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This Month in Archives of Dermatology
July 2011

This Month in Archives of Dermatology

Arch Dermatol. 2011;147(7):774. doi:10.1001/archdermatol.2011.180

Mucous membrane pemphigoid (MMP) is a potentially life-threatening autoimmune disease in the case of laryngeal, conjunctival, tracheal, or esophageal involvement. Current therapeutic options include topical corticosteroids, dapsone, sulfasalazine, tetracycline, and a variety of systemic immunosuppressive medications, but the condition remains refractory in some cases. Rituximab is a genetically engineered chimeric anti-CD20 monoclonal antibody that has been successfully used to treat autoimmune antibody-mediated diseases. In this case series, Le Roux-Villet et al demonstrate a rapid and dramatic efficacy for rituximab in treating 25 patients with severe, refractory MMP. The occurrence of severe infections in patients receiving concomitant immunosuppressants supports using rituximab as monotherapy.

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The surface morphologic characteristics of facial wrinkles are well described, but little is known about the changes beneath those wrinkles. In this analysis of human cadavers, Tsukahara et al use image analysis and measure the dermal thickness in forehead and lateral canthus wrinkles. The dermal thickness underneath a wrinkle was found to decrease as the depth of the wrinkle increased, until the dermis reached one-half of its original thickness. Under deeper wrinkles, microscopic observations revealed that the junction between the dermis and subcutaneous layers curved downward into the subcutaneous layer.

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Dermoscopy is a useful tool in diagnosing acquired melanocytic nevi on acral volar skin, where typical benign dermoscopic patterns (parallel furrow, latticelike, or regular fibrillar patterns) and a size less than 7 mm prove reassuring. In this retrospective study, Minagawa et al examine the dermoscopic features of congenital melanocytic nevi and demonstrate several patterns that were easily distinguished from early acral melanoma: the parallel furrow pattern, the crista dotted pattern, and the fibrillar pattern. The combination of the crista dotted and parallel furrow pattern was the most prevalent in this series, and the authors term this the peas in a pod pattern.

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Malignant melanoma (MM) is an immune-responsive tumor, posing concern when encountered in immunosuppressed patients. In this retrospective review, Brewer et al compared the MM cause-specific and overall survival among patients with MM diagnosed after solid organ transplantation compared with a national sample with MM. Immunosuppressed organ transplant recipients with thicker melanomas had a significantly poorer MM cause-specific survival, and overall survival was worse among patients with a history of transplant regardless of Breslow thickness or Clark level. As the number of solid organ transplants and their longevity increases, there will be a growing population of patients at risk of long-term complications from chronic immunosuppression, including MM.

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The incidence rates of melanoma among non-Hispanic white girls and women have more than doubled during a 3-decade period. Increases were comparable for localized as well as late-stage tumors, suggesting that heightened surveillance does not explain these incidence changes. In this longitudinal study of California Cancer Registry, US Census, and National Oceanic and Atmospheric Administration data, Hausauer et al demonstrate a significant and substantial increase in melanoma among white girls and women in the highest 3 quintiles of socioeconomic status and high UV-radiation exposure. By identifying this population with the greatest and most rapidly increasing incidence rates, screening and educational interventions may be more effectively targeted.

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