The systematic review by Khumalo et al of 6 randomized controlled trials of bullous pemphigoid therapy emphasizes the difficulty of making precise recommendations in the near absence of reliable data from such trials. This review suggests that a less aggressive approach, tending toward lower doses of systemic corticosteroids, may be adequate therapy and associated with less morbidity and mortality than higher-dose regimens.
In this longitudinal study of the determinants of self-reported compliance with dermatologic therapies, almost 400 dermatologic outpatients were surveyed by telephone regarding their overall satisfaction with their care and compliance with prescribed treatment regimens. Overall satisfaction with care was associated with a high degree of compliance, whereas psychiatric comorbidity predicted diminished compliance. Renzi et al suggest that timely identification and appropriate management of psychiatric disorders in dermatology practice may improve adherence to therapeutic regimens.
Physicians have a legal and moral responsibility to investigate any case of suspected child abuse, but recognition of some forms of child abuse proves challenging. Parents from all levels of society and educational backgrounds may abuse children, and scald abuse is a common but underrecognized form of child abuse. Stratman and Melski offer the dermatologist useful clues in the history and physical examination that may allow early identification and intervention with respect to this injury.
During manicures and pedicures, technicians may use sharp implements and unintentionally injure the cuticles or the nail folds. Bleeding may result, setting the stage for potential transmission of infectious agents. Sekula et al demonstrate a variety of bacterial and fungal species cultured from instruments disinfected with disinfectants registered with the Environmental Protection Agency. Many consumers patronize nail salons with the belief that the instruments have been appropriately sanitized, and this belief may be mistaken.
Thumbnail of a patient with Pseudomonas aeruginosa that developed after a manicure.
Sweet syndrome is clinically characterized by rapid onset of painful, erythematous plaques accompanied by fever. Absence of vasculitis has been considered by many to be a histologic criterion for diagnosis. In this study, Malone et al suggest that the histologic presence of vasculitis does not exclude a diagnosis of Sweet syndrome, and they further suggest that vasculitis may be a process secondary to neutrophilic infiltration, with the affected vessels considered simply "innocent bystanders."
A limited number of topical therapies are useful for cutaneous T-cell lymphoma (CTCL). Patients often encounter adverse effects related to currently available topical therapies, or simply a loss of therapeutic efficacy, thus emphasizing the need for developing additional effective skin-directed therapies for CTCL. Breneman et al demonstrate that bexarotene gel, a retinoid X receptor–selective retinoid, is well tolerated. The substantial response rate in treating patients with early CTCL suggests that dermatologists may be able to add bexarotene gel to their therapeutic armamentarium.
This Month in Archives of Dermatology. Arch Dermatol. 2002;138(3):311. doi:10.1001/archderm.138.3.311