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This Month in Archives of Dermatology
Arch Dermatol. 2003;139:131.
Topical Nitrogen Mustard in the Management of Mycosis Fungoides: Update of the Stanford Experience
Nitrogen mustard is an effective topical therapy for early mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma. In this extensive update of the long-term results in patients with MF who were treated with topical nitrogen mustard as initial therapy, Kim et al suggest that topical nitrogen mustard monotherapy should be considered primary treatment for patients with T1/T2 disease and should also be considered an effective salvage therapy for disease relapse.
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Narrowband (312-nm) UV-B Suppresses Interferon  and Interleukin (IL) 12 and Increases IL-4 Transcripts: Differential Regulation of Cytokines at the Single-Cell Level
Ultraviolet B radiation has the interesting property of altering immunologic responsiveness, and it is this activity that may be the underpinning of UV-B therapy's effectiveness in treating inflammatory skin disease such as psoriasis. In this study, Walters et al demonstrate that narrowband UV-B phototherapy causes a down-regulation of helper T (TH) 1 cytokines as well as an up-regulation of TH2 cytokines in lesional skin of patients with psoriasis, thus modulating the TH1 polarized response in lesional skin. These findings broaden our understanding not only of the mechanisms of therapeutic UV-B but also of the pathogenesis of psoriasis.
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Late Recurrence of Inflammatory First-Stage Lesions in Incontinentia Pigmenti: An Unusual Phenomenon and a Fascinating Pathologic Mechanism
Incontentia pigmenti is an X-linked genodermatosis that typically manifests as an orderly progression of lesions from the neonatal inflammatory vesicles localized along the lines of Blaschko that clear spontaneously, to be subsequently replaced by hyperpigmented macules and verrucous and keratotic lesions. In this case series, Bodak et al report on 5 cases of children who experienced episodes of late recurrences of first-stage inflammatory lesions. They offer hypotheses as to the role of infections and proinflammatory cytokines such as tumor necrosis factor  as triggers in this rare clinical situation.
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9-cis-Retinoic Acid Capsules in the Treatment of AIDS-Related Kaposi Sarcoma: Results of a Phase 2 Multicenter Clinical Trial
Retinoids have been examined as a potential new modality for treating Kaposi sarcoma (KS) related to acquired immunodeficiency syndrome, and topical 9-cis-retinoic acid gel has been shown to have moderate response rates in previous trials. In this study, Aboulafia et al demonstrate that systemic 9-cis-retinoic acid therapy may have moderate activity against KS and that it provides a durable therapeutic response. However, there are important dose-related toxic effects that may limit the usefulness of this therapy.
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A, Kaposi sarcoma lesion at baseline on the right forearm of a 55-year-old white man with human immunodeficiency virus for about 9 years, tumor in situ stage 1, and Kaposi sarcoma for 6 years. B, The same forearm lesion at week 20 of treatment with 9-cis-retinoic acid.
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A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery
It is a generally held belief that dermatologic outpatient surgery is relatively safe, yet there has been little published data on which to base this belief. In this outcome-based prospective analysis, Cook and Perone substantiate these beliefs with respect to Mohs micrographic surgery and reconstruction. When Mohs surgery is performed by appropriately trained physicians, the overall complication rate of 1.64% for the surgery and reconstruction was equal to or lower than the published complication rates from specialists in other surgical fields.
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