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This Month in Archives of Dermatology
Arch Dermatol. 2008;144(9):1100.
Lymphocytic Thrombophilic Arteritis
Although clinical criteria exist for the classification of systemic vasculitides, certain cases defy precise classification. In this case series, Lee et al describe a series of 5 young women with slowly progressive, patchy, subtly indurated hyperpigmentation associated with fixed livedo racemosa affecting predominantly the lower limbs. The histologic findings revealed a dense mononuclear cell infiltrate that invaded the walls of arterioles in the dermosubcutaneous junction, associated with nuclear dust and a hyalinized fibrin ring encircling the entire periphery of the lumina of affected vessels. Four patients tested positive for antiphospholipid antibodies on serologic analysis. The authors term this newly described condition lymphocytic thrombophilic arteritis.
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Immediate Type I Hypersensitivity Response Implicated in Worsening Injection Site Reactions to Adalimumab
Adalimumab is a generally well-tolerated and safe monoclonal anti–tumor necrosis factor antibody that has a well-established place in the dermatologist's armamentarium against psoriasis. Adverse effects include occasional dermatologic conditions, and in this case report, Paltiel et al describe 2 patients with worsening injection site reactions to adalimumab. Skin testing in both patients suggested an immediate type hypersensitivity response, and a histamine release assay performed on peripheral blood leukocytes from both patients demonstrated significant histamine release on exposure to adalimumab. These data suggest that an IgE-mediated immediate type hypersensitivity response mediates worsening injection site reactions in some patients receiving adalimumab.
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Variation in Care for Recurrent Nonmelanoma Skin Cancer in a University-Based Practice and a Veterans Affairs Clinic
Treatment of recurrent nonmelanoma skin cancers (NMSCs) often proves challenging. Treated recurrent NMSCs have a higher rate of subsequent recurrence than primary tumors, and serious sequelae such as metastases are more frequent. Although formal recommendations for treatment of NMSCs include both surgical excision and Mohs surgery, some authors believe that existing data justify Mohs as the treatment of choice. Little is known about how physicians choose between therapies for recurrent NMSC. In this prospective cohort study of consecutive patients with recurrent NMSC, Clark et al demonstrate substantial and consistent differences in the treatment of recurrent NMSCs at a university-based site vs a Veterans Affairs site. Although there is no demonstrable evidence that the quality of care varied at the 2 sites, these data highlight the lack of consensus about a single preferred treatment for recurrent NMSC.
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Dermoscopic Evaluation of Amelanotic and Hypomelanotic Melanoma
Pure amelanotic melanoma represents less than 2% of all melanomas. Because melanin is usually found histopathologically, the difficulty in diagnosing these lesions lies with the clinician and not the pathologist. Because dermoscopic evaluation allows the visualization of pigment that is not discernible with the naked eye, Menzies et al sought to determine the predictive dermoscopic features of amelanotic and hypomelanotic melanoma. Although the sensitivity and specificity of dermoscopic evaluation of melanomas lacking significant pigment were inferior to that of more pigmented lesions, features distinguishing amelanotic melanomas from benign lesions can be visualized on dermoscopic examination.
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Induction of Collagen by Estradiol
Skin aging is associated with reduced skin function, increased skin fragility, and compromised wound healing, and photoaging is the main process responsible for the worsening appearance of aged skin. However, both intrinsic aging and photoaging share major biochemical features such as reduced collagen content. The effects of estrogens on skin collagen content are unclear. In this study of 70 healthy volunteers with sun-damaged skin, Rittié et al demonstrated that a 1-week topical treatment with estradiol stimulated procollagen I and III expression in sun-protected skin but had no effect on procollagen expression on photoaged skin. These data suggest that alterations induced by long-term sun exposure hinder the ability of topical estradiol to stimulate collagen production in human skin in vivo.
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SECTION EDITOR: ROBIN L. TRAVERS, MD
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