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This Month in Archives of Dermatology
Nov 2012

This Month in Archives of Dermatology

Arch Dermatol. 2012;148(11):1236. doi:10.1001/archdermatol.2011.559

Psoriasis is a chronic inflammatory state associated with cutaneous manifestations as well as increased risk of cardiovascular disease. The effect of systemic treatment for psoriasis on cardiovascular disease has been largely unexplored. In this retrospective cohort study, Wu et al demonstrate that the use of tumor necrosis factor inhibitors for psoriasis was associated with a significant reduction in myocardial infarction (MI) risk and incident rate compared with topical agents. Treatment with these agents for psoriasis was associated with a lower MI rate than treatment with oral agents or phototherapy, although the difference did not reach statistical significance.

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Two million patients who have undergone amputation reside in the United States alone, yet the prevalence of skin conditions they experience is underappreciated. In this cross-sectional health questionnaire of Vietnam War veterans, Yang et al describe a high prevalence of stump dermatoses at least 38 years after major limb amputation. Frictional and mechanical trauma to the stump skin caused by the prosthesis is believed to cause most of the stump dermatoses, and there is limited natural adaptation to these prostheses over time. These data demonstrate the need for further research in resolving the challenges of customization, fit, and comfort of prostheses for amputees.

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Molluscum contagiosum (MC) is a self-limited viral skin infection that typically presents as umbilicated papules in children that spontaneously resolve in a few months to years. In this retrospective medical chart review, Berger et al demonstrate that several types of inflammatory reactions commonly occur with MC: lesions may become inflamed and surrounded by eczematous dermatitis, and Gianotti-Crosti syndrome–like reactions (GCLRs) can occur. Treatment of the molluscum dermatitis can reduce spread of MC via autoinoculation, whereas inflamed MC lesions and GCLRs reflect cell-mediated immune responses that may lead to viral clearance.

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Skin compromised by traumatic scarring and split-thickness skin graft placement is often fragile. Scar contractures increase skin tension and decrease mobility, contributing to chronic erosions and ulcerations. These issues may impede rehabilitation after traumatic injuries by limiting prosthetic use, increasing pain, and increasing the risk of infection. In this case series, Shumaker et al describe patients with traumatic scars related to blast injury, complicated by skin fragility, sensitivity, contractures, and nonhealing areas. The sites were treated with a course of ablative fractional laser therapy, and healing was associated with gradual enhancements in scar pliability, texture, durability, and range of motion.

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The potent sensitizer paraphenylenediamine (PPD) is often found in permanent hair dyes. Contact allergy to hair dyes is common among hairdressers and consumers, and the acute-stage lesions histologically resemble any eczematous reaction with marked spongiosis. In this case report, Lönngren et al describe a patient with scalp dermatitis and widespread skin lesions as well as lymphadenopathy and dyspnea resembling asthma after dying her hair. Biopsy specimens revealed a neutrophilic cellulitis and eosinophilic granulocytes. Patch testing produced a 3+ reaction to PPD, and biopsy specimens from the patch test site revealed these same unusual histologic features.

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