Oral isotretinoin is the only treatment approved by the US Food and Drug Administration for treatment of severe recalcitrant nodular acne. Several reports of inflammatory bowel disease (IBD) associated with isotretinoin use have been published. In this analysis, Popescu and Popescu critically examine 3 observational studies that provide the best available evidence to answer whether isotretinoin use is associated with IBD. The risk of ulcerative colitis, but not Crohn disease, seems to be increased in patients taking isotretinoin, but further studies will be needed to confirm this finding. Although the absolute risk is very small, dermatologists and patients should be aware of it and seek further evaluation in the setting of gastrointestinal tract symptoms.
Acute generalized exanthematous pustulosis (AGEP) is an adverse and potentially severe cutaneous reaction that usually occurs in response to drugs but may also be triggered by viral infections, UV irradiation, and heavy metal exposure. The onset of AGEP is rapid, often occurring hours to days following drug exposure. In this case report, Peermohamed and Haber describe a 25-year-old man who developed a widespread diffusely erythematous eruption with a positive Nikolsky sign, highlighting the fact that complicated clinical presentations may display features of both toxic epidermal necrolysis and AGEP. Skin biopsy confirmed AGEP, which carries an excellent prognosis once the precipitating agent is eliminated.
The mainstay of therapy for extramammary Paget disease (EMPD) remains surgical management, but alternatives for primary limited cutaneous EMPD in the anogenital region have been sought to avoid the cosmetic and functional defects associated with extensive tissue removal. In this case report, Green et al describe a case of genital in situ EMPD treated with the topical immunomodulator imiquimod cream, 5%, which has been reported to induce clinical and histologic resolution of EMPD. The condition proved refractory and progressed to invasive disease during treatment, highlighting the fact that refractory cases of presumed in situ EMPD may require further evaluation for an invasive component.
Reticular erythematous mucinosis (REM) is a rare cutaneous disease, most often affecting middle-aged women, that presents as persistent reticular or confluent erythematous papules and plaques that lack scale. It has been considered by some authors to belong to a spectrum of cutaneous lupus erythematosus–like skin changes. In this retrospective analysis of 11 patients with REM, Kreuter et al confirm the association of REM with concomitant autoimmune disorders and the effectiveness of antimalarial agents in treating this disorder.
Most commonly used for mildly or moderately atypical nevi, short-term sequential digital dermoscopy imaging allows detection of morphologic changes of melanocytic nevi over 3-month intervals. Virtually any morphologic change leads to excision of these nevi. In this retrospective cohort study, Menzies et al demonstrate that the only significant factor predicting change was patient age, with the elderly and children and adolescents showing a similarly higher likelihood of change, resulting in a poorer specificity for the diagnosis of melanoma.
This Month in Archives of Dermatology. Arch Dermatol. 2011;147(6):648. doi:10.1001/archdermatol.2011.130