There remains a lack of epidemiologic evidence for an association between isotretinoin therapy and depression. Despite this, widely publicized anecdotal reports continue to fuel concerns among patients regarding the potential psychiatric adverse effects of this powerful acne medication. In this prospective cohort study, Chia et al assessed depressive symptoms among patients treated with either isotretinoin or maximal conservative therapy. A decrease in depressive symptoms was demonstrated among patients in both treatment groups.
Anecdotal reports suggest that psoriasis tends to improve during pregnancy. Hormonal changes in pregnancy may play a role in improving psoriasis by promoting a state of immune tolerance. In this prospective case-control series, Murase et al investigated how psoriasis fluctuates during pregnancy and the postpartum period and correlated progesterone and estrogen levels in pregnancy with psoriatic change. This study confirms prior retrospective studies, indicating that pregnant patients with psoriasis are more likely to improve. Increased estrogen levels relative to progesterone correlated with psoriatic improvement.
In the past decade, there has been an increase in the number and complexity of dermatologic procedures performed on infants and children. Laser treatment of vascular lesions and surgical excision of congenital lesions may require general anesthesia if children are too young to fully cooperate with local anesthesia. Limited data exist regarding the safety and risk of complications associated with the use of general anesthesia in pediatric dermatologic surgery. In this multicenter retrospective review of the complications associated with general anesthesia in 881 pediatric dermatologic procedures, Cunningham et al demonstrate that the use of general anesthesia is safe and that the risk of complications is low. No serious adverse events were noted, and the mortality rate was 0%.
Most first-line therapies for warts, such as topical salicylic acid, cryotherapy, excision, carbon dioxide laser treatment, and bleomycin injection, are destructive in nature. Various methods have also been used to provoke an immunologic response to the human papillomavirus (HPV), including contact sensitization, topical imiquimod, intralesional interferon, and intralesional antigen injections. In this randomized, blinded, placebo-controlled trial, Horn et al document the clinical efficacy of intralesional immunotherapy using mumps, Candida, and Trichophyton skin test antigens with and without interferon alfa-2b. Their repeated observation that untreated warts resolve after injection of only 1 wart suggests that intralesional immunotherapy induces HPV-directed immunity and may be particularly useful in patients with numerous lesions or a large surface area involved.
Bites of Loxosceles spiders, such as the brown recluse, are capable of inducing extensive skin necrosis. Several therapies have been advocated, but the applicability of previous data to real-life envenomation has been unclear because most studies have failed to recreate the expected delay in onset of treatment. In this study using a rabbit model, Elston et al administered therapeutic agents following a 2-hour delay after envenomation to better mimic real-life circumstances. Colchicine, dapsone, triamcinolone, and diphenhydramine were ineffective in reducing eschar size or preventing coagulopathy.
Brown recluse spider, Loxosceles reclusa, with a US quarter for scale.
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(5):543. doi:10.1001/archderm.141.5.543