Dermatologists caring for patients with melanoma must be alert to second primary melanomas. Identifying the primary melanoma in a patient with metastatic disease occasionally presents an additional challenge. In this case series, Hu et al describe 3 patients with high-risk melanomas treated with adjuvant interferon therapy. Each patient received a new diagnosis of primary cutaneous melanoma within weeks of therapy, prompted by the distinguishing clinical feature of inflammation. These data suggest that inflamed melanocytic lesions should be evaluated carefully in melanoma patients receiving interferon therapy.
Pemphigus encompasses a group of severe autoimmune diseases characterized by blistering of the skin and mucous membranes. The 2 main types of pemphigus have been identified as pemphigus vulgaris (PV) and pemphigus foliaceus (PF), in which pathogenic IgG autoantibodies are directed against desmosomal transmembrane glycoproteins Dsg3 and Dsg1. In this retrospective study, Abasq et al demonstrate that serial anti-Dsg1 antibody values are more closely correlated with disease course in PF than anti-Dsg3 values are in PV. Persistently high levels or a rise in anti-Dsg1 values should be taken into account before decreasing corticosteroid doses in patients with pemphigus.
Hidradenitis suppurativa (HS) is a chronic, relapsing skin disorder characterized by recurrent inflammatory lesions that lead to scarring, sinus tract formation, and fistula development. Refractory HS may respond well to tumor necrosis factor α (TNF-α) inhibitors such as infliximab and etanercept. In this case series, Blanco et al demonstrate the long-term safety and efficacy of the newest fully human anti–TNF-α monoclonal antibody, adalimumab, for multifocal HS. Because anti–TNF-α therapy is associated with an increased risk of serious skin and soft-tissue infections, the importance of obtaining culture specimens from every draining lesion before starting therapy is emphasized.
Bullous pemphigoid (BP) is the most common subepidermal autoimmune bullous disease characterized by autoantibodies directed against the hemidesmosomal antigens BP180 and BP230. Systemic corticosteroids remain first-line therapy for BP. The efficacy of other commonly used immunosuppressants has not been firmly established. In this prospective multicenter cohort study, Bernard et al identify the clinical and immunologic factors most predictive of BP relapse after corticosteroid cessation. High-titer anti–BP180 levels and positive direct immunofluorescence findings were good indicators of BP relapse, suggesting that one of these assays should be performed before discontinuing therapy.
In Western countries, socioeconomic pressures have increased demand for specialist evaluation, including dermatologic evaluation. Asynchronous “store-and-forward” teledermatologic consultation is inexpensive and flexible. In this multicenter cluster randomized controlled trial, Eminović et al demonstrate that offering teledermatologic consultation to general practitioners (GPs) reduced outpatient referrals by GPs by 20.7%. While not specifically measured in this study, GPs reported high levels of patient enthusiasm when being included in this study, suggesting that patient satisfaction merits further study.
This Month in Archives of Dermatology. Arch Dermatol. 2009;145(5):521. doi:10.1001/archdermatol.2009.96