The pemphigus group comprises the autoimmune intraepidermal blistering diseases classically divided into two major types: pemphigus vulgaris and pemphigus foliaceous. Pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus are rarer forms that present some clinical, histological and immunopathological characteristics that are different from the classical types. These are reviewed in this article. Future research may help definitively to locate the position of these forms in the pemphigus group, especially with regard to pemphigus herpetiformis and the IgG/ IgA pemphigus.

The authors discuss the choice of parameters for forearm photoageing assessment using high-frequency ultrasound.

Ultrasound imaging has been increasingly used in dermatologic research over the past four decades. This paper aims to review its use as a disease severity and treatment efficacy assessment tool, with emphasis on the past five years. Quantitative parameters such as skin thickness, overall echogenicity, echogenicity distribution, dermal-subcutaneous interface length or area are used. The authors review skin aging, cellulite, striae, fillers, scleroderma, hypertrophic scar, wounds and psoriasis studies, and discuss correlation between sonographic findings and clinical assessment and/or validated scores. Data are still insufficient to support ultrasound imaging use as an unique efficacy assessment method in a trial, but favor that it is a valuable adjuvant assessment tool that brings objectiveness to subjective clinical assessment. Further studies and technology improvement will expand its applications in dermatology. KEYWORDS: dermatology • lipodystrophy • localized scleroderma • psoriasis • scars • skin aging • systemic scleroderma • ultrasonography • ultrasound biomicroscopy • wound healingUltrasonography has been used in medicine for more than 50 years and is one of the most frequently applied diagnostic tools. It is a noninvasive and non-ionizing method with a relatively low cost when compared with computed tomography and scintigraphic scanning techniques [1]. Alexander and Miller were the pioneers in the use of ultrasound (US) in dermatology since 1979 [2]. They demonstrated a15 MHz one-dimensional (A-scan) US equipment that measured the skin thickness with similar accuracy to the radiological techniquethe most accurate non-invasive method so far. Three years later its reproducibility and validation was shown, although the skin thickness determined in vitro was found to be greater than when in vivo determinations were made, probably due to the release of in vivo tension within the dermis [3].The 20 MHz bidimensional (B-scan) US units were first available in the 1980s, thanks to the emergence of mechanical transducers that enabled the cross-sectional imaging of the skin [4]. From then on, studies have evaluated its application in a range of skin conditions with different aims: disease severity and treatment response evaluation, adjunct diagnostic tool, tumor dimensions assessment and other uses. This paper reviews the state of art of US imaging in dermatologic research, focusing on its role as a disease severity and/or treatment efficacy assessment tool, with emphasis on the most frequently reported applications over the past five years. The use of US as a diagnostic tool or for tumor dimension assessment is not discussed here. ConceptsUS is a mechanically propagated wave with frequency above 20 kHz -the upper frequency limit of human hearing [5]. US transducers are made out of piezoelectric materials that generate acoustic energy when a voltage is applied to them. The US beam is transferred as a pulse from the transducer to the adjacent fluid or tissue and propagates as a wave, which can be reflected or refract...

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The wavenumber region between 798 and 994cm is useful for the analysis of dermal collagen alterations through the intrinsic aging process, while photoaging is better assessed by the I/I intensities ratio. This is the first skin aging study to show a correlation between Raman peaks and the amount of collagen assessed by HFUS and histology.