High doses of vitamin A have been associated with adverse skeletal effects. Although most studies have not reported any detrimental effect of vitamin A intake on bone mineral density (BMD), it remains unclear whether high doses of vitamin A analogues, such as isotretinoin and acitretin, may have detrimental skeletal effects. In this large-scale, population-based, case-control study, Vestergaard et al find no trend in risk of any fractures with increasing doses or durations of treatment with vitamin A analogues. Although a decreased BMD has been reported with high doses of vitamin A, the decrease may not have been of such magnitude that bone biomechanical competence is altered.
Youthful indoor tanning is associated with melanoma and nonmelanoma carcinoma. Despite this, the tanning industry continues to promote itself as safe and even healthful. Skin cancer prevention efforts using appearance-focused messages have demonstrated consistent efficacy in convincing young people to reduce tanning. In this randomized controlled clinical trial in young women, Hillhouse et al demonstrate that an appearance-focused intervention is robust enough to reduce tanning behavior, even in individuals who report non–appearance-based tanning motives such as reduction of seasonal affective disorder symptoms.
Hidradenitis suppurativa (HS) is a debilitating disease characterized by follicular occlusion, painful abscesses, nodules, fistulas, and scarring. Consistently effective treatments are lacking, although anti–tumor necrosis factor (TNF) biologic agents have recently shown promise. In this randomized, prospective, double-blinded, placebo-controlled study, Adams et al demonstrate that subcutaneous etanercept, 50 mg, administered twice weekly does not have significant efficacy in improving HS over the course of 12 to 24 weeks. These data suggest that anti-TNF agents other than etanercept may be more effective in the treatment of HS.
Dissecting cellulitis of the scalp (DCS) is a rare inflammatory disease of the scalp that leads to scarring alopecia. As part of the follicular occlusion triad, DCS may be associated with acne conglobata and HS. Various treatments have proven disappointing. Because the pathogenetically related HS has responded favorably to TNF blocking agents such as adalimumab, Navarini and Trüeb sought to examine the usefulness of this agent in DCS. In this case series, adalimumab was rapidly effective, but continuous treatment was necessary to prevent relapse.
Over recent decades, the incidence of pediatric melanoma has markedly increased. The scalp has been added to the list of anatomic locations for “nevi with site-related atypia,” a subset of melanocytic nevi that share histologic features with melanoma but are benign. Opinions differ on appropriate management of clinically distinctive scalp nevi in children. In this descriptive study of the morphologic features and natural history of a subset of pediatric scalp nevi, Gupta et al demonstrate that scalp nevi are clinically dynamic in childhood, with over 77% of them showing signs of benign changes over a mean follow-up of 2.8 years. These preliminary data do not support excisional biopsy but do support physician evaluation of scalp nevi evolution and serial photography.
High-Dose Treatment With Vitamin A Analogues and Risk of Fractures. Arch Dermatol. 2010;146(5):471. doi:10.1001/archdermatol.2010.104