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In This Issue of JAMA Dermatology
January 2017


JAMA Dermatol. 2017;153(1):3. doi:10.1001/jamadermatol.2016.1650

Cutaneous melanoma practice guidelines recommend that high-risk patients get regular surveillance and education about skin self-examination and sun protection. In this population-based study, Watts et al demonstrate that the age at diagnosis was lower for patients with a family history or many nevi. Melanoma more commonly occurred on the trunk for those with many nevi, on the limbs for those with a family history, and on the head and neck for those with a previous melanoma. These data suggest that a patient’s melanoma risk factor status could be used to tailor screening and primary prevention interventions.

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Bullous pemphigoid (BP) is the most frequent autoimmune blistering disease. The presence of IgE autoantibodies against the transmembrane protein BP antigen (BP180) has been reported in BP serum samples. In this case-control cohort study, van Beek et al demonstrate that although anti-BP180 IgE levels were not of diagnostic importance, they were correlated with disease activity in some patients and may help identify patients with BP who are suitable candidates for anti-IgE therapy.

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Tuberous sclerosis complex (TSC) is an autosomal dominant inherited disorder characterized by systemic hamartomas, epilepsy, cognitive impairment, and hypopigmented macules. Inhibitors of mammalian target of rapamycin complex 1, such as sirolimus, effectively target skin lesions in TSC, such as facial angiofibromas. However, systemic sirolimus is associated with adverse effects. In this double-blind, placebo-controlled, randomized clinical trial, Wataya-Kaneda et al demonstrate that topical sirolimus gel was safe and effective for facial angiofibromas in TSC, at an optimal concentration of 0.2%.

Continuing Medical Education

Prescription underuse is associated with poorer clinical outcomes. A significant proportion of underuse is due to primary nonadherence, defined as the rate at which patients fail to fill and pick up new prescriptions. Although electronic prescribing increases coordination of care and decreases errors, it might seem intuitive that primary nonadherence would increase by removing the patient from the prescription-to-pharmacy routing process. In this retrospective review, Adamson et al demonstrate that electronic prescriptions for dermatologic medications were associated with less primary nonadherence than paper prescriptions. Number of prescriptions, language, race/ethnicity, and age were associated with increased rates of primary nonadherence.

Until recently, no ideal, valid, feasible, and reliable scar scale existed to effectively assess the quality of postoperative linear scars. The Scar Cosmesis Assessment and Rating (SCAR) scale was developed and validated as a tool to assess the quality of postoperative scars in clinical and research settings. In this study, Kantor demonstrates the reliability of using photographs in lieu of live patient scar rating assessments, suggesting that the SCAR scale could become the new standard outcome measure for postoperative scar quality.