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This Month in Archives of Dermatology
Arch Dermatol. 2002;138:311.
A Systematic Review of Treatments for Bullous Pemphigoid
The systematic review by Khumalo et al of 6 randomized controlled trials
of bullous pemphigoid therapy emphasizes the difficulty of making precise
recommendations in the near absence of reliable data from such trials. This
review suggests that a less aggressive approach, tending toward lower doses
of systemic corticosteroids, may be adequate therapy and associated with less
morbidity and mortality than higher-dose regimens.
(SEE ARTICLE)
Association of Dissatisfaction With Care and Psychiatric Morbidity
With Poor Treatment Compliance
In this longitudinal study of the determinants of self-reported compliance
with dermatologic therapies, almost 400 dermatologic outpatients were surveyed
by telephone regarding their overall satisfaction with their care and compliance
with prescribed treatment regimens. Overall satisfaction with care was associated
with a high degree of compliance, whereas psychiatric comorbidity predicted
diminished compliance. Renzi et al suggest that timely identification and
appropriate management of psychiatric disorders in dermatology practice may
improve adherence to therapeutic regimens.
(SEE ARTICLE)
Scald Abuse
Physicians have a legal and moral responsibility to investigate any
case of suspected child abuse, but recognition of some forms of child abuse
proves challenging. Parents from all levels of society and educational backgrounds
may abuse children, and scald abuse is a common but underrecognized form of
child abuse. Stratman and Melski offer the dermatologist useful clues in the
history and physical examination that may allow early identification and intervention
with respect to this injury.
(SEE ARTICLE)
Nail Salons Can Be Risky Business
During manicures and pedicures, technicians may use sharp implements
and unintentionally injure the cuticles or the nail folds. Bleeding may result,
setting the stage for potential transmission of infectious agents. Sekula
et al demonstrate a variety of bacterial and fungal species cultured from
instruments disinfected with disinfectants registered with the Environmental
Protection Agency. Many consumers patronize nail salons with the belief that
the instruments have been appropriately sanitized, and this belief may be
mistaken.
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Thumbnail of a patient with Pseudomonas aeruginosa that developed after a manicure.
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(SEE ARTICLE)
Vascular Inflammation (Vasculitis) in Sweet Syndrome: A Clinicopathologic
Study of 28 Biopsy Specimens From 21 Patients
Sweet syndrome is clinically characterized by rapid onset of painful,
erythematous plaques accompanied by fever. Absence of vasculitis has been
considered by many to be a histologic criterion for diagnosis. In this study,
Malone et al suggest that the histologic presence of vasculitis does not exclude
a diagnosis of Sweet syndrome, and they further suggest that vasculitis may
be a process secondary to neutrophilic infiltration, with the affected vessels
considered simply "innocent bystanders."
(SEE ARTICLE)
Phase 1 and 2 Trial of Bexarotene Gel for Skin-Directed Treatment of
Patients With Cutaneous T-Cell Lymphoma
A limited number of topical therapies are useful for cutaneous T-cell
lymphoma (CTCL). Patients often encounter adverse effects related to currently
available topical therapies, or simply a loss of therapeutic efficacy, thus
emphasizing the need for developing additional effective skin-directed therapies
for CTCL. Breneman et al demonstrate that bexarotene gel, a retinoid X receptor–selective
retinoid, is well tolerated. The substantial response rate in treating patients
with early CTCL suggests that dermatologists may be able to add bexarotene
gel to their therapeutic armamentarium.
(SEE ARTICLE)
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