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This Month in Archives of Dermatology
Arch Dermatol. 2009;145(4):371.
Calciphylaxis With Normal Renal and Parathyroid Function
Calciphylaxis is a metastatic, calcification-induced, microvascular occlusion syndrome classically associated with end-stage renal disease and/or hyperparathyroidism. The cutaneous form manifests with painful, retiform purpuric plaques with potential ulceration and secondary infection. Hypoperfusion may result in gangrene, sepsis, and the need for amputation. In this case report of a 58-year old woman with calciphylaxis in the setting of normal renal and parathyroid function, Kalajian et al describe the increasing incidence of such nontraditional calciphylaxis and highlight the clinical situations that may predispose to this condition.
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Treatment of Refractory Ulcerative Necrobiosis Lipoidica Diabeticorum With Infliximab
Necrobiosis lipoidica diabeticorum (NLD) is a granulomatous condition presenting as an atrophic plaque with raised borders and telangiectasia, occurring typically on the shins of younger women. Two-thirds of cases are found in patients with diabetes, without correlation to glycemic control. In this case report, Hu et al describe a patient with a history of type 1 diabetes mellitus and NLD lesions refractory to intensive local wound care. The patient improved dramatically under treatment with intravenous infliximab, a monoclonal antibody that binds to tumor necrosis factor (TNF)  . This marked response supports the use of anti-TNF agents and suggests further study to define the efficacy of infliximab or other anti-TNF agents for this condition.
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Occurrence of Nonmelanoma Skin Cancers on the Hands After UV Nail Light Exposure
Artificial nails are an increasingly popular cosmetic augmentation. Ultraviolet nail lights are commonly used to cure UV gel nails, certain acrylic nails, and nail fill-ins and to dry traditional nail polish and UV top sealers. These lights emit predominantly UV-A, and when corrected for body surface area, the dose of UV radiation to the hands is comparable to that from a tanning bed. In this case series, MacFarlane and Alonso describe 2 healthy, middle-aged women with no personal or family history of skin cancer who developed nonmelanoma skin cancers on the dorsal surface of their hands. Both women reported exposure to UV nail lights. These cases suggest a possible association of UV nail light exposure and the development of skin cancer.
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Melanoma in Middle-aged and Older Men
Melanoma incidence and mortality continue to rise for middle-aged and older men. The disproportionate burden of melanoma deaths in middle-aged and older men is partly explained by sex differences in melanoma knowledge, awareness, and prevention. Middle-aged and older men may benefit the most from tailored efforts to promote early detection and treatment of melanoma. In this report on a multi-institutional survey of men 40 years or older with invasive primary melanoma, Swetter et al found that thinner tumors were associated with physician detection, higher melanoma awareness, higher educational level, and the presence of atypical nevi. These data suggest physician skin examinations and improved public awareness as major targets for new interventions to promote earlier melanoma detection.
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Risk Factors in Elderly People for Lentigo Maligna Compared With Other Melanomas
The incidence of melanoma continues to increase in the elderly population. Whether lentigo maligna (LM) really represents a separate epidemiologic subtype of melanoma or rather a tautologically defined histologic subtype of melanoma remains uncertain. In this double case-case-control study, Gaudy-Marqueste et al compared the risk factors for LMs and other melanomas among elderly patients. Their data reveal that the risk factors for LM were highly similar to those for other melanoma subtypes except for an absence of association with a greater number of nevi. Advanced chronic sun damage may be a prerequisite for LM, but no dose-effect relationship with cumulative exposure was demonstrable.
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SECTION EDITOR: ROBIN L. TRAVERS, MD
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