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In This Issue of JAMA Dermatology
March 2013

In This Issue of JAMA Dermatology

JAMA Dermatol. 2013;149(3):273. doi:10.1001/jamadermatol.2013.2207

Hand dermatitis has a lifetime prevalence rate of up to 15%. This common skin disease affects quality of life and may necessitate medical leaves and job changes. Because hand dermatitis can involve the pulp of the thumb, it has been reported to cause significant fingerprint changes. These may impair fingerprint recognition systems, which are increasingly being used in national registration, immigration, banking transactions, building and door access, and other settings. In this case-control study, Lee et al demonstrate that 27% of patients with hand dermatitis failed fingerprint verification compared with only 2% of controls.

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Opioids are potent pain-reducing agents and are used frequently after dermatologic surgical procedures. Opioid misuse and abuse have been increasing, and it has been suggested that opioid pain medications are frequently overprescribed. In this prospective observational study by Harris et al, opioids were prescribed to 34% of patients undergoing a single skin excision. Thirty-five percent of patients did not use their prescribed opioids, and of those who filled their prescriptions, 86% had leftover pills. These data suggest that opioids were overprescribed after dermatologic surgery and that patients with leftover opioids did not dispose of them properly.

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Spitz (spindle- and epithelioid-cell) nevus is a distinct melanocytic neoplasm that is most often seen in children. A lack of consensus exists regarding diagnosis and management strategies for Spitz nevi. In this web-based survey of private and academic dermatology practices, Tlougan et al confirm that pediatric dermatologists commonly see Spitz nevi. Many of the respondents used dermoscopy to evaluate suspected Spitz nevi. These anonymous survey data support conservative management of typical Spitz nevi in pediatric patients.

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Breastfeeding offers optimal nutrition and immunologic protection for the infant, but nipple pain may precipitate early discontinuation of this practice. Up to 96% of breastfeeding mothers experience nipple pain in the first 6 weeks post partum, and the differential diagnosis includes milk let-down pain, problems with infant latch-on, plugged lactiferous ducts, inflammatory skin conditions, secondary infections, and Raynaud phenomenon of the nipple. In this retrospective review of a patient database of breastfeeding mothers, Barrett et al demonstrate that nifedipine was a safe and effective treatment for this condition. Early recognition and treatment of Raynaud phenomenon of the nipple can help prevent premature cessation of breastfeeding.

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A topic dermatitis (AD) is the most common chronic inflammatory skin disease in infants. Many researchers have suggested that supplementation with specific nutrients such as probiotics, partially hydrolyzed whey protein formula, or other formulas may prevent the development of AD or decrease its severity. In this systematic review of randomized controlled trials and cohort studies, Foolad et al demonstrate that certain types of nutrient supplementation, particularly probiotics, are beneficial in preventing AD development and reducing its severity in children younger than 3 years.

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