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This Month in Archives of Dermatology
August 16, 2010

This Month in Archives of Dermatology

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Arch Dermatol. 2010;146(8):828. doi:10.1001/archdermatol.2010.185
Risk Factors for Single and Multiple Basal Cell Carcinomas

Basal cell carcinoma (BCC) continues to be the most common cancer in people of European ancestry. Although treatment is relatively straightforward and mortality rates are low, the high incidence and risk of developing multiple BCCs put a major burden on health care resources. Individual risk factors for BCC include age, male sex, race, phenotypic characteristics, and genetic predisposition. In this prospective, population-based cohort study, Kiiski et al demonstrate that individuals who developed a first BCC after age 75 years were less likely to develop multiple BCCs. Younger patients, and those with red hair, high educational level, and a first BCC on the upper extremity had an elevated risk of multiple BCCs and required closer follow-up over time.

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The Effect of Narrowband UV-B Treatment for Psoriasis on Vitamin D Status During Wintertime in Ireland

Abnormalities in vitamin D metabolism may play a role in the pathogenesis of psoriasis. Narrowband UV-B (NB–UV-B) treatment has become standard phototherapy for psoriasis, and its effect on vitamin D status may account for some of the benefit. This prospective controlled study of patients receiving NB–UV-B treatment 3 times weekly in the wintertime demonstrated that serum 25-hydroxyvitamin D [25(OH)D] increased during the course of therapy as psoriatic lesions improved. The number of exposures was the sole predictor of increased 25(OH)D levels. No correlation between increased 25(OH)D levels and treatment response was observed, suggesting that improvements in vitamin D status and psoriasis are contemporaneous, but unrelated, consequences of NB–UV-B therapy.

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Lipoatrophic Panniculitis

Lipoatrophic panniculitis is a rare disease of childhood characterized by a distinctive eruption of tender erythematous nodules and plaques followed by striking circumferential bands of lipoatrophy on the arms or legs. In this case report, Shen et al describe a previously healthy 8-year-old boy with this condition who was treated with a combination of prednisone, hydroxychloroquine, and methotrexate. Although the cutaneous disease progression was nearly halted, lower leg pain and radiographically demonstrated bone changes persisted.

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Advanced Biological Therapies for Diabetic Foot Ulcers

Foot ulceration is a major complication of diabetes. Improved and faster healing of diabetic foot ulcers (DFUs) has been shown to reduce the incidence of amputation. Current therapies for DFUs include off-loading, debridement, restoration of skin perfusion, and advanced biological therapies such as autologous growth factors, recombinant growth factors, and bioengineered cell-based therapies. In this retrospective cohort study, Kirsner et al analyze clinical utilization patterns and comparative outcomes of advanced biological therapies in a real-world clinical setting. While there were differences among the various therapies, the earlier an advanced biological therapy was initiated, the sooner the DFU was likely to heal.

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Confocal Laser Scanning Microscopy vs 3-Dimensional Histologic Imaging in Basal Cell Carcinoma

Micrographic surgery is the gold standard treatment for basal cell carcinomas (BCCs) of the face. Careful processing and frozen section evaluation can identify the tumor at the margins, allowing the surgeon to remove and examine additional tissue until the margins are clear. Ex vivo confocal laser scanning microscopy (CLSM) is a new procedure that may offer an alternative to using frozen histologic specimens. Immediately after the tumor is excised, CLSM images of the fresh tissue can be scanned. In this prospective trial, Ziefle et al found CLSM to lack high enough sensitivity to detect small tumor strands of BCC, but future refinements may offer a time- and cost-saving alternative to cryostat histopathologic analysis.

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