Idiopathic solar urticaria (SU) is an uncommon photodermatosis. Little has been published on the clinical course of SU, and patients typically do not receive prognostic advice. In this historical cohort study, Beattie et al report the clinical features, photobiological characteristics, response to therapy, and natural history of 87 cases of idiopathic SU. Although patients may be discouraged by the severe symptoms sometimes associated with this chronic disease, they may be reassured that many patients with SU improve over time or even experience spontaneous resolution. Even those patients who continue to experience SU achieve good symptomatic control with antihistamines, sunscreen use, and sun avoidance behaviors.
Cutaneous malignancies such as basal cell carcinoma (BCC) and squamous cell carcinoma affect up to 40% of solid organ transplant recipients (OTRs) within 20 years after transplantation. These tumors account for a mortality rate of 5% to 8% among OTRs. In this case series, Kanitakis et al review their experience and offer deeper insight into the clinical and pathological aspects of carcinogenesis in the context of long-term systemic immunosuppression. Cases of excised BCCs in a cohort of OTRs differed from those of nonimmunosuppressed patients in a younger age at tumor development, male predominance, more frequent distribution on non–sun-exposed extracephalic sites, and a higher frequency of superficial subtypes.
Incontinentia pigmenti (IP) is a rare X-linked dominant genodermatosis. Identification of the causative NEMO gene mutation has offered a powerful new tool in the diagnosis of unusual forms of this disease, but attentive physical examination remains an indispensable diagnostic tool for IP in the clinical setting. Failure to adhere to stringent diagnostic criteria may lead to overdiagnosis of IP in patients with linear hyperpigmentation following Blaschko lines. Among the 47 cases of IP retrospectively reviewed here by Hadj-Rabia et al, 7 failed to meet accepted diagnostic criteria and were found to be other cutaneous disorders. For those patients correctly diagnosed with IP, the goal of multidisciplinary follow-up is the detection of rare occurrences of ophthalmologic and neurologic complications, particularly during the first year of life.
Primary cutaneous amyloidosis refers to amyloidosis involving the skin with no evidence of systemic involvement. In the less common primary nodular cutaneous form, the amyloid is derived from immunoglobulin light chains produced by a local population of plasma cells. Progression of nodular amyloidosis to systemic amyloidosis has been reported in 7% to 50% of patients. In this retrospective case series, Moon et al summarize the clinical data of 16 patients diagnosed with nodular amyloidosis and suggest that progression to primary systemic amyloidosis is uncommon.
Topical photodynamic therapy (PDT) is a novel method for treating cutaneous malignancies. In PDT using 5-aminolevulinic acid (ALA), ALA converts in situ into protoporphyrin IX, an active photosensitizer activated by red light. 5-ALA methylester (ALA-ME) has enhanced lipophilicity and is expected to penetrate more easily and deeply into target tissues where it is de-esterified into ALA intracellularly. Pain during and after PDT may be a severe adverse effect. In this double-blind randomized trial, Wiegell et al compared PDT responses using these 2 agents and found that ALA-ME was less painful than ALA on normal skin. The theory that ALA and not ALA-ME is transported by γ-aminobutyric acid receptors into the peripheral nerve endings leading to pain may explain the differences in pain scores between the 2 treatments.
This Month in Archives of Dermatology. Arch Dermatol. 2003;139(9):1113. doi:10.1001/archderm.139.9.1113