Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007
Extracorporeal photochemotherapy (ECP), or photopheresis, is a therapeutic approach based on the biological effect of 8-methoxypsoralen (8-MOP) and UV-A light on mononuclear cells collected by apheresis and reinfused into the patient. Extracorporeal photochemotherapy has been used to treat cutaneous T-cell lymphoma as well as T-lymphocyte–mediated diseases. Clinical complications related to ECP are uncommon because of the relatively rapid elimination of the drug. In this case study, Vagace et al describe a patient with Sézary syndrome who developed retinal toxic effects following ECP related to unexplained extremely durable levels of plasma psoralen, possibly related to a genetic defect altering the genes involved in 8-MOP metabolism or transport.
The appearance of photoaged skin, characterized by wrinkles and brown spots, can be improved with the use of topical retinoids. Intrinsically aged skin is characterized by thinness, laxity, fine wrinkling, fragility, and impaired wound healing. In this double-blinded, randomized, vehicle-controlled trial, Kafi et al demonstrated that topical retinol was well tolerated among elderly patients and produced significant improvement in fine wrinkles after 24 weeks, possibly related to glycosaminoglycan induction. With greater skin matrix synthesis, retinol-treated intrinsically aged skin may be not only cosmetically improved but also more likely to withstand skin injury.
Treatment of moderate to severe psoriasis remains challenging, and therapeutic options such as UV phototherapy or systemic therapies are complex and have safety concerns that limit long-term use. In this prospective, randomized, controlled trial of 4 parallel groups, Schiener et al demonstrate that warm-water bath followed by exposure to UV-radiation and saltwater bath followed by UV-B phototherapy are superior to tap-water phototherapy or UV-B irradiation alone. No significant difference between warm-water bath followed by exposure to UV-radiation and saltwater bath followed by UV-B phototherapy was found.
Therapeutic options for vitiligo include potent topical steroids, calcipotriol and tacrolimus, cosmetic camouflage, melanocyte transplantation, skin grafting, pseudocatalase, and psychological therapy. These often produce an unsatisfactory response. In this double-blind, randomized trial of psoralen–UV-A vs narrowband–UV-B phototherapy, Yones et al found narrowband UV-B to be superior in the treatment of nonsegmental vitiligo with respect to percentage improvement, color match in the repigmented skin, and adverse effect profile.
Most fluoroscopy-guided diagnostic studies and interventional therapeutic procedures do not result in perceptible radiation-induced skin injury. Fluoroscopy-induced chronic radiation dermatitis (FICRD) is a rare consequence of these procedures. Patients may present with cutaneous findings months or even years after fluoroscopy, thus obscuring the temporal relationship to the original procedure. Also confounding the diagnosis is a lack of patient awareness of the use of ionizing radiation, particularly in cardiac procedures. In this case report, Frazier et al highlight the clinical and histopathologic findings, particularly with respect to the site where lesions appear, that can alert the dermatologist to the diagnosis of FICRD. If patients are unaware of previous radiation exposure, dermatologists are encouraged to obtain further information from hospital records or other physicians with regard to this history.
A 15 × 15-cm telangiectatic patch on the left posterior shoulder over the scapula.
This Month in Archives of Dermatology. Arch Dermatol. 2007;143(5):568. doi:10.1001/archderm.143.5.568