Behavioral changes could prevent most skin cancers, yet health-based educational interventions alone have had only limited success in motivating the necessary changes. Interventions that emphasize the negative appearance-related consequences of UV exposure may be more effective than health warnings alone. In this randomized controlled trial, Mahler et al demonstrate that individuals who received information about photoaging and were shown their UV facial photographs developed stronger intentions than controls to protect themselves from the sun, were more likely to report subsequently using sun protection, and were more likely to have used the provided sunscreen sample.
Bexarotene is a novel third-generation retinoid X receptor–selective retinoid currently approved for the treatment of early and advanced cutaneous T-cell lymphoma (CTCL), although the molecular mechanism of action remains unclear. In this case series, Budgin et al examined the peripheral blood mononuclear cells from 9 patients with Sézary syndrome. Apoptosis of cultured malignant T-cells was demonstrated in a dose-dependent response to bexarotene at clinically relevant concentrations. In addition, decreased interleukin (IL) 4 production correlated with apoptosis, while no change or increased IL-4 production correlated with resistance to apoptosis, which suggests that bexarotene may also act through down-regulation of type 2 helper–T-cell cytokines.
Sebum production is a major pathophysiologic factor in acne. The effects of hormones on this process are incompletely understood. Growth hormone and insulin-like growth factor 1 (IGF-1) may play roles in the physiologic characteristics of sebaceous glands, and in this case-control study, Cappel et al demonstrate that the total number of acne lesions, both inflammatory and comedonal, were correlated with serum IGF-1 levels in adult women. Dehydroepiandrosterone sulfate and dihydrotestosterone levels also correlated with acne lesion counts. These data suggest an avenue of study for the development of acne therapies that down-regulate or block receptor signaling in a tissue-specific manner.
Psoralen plus UV-A (PUVA) has become one of the preferred therapeutic options for CTCLs, despite a wide range of short- and long-term adverse effects. Several studies have confirmed high remission rates in the early stages of CTCL, but few data exist regarding the long-term course of PUVA-treated patients with CTCL. In this single-center retrospective cohort analysis, Querfeld et al demonstrate that PUVA monotherapy can induce long-term remissions from CTCL, and perhaps in some cases the disease may be considered “cured.” Dose and duration of PUVA therapy may affect disease-free survival, and therefore the risk of photodamage must be weighed against the potential benefit of greater disease suppression.
Mycosis fungoides (MF) is the most common type of CTCL. In many patients with limited disease, CTCL has an indolent course, and patients often have a normal life expectancy. Although neutrophilic dermatosis (ND) has been associated with various hematologic disorders, this condition occurs only rarely with CTCL. In this case series of 3 patients with MF who developed ND, the dermatosis was resistant to conventional therapies and histologically exhibited marked pilotropism and syringotropism. Also, ND was associated with a poor prognosis regardless of the initial MF staging. The triggering role of interferon alfa is postulated for ND.
Plaques from case 2 suggesting Sweet syndrome (edema over a plaque of mycosis fungoides).
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(3):293. doi:10.1001/archpedi.161.4.356