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In This Issue of JAMA Dermatology
January 2013

In This Issue of JAMA Dermatology

JAMA Dermatol. 2013;149(1):17. doi:10.1001/jamadermatol.2013.2196

The alkylating agent mechlorethamine hydrochloride has been used successfully in the treatment of the mycosis fungoides (MF) form of cutaneous T-cell lymphoma (CTCL) since the 1950s. Despite well-documented clinical experience with mechlorethamine, no topical formulation has been approved by the US Food and Drug Administration. Reliance on compounding pharmacies and the lack of insurance coverage have proven problematic. In this randomized, controlled, multicenter trial, Lessin et al demonstrate the safety and efficacy of a novel mechlorethamine, 0.02%, gel. A manufactured mechlorethamine, 0.02%, gel addresses the unmet needs for good manufacturing product quality assurance that will improve the availability of this drug for patients with MF-CTCL.

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Skin cancer incidence has increased dramatically, and one of the main risk factors is exposure to UV radiation (UVR). Detailed population-based data about the prevalence of sunbed use and individual user characteristics are lacking. In this nationwide telephone survey of the general population in Germany, Schneider et al demonstrate that the prevalence of ever use of sunbeds was 39.2%. Higher prevalence rates were observed among female subjects, persons aged 18 to 25 years, and those with immigrant backgrounds, emphasizing the need for more frequent and higher quality educational interventions to change tanning behavior in these groups.

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In the United States, approximately 500 000 patients are treated yearly for burn injuries, and the resulting scars have devastating emotional and physical impacts. Management has focused on addressing the aberrant collagen deposition seen in mature scars. Despite anecdotal reports that ablative lasers improve scars, no formal investigation has quantified improvement or explored underlying mechanisms. In this case series of 18 patients, Ozog et al demonstrate that fractional carbon dioxide laser treatment improved the appearance of mature burn scars and improved the collagen architecture. Given the excellent tolerability and lack of prolonged adverse effects, this technique should be further evaluated for the treatment of mature burn scars.

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Bullous pemphigoid (BP) is an autoimmune bullous dermatosis in which autoantibodies to dermoepidermal junction components lead to subepidermal blister formation. Drug-induced BP has been documented in anecdotal case reports. In this case-control study comparing drug history of consecutive patients with BP, Lloyd-Lavery et al demonstrated that loop diuretics were used significantly more frequently by patients with BP. This association was independent of age, sex, cerebrovascular disease, dementia, hypertension, and ischemic heart disease. The mechanism behind such an association clearly warrants further investigation.

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Calciphylaxis is a rare syndrome involving painful subcutaneous nodules and necrotic ulcerations of the skin that occurs in up to 4% of patients undergoing long-term dialysis. Restoration of blood flow is the most critical intervention. In this case series, el-Azhary et al describe 14 cases of calciphylaxis treated with tissue plasminogen activator (tPA), a thrombolytic agent that is an effective treatment for coagulopathic disorders of the skin microvasculature. Although tPA proved to be a useful adjuvant therapy for calciphylaxis, a multidisciplinary approach that includes wound care, debridement, thrombolytic therapy, restoration of tissue oxygenation, infection avoidance, and control of calcium-phosphate hemostasis is essential.

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