Many primary cutaneous T-cell lymphomas (CTCLs) such as mycosis fungoides or CD30+ large T-cell lymphomas typically demonstrate an indolent course, whereas other types such as Sézary syndrome and CD30−large T-cell lymphomas demonstrate a more aggressive clinical course. Eosinophilia is common in each of these entities, most likely related to the secretion of eosinophilotactic cytokines by neoplastic cells. In this retrospective cohort study of 104 patients with CTCL, Tancrède-Bohin et al demonstrate that peripheral blood eosinophilia at diagnosis was an independent prognostic factor for disease progression. Eosinophilia might be an indicator of predominant TH2 differentiation that has been associated with a relative defect of the antitumoral response and thus the observed poor prognosis.
Posttransplantation lymphoproliferative disorders (PTLDs) most commonly represent Epstein-Barr virus–driven proliferation of B lymphocytes in patients who have undergone solid organ or bone marrow transplantation. In this case series, Beynet et al describe 4 patients with cutaneous PTLDs who had a late onset of disease and a favorable outcome relative to the general experience with PTLDs involving other extranodal sites.
Spinal dysraphism (SD) refers to a spectrum of congenital anomalies characterized by an incomplete fusion of the midline elements of the spine. Recognition of certain cutaneous markers allows detection of occult SD (OSD), a form of SD in which the skin covers the spinal anomaly. In this retrospective analysis of 54 children, Guggisberg et al found that a combination of 2 or more congenital midline skin lesions constitutes the strongest marker for OSD. Isolated lipomas or lipomas occurring in combination with other lesions such as an overlying port-wine stain were the most common midline cutaneous lesions associated with OSD, and deviation in the gluteal furrow was found to be a reliable associated feature. Not all midline lumbosacral cutaneous lesions carry the same risk: none of the patients who presented with a "simple" dimple had OSD, which emphasizes that this lesion is not a cutaneous marker of SD. Similarly, isolated port-wine stain was not associated with OSD. The authors present a risk classification scheme for the systematic assessment of congenital medial lumbosacral cutaneous lesions.
Nonmelanoma skin cancers are the most frequent malignancies seen in organ transplant recipients. In this prospective study of 230 adult heart transplant recipients observed for at least 3 years, Belloni Fortina et al found no association between cumulative doses of any single immunosuppressive drug and the risk for squamous cell carcinomas, which suggests that the risk was associated with the overall level of immunosuppression rather than with any specific immunosuppressive drug. The authors suggest that high-risk patients should maintain as low a level of immunosuppression as possible and receive regular careful dermatologic screening examinations.
Vitiligo is an acquired leukoderma in which interfollicular epidermal melanocytes are selectively destroyed. Current first-line therapies include topical corticosteroids and phototherapy. Narrowband UV-B therapy is considered the best treatment for extensive vitiligo, perhaps through stimulation of melanocyte migration and proliferation starting from the niches located in the hair follicles. Recently, the 308-nm excimer laser was developed, which allows targeted narrowband UV-B phototherapy to treat localized plaques of vitiligo. In addition, tacrolimus, a new topical immunosuppressive drug, was shown to have promise in treating vitiligo. In this prospective, randomized, left/right comparison pilot study, Passeron et al demonstrate that the combination of 308-nm excimer laser therapy and 0.1% tacrolimus ointment applied topically twice daily produced a synergistic response. Not only was this combination regimen well tolerated, but patients were able to achieve a repigmentation rate of at least 75% in localized vitiligo.
This Month in Archives of Dermatology. Arch Dermatol. 2004;140(9):1039. doi:10.1001/archderm.140.9.1039