The hypothalamic-pituitary-adrenal axis may be suppressed by topical steroids to an extent related to the potency of the steroid, the frequency of application, body surface area, and the skin's barrier function. In this multicenter, multiple-dose, open-label study, Schlessinger et al investigated the systemic and topical safety of a new super high–potency formulation of fluocinonide cream, 0.1%, in pediatric patients with clinically diagnosed atopic dermatitis. For a 2-week course of therapy, once-daily application was found to be as effective as twice-daily application, with no hypothalamic-pituitary-adrenal axis suppression.
The term cutaneous lymphoid hyperplasia (CLH) has been used to describe the benign end of the spectrum of cutaneous lymphoproliferative disorders, with cutaneous lymphoma at the malignant end. Most commonly presenting on the face, CLH consists histologically of a mixture of B and T lymphocytes. In this case series, Bergman et al demonstrate that with solitary facial CLH, the differentiation between pseudolymphoma and lymphoma may prove difficult. Although spontaneous regression following incisional biopsy may be a reassuring finding, careful clinical follow-up is warranted.
Cutaneous leishmaniasis caused by Leishmania tropica or by Leishmania major is endemic in Iran. A papule appears at the feeding site of the sand fly, which later develops into an ulcer with a violaceous border. Although the lesions heal spontaneously, it may take weeks to months to do so, and there is usually significant scarring. Systemic pentavalent antimonials remain the standard therapy for cutaneous leishmaniasis, despite the discomfort, toxic effects, and expense of these medications. Imiquimod has recently been shown effective in the treatment of an experimental model of leishmaniasis. Unfortunately, in this prospective, randomized, blinded, placebo-controlled trial, Firooz et al demonstrate that the addition of topical imiquimod cream, 5%, to a standard course of meglumine antimoniate had no beneficial effect.
The number of cutaneous melanocytic nevi an individual has is one of the strongest phenotypic risk factors for the development of melanoma. The pattern and timing of solar exposure, with respect to both UV and visible spectrum regions, may be a factor in the development of such nevi. Visible light phototherapy remains the treatment of choice for neonatal hyperbilirubinemia. In this exposed-nonexposed study of 58 children, Matichard et al demonstrate that nevus counts in 8- and 9-year-old children were significantly higher in those with a history of neonatal phototherapy. These data suggest that these children should be targeted for prevention and surveillance.
Halo nevi are benign melanocytic nevi surrounded by a macular rim of depigmentation resembling a halo. They may progressively involute over the course of years, with subsequent total regression of the central nevus. In this retrospective study, Kolm et al reviewed digital dermoscopic images of halo nevi and classified them according to dermoscopic morphologic criteria. Halo nevi were found to be relatively common, and a benign globular and/or homogeneous pattern was the most typical dermoscopic feature noted. Only 2 melanomas were observed with an encircling halo, but in both cases, clear-cut dermoscopic features of melanoma were observed.
This Month in Archives of Dermatology. Arch Dermatol. 2006;142(12):1545. doi:10.1001/archderm.142.12.1545