The uncontrollable, excessive sweating of primary axillary hyperhidrosis may cause skin maceration, secondary infection, drenching of clothing, and social stigmatization. Botulinum toxin A blocks the autonomic innervation of the eccrine sweat glands and has become a useful treatment for this condition. Treatment is quite costly, and optimal dosing regimens have not been previously studied. In this randomized multicenter controlled trial, Heckmann and Plewig use gravimetric measurements of sweat production as well as subjective patient ratings and find no difference between 100 and 200 U side by side over the course of 96 weeks. They conclude that lower-dose regimens should be preferred for treating axillary hyperhidrosis.
Intense pulsed-light treatments are commonly used as a convenient, well-tolerated, nonablative therapy to improve pigmentary and textural changes as well as the telangiectasia associated with photoaged skin. In this prospective, randomized, controlled, split-face study, Dover et al demonstrate that the adjunctive topical use of the photosensitizer 5-aminolevulinic acid maximizes the efficacy of intense pulsed-light treatment without significantly altering the adverse effects. Despite the need to maintain strict sun avoidance after the procedure to limit redness, swelling, crusting, and pain, patients reported no lowered tolerability with the addition of 5-aminolevulinic acid.
Eosinophilic folliculitis (EF) is most commonly seen in the setting of human immunodeficiency virus (HIV) infection, where it commonly presents as recurrent crops of pruritic, sterile, follicular pustules on the head and trunk. It may develop in late-stage HIV disease, where it may identify patients at high risk of opportunistic infection. Eosinophilic folliculitis may also be seen during the initial phases of immune reconstitution with antiretroviral therapy (ART). In this retrospective cohort analysis, Rajendran et al demonstrate a close association between the initiation of ART and the onset of EF. The appearance of EF in this setting should not indicate a failure of ART but rather a complication of a rejuvenated immune response.
Characteristic follicular papules and pustules on the upper body of a patient with eosinophilic folliculitis.
Highly active antiretroviral therapy (HAART) has greatly improved the prognosis of human immunodeficiency virus 1 infection. As a result of using these regimens, many patients develop metabolic alterations and clinical lip dystrophy characterized by peripheral fat wasting, abdominal visceral fat accumulation, and facial lipoatrophy. The loss of subcutaneous fat in the face produces a stigmatizing cachectic emaciated appearance. In this case series, Burnouf et al demonstrate the long-term efficacy of structural autologous fat grafts to correct HAART-induced facial lipoatrophy.
Scleromyxedema, or generalized lichen myxedematosus, is a rare, idiopathic, fibromucinous disorder characterized initially by waxy papules on sun-exposed skin and later progressing to widespread and extracutaneous sclerosis. No uniformly successful treatment has been described for this chronic and potentially lethal disease. In this retrospective review of 6 cases, Lacy et al demonstrate that high-dose chemotherapy with peripheral blood stem cell rescue is feasible for patients with scleromyxedema. Although not curative, this regimen offered durable remissions in most patients and should be considered prior to treatment with alkylating agents that could adversely affect the ability to collect stem cells.
This Month in Archives of Dermatology. Arch Dermatol. 2005;141(10):1199. doi:10.1001/archderm.141.10.1199