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This Month in Archives of Dermatology
November 2006

This Month in Archives of Dermatology

Author Affiliations
 

ROBIN L.TRAVERSMD

Arch Dermatol. 2006;142(11):1398. doi:10.1001/archderm.142.11.1398
Malignant Melanoma in Marathon Runners

Marathon running has surged in popularity over the past decades as a form of exercise. Although regular exercise is recommended to improve an individual's health, there are risks associated with endurance sports. In this study of marathon participants, Ambros-Rudolph et al demonstrated that marathon runners showed significantly more atypical melanocytic nevi and more solar lentigines than age- and sex-matched controls, and the referral rate for surgical removal of skin lesions suggestive of nonmelanoma skin cancer was higher in marathon runners than in control subjects. Marathon runners are exposed to UV light during training and competition, and sweating increases the photosensitivity of the skin, increasing the risk of sunburn. Cumulative high-intensity training may lead to depressed immunosurveillance that may also render the endurance athlete more susceptible to skin cancer development.

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Successful Treatment of Mucous Membrane Pemphigoid With Etanercept in 3 Patients

Mucous membrane pemphigoid (MMP), also known as cicatricial pemphigoid, is a heterogeneous group of rare, autoimmune, subepithelial blistering diseases that put patients at risk for blindness as well as stenosis of the nasopharynx, trachea, and other mucosal surfaces. A wide variety of therapeutic options exist, but there is no gold standard. Chronic overproduction of tumor necrosis factor α has been implicated in the pathogenesis of MMP. In this case series, Canizares et al demonstrate the efficacy and safety of etanercept, an anti–tumor necrosis factor α agent, in treating this potentially devastating disease.

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A Comparison of Oral Methylprednisolone Plus Azathioprine or Mycophenolate Mofetil for the Treatment of Pemphigus

Pemphigus is an acquired bullous autoimmune disorder of skin and mucous membranes in which autoantibodies directed against epidermal cadherins lead to loss of cell-cell adhesion. Corticosteroids remain the mainstay of pemphigus therapy because they are the only agents that rapidly inhibit new blister formation. Adjuvant immunosuppressants are commonly used to reduce the cumulative steroid dose and the potential adverse effects. In this prospective, multicenter, randomized, nonblinded clinical trial, Beissert et al demonstrate that mycophenolate mofetil and azathioprine are equally effective and safe as steroid-sparing adjuvants when used to treat both pemphigus vulgaris and pemphigus foliaceous.

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Imiquimod Treatment of Anal Intraepithelial Neoplasia in HIV-Positive Men

The pathogenesis of anal cancer is linked to persistent infection with high-risk human papillomavirus (HPV) subtypes such as HPV16 or HPV18. Men testing positive for HIV have a strongly increased risk for anal cancer and its precursor lesion, anal intraepithelial neoplasia (AIN), both of which are associated with a high prevalence of HPV infection. In this prospective, nonrandomized, open-label pilot study, Wieland et al demonstrate that many HIV-positive men with AIN achieved clinical and histologic clearance of AIN at the end of 16 weeks of topical imiquimod application 3 times weekly. Although a sharp decline of HPV DNA loads was observed, long-term HPV clearance was rarely achieved.

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Livedoid Vasculopathy

Livedoid vasculopathy is a chronic recurrent disease characterized by focal purpura that progresses to shallow ulcerations accompanied by atrophie blanche. In this retrospective review of 45 patients, Hairston et al describe the clinical and histopathologic features, laboratory abnormalities, and comorbid conditions that are associated with livedoid vasculopathy. These data lend support to the concept that livedoid vasculopathy represents the end result of multiple disease processes accompanied by thrombogenic factors.

Endothelial proliferation, hyalinized vascular change, and thrombosis of upper reticular dermal blood vessels (hematoxylin-eosin, original magnification ×200.)

Endothelial proliferation, hyalinized vascular change, and thrombosis of upper reticular dermal blood vessels (hematoxylin-eosin, original magnification ×200.)

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