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This Month in Archives of Dermatology
Arch Dermatol. 2002;138:1133.
Efficacy of Topical 5% Imiquimod Cream for the Treatment of Nodular Basal Cell Carcinoma
Imiquimod is an immune-response modifier that exerts antiviral and antitumor
activity by stimulating the local production of interferon and other cytokines.
Shumack et al evaluate the safety and efficacy of 2 different imiquimod dosing
regimens in the treatment of small, nodular basal cell carcinomas. Although
the therapeutic efficacy level of daily topical imiquimod treatment for 12
weeks does not approach that of surgical excision, there are certainly clinical
settings in which this therapeutic strategy might be warranted.
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A, Week 6 of daily treatment; B, posttreatment.
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(SEE ARTICLE)
Clindamycin for Intraincisional Antibiotic Prophylaxis in Dermatologic
Surgery
The risk of wound infection following skin surgery is small, and prophylactic
systemic antibiotics are not routinely indicated. In this prospective, blinded,
placebo-controlled trial, local anesthesia administered with admixed clindamycin
phosphate decreased the incidence of postoperative wound infections. Intra-incisional
antibiotic prophylaxis with clindamycin is inexpensive, easy to deliver, and
may offer the benefits of antibiotic prophylaxis without the risks of systemic
therapy.
(SEE ARTICLE)
Botulinum A Exotoxin for Hyperfunctional Facial Lines
The cosmetic use of botulinum A exotoxin (BTX) for the treatment of
hyperfunctional facial lines is well established. Serious adverse effects
of BTX treatment are rare, but milder adverse effects may occur. Alam et al
demonstrate that complications such as eyelid and eyebrow ptosis or weakened
perioral muscles are avoidable by adherence to a few guidelines based on the
pharmacology of BTX, the principles of aesthetics, and an understanding of
the underlying muscular anatomy. Knowing where not to inject this neurotoxin
is perhaps the most important factor in avoiding complications.
(SEE ARTICLE) | (SEE ARTICLE)
Adverse Cutaneous Reactions to Hydroxychloroquine Are More Common in
Patients With Dermatomyositis Than in Patients With Cutaneous Lupus Erythematosus
Antimalarial agents have been used in dermatologic therapy for over
a century. Hydroxychloroquine sulfate is commonly used to treat cutaneous
lupus and dermatomyositis (DM). In this retrospective case-control study,
Pelle and Callen confirm the suggested hypothesis that there is an increased
frequency of adverse cutaneous reactions to antimalarial agents in patients
with DM. Although hydroxychloroquine may exert beneficial effects in many
patients with DM, this elevated risk should be reviewed with patients in advance.
(SEE ARTICLE)
Corticosteroid-Sparing Effect of Intravenous Immunoglobulin Therapy
in Patients With Pemphigus Vulgaris
High-dose corticosteroids often provide effective control of pemphigus
vulgaris, but at the risk of multiple adverse effects. Other therapeutic options
include plasmapheresis, photochemotherapy, intravenous pulsed methylprednisolone,
and cyclophosphamide. In this retrospective review, the efficacy of intravenous
immunoglobulin therapy is shown in the treatment of this rare and potentially
fatal autoimmune blistering disease.
(SEE ARTICLE)
Should the Skin Cancer Examination Be Taught in Medical School?
Most patients with skin lesions are first seen by nondermatologists.
Despite a new national skin cancer educational agenda, it remains unclear
how many future physicians receive adequate training. In this analysis of
anonymous survey data, Geller et al report that most fourth-year medical students
from one university feel unskilled in the skin cancer examination, and 40%
reported no training in the skin cancer examination.
(SEE ARTICLE)
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