Dermatomyositis (DM) is an idiopathic inflammatory multisystem disorder that most commonly affects the proximal limb muscles and the skin. Characteristic cutaneous findings include heliotrope rash, Gottron papules, cuticular changes, poikiloderma, and a scaly alopecia. Despite the risks of toxic effects, systemic corticosteroids remain the mainstay of therapy. Steroid-sparing agents such as methotrexate, azathiaprine, cyclophosphamide, and cyclosporine have proven useful, and in this case series, Edge et al demonstrate the usefulness of mycophenolate mofetil in patients with DM for whom conventional treatments failed or caused significant toxic effects.
Classic urticaria is characterized by individual lesions that disappear within 24 hours. There can be identified a group of patients with urticarial papules and plaques in whom the individual lesions persist for longer. Biopsy specimens of these lesions typically reveal upper dermal perivascular lymphocytes and eosinophils without epidermal vesiculation or parakeratosis. Pathologists often term these features a dermal hypersensitivity reaction pattern. In this retrospective analysis, Kossard et al demonstrate that the term urticarial dermatitis defines a useful histologic and clinical subset of dermal hypersensitivity reactions.
Neutrophilic dermatosis of the dorsal hands (NDDH) presents as violaceous papulonodules on the radial aspects of the dorsal hands. Although this condition is characterized histologically by a brisk neutrophilic infiltrate and clinically by steroid responsiveness, it was originally classified as a pustular vasculitis. In this case series, Walling et al offer further support for the concept that NDDH represents a distributional variant of acute febrile neutrophilic dermatosis.
The clinical presentation of granuloma annulare (GA) is variable. Five distinct clinical forms of GA have been described previously: localized, generalized, subcutaneous, perforating, and patch type. In this case series, Brey et al describe an atypical clinical presentation of GA that is characterized by an acute onset, acral location, and pain. Although the clinical presentation was atypical in each of these cases, GA was confirmed histologically, highlighting the importance of the skin biopsy in the diagnosis of atypical cases.
Prolonged administration of oral corticosteroids is the mainstay of therapy for a number of severe dermatologic diseases, despite the risk of associated systemic toxic effects. In particular, patients are at risk for developing osteoporosis, and one fourth of patients undergoing long-term corticosteroid treatment may develop osteoporotic fractures. There is general agreement that these patients should receive calcium and cholecalciferol (vitamin D) supplementation. In addition, American College of Rheumatology guidelines recommend bisphosphonate therapy for patients taking more than 5 mg of prednisone daily. In this small cross-sectional chart review, Liu et al demonstrate a dramatic underutilization of bisphosphonates by dermatologists. Unless there is a specific contraindication, bisphosphonates should be prescribed concomitantly with systemic corticosteroids where long-term use is anticipated.
This Month in Archives of Dermatology. Arch Dermatol. 2006;142(1):10. doi:10.1001/archderm.142.1.10