Chronic idiopathic urticaria (CIU) is often diagnosed clinically because extensive diagnostic testing fails to reveal a cause. Many patients have associated angioedema. Unanticipated health care visits and aggressive therapies contribute substantially to disease burden and diminish health-related quality of life. In this survey-guided and retrospective medical chart review, DeLong et al sought to estimate annual direct and indirect health care costs from a societal perspective in patients with CIU. High medication costs were found to be the largest component of total health care costs (63%), while indirect costs, such as missed work or school, accounted for 16%. These data underscore the impact of medication costs in predominantly outpatient diseases, and the work serves as a model for other cost-accounting studies of other dermatologic conditions.
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Many dermatologists use a standard series of allergens for patch testing as the primary diagnostic tool in allergic contact dermatitis. In this retrospective study of results of patch testing with a standard series over a 5-year period, Davis et al demonstrated that allergic patch test reaction rates were significantly higher for nickel, markers of fragrance allergy, and some preservatives than in previous reports. The need for use of a broad and dynamic standard patch test series is emphasized by these data.
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Amiodarone is widely used in the treatment of cardiac arrhythmias. Although amiodarone photosensitivity is common, the characteristic blue-gray cutaneous hyperpigmentation in sun-exposed areas occurs in less than 10% of treated patients. This pigmentation occurs mainly in patients of skin type I after 20 months of continuous treatment and has been attributed to lipofuscin deposition. In this case report, Ammoury et al used electron microscopy to demonstrate that lipofuscin was absent in a 64-year-old man with amiodarone-induced cutaneous pigmentation. High-performance liquid chromatography demonstrated that the pigmentation was instead related to drug deposition.
Blue-gray amiodarone hyperpigmentation of the face.
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Treatments for atopic dermatitis include anti-inflammatory agents, immune modulators, phototherapy, and emollients. Peroxisome proliferator-activated receptors (PPARs) are nuclear hormone receptors that have been recently linked to several genes involved in inflammation. These may reduce inflammatory mediators in the skin and regulate epidermal barrier homeostasis. In this retrospective review, Behshad et al demonstrated the safety and efficacy of rosiglitazone, a PPAR agonist, in 6 cases of severe atopic dermatitis that were unresponsive to first- and second-line therapies. These data suggest that the potential role of rosiglitazone in the treatment of atopic dermatitis merits further study in controlled trials.
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Pemphigus vulgaris (PV) is an autoimmune vesicobullous disorder for which glucocorticoid treatment remains a first-line therapy. Several immunosuppressant steroid-sparing regimens have been reported useful in case series. In this randomized, placebo-controlled study, Werth et al demonstrated a trend to efficacy of dapsone as a steroid-sparing agent in maintenance-phase PV. This inexpensive and relatively nontoxic drug represents an appropriate adjunctive therapy for patients with steroid-dependent PV.
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This Month in Archives of Dermatology. Arch Dermatol. 2008;144(1):15. doi:10.1001/archdermatol.2007.23