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This Month in Archives of Dermatology
Arch Dermatol. 2006;142:823.
Randomized Double-blind Trial of the Treatment of Chronic Plaque Psoriasis
Photochemotherapy with oral 8-methoxypsoralen and UV-A (PUVA) is a well-established and effective treatment for psoriasis. Recently, narrowband UV-B (NB-UVB) therapy has also been shown effective for psoriasis. Because there is no need for oral medication use or eye protection after treatment, NB-UVB would be preferable to PUVA if it could be demonstrated to be of similar efficacy. In this double-blind, randomized study, Yones et al compared these methods for the treatment of chronic plaque-type psoriasis and found that PUVA was significantly more effective than NB-UVB at achieving clearance, and the median time to clearance was significantly lower in the PUVA group. Six months after cessation of therapy, more of the PUVA-treated patients were still in remission compared with those who received NB-UVB.
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PELVIS Syndrome
Congenital hemangiomas are generally benign vascular anomalies that are only rarely associated with systemic malformations. In this case report, Girard et al describe 2 infants with large sacral and visceral malformations. After reviewing previously published cases, the authors propose the acronym PELVIS to emphasize the characteristic findings of this syndrome: perineal hemangioma, external genital malformations, lipomyelomeningocele, vesicorenal abnormalities, imperforate anus, and skin tag. Patients with large perineal hemangiomas should undergo spine imaging to detect spinal dysraphism and systematic pelviperineal imaging to detect occult urogenital anomalies.
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Clinical Relevance of Different IgG and IgM Serum Antibody Responses to Borrelia burgdorferi After Antibiotic Therapy for Erythema Migrans
Lyme disease is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. From 70% to 80% of cases manifest with the early hallmark of erythema migrans (EM). Early antibiotic treatment is effective in resolving EM within 1 to 4 weeks. Left untreated, the infection may spread to other organs. There remains some uncertainty about the use and interpretation of laboratory examinations in the follow-up of antibiotic-treated patients with EM. In this retrospective study of serial anti–B burgdorferi antibody titers, Glatz et al demonstrate that long duration or large size of EM before antibiotic treatment correlates with persistence of positive anti–B burgdorferi titers. A persistent IgG immune response is hypothesized to develop in the case of a longer pretreatment interaction between the host immune system and the spirochete. Titers did not correlate with type or duration of therapy or with clinical course and are therefore inappropriate for the assessment of the therapeutic response.
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Congenital Plaque-Type Glomuvenous Malformations Presenting in Childhood
Some venous anomalies have an increased number of rounded cells in their walls known as glomus cells. These glomus tumors or glomangiomas are more appropriately termed glomuvenous malformations (GVMs) to better reflect the fact that they are not true tumors but rather malformations. These GVMs have been associated with mutations in the glomulin gene. In this case series, Mallory et al describe 10 patients affected with a rare type of GVM, the generalized congenital plaque-type GVM. These cases may be familial or sporadic and are often misdiagnosed as capillary malformations, early hemangiomas, or even blue nevi at birth. The typical clinical course is progressive thickening and darkening, with new papules and nodules appearing over time, and treatment is often difficult.
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Cutaneous Calcification in Patients With End-Stage Renal Disease
Severe calcinosis cutis (CC) develops in approximately 1% of patients with end-stage renal disease (ESRD) annually. This condition generally presents with painful, purple skin lesions with purpura and surrounding livedo reticularis, progressing to nonhealing ulcers and soft tissue necrosis. Noncutaneous vascular calcification is far more common in ESRD and has been shown to be associated with osteopontin secretion. Osteopontin is a secreted phosphoprotein adhesion molecule with a high affinity for calcium ions. In this retrospective study, Rivet et al demonstrate that calcinosis of the vascular media of subcutaneous vessels was the most common histologic feature in CC and was always associated with osteopontin staining, suggesting that CC is a regulated process that is associated with osteogenic differentiation of vascular muscle cells.
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SECTION EDITOR: ROBIN L. TRAVERS, MD
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