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This Month in Archives of Dermatology
December 2005

This Month in Archives of Dermatology

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Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Dermatol. 2005;141(12):1501. doi:10.1001/archpedi.161.4.356
Targeted UV-B Phototherapy for Plaque-type Psoriasis

The action spectrum for psoriasis clearing lies within the 300- to 313-nm range. Although total-body narrowband UV-B phototherapy has been shown to be useful in the treatment of psoriasis, the fluence is limited by the sensitivity of uninvolved skin. The 308-nm excimer laser is useful for delivering narrowband UV-B radiation precisely to psoriatic lesions, but the cost of this device precludes its use in economically disadvantaged settings. In this randomized controlled trial of 14 patients with stable, localized, plaque-type psoriasis, Asawanonda et al demonstrate the safety and efficacy of an incoherent, targeted, UV-B phototherapy light source at doses ranging from 1 to 6 minimal erythema doses.

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Impact of Obesity and Smoking on Psoriasis Presentation and Management

The Utah Psoriasis Initiative is a prospective study designed to characterize phenotypic features of patients with psoriasis and their family members. In this cross-sectional study, Herron et al used these data to evaluate the impact of obesity and smoking on the natural history of psoriasis. Patients with psoriasis were found to have a higher prevalence of obesity, but obesity did not appear to trigger the onset of the disease. Rather, psoriasis appeared to have a causal effect on obesity. Smoking, on the other hand, did appear to play a role in the onset of psoriasis. These data carry implications for the future burden of these comorbidities as they relate to health care costs associated with psoriasis treatment.

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Skin Excision and Osteophyte Removal Is Not Required in the Surgical Treatment of Digital Myxoid Cysts

Digital myxoid cysts arise as a result of joint fluid leaking from the underlying distal interphalangeal joint (DIPJ). Surgical therapeutic options include cyst removal with or without excision of osteophytes on the adjacent DIPJ. In this prospective study of 32 patients, Lawrence demonstrates a 92% cure rate on the fingers with no joint limitation, tenderness, visible scarring, or permanent nail dystrophy by raising a proximally based flap to include the cyst and the tissues between the DIPJ and the cyst. Relapse was common on the toes.

Image not available

Two posterior nail fold digital myxoid cyst treatment stages. A, Preoperative view showing the cyst at the distal margin of the right middle finger posterior nail fold with associated rippled dystrophy of the adjacent nail. B, Postoperative view after the tourniquet was removed, hemostasis established, and the flap resited and sutured into place.

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Two Brothers With Mild Congenital Erythropoietic Porphyria Due to a Novel Genotype

Congenital erythropoietic porphyria (CEP), or Günther disease, is caused by an inborn error of heme biosynthesis that results from the markedly deficient activity of uroporphyrinogen III synthase. The subsequent elevated levels of the nonphysiologic and phototoxic porphyrin I isomers may cause massive hemolysis and phototoxic effects, but there is significant phenotypic heterogeneity in the severity of the clinical presentation. In this case report, Berry et al describe 2 brothers with a mild CEP phenotype and a previously unreported genotype for this disease, highlighting the fact that in vitro enzyme expression studies can correlate genotype with phenotype.

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Soak and Smear: A Standard Technique Revisited

Common inflammatory skin conditions such as atopic dermatitis, nummular eczema, chronic hand dermatitis, and palmoplantar psoriasis may all be characterized by a compromised skin barrier function. Despite the general agreement that moisturization and occlusive therapy are effective, patients find these techniques messy and time-consuming. In this retrospective study, Gutman et al demonstrate substantial subjective and objective improvement in 28 patients with refractory chronic pruritic eruptions who were educated extensively regarding the use of the “soak and smear” technique that incorporates 20 minutes of soaking followed by topical corticosteroid application. An important component of this regimen was the implementation of a maintenance phase.

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