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This Month in Archives of Dermatology
February 1, 2008

This Month in Archives of Dermatology

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Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Dermatol. 2008;144(2):152. doi:10.1001/archdermatol.2007.59
Prognosis of Unclassified Eczema

In clinical practice, a large number of eczematous dermatitis cases do not meet the criteria for known types of eczema and may be considered unclassified eczema (UE). In this cohort study with 1-year follow-up, Li et al observed patients with UE after patch testing. Patients were treated with emollients, topical corticosteroids, and systemic corticosteroids according to well-accepted methods, but the 1-year outcome was disappointing, with a clearance rate of only 15.1%. Undiagnosed allergic contact dermatitis may play a role in UE, and the authors suggest that a broader panel of contact allergens may more clearly elucidate the mechanisms of UE in these patients.

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Measures of Sun Exposure and Sun Protection Practices for Behavioral and Epidemiologic Research

Although skin cancer is one of the most preventable forms of cancer, incidence rates continue to rise. Careful measurement of sun protection behaviors and sun exposure patterns across multiple populations is essential for population surveillance and intervention research, yet no standard measure currently exists. In this collaborative project, Glanz et al developed a standardized set of core questionnaire items for cognitive testing across a diverse range of populations and suggest that a quantitative evaluation of these core items for internal consistency, test-retest reliability, and concurrent and criterion validity may augment their usefulness.

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Cutaneous and Ocular Signs of Childhood Rosacea

Rosacea is a chronic cutaneous condition of vasomotor instability characterized by central facial erythema, flushing, papules, pustules, and telangiectasia. Ocular symptoms may also be associated. Rosacea is rarely reported in children, and in this retrospective study of 20 children aged 1 to 15 years, Chamaillard et al describe the clinical cutaneous and ocular manifestations of rosacea in this population. The clinical features of childhood rosacea seem similar to those in adults, but ocular manifestations are frequently underdiagnosed or misdiagnosed, leading to ophthalmologic complications. If pediatric cutaneous rosacea is suspected, an ophthalmologic evaluation is necessary to detect ocular involvement and prevent complications such as keratitis and corneal ulcers.

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Pathologic Changes After Photodynamic Therapy for Basal Cell Carcinoma and Bowen Disease

Photodynamic therapy (PDT) is increasingly being used to treat nonmelanoma skin cancers. In this sequential histologic analysis of specimens obtained after PDT, Fantini et al compared routine histologic evaluation, immunohistologic panels of apoptotic and inflammatory markers, and electron microscopy studies. As soon as 15 minutes after PDT, diffuse epidermal damage was noted, with an immediate and intense inflammatory response. Single apoptotic cells were observed 1 hour after PDT, and ultimately massive destruction was observed in 1 to 2 days. Early activation of the apoptosis-inducing enzyme caspase-3 and the ultrastructural observations correlated well with these findings. Apoptosis appears to be the main effector mechanism leading to the PDT response.

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Toxic Epidermal Necrolysis Due to Zonisamide Associated With Reactivation of Human Herpesvirus 6

Recent reports have described a close relationship between human herpesvirus 6 (HHV-6) reactivation and drug-induced hypersensitivity syndrome (DIHS). Because HHV-6 reactivation has not been previously reported to be associated with other types of drug eruptions, it is thought to be the most important diagnostic marker for DIHS because it is reliable and easy to determine on a routine basis. In this case report, Teraki et al describe a 71-year-old man who developed toxic epidermal necrolysis 3 weeks after initiation of zonisamide therapy for a seizure disorder. Virologic examination revealed marked elevation of serum HHV-6 IgG antibody titers and HHV-6 DNA levels in whole blood samples, suggesting that HHV-6 reactivation may be detected in drug reactions other than DIHS.

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