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This Month in Archives of Dermatology
Apr 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(4):421. doi:10.1001/archdermatol.2011.524

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating follicular disease that manifests with deep inflamed nodules in the apocrine gland–bearing areas of the body. In this comprehensive review of research studies on HS treatment in the last 20 years, Rambhatla et al demonstrate that most therapies used to treat HS were supported by limited or weak scientific evidence owing to a paucity of randomized controlled studies. Effective treatments include a clindamycin-rifampin combination, a course of infliximab, monthly Nd:YAG laser sessions, and surgical excision and primary closure with a gentamicin sulfate–collagen sponge.

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Despite the growing popularity of sunless tanning products (STPs), their effect on tanning behaviors has not been fully explored. Some studies support STP use as an acceptable substitute for UV radiation (UVR) tanning methods, but others raise concerns that STPs encourage intentional UVR exposure. In this cross-sectional survey study, Sahn et al demonstrate that the desire for tanned skin remains strong and that in some women, STP use is associated with decreased UVR tanning frequency. Improvements in the appearance of STP-induced tans may allow wider public acceptance and a further decrease in UVR tanning practices.

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Wound-bed preparation with debridement not only helps remove damaged tissue and biofilms and restore normal bacterial flora, it also improves growth factors and senescent cell activities. In this randomized, controlled, prospective clinical trial, Opletalová et al demonstrate no significant difference between maggot debridement therapy (MDT) and conventional therapy at day 15. However, debridement by MDT was significantly faster in the first week of therapy, reaching the same level as the control group at day 15. This may prove useful in wounds needing fast debridement, such as in preparation for skin grafting. An additional MDT advantage is the lack of operator dependency.

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Antimalarial agents, including hydroxychloroquine (HCQ), are considered first-line systemic treatment for cutaneous lupus erythematosus (CLE). Prescribed HCQ doses theoretically depend on patient weight, but a standard dose of 400 mg/d is often prescribed regardless of patient height and weight. In this prospective multicenter study, Francès et al demonstrate that median blood HCQ concentration was significantly higher in patients with complete remission. Ten percent of patients had very low blood HCQ concentration and may be considered nonadherent. These data indicate that monitoring blood HCQ concentration might be very useful in the management of patients with CLE being treated with HCQ.

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Psoriasis is a common, chronic, inflammatory disease of the skin and joints. Use of traditional oral systemic therapies for moderate to severe psoriasis such as methotrexate, acitretin, and cyclosporine may be limited by patient intolerance or organ-specific toxic effects. Several new biologic drugs have been approved for the treatment of moderate to severe psoriasis, but they are associated with high costs, diminished efficacy during long-term treatment, and risks of rare but serious adverse effects. In this cross-sectional study, Gelfand et al demonstrate that patients taking adalimumab, etanercept, and ustekinumab were more likely to have clear or almost clear skin compared with those taking methotrexate. Patients receiving phototherapy showed no difference compared with methotrexate.

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