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This Month in Archives of Dermatology
Aug 2011

This Month in Archives of Dermatology

Arch Dermatol. 2011;147(8):892. doi:10.1001/archdermatol.2011.227

Hypertensive leg ulcers are painful, superficial, rapidly spreading necrotic wounds on the dorsolateral leg. They occur in older patients with long-standing hypertension without peripheral arterial occlusive disease. Medical therapies include antihypertensive agents, wound debridement, and wound dressings. Only surgical therapies with grafting achieve rapid pain relief and healing. In this randomized, double-blind controlled study, Senet et al demonstrate that topical becaplermin gel is not superior to hydrogel dressing for hypertensive leg ulcer closure, suggesting that surgical management remains the most promising treatment.

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Erythema induratum (EI) manifests as tender, indurated nodules on the legs associated with concomitant active tuberculosis (TB). It may be considered a hypersensitivity to mycobacterial antigens. Tuberculin skin testing (TST) can be used in nonimmunized populations to investigate the presence of active or latent TB, but it is of limited use in populations exposed to BCG vaccination. Interferon- γ release assays (IGRAs) offer an alternative to the TST and have a high specificity for identification of Mycobacterium tuberculosis infection. Vera-Kellet et al describe a series of patients with tender nodules on the legs consistent with EI and a history of BCG vaccination. The findings of IGRAs supported initiation of anti-TB treatment in 4 of 5 patients, demonstrating the value of these tests as an adjunct in the diagnosis of EI.

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Central centrifugal cicatricial alopecia (CCCA) describes the most common form of scarring alopecia among African American women, centered on the vertex and spreading peripherally. The true prevalence, etiology, and risk factors remain unclear. In this population study using a quantitative cross-sectional survey data, Kyei et al demonstrate a high prevalence of CCCA among 326 African American women. Hair grooming practices causing traction as well as inflammation in the form of bacterial infection may contribute to developing CCCA. There was an overrepresentation of type 2 diabetes mellitus among patients with CCCA, suggesting that CCCA may be a marker of metabolic dysregulation.

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Staphylococcus aureus is a ubiquitous organism found in both hospital and community settings, and methicillin-resistant strains (MRSA) have become commonplace. One cause for the emergence of MRSA may be long-term antibiotic exposure, as in patients with moderate to severe acne who are treated with tetracycline-class antibiotics. In this cross-sectional survey of acne patients, Fanelli et al demonstrate that the prolonged use of tetracyclines lowered the prevalence of S aureus colonization and was not associated with resistance to these antibiotics.

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Postherpetic neuralgia (PHN) is the painful sequela of acute herpes zoster virus infection that is presumably caused by nerve damage. Current therapies include tricyclic antidepressants, anticonvulsive agents, and a variety of oral and topical analgesics. Several studies have demonstrated the efficacy of gabapentin for chronic PHN, and animal studies suggest that it may be even more effective when prescribed in the acute care setting. In this open-label uncontrolled study, Lapolla et al demonstrate that the combination of gabapentin and valacyclovir administered acutely in patients with herpes zoster reduced the incidence of PHN. While confirmatory larger-scale blinded studies are necessary, these data suggest that gabapentin may be considered an adjunct to antiviral therapy for acute herpes zoster management in patients at high risk for PHN.

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