ROBIN L. TRAVERSROBIN L. TRAVERSMD
Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. Early-stage MF often responds well to daily applications of topical mechlorethamine, although cutaneous intolerance is a frequent and major adverse reaction that often leads to discontinuation of therapy. In this nonrandomized prospective study, de Quatrebarbes et al demonstrate that a therapeutic regimen of twice-weekly applications of mechlorethamine in combination with topical corticosteroids could be an effective treatment regimen for early-stage MF. Not only was the decreased frequency of application simpler for patients, but it also reduced the incidence of severe cutaneous intolerance reactions.
Standard punch biopsy technique involves closing the surgical wound with nonabsorbable suture material, requiring time and cost for both suture placement and removal. In this prospective, randomized study, Christenson et al demonstrated the equivalence of clinical outcomes with second-intention healing and primary closure of punch biopsy sites. Allowing punch biopsy sites to heal by second intention can help patients avoid activity restrictions associated with a sutured wound as well as the inconvenience of returning for suture removal.
Atopic dermatitis is a common inflammatory skin disease that is associated with several humeral and cellular immunological aberrations. Many treatments for atopic dermatitis affect cutaneous immunosurveillance and might be expected to increase the risk for skin cancer, although the treatment risk is considered small. In this register-based retrospective cohort study of patients with atopic dermatitis, Hagströmer et al demonstrate a slightly elevated relative risk for lung, brain, esophageal, and pancreatic cancer as well as lymphoma. A 2-fold elevation of nonmelanoma skin cancer risk was also observed among men.
Antibiotic overuse has been associated with the emergence of resistant organisms, increased frequency of human exposure to pathogenic organisms, and an increase in infectious illnesses. There are very few natural models of truly long-term antibiotic use. In this retrospective cohort analysis, Margolis et al use acne vulgaris as a model of a disease for which long-term topical and systemic antibiotic use is standard and appropriate therapy. Acne patients on long-term antibiotic therapy were found to be more likely to develop an upper respiratory tract infection than those with acne who were not treated with antibiotics. Patients and physicians will need to balance the risk of these infections with the benefits of acne therapy.
Primary cutaneous marginal zone B-cell lymphomas (PCMZLs) are low-grade B-cell malignancies presenting in the skin with no evidence of extracutaneous localizations at the time of diagnosis. Initial studies on PCMZLs emphasized their indolent behavior, but more recent studies have documented extracutaneous dissemination and mortality associated with this disease. In this retrospective analysis of 50 patients with PCMZL, Hoefnagel et al confirm the excellent prognosis of PCMZL and outline a therapeutic strategy for solitary or multifocal disease.
Two presentations of PCMZL: A, a solitary nodule on the right upper arm area; B, localized nodules in the knee cavity.
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(9):1069. doi:10.1001/archderm.141.9.1069