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This Month in Archives of Dermatology
Aug 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(8):883. doi:10.1001/archdermatol.2011.544

Moderate to severe atopic dermatitis (AD) is often treated with systemic agents associated with significant adverse effects. Topical phosphodiesterase (PDE) inhibitors have proven benefit, although none have been brought to market. In this open-label prospective trial, Samrao et al demonstrate that apremilast, a PDE4 inhibitor, was safe and tolerable therapy for mild to moderate AD. Apremilast significantly improved inflammation, pruritus, and quality of life. Nausea was the most common adverse event, and clinical responses were similar to those seen with immunosuppressant medications currently used to treat AD.

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The incidence of skin cancer has risen dramatically in the past 30 years. Mass screenings have reached almost 3 million individuals in the United States and Europe, but there are insufficient dermatologists to conduct population-wide screenings of high-risk individuals. In this large-scale, population-based, skin cancer screening intervention, Waldmann et al find that screening yielded a high number of malignant skin tumors. However, a high number of excisions performed in the youngest screenees were associated with a low yield, suggesting a need for screener training to emphasize a more conservative approach toward excisions in young patients.

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Porphyria cutanea tarda (PCT) is caused by an enzymatic defect in uroporphyrinogen decarboxylase, a component in heme biosynthesis. The resulting accumulation of porphyrins leads to skin symptoms: photosensitivity, vesicles, bullae, erosions, crusts, scars, and milia. Treatments include photoprotective clothing, sunscreens, therapeutic phlebotomy, and antimalarial medications. Slow infusion of subcutaneous desferrioxamine, an iron chelator, reduces iron stores in patients with PCT, but treatment is prolonged and cumbersome. In this prospective, open-label study, Pandya et al demonstrate that the oral iron-chelating agent deferasirox may be a useful, effective, and well-tolerated alternative to desferrioxamine.

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The relationship between dermal thinning and solar elastosis remains unclear. Tsukahara et al measure the degree of solar elastosis at wrinkle points and nonwrinkle points on the forehead and lateral canthus. Advanced solar elastosis was demonstrated at nonwrinkle points but to a lesser extent at wrinkle points. Elastosis ratios increased with the deepening of a shallow wrinkle up to 0.6 mm, after which elastosis ratios remained less than 1. These findings indicate that solar elastosis contributes to shallow wrinkles but not to deeper wrinkles. These seemingly contradictory findings suggest that other factors, such as stress from facial muscle movement, may be associated with deeper wrinkles.

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intake, and smoking are associated with an increased risk of psoriasis. Although physical activity has been associated with decreased risk of other systemic inflammatory disorders, the role of physical activity in psoriasis prevention remains undetermined. In this cohort study, Frankel et al demonstrate that vigorous physical activity among women was independently associated with a reduced risk of incident psoriasis. In addition to providing other health benefits, vigorous exercise may represent a new preventive measure for women at high risk for psoriasis.

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