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This Month in Archives of Dermatology
Arch Dermatol. 2008;144(12):1554.
Infantile Hemangiomas With Unusually Prolonged Growth Phase
Infantile hemangiomas (IHs) are the most common tumor of infancy. They typically follow a well-described natural history of rapid growth during infancy followed by gradual involution. Although most IHs reach their maximum size by patient age 10 months, a small subset can continue to grow beyond this time. In this retrospective case series, Brandling-Bennett et al demonstrate that prolonged IH growth was observed primarily in the minority of tumors that demonstrated a deep component and segmental morphologic characteristics. Early recognition of these characteristics may alert parents and providers to consider more aggressive therapy.
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Hematologic Safety of Dapsone Gel, 5%, for Topical Treatment of Acne Vulgaris
Dapsone is a sulfone with both antiinflammatory and antimicrobial properties. Systemic use may be associated with hematologic adverse effects such as dose-dependent hemolysis. Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency are more sensitive to developing hemolytic anemia after exposure to hemolytic stressors such as dapsone. A topical formulation of dapsone was recently developed and found effective in the treatment of acne vulgaris. In this double-blinded, randomized, vehicle-controlled study, Piette et al found no clinical or laboratory evidence of drug-induced hemolytic anemia in G6PD-deficient subjects after 12 weeks of therapy with topical dapsone gel, supporting the excellent safety profile of this acne medication.
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Gingival Manifestations of Orofacial Granulomatosis
Orofacial granulomatosis is a clinical entity presenting with swelling of the facial and oral tissues, especially the lips. In this case series, Lourenço et al characterized granulomatous gingivitis that was noted in 5 of 29 patients with orofacial granulomatosis. Histologic examination of gingival biopsy specimens revealed noncaseating granulomatous inflammation, edema of the superficial lamina propria, and a chronic inflammatory infiltrate consisting predominantly of lymphocytes and multinucleated giant cells. Appropriate management of the dental and periodontal conditions associated with orofacial granulomatosis can be essential for improving patient outcome.
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Association of Germline Mutations in the Fumarate Hydratase Gene With Uterine Fibroids in Women With Hereditary Leiomyomatosis and Renal Cell Cancer
Cutaneous leiomyomas are benign mesenchymal tumors with smooth muscle differentiation. Familial cutaneous and uterine leiomyomas have been associated with a form of papillary renal cell cancer (RCC). The susceptibility gene for this syndrome of hereditary leiomyomatosis and RCC (HLRCC) was mapped to the long arm of chromosome 1 and subsequently identified as the fumarate hydratase gene (FH). In this case-control study, Stewart et al evaluated the risk and severity of uterine fibroids in women with HLRCC and FH mutations. Women with germline mutations in the FH gene were noted to have an increased risk of developing uterine fibroids and were more likely to have treatment for these fibroids at a younger age.
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Psoriasis Independently Associated With Hyperleptinemia Contributing to Metabolic Syndrome
Psoriasis has been associated with obesity, hypertension, diabetes mellitus, and metabolic syndrome, and has recently been proposed as an independent risk factor for myocardial infarction. The underlying mechanisms of these associations are complex, but the "obesity of psoriasis" may be a key link. The hormone leptin stimulates endocrine activity in adipose tissue and is a hypothalamic modulator of food intake, body weight, and fat stores. In this case-control study, Chen et al demonstrated that psoriasis was independently associated with hyperleptinemia and that hyperleptinemia was associated with a higher risk of developing metabolic syndrome. Body weight loss could potentially become part of the general treatment of psoriasis, especially in patients with obesity.
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SECTION EDITOR: ROBIN L. TRAVERS, MD
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