Oral lichen planus is an uncommon, difficult-to-treat, chronic inflammatory disorder characterized by painful white striations, papules, and plaques on the buccal, lingual, and gingival mucosa. Current therapeutic options include topical, intralesional, or systemic corticosteroids; topical anesthetics; topical or systemic retinoids; and topical immunomodulators. Narrowband UV-B phototherapy has been used successfully for cutaneous lichen planus, but no delivery system exists for intraoral exposures. In this open-label pilot study, Trehan and Taylor demonstrate the effective use of a flexible fiberoptic delivery system for the 308-nm excimer laser treatment of oral lichen planus.
Psoriasis is one of the most common conditions seen in dermatological practice, and it has profound negative effects on patients' quality of life. The psychosocial effects of psoriasis on a patient's life may be unrelated to the objective quantification of the clinical severity of disease as assessed by tools such as the Psoriasis Area Severity Index (PASI) score. Many patients are frustrated with this chronic dynamic disease and the perceived ineffectiveness of therapy. In this open prospective study, Zaghloul and Goodfield assess adherence to medical therapies by direct questioning and by identifying social, treatment-related, and disease distribution factors that affect medication compliance.
The immunosuppressive macrolide tacrolimus is commonly and increasingly used to treat inflammatory dermatoses in sensitive areas such as the face where corticosteroid-induced atrophy is a risk. Topical tacrolimus has been reported useful in the treatment of steroid-induced rosacea and perioral dermatitis. In this case series, Antille et al describe rosaceiform dermatitis arising in 6 patients after treatment with tacrolimus ointment. Potential mechanisms for this reaction include local immunosuppression-induced proliferation of Demodex mites, induction of vasomotor instability, and the occlusive properties of the ointment vehicle.
Long-standing atopic dermatitis is not generally regarded as a precursor to malignancy. In this observation, Fletcher et al describe the association of severe, chronic atopic dermatitis with primary CD30+ cutaneous tumors in 4 young adults. Several possible mechanisms are discussed, including immunosuppression, phototherapy-induced malignancy, and chronic superantigen stimulation of cutaneous lymphocyte-associated antigen-positive T cells from cutaneous bacterial flora.
Numerous studies have demonstrated the efficacy of the topical immunomodulator imiquimod in the treatment of basal cell carcinoma, Bowen disease, and actinic keratosis. In this observation, Hengge and Schaller demonstrate the efficacy of topical imiquimod in treating an invasive cutaneous squamous cell carcinoma in a patient with hemodialysis-dependent chronic renal failure and metastatic prostate cancer. This nonsurgical, patient-administered therapy offers great promise for the treatment of cutaneous malignancies in the appropriate clinical setting where surgical therapies may not be an option.
This Month in Archives of Dermatology. Arch Dermatol. 2004;140(4):395. doi:10.1001/archderm.140.4.395