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This Month in Archives of Dermatology
August 2004

This Month in Archives of Dermatology

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Copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2004

Arch Dermatol. 2004;140(8):914. doi:10.1001/archderm.140.8.914
Changing Patterns of Sun Protection Between the First and Second Summers for Very Young Children

Childhood sun exposure, particularly blistering sunburns, is thought to represent an important risk factor for cutaneous malignancies, particularly melanoma. Primary prevention strategies, therefore, might focus mainly on education of mothers of newborns on comprehensive sun protection practices. In this report on the findings of a randomized controlled study conducted among 92 mothers of newborns, Steinberg Benjes et al demonstrate that children whose mothers received tailored education regarding sun protection strategies for their newborns experienced lowered rates of sunburns. This benefit waned by the second summer, however, suggesting that sun protection begins to decline and skin damage increases at an age much earlier than previously thought.

High Recurrence Rates of Basal Cell Carcinoma After Mohs Surgery in Patients With Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia. The depressed immune function associated with CLL is thought to play a role in the greater risk of developing subsequent malignancies. Patients with CLL are particularly at greater risk of developing cutaneous malignancies. In this retrospective survey, Mehrany et al found that patients with CLL who underwent Mohs surgery were 13.7 times more likely to have recurrent basal cell carcinomas than controls. The most likely reason for the failure of this technique is thought to be the dense leukemic infiltrates that may obscure residual tumor cells during interpretation of histologic margins. Close surveillance for basal cell carcinoma recurrence in patients with CLL is warranted.

Antineutrophil Cytoplasmic Antibodies of IgA Class in Neutrophilic Dermatoses With Emphasis on Erythema Elevatum Diutinum

The presence of antineutrophil cytoplasmic antibodies (ANCAs) in dermatologic disease has been studied for 4 decades. Initial studies focused mainly on the IgG class, which may be associated with a wide range of conditions including Wegener granulomatosis, Churg-Strauss disease, and a wide range of connective tissue diseases. Reports of the IgM and IgA subtypes have subsequently emerged. The activity of ANCA has been previously reported in association with neutrophilic dermatoses. In this study, Ayoub et al demonstrate the presence of IgA class ANCAs in 60% of neutrophilic dermatoses. All patients with erythema elevatum diutinum had IgA ANCAs, a surprising finding that may shed light on the pathophysiology of this disease.

The Safety and Efficacy of the 308-nm Excimer Laser for Pigment Correction of Hypopigmented Scars and Striae Alba

Hypopigmentation in scars and striae alba may be due to hypomelanocytosis, hypomelanosis, or other optical factors. Effective, low-risk therapies for hypopigmented scars and striae alba remain elusive. In this randomized controlled trial, Alexiades-Armenakas et al used visual assessment and colorimetry data to judge whether the 308-nm excimer laser can correct the pigmentation in these lesions as compared with untreated control sites. Mean final pigment correction rates after 9 biweekly treatments ranged up to 100% by colorimetric analysis, although maintenance treatments were required to sustain the cosmetic benefits.

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Prominent hypopigmented facial scars present at baseline (A) demonstrated excellent pigment correction following 5 treatments (B).

Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

Over the past 30 years, glucocorticosteroids (GSs) have been first-line drug therapy for the treatment of problematic infantile hemangiomas. Doses range from standard doses of 2 to 3 mg/kg of body weight to more recently advocated 3 to 5 mg/kg of body weight. Previous reports have indicated that systemic GS therapy carries minimal risk for short-term adverse effects and no serious long-term adverse effects. In this retrospective case series, George et al evaluated these adverse effects in infants treated with GSs with a goal of establishing guidelines for appropriate monitoring in this group of patients. Although GS therapy was well tolerated overall, hypertension and hypothalamic-pituitary-adrenal axis suppression were observed frequently. The authors present guidelines for careful monitoring for these adverse effects and suggest dosing schedules that may minimize these effects.