Urticaria pigmentosa (UP) may be associated with systemic disease. This associated systemic mastocytosis may be indolent or may be associated with a hematologic disorder. What is the natural history of systemic mastocytosis in those patients in whom the UP regresses? On review of the records of 106 patients with adult onset UP, Brockow et al found that, in patients with mastocytosis with an associated hematologic disease, regression of UP may occur even as the bone marrow disease becomes progressively more severe. However, in patients with indolent mastocytosis, regression of the UP often parallels regression of the systemic disease.
Any UV-induced prostaglandin synthesis and up-regulation of cyclooxygenase 2 (COX-2) may contribute to the initiation and promotion of skin carcinogenesis. Celecoxib is a selective COX-2 inhibitor that is a commonly prescribed nonsteroidal anti-inflammatory agent. In this randomized, dose-response study, Orengo et al demonstrate that SKH hairless mice fed therapeutic doses of celecoxib had dramatically fewer UV-B–induced tumors, suggesting an exciting new therapeutic approach to the chemoprevention of skin cancers.
Patients infected with human immunodeficiency syndrome (HIV) can live longer and healthier lives than ever before. While previous studies have demonstrated an increased incidence of squamous cell carcinomas (SCCs) among HIV-infected patients, this retrospective case series demonstrates for the first time the aggressive nature of these tumors. Patients with long-standing HIV disease may develop rapidly growing SCCs at a young age, with an increased risk of local recurrence and metastases. The finding that these tumors present a higher morbidity and mortality than HIV disease itself points out the need for early and aggressive therapy for these high-risk malignancies in the setting of immunosuppression.
An exponentially increasing number of users are logging onto the World Wide Web to access medical information. Despite this increased demand the validity and reliability of patient-related Web sites remain uncertain. A number of groups, including the American Medical Association, have developed rating instruments for Web-based medical sites, but these instruments have not been widely validated or used. Using several search engines, Hu et al demonstrate that most Web sites retrieved from typical search strategies for dermatology-related key words contained product-oriented material rather than educational information, and that the search engine ranking may be easily misinterpreted by patients as an expression of quality.
Skin cancers are epidemic, and evidence suggests that childhood sun exposure plays a critical role in cutaneous carcinogenesis. In this random survey of public elementary schools in the United States, only 3.4% of schools had a policy with rules or recommendations designed to improve sun protection. The most common reason cited for not having a policy was the school principal's lack of awareness of the problem. These findings offer a logical starting point for developing and promoting sun protection policies in schools.
Vascular endothelial growth factor (VEGF) is locally produced by lesional psoriatic tissue but is also released into the systemic circulation where it exerts potent microvascular permeability activity, particularly in the kidneys and lungs. Creamer et al demonstrate that markedly elevated plasma VEGF levels, as well as pathologic proteinuria, accompany generalized pustular psoriasis. Plasma VEGF analysis in patients with severe psoriasis may represent a useful predictor of clinical outcome.
This Month in Archives of Dermatology. Arch Dermatol. 2002;138(6):734. doi:10.1001/archderm.138.6.734