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Arch Dermatol. 2008;144(8):978.

Perifollicular Xanthomatosis as the Hallmark of Axillary Fox-Fordyce Disease
Fox-Fordyce disease (FFD) is a rare condition characterized by apocrine miliaria. Although the sweat retention vesicle has been called the singular diagnostic feature, it is often not easily demonstrated. In this case series, Bormate et al examined biopsy specimens from 7 cases of FFD and confirmed that traditional histopathologic criteria are nonspecific and of little diagnostic help. The recently described peri-infundibular and periductal xanthomatized cells represent a more sensitive and specific means to recognize FFD and may be considered the hallmark in diagnosis.

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A Community-Based Study of Acne-Related Health Preferences in Adolescents
The psychological impact of acne vulgaris on adolescents has been documented for more than 50 years. Reduction in anxiety, depression, embarrassment, lack of self-confidence, social dysfunction, and even unemployment are potential goals for acne therapy. In this survey of a convenience sample of adolescents, Chen et al demonstrated that adolescents consider 50% clearing or total clearance with scarring to be not much of an improvement over their current level of acne. These data may help dermatologists balance clinical data with their patient's high expectations of therapy, given that randomized, blinded, placebo-controlled trials have shown that 3 to 4 months of conventional acne therapy typically produce lesion count reduction only in the 40% to 60% range.

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CD8⁺ Epidermotropic Cytotoxic T-Cell Lymphoma With Peripheral Blood and Central Nervous System Involvement
Cutaneous T-cell lymphomas (CTCLs) are a group of primary malignant neoplasms of skin-homing T cells, usually deriving from CD4⁺ cells. In rare cases, CD8⁺ immunophenotypes have been described. In this case report, Introcaso et al describe a patient with a CD8⁺ epidermotropic T-cell lymphoma that demonstrated the loss of the same T-cell markers CD7 and CD26 that have been previously described as absent in CD4⁺ CTCLs. The demonstration of the loss of these markers represents a powerful tool for early diagnosis and monitoring of peripheral blood involvement in these patients and allows initiation of appropriate therapy, such as photopheresis or stem cell transplantation, at an earlier point.

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High Association of Human Herpesvirus 8 in Large-Plaque Parapsoriasis and Mycosis Fungoides
Human herpesvirus 8 (HHV-8) has been unambiguously identified as the etiologic agent of Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. Although investigations have failed to demonstrate an association of HHV-8 to the pathogenesis of CTCL, an association with other lymphoproliferative disorders has been suggested. In this retrospective study of 53 patients with lymphoproliferative diseases, Kreuter et al confirmed the previously described association of HHV-8 with large-plaque parapsoriasis (LPP) but also demonstrated low levels of HHV-8 in most of the MF samples. Although no conclusions may be drawn on the etiologic and pathogenic role of HHV-8 in these diseases, HHV-8 may act as a cofactor in the progression of LPP and CTCL.

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Retrospective Evaluation of Patch Testing Before or After Metal Device Implantation
Implanted devices such as orthopedic prostheses and pacemakers are being increasingly used, raising concerns regarding allergenicity of the devices, particularly the implanted metals. The components of implanted devices may play a role in both device failure and dermatitis. Patch testing represents a means of detecting an allergy to the components of an implanted device. In this retrospective medical chart review, Reed et al demonstrated that preimplantation patch testing, generally performed because of a patient-reported history of metal allergy, was useful in guiding the device selection. Postimplantation patch testing was commonly performed because of unexplained skin eruptions at the implantation site, chronic joint pain, and joint loosening. No patients in this series demonstrated positive reactions to components of their implanted devices, and postimplantation patch testing may be of less value.

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SECTION EDITOR: ROBIN L. TRAVERS, MD

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