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This Month in Archives of Dermatology
Mar 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(3):290. doi:10.1001/archdermatol.2011.519

The mainstay of therapy of immunobullous disease continues to be long-term glucocorticoid use, despite the risks of bone loss and fracture. Bisphosphonate use has been advocated in treatment guidelines for patients being treated with glucocorticoids for longer than 3 months. However, published trials have involved white patients with rheumatologic and respiratory diseases for which the doses are generally lower than for immunobullous diseases. In this randomized, double-blind, placebo-controlled trial, Tee et al demonstrate a significant increase in bone mineral density with alendronate therapy in patients treated with oral corticosteroids for immunobullous disease, suggesting that using bisphosphonates is imperative in this patient population.

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Between 59% and 85% of patients with systemic lupus erythematosus (LE) develop dermatologic involvement. The specific manifestations of cutaneous LE are diverse and can be grouped into acute, subacute, and chronic subtypes. In this prospective longitudinal cohort study, Piette et al demonstrate that current smokers with lupus have worse disease and lower quality of life and respond less well to treatment when they need both antimalarial agents and immunomodulators. These data further strengthen the need for smoking cessation in the cutaneous LE population.

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Many inconsistent concerns have been voiced about the safety of long-term antibiotic use. Because of the high prevalence of acne and frequent use of antibiotics to control acne, patients with acne are the ideal group in which to study the effects of long-term antibiotic use. In this cross-sectional prospective cohort study, Margolis et al demonstrate that the odds of developing self-reported pharyngitis was more than 3 times that at baseline in patients receiving oral antibiotics for acne vs those who were not receiving oral antibiotics. The cause of this phenomenon is not known, but this finding was not associated with group A streptococcus.

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Basal cell carcinoma (BCC) is the most common cancer among whites by far, and incidence rates are increasing worldwide. Multiple primary tumors in patients with a BCC history and the large total number of patients with BCC translate into substantial costs and an important public health burden. However, the precise magnitude of BCC incidence and prevalence remains unknown because the total number of BCC cases continues to be markedly underreported by cancer registries that often report information only for first primary BCC. In this cancer registry evaluation, de Vries et al demonstrate that the total annual incidence rates are about 1.3 times higher than the rates of first primary BCC.

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Melanocytic proliferations remain among the most critical diagnostic challenges in the field of dermatopathology. A few immunohistochemical stains, such as HMB45 and Ki67, are routinely used to distinguish benign lesions from melanoma. Neither is specific or especially sensitive. In this qualitative study, Magro et al demonstrate that a novel monoclonal antibody against soluble adenylyl cyclase (sAC) produced distinctive patterns that paralleled melanoma genesis. The sAC expression pattern is complex but seems discriminatory, and it seems to provide a confirmatory test to distinguish benign from malignant lesions.

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