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This Month in Archives of Dermatology
June 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(6):677. doi:10.1001/archdermatol.2011.534

In the setting of long-term immunosuppression, such as in organ transplant recipients (OTRs), the incidence of squamous cell carcinoma (SCC) rises dramatically. Chronic UV damage is a major risk factor for this field cancerization, ie, the presence of widespread DNA damage in sun-exposed skin. In this case series of a highly selected SCC sample group, Mühleisen et al demonstrate reduced allelic balance at chromosome 9p21-22 for all SCCs, and OTRs had an even further reduced allelic balance for D9S162, suggesting a common trait for SCC in OTRs.

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Skin cancers associated with chronic leg ulcers (CLUs) are underrecognized and may result from CLU malignant transformation, usually toward SCC, or may arise de novo. In this prospective cross-sectional study, Senet et al evaluate the association between skin cancers and CLUs that failed to heal despite 3 months of appropriate treatment. Sixteen of 154 nonhealing CLUs were associated with skin cancer. This high frequency of malignant transformation was sufficiently high to consider systematic biopsy of ulcers refractory to 3 or more months of appropriate treatment.

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More than 1 million lower-extremity total joint replacements are completed yearly in the United States, and this number is increasing. Most implants are metal alloys, made from a mixture of 2 or more components. Nickel is a commonly used metal, but nickel hypersensitivity may affect up to 19% of the population. In this medical chart review, Atanaskova Mesinkovska et al demonstrate that although nickel remained the most common relevant allergen, 74% of preimplantation patients showing metal hypersensitivity on patch testing had positive reactions to additional metals, including palladium, cobalt, gold, and chromium. These data support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation.

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Many dermatologic medications are administered topically, but cutaneous absorption is significantly impaired by the stratum corneum. Pretreatment with microneedles may facilitate transepidermal transport of drugs by creating microchannels. In this subject- and live rater–blinded randomized trial, Hoesly et al demonstrate that the microneedle device was safe and well tolerated by patients of both sexes and various skin types and ages. Although no topical medications were used with the device and no data were gathered regarding device efficacy with specific topical products, the device appears to offer a safe and practical mechanism by which to enhance cutaneous absorption of topically applied medications such as anesthetics or cosmeceuticals.

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Pemphigus is a rare, life-threatening, mucocutaneous, autoimmune blistering disease. Therapeutic options include long-term, high-dose corticosteroid therapy and steroid-sparing agents such as azathioprine, cyclophosphamide, methotrexate, and intravenous immunoglobulin. Rituximab is a chimeric murine-human monoclonal antibody targeting the CD20 antigen on B cells. In published studies of pemphigus, the dosing schedule for rituximab is similar to that indicated for non-Hodgkin B-cell lymphoma, namely 1 cycle of 4 weekly infusions at 375 mg/mm2 of body surface area. In this case series, Matsukura et al demonstrate that an alternative dosing regimen of 100 mg on days 1 and 15 was an effective treatment for pemphigus.

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