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This Month in Archives of Dermatology
Feb 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(2):157. doi:10.1001/archdermatol.2011.514

Each year, younger dermatologists replace aging practitioners, decreasing the availability of medical dermatologic care because younger physicians are more prone to engage in education, research, or cosmetics. An unmet demand for dermatologic care in the United States has led to greater use of physician extenders. Melanoma mortality may be predicted by factors such as physician specialty density, neighborhood racial heterogeneity, and median household income. In this analysis, Aneja et al demonstrate that within a given county, greater dermatologist density is associated with lower melanoma mortality rates compared with counties lacking dermatologists.

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Hidradenitis suppurativa (HS) is characterized by nodular inflammatory lesions evolving into abscesses that are mainly located near apocrine glands. Current pathogenetic theories implicate hyperkeratosis of the follicular epithelium leading to apocrine gland occlusion, follicular rupture, inflammation, and secondary corynebacteria infection. In this prospective analysis, Dr éno et al demonstrate downregulation of innate immunity markers in HS skin, suggesting that deficient cutaneous innate immunity may play a crucial role in the development of HS. Three months of zinc treatment induced a significant increase in the expression of all the markers involved in innate immunity.

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The clinical presentation of drug-induced subacute cutaneous lupus erythematosus (DI-SCLE) is similar to that of non –DI-SCLE, with photodistributed nonscarring annular or papulosquamous lesions that may resolve after withdrawal of the causative drug treatment. The histopathologic finding of tissue eosinophils is typically not seen in SCLE. In this retrospective medical record review of patients with SCLE and prospective blinded histopathologic analysis, Hillesheim et al found no significant difference in the mean eosinophil ratios in the DI-SCLE vs non –DI-SCLE groups. Tissue eosinophilia is not a differentiating feature of DI-SCLE, and careful review of a patient's history in correlation with clinical findings remains the standard for identifying a drug as an etiologic factor in SCLE.

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Infantile hemangiomas (IHs) are the most common benign tumors of infancy. They range from small localized papules to large, disfiguring and function-threatening tumors. The heterogeneity of IHs has been described by classification schema based on depth, morphologic characteristics, and clinical behavior. Given the wide heterogeneity of IHs, it is imperative to carefully assess the risk associated with an individual IH to guide clinical decision making. Haggstrom et al describe the Hemangioma Severity Scale (HSS) and the Hemangioma Dynamic Complication Scale (HDCS), which will allow detailed assessment of clinical outcome and standardization of hemangioma research.

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Dystrophic epidermolysis bullosa (DEB) is a bullous genodermatosis caused by mutations in the type VII collagen gene. In revertant mosaicism, germline mutations are corrected by somatic events resulting in a mosaic disease distribution. This “natural gene therapy ” phenomenon has long been recognized in other forms of epidermolysis bullosa. In this case report, van den Akker et al describe a 21-year-old man with recessive DEB who reported an unaffected skin patch on his neck where blisters never occurred. In the unaffected skin, the somatic nucleotide substitution reverted the nonsense codon to tyrosine, thus restoring functional protein production. Cases such as this suggest promising therapeutic opportunities for the future.

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