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Nephrogenic systemic fibrosis (NSF) is a relatively new serious disease that occurs only in patients with severe renal disease. An association with exposure to gadolinium-containing contrast agents has been increasingly supported. Most reported NSF cases have been in the early stages of the disease. In this descriptive case series, Bangsgaard et al offer a detailed clinical picture of late NSF that includes epidermal atrophy, hair loss, confluent dermal plaques of thickening and hardening, and in a few patients a cutis laxa–type appearance. Daily Life Quality Index questionnaire scoring revealed a significantly impaired quality of life among patients with late-stage NSF, similar to other severe dermatologic diseases.
Exposure to UV radiation (UVR) is the most important environmental factor in skin carcinogenesis. Studies have demonstrated that repeated exposure to UVR can influence the number of circulating blood dendritic cells and alter serum concentrations of interleukin 8 and tumor necrosis factor in healthy human subjects. Apoptosis induced by UVR clearly occurs in the skin, but systemic effects remain uncertain. In this cohort study, Narbutt et al demonstrated that repeated suberythemal UV exposure enhances the apoptosis of peripheral blood mononuclear cells in healthy subjects. These data highlight the potentially harmful effects of even small doses of UVR on the human immune system.
Most melanocytic nevi develop in childhood, and several factors have been consistently shown to be related to higher numbers of nevi: lighter skin, lighter hair color, blue or green eyes, and higher levels of sun exposure. Because the risk factors for nevi closely match the risk factors for melanoma, understanding nevus development may improve our understanding of the pathophysiology of melanoma. In this longitudinal observational study, Crane et al described the development of nevi in children aged 3 to 8 years in a birth cohort in Colorado. Nevus development patterns were similar to those reported in the United Kingdom but were notably different from those in children in other Northern European countries and Australia, particularly with respect to the small size of the nevi and the patterns of nevus development on intermittently and chronically exposed body sites. These differences highlight the importance of studying nevus development in various regions of the world.
Palifermin is a truncated version of endogenous keratinocytic growth factor (KGF) that is used to reduce the duration and severity of oral mucositis in patients undergoing hematopoietic stem cell transplantation after myelotoxic therapy. Reported cutaneous adverse effects include eruption, pruritus, and erythema, but in this case report, King et al describe a patient who developed a papular eruption that clinically resembled lichen planus or planar warts. The histologic features were consistent with verrucae, but in situ hybridization studies failed to reveal the presence of human papillomavirus. These lesions likely correspond to the hyperproliferative state of keratinocytes in response to KGF.
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe, rare skin reactions to drugs that are characterized by widespread destruction of the epidermis and differ mainly with respect to the degree of body surface area involvement. Severe ocular complications may result in permanent visual loss due to corneal scarring or vascularization. In this retrospective cohort study, Gueudry et al describe the acute and late ocular manifestations of SJS and TEN in an effort to identify possible clinical predictors of ocular complications. The severity of the acute ocular disease was found to be the only significant predictor of late complications, although 5 patients without any acute ocular involvement went on to develop late sequelae. The authors suggest that all patients with SJS or TEN should undergo initial ophthalmologic screening and follow-up during the acute phase of the disease, and that prospective follow-up for up to a year may be necessary.
This Month in Archives of Dermatology. Arch Dermatol. 2009;145(2):119. doi:10.1001/archdermatol.2008.601