University, and a past president of the American Academy of Dermatology.

New York - Adjuvant therapy with a macrophage-activating growth factor appears to prolong survival in high-risk melanoma, Lynn E. Spitler, M.D., said.

Waikoloa, Hawaii - The large, multicenter B.E.S.T. (Balancing Efficacy, Speed and Tolerability) clinical trial provides real-world data, reinforcing the conclusion that tazarotene 0.1 percent cream (Tazorac for acne) applied once daily in the evening is a highly and rapidly effective, well-tolerated treatment for acne vulgaris, said Dina N. Anderson, M.D., at the annual Hawaii Dermatology Seminar in January.

Waikoloa, Hawaii - A investigational foam preparation of clindamycin phosphate 1 percent (Actiza) provides a safe, effective, well-tolerated, and innovative new treatment for acne vulgaris, said Lawrence F. Eichenfield, MD, at the annual Hawaii Dermatology Seminar in January.

Washington, D.C. - Without a working knowledge of oral sores, it's easy to confuse one type with another, according to Alison Bruce, M.D. "You need a tier system for approaching these conditions. Once you know what questions to ask, they're not so hard to diagnose."

Waikoloa, Hawaii - Natural ingredients are often accompanied by scientific research findings that tout their benefits - and it is imperative for dermatologists to critically evaluate that data, said Susan C. Taylor, M.D.

Waikoloa, Hawaii - Phase III trials show etanercept (Enbrel, Amgen Inc. and Wyeth) has efficacy and safety for moderate to severe psoriasis.

Waikoloa, Hawaii - A new foam formulation of the antifungal drug ketoconazole (Extina 2 percent, Connetics Corp.), currently under FDA review, seems to be more completely absorbed into the skin than the same ingredient in other formulations and could be more effective in the treatment of seborrheic dermatitis, said Linda F. Stein Gold, M.D., director of clinical research, Department of Dermatology, Henry Ford Health System, West Bloomfield, Mich.

The Medicare reform law passed by Congress late last year contains what one organization calls "a bitter pill" for physicians who perform services, or have financial interests, in ambulatory surgery centers (ASC).

The arena of cosmeceuticals, cosmetics, and skincare has undergone dramatic changes in the past 25 years. Why, 25 years ago there were no cosmeceuticals, in fact the word had not yet been coined by Dr. Albert Kligman, and the most sophisticated product in the over-the-counter skincare market was a petrolatum, mineral oil, and glycerin moisturizer. Exciting changes have occurred on many fronts, including the development of new ingredients, new classes of products, and new biologic actives.

I am constantly impressed by the perceptions and misconceptions of my patients, which gives me cause to sit and reflect a moment on how our lives are shaped by marketing and economic forces that go unrecognized by most.

Q. After being very unsuccessful in buying individual stocks, I have decided to invest in actively managed mutual funds. What is the best way to compare mutual funds?

British Columbia - While dermatologists tend to think of Botox as a primary therapy, some are looking at it as an adjunctive therapy, offering benefits from longer- lasting results to better wound healing and less scarring.

Washington - Recent regulatory decisions about hyaluronic acids and hyaluronic gels have brought facial wrinkle fillers even further into the fold of the impulse purchase.

Waikoloa, Hawaii - Many modalities are available for minimizing patient discomfort during laser and radiofrequency procedures, but for optimal benefit, method selection should be tailored to the patient's needs as well as the type of procedure, said Suzanne L. Kilmer, M.D., at the annual Hawaii Dermatology Seminar in January.

Q. How do facial sebum- reducing products work?

Waikoloa, Hawaii - The increase in the number of topical anesthesia options available mandates that dermatologists consider how they compare with respect to efficacy, safety, and patient convenience when selecting an agent to minimize the pain of a cutaneous procedure, said Dina N. Anderson, M.D., at the annual Hawaii Dermatology Seminar in January.

Amsterdam -- Combined use of an artificial skin substitute and stem cells may promote healing of difficult wounds, according to Sadanori Akita, M.D., Ph.D., senior assistant professor in the division of plastic and reconstructive surgery at Nagasaki University, Japan. "When dealing with serious wounds, such as extensive burn wounds, acceleration of wound healing is critical for survival," Dr. Akita said. "There is an unmet surgical need for better treatments for difficult wounds, especially in cases requiring resurfacing of large skin defects, and in contaminated or poorly vascularized wounds caused by irradiation or systemic diseases such as diabetics."