Treatment of actinic keratoses (AKs) is recommended because of the potential of these lesions to evolve into invasive squamous cell carcinoma. Therapeuticoptions include chemical destruction, such as with 5-fluorouracil, or physical destruction, such as with cryosurgery, curettage, or electrosurgery. In thisprospective, multicenter, randomized, double-blind, vehicle-controlled clinical trial, Jorizzo et al demonstrate that pretreatment with a 1-week course of0.5% fluorouracil before cryosurgery significantly reduced the proportion of patients with AKs at 6 months following therapy compared with patientsreceiving cryosurgery alone. This serial treatment may reduce the need for long-term retreatment for AKs.
The melanocortins are a family of peptide hormones that induce pigmentation by interaction with melanocortin 1 receptors in the epidermis. α-Melanocytestimulating hormone (α-MSH) is the primary pigmentary hormone in the skin. Using a superpotent derivative of α-MSH, melanotan-1 (MT-1), Dorret al examine whether MT-1 could be safely combined with small amounts of UV-B from a solar stimulator and demonstrate a marked enhancement of skintanning. Thus, MT-1 in combination with minimal sun exposure should provide the cosmetic benefits of a tan without the need for substantial solar exposureand its inherent risks.
Prurigo nodularis (PN) is a chronic, intensely itchy condition characterized clinically by discrete hyperkeratotic nodules primarily on the extensor surfacesof the extremities. Standard therapies, such as antihistamines, UV phototherapy, and topical and systemic corticosteroids, may prove ineffective or problematicin human immunodeficiency virus (HIV)–seropositive patients. Thalidomide has been used to treat refractory PN in non–HIV-infected subjects, andin this prospective study, Maurer et al demonstrate its safety and efficacy in treating PN in HIV-seropositive patients. The significant number of patientswho developed treatment-associated peripheral neuropathy in this setting emphasizes the need for careful neurologic assessment during the course of therapy.
Pyoderma gangrenosum (PG) is an idiopathic, rare, destructive, necrotizing skin disease characterized by noninfectious ulcers that most commonly affectthe lower extremities. Approximately 50% of patients with PG have an associated systemic disease, including various types of arthritis. In this retrospectivereview, Charles et al compare a series of patients with lower extremity ulcers of PG confined to the skin with patients with PG associated with arthritis(PGA). The ulcers of patients with PGA appeared to be more refractory to treatment than the ulcers of patients with PG alone.
Infantile hemangiomas are the most common benign tumor of childhood, and ulcerations are the most common complication. Such ulcerations representa therapeutic challenge for which no single treatment has been demonstrated to be uniformly effective. Becaplermin gel is a recombinant human platelet-derivedgrowth factor-BB gel that is currently approved in the United States for the treatment of lower extremity diabetic neuropathic ulcers. Becaplermin gelhas also been reported useful in treating pressure ulcers. In this open study on 8 patients with ulcerated perineal hemangiomas of infancy, Metz et al demonstratethe safety and efficacy of of this medication for this painful complication.
A, Ulcerated hemangioma worsening in patient 1 despite wound care and intralesional steroids. B, Lesion appearance 19 days after starting treatmentwith 0.01% becaplermin gel.
This Month in Archives of Dermatology. Arch Dermatol. 2004;140(7):785. doi:10.1001/archderm.140.7.785