SummaryProstaglandins play important roles in in¯ammation and the maintenance of normal physiological function of several organ systems. Prostaglandin production requires the conversion of arachidonic acid to the intermediate prostaglandin H 2 catalysed by the cyclo-oxygenase (COX) enzyme. There are two isoforms of the COX enzyme, COX-1 and COX-2. These isoforms vary in their distribution and expression but are similar in size, substrate speci®city and kinetics. Normal physiological functions are mediated by`constitutive' COX-1, while the in¯ammatory response is mediated by`inducible' COX-2. Current nonsteroidal anti-in¯ammatory drugs inhibit both enzymes to varying degrees and can cause adverse effects in the gastrointestinal tract, kidney, respiratory system and platelets. Newer, selective COX-2 inhibitors offer real hope for safer anti-in¯ammatory drugs although their long-term safety and ef®cacy need to be studied as questions remain unanswered about possible physiological functions of COX-2.

Prevalence of CAM use in dermatology patients was high. Many doctors were unaware of patients' CAM use despite most patients being willing to declare it. Patients generally expected dermatologists to provide CAM advice. Dermatologists should make a concerted effort to identify likely CAM users and consider openly discussing CAM use with them.

Skin conditions can have a profound impact on patient QOL, which is affected by patients' perception of disease severity and not fully appreciated by dermatologists' own severity assessments. Laser therapy is associated with high patient satisfaction.