Biologic agents have revolutionized therapy for moderate to severe psoriasis. Although an increased infection risk has been associated with these agents, this risk may be balanced by overall decreased mortality and improved quality of life. In this case report, Kling et al describe an obese woman, previously treated with efalizumab over 3 years, who died from influenza A(H1N1) viral infection 1 week after her first infliximab infusion. Although no causal relationship can be proven, it is prudent to suggest annual inactivated influenza vaccine for patients being treated with biologic agents. Patients should be encouraged to report any upper respiratory symptoms early.
Ongoing bioterrorism threats make smallpox vaccination for high-risk persons essential. A second-generation smallpox vaccine, ACAM2000, was approved by the US Food and Drug Administration in 2007. Although generalized vaccinia (GV) and benign cutaneous eruptions are well described following the old smallpox vaccine, risks with ACAM2000 remain unclear. In this case series, Beachkofsky et al review 8 cases of cutaneous reactions following ACAM2000 vaccination, confirming the first case of GV following this vaccine. In addition, 7 cases of a benign, acral, papulovesicular eruption were described. Immunohistochemical antibodies directed against vaccinia proteins may help identify deposits within biopsy specimens of these eruptions.
Epidermolysis bullosa (EB) is a group of genodermatoses characterized by excessive susceptibility of the skin to separate from underlying tissues following minimal mechanical trauma. While several EB registries exist, no epidemiologic or clinical data have previously been published for Australasian patients with EB. In this review of demographic and prognostic data obtained from the Australasian EB Registry, Kho et al verified that the nationwide prevalences of junctional EB (JEB) and dystrophic EB were consistent with those found in epidemiologic studies performed overseas. Epidermolysis bullosa simplex prevalence was lower, its milder phenotype possibly contributing to underreporting. The JEB-Herlitz type was associated with a higher infant mortality rate than in the United States, which may reflect parental wishes for nonaggressive management. Despite the limited number of JEB-Herlitz cases, this Australasian cohort remains one of the largest series ever reported to date.
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a rare plasma cell disorder. While the skin findings do not influence prognosis, their recognition helps confirm diagnosis. Many reports highlight the key pathologic role of elevated levels of serum vascular endothelial growth factor (VEGF-A). In this case series, Barete et al demonstrate that, despite some effect of VEGF-A levels in skin manifestations, the impact of lowered levels following autologous peripheral blood stem cell transplantation was weak. The authors suggest that facial lipoatrophy and livedo should be added to the skin manifestations of POEMS syndrome.
Folliculotropic mycosis fungoides (MF) is an uncommon MF subtype characterized by neoplastic lymphoid cell infiltration of the hair follicle. Folliculotropic MF may have a more aggressive natural history than other forms. In this case series, Lehman et al review the clinical and histopathologic features of folliculotropic MF cases seen over 12.5 years at the Mayo Clinic. Distinct clinical features and histopathologic findings are described. Folliculotropic MF was found to be less responsive to treatment than classic MF, with a relatively poor 5-year overall survival rate.
This Month in Archives of Dermatology. Arch Dermatol. 2010;146(6):597. doi:10.1001/archdermatol.2010.126