Imiquimod is an immune-response modifier that exerts antiviral and antitumor activity by stimulating the local production of interferon and other cytokines. Shumack et al evaluate the safety and efficacy of 2 different imiquimod dosing regimens in the treatment of small, nodular basal cell carcinomas. Although the therapeutic efficacy level of daily topical imiquimod treatment for 12 weeks does not approach that of surgical excision, there are certainly clinical settings in which this therapeutic strategy might be warranted.
A, Week 6 of daily treatment; B, posttreatment.
The risk of wound infection following skin surgery is small, and prophylactic systemic antibiotics are not routinely indicated. In this prospective, blinded, placebo-controlled trial, local anesthesia administered with admixed clindamycin phosphate decreased the incidence of postoperative wound infections. Intra-incisional antibiotic prophylaxis with clindamycin is inexpensive, easy to deliver, and may offer the benefits of antibiotic prophylaxis without the risks of systemic therapy.
The cosmetic use of botulinum A exotoxin (BTX) for the treatment of hyperfunctional facial lines is well established. Serious adverse effects of BTX treatment are rare, but milder adverse effects may occur. Alam et al demonstrate that complications such as eyelid and eyebrow ptosis or weakened perioral muscles are avoidable by adherence to a few guidelines based on the pharmacology of BTX, the principles of aesthetics, and an understanding of the underlying muscular anatomy. Knowing where not to inject this neurotoxin is perhaps the most important factor in avoiding complications.
Antimalarial agents have been used in dermatologic therapy for over a century. Hydroxychloroquine sulfate is commonly used to treat cutaneous lupus and dermatomyositis (DM). In this retrospective case-control study, Pelle and Callen confirm the suggested hypothesis that there is an increased frequency of adverse cutaneous reactions to antimalarial agents in patients with DM. Although hydroxychloroquine may exert beneficial effects in many patients with DM, this elevated risk should be reviewed with patients in advance.
High-dose corticosteroids often provide effective control of pemphigus vulgaris, but at the risk of multiple adverse effects. Other therapeutic options include plasmapheresis, photochemotherapy, intravenous pulsed methylprednisolone, and cyclophosphamide. In this retrospective review, the efficacy of intravenous immunoglobulin therapy is shown in the treatment of this rare and potentially fatal autoimmune blistering disease.
Most patients with skin lesions are first seen by nondermatologists. Despite a new national skin cancer educational agenda, it remains unclear how many future physicians receive adequate training. In this analysis of anonymous survey data, Geller et al report that most fourth-year medical students from one university feel unskilled in the skin cancer examination, and 40% reported no training in the skin cancer examination.
Clindamycin for Intraincisional Antibiotic Prophylaxis in Dermatologic Surgery. Arch Dermatol. 2002;138(9):1133. doi:10.1001/archderm.138.9.1133