Topical corticosteroids are the most frequently used drugs for treating skin conditions and are prescribed to more than 6% of pregnant women. The US Food and Drug Administration labels topical corticosteroids as pregnancy risk category C, meaning that animal studies have shown adverse fetal effects, but there are no adequate and well-controlled studies in pregnant women. In this retrospective cohort study, Chi et al reassuringly show no associations of maternal topical corticosteroid exposure with a comprehensive set of adverse fetal outcomes. The risk of low birth weight persists, especially with heavy maternal use of strong topical corticosteroids, and authors recommend keeping potent topical steroid use to a minimum and monitoring fetal growth if they are used.
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The pathogenesis of acral melanoma remains unclear, although trauma has been suggested to be a predisposing factor. In this cross-sectional, retrospective study, Jung et al analyze the anatomic mapping and histopathologic features of acral melanomas and demonstrate that physical stress or pressure can influence the incidence and spreading pattern of these tumors. The long axis of spreading in plantar melanomas was typically along naturally occurring creases, which are the vectors that transmit the pressure strength when the soles contact a surface. Prospective studies of in situ lesions are necessary to better understand the spreading pattern.
Continuing Medical Education
Cutaneous T-cell lymphoma (CTCL) refers to a group of lymphoproliferative disorders characterized by localization of T lymphocytes to the skin. A consistent increase in incidence of CTCL has been regularly documented since the early 1970s, which may be related to a real increase in cases along with an improvement in physician detection and diagnostic changes. In this population-based study designed to update our current understanding of CTCL epidemiology, Korgavkar et al demonstrate that the overall CTCL incidence has stabilized since 1998 and that 5-year CTCL survival rates increased until 2004.
Advancements in mobile technology, along with the ubiquitous adoption of the smartphone, have had a profound effect on the practice of medicine. Downloadable mobile applications (apps) have the ability to serve as diagnostic tools for physicians, educational resources for students, and health management programs for patients. In this study, Brewer et al identify and categorize the variety of current mobile apps available in dermatology for patients and providers. Although many apps had potential usefulness, the authors encourage users to recognize potential risks of using these as valid resources for dermatology information.
Tumor necrosis factor inhibitors have become important components in the treatment of multiple chronic inflammatory skin disorders. In this case report, Sand and Thomsen describe a patient with severe refractory acne conglobata that was unresponsive to doxycycline, isotretinoin, prednisolone, and dapsone. A sustained and marked reduction of symptoms was seen after 12 continuous months of adalimumab therapy, although the durability of this remission remains unknown.
Highlights. JAMA Dermatol. 2013;149(11):1261. doi:10.1001/jamadermatol.2013.4093