Vitiligo is an acquired progressive leukoderma in which epidermal melanocytes are destroyed. Current therapeutic options include UV-B or psoralen UV-A phototherapy or topical steroids. Additional surgical therapeutic options exist for patients with chronic stable vitiligo: split-thickness skin grafts, punch grafts, suction blister grafts, autologous cultured epithelial grafts, and autologous cultured melanocytes. In this double-blind, randomized, placebo-controlled study, van Geel et al achieved repigmentation of at least 70% in areas treated by autologous noncultured cellular grafts with viscosity increased by the addition of hyaluronic acid to improve adhesion of the graft to dermabraded skin. Transplanted melanocytes were the most important of the parameters that participate in the repigmentation process.
Atrophic hyperpigmented macules on the pretibial regions are one of the most common cutaneous findings in patients with diabetes. The pathophysiologic mechanism for this diabetic dermopathy remains unclear, although diabetes-induced microangiopathy remains the most commonly cited theory. In this consecutive case series, Wigington et al compared measured blood flow in diabetic dermopathy lesions with results from contiguous uninvolved skin areas. Surprisingly, blood flow levels were higher at dermopathy sites, similar to what might be found at scar sites, which suggests the possibility that skin perfusion in patients with diabetes may be insufficient to heal even minor trauma without scarring.
Herpes zoster is a common, painful, vesicular dermatomal eruption resulting from the reactivation of latent varicella-zoster virus (VZV) from infected posterior spinal or cranial sensory ganglia. Herpes zoster represents a localized infection, perhaps contained by circulating varicella antibodies in immune individuals, typically adults. This contrasts with primary VZV infection, a disseminated condition in patients without prior immunologic exposure to VZV, most commonly children. In this case series, Kurlan et al describe 4 unusual cases of herpes zoster in healthy immunocompetent children aged 4 to 11 months following postnatally acquired primary varicella, suggesting that a dermatomal vesicular eruption in an infant should point clinicians toward the diagnosis of herpes zoster.
The frequency of contact allergen sensitivity has been shown to be high in the leg ulcer population in multiple European studies. In this investigation, Saap et al demonstrate that 67% of patients with leg ulcers at 2 North American wound healing centers showed sensitivity to at least 1 contact allergen. While many of the common allergens to which sensitivity was demonstrated were from the North American Contact Dermatitis Group series, others were related to the wound dressings, medicaments, and ointments that are commonly used in ulcer management in North America. These findings suggest that in a patient whose leg ulcer is not healing, contact allergy must be considered as a potential impediment to wound healing.
The incidence of vulvar intraepithelial neoplasia (VIN) has increased in the past 2 decades. Undifferentiated VIN is characterized by full-thickness cytologic and architectural atypia. This condition predominantly affects young women and is associated with high-risk human papillomavirus types such as HPV-16. Conventional therapeutic options are typically destructive and include partial vulvectomy, cryotherapy, laser therapy, or electrocoagulation. In this prospective uncontrolled study, Wendling et al demonstrate that the immune response modifier imiquimod represents a medical therapeutic option for this condition, with the major adverse effects being local intolerance and flulike symptoms.
This Month in Archives of Dermatology. Arch Dermatol. 2004;140(10):1192. doi:10.1001/archderm.140.10.1192