In severe drug-induced eruptions, bullous lesions can be associated with immune complex–mediated vasculitis or T-lymphocyte–mediated (TLM) keratinocyte apoptosis. In addition, endothelial cell apoptosis has been identified in severe bullous TLM drug eruptions. In this ultrastructural study of skin biopsy specimens obtained from 32 patients with TLM drug eruptions, Verneuil et al identify endothelial cell apoptosis in all cases. The relations between the skin apoptotic endothelial cell numbers and cases of systemic involvement in toxic epidermal necrolysis/Stevens-Johnson syndrome and drug rash with eosinophilia and systemic symptoms cases were highly significant, suggesting the possibility that skin endothelial cell apoptosis might reflect systemic endothelial cell involvement.
Atopic dermatitis (AD) is a common form of chronic eczematous dermatitis that typically begins in infancy or childhood and continues on a waxing-waning course into adulthood. Ocular sequelae are common, including subcapsular cataracts, herpes simplex, conjunctivitis, keratoconus, and retinal detachment. In this case report, Bair et al emphasize that, while anterior subcapsular cataracts are more specific to AD, posterior subcapsular cataracts (PSCs) are more common. Risk factors for PSC development include infantile AD onset, family history of atopy, systemic corticosteroid use, and elevated lipid peroxide levels. Dermatologists caring for patients with AD are encouraged to refer these patients for ophthalmologic monitoring.
Papular mucinosis (PM) is an idiopathic cutaneous mucinosis characterized by lichenoid papules, nodules, and plaques due to mucin deposition. The Rongioletti classification scheme recognizes 3 clinicopathologic subtypes, of which the localized form is further subdivided into 5 additional sub-subtypes. In this case report, Wang et al describe a patient with localized PM confined to the neck who later developed IgA nephropathy, highlighting the fact that some cases of PM cannot be well classified in the Rongioletti scheme. A new classification subtype is suggested to take into account similar cases.
Mycosis fungoides (MF) is an extranodal non-Hodgkin lymphoma of CD4+ T-cell origin with primary cutaneous involvement. The heterogeneous cutaneous presentations of MF include pruritic patches and plaques in early stages and cutaneous tumors or erythroderma in more advanced stages. Despite the wide spectrum of therapeutic options, MF remains largely incurable: treatment goals include palliation of symptoms and decreasing the risk of extracutaneous spread. In this retrospective study, Navi et al demonstrate that total skin electron beam therapy is highly effective in treating T2 and T3 MF and that adjuvant topical nitrogen mustard treatment confers no added benefit.
It is widely recognized in dermatology that the unique feature of many “new” drugs resides in incremental changes such as a new vehicle, a new concentration of the active agent, or even a new combination of known active ingredients. Remarkably few drugs with new molecular entities (NMEs) are developed primarily for dermatologic conditions. In this systematic review and analysis, Eaglstein and Corcoran identify the major factors precluding NME development for dermatologic disease. One major reason that few companies undertake the development of dermatologic NMEs is that the economic return from dermatologic drugs is relatively small compared with, for example, cardiovascular drugs, where “blockbuster” drugs remain the focus of “big Pharma.”
This Month in Archives of Dermatology. Arch Dermatol. 2011;147(5):535. doi:10.1001/archdermatol.2011.101