Actinic keratoses are common in light-skinned individuals who spend significant time in geographic areas with moderate to high levels of solar radiation. Cryotherapy is the most widely used therapy for these premalignant lesions. Field therapies that treat the entire field of sun-damaged skin include fluorouracil, imiquimod, diclofenac, and photodynamic therapy. In this study, Lebwohl et al demonstrate that ingenol mebutate, the active ingredient in the sap of the plant Euphorbia peplus applied as a gel for 2 or 3 consecutive days was well tolerated and produced clinically relevant sustained clearance and long-term reduction in actinic keratoses.
The aesthetic outcome of a scar after surgery has been shown to be the most important predictor of a patient's overall assessment of skin cancer treatment. A higher level of patient dissatisfaction has been noted with wounds on the trunk compared with the face, often because of scar widening. In this prospective, randomized, controlled trial, Kia et al demonstrate that an intradermal suture material with a prolonged lifetime led to significantly decreased scar spread but an increased rate of noted suture reaction at 3 months. These data suggest that further studies into less reactive, longer-acting biomaterials are needed.
Lentigo maligna (LM) presents clinical, pathologic, and therapeutic challenges and a higher risk of local recurrence than other types of melanoma and common localization on cosmetically sensitive areas of the head and neck. In this case series of patients with LM and LM melanoma, Guitera et al demonstrate that in vivo confocal microscopy is a noninvasive imaging technique that can aid in mapping difficult lesions. This technique can guide overall case management and assist multidisciplinary medical teams in their management of these difficult cases.
Hepatitis C virus (HCV) is a global health problem, and pegylated interferon alfa-2b with ribavirin is the treatment of choice. Dermatologic manifestations of HCV infection include lichen planus, porphyria cutanea tarda, and vasculitis, but dermatologic adverse effects of HCV treatment have also been reported. In this prospective, descriptive clinical trial, Tsilika et al determined that secondary hyperpigmentation during interferon alfa treatment occurs as an adverse event in 21% of patients, especially in those with skin type III or IV who have unprotected sun exposure.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease presenting with tender subcutaneous nodules and dermal abscesses in the axillae, groin, and anogenital regions. Onset typically occurs in the second or third decade of life. Anti-androgenic medications are among those used to treat HS, and in this case series, Randhawa et al demonstrate the therapeutic benefit of finasteride in pediatric patients with HS. Further prospective and randomized controlled trials will offer additional information about the use of finasteride for HS.
In This Issue of JAMA Dermatology. JAMA Dermatol. 2013;149(6):659. doi:10.1001/jamadermatol.2013.20