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In This Issue of JAMA Dermatology
January 2015


JAMA Dermatol. 2015;151(1):5. doi:10.1001/jamadermatol.2014.2896

Allogeneic hematopoietic stem cell transplantation offers potential cure for certain hematologic diseases, but its use is limited by graft-vs-host disease (GvHD). Although cutaneous manifestations of chronic GvHD are highly variable and may resemble well-characterized autoimmune diseases, vitiligo and alopecia areata (AA) have not been well characterized in this setting. In this cross-sectional, retrospective study, Zuo et al demonstrate that, although vitiligo and AA were uncommon phenomena in this population, female donor and female donor to male recipient sex mismatch were significantly associated with the development of these conditions.

Eczema is a chronic inflammatory disorder that causes significant morbidity related to itch, sleep impairment, and a wide range of comorbidities. In this prospective questionnaire-based study, Garg and Silverberg demonstrate an increased risk of fracture and bone or joint injury among adults with a history of eczema. Adults with both eczema and fatigue or sleep symptoms demonstrated higher rates. Lowered bone mineral density due to chronic corticosteroid use or chronic inflammation may also play a role, and developing safer, more effective clinical interventions for itch and sleep problems may be effective preventive measures for injury reduction in eczema.

Narrowband UV-B phototherapy is used extensively to treat vitiligo. Subcutaneous injection of afamelanotide, an analogue of α-melanocyte–stimulating hormone, is known to increase skin pigmentation and has been proven useful in the treatment of erythropoietic protoporphyria and solar urticaria. In this multicenter randomized study, Lim et al demonstrate that afamelanotide administration to patients receiving narrowband UV-B phototherapy for vitiligo significantly enhanced the rate and total surface area of repigmentation.

Continuing Medical Education

Cutaneous melanoma is 1 of the 5 most common cancers in the United States and is the most common fatal malignant neoplasm in young adults. Several cohort studies have suggested a higher incidence of melanoma in pilots and flight crew, thought to be at greater risk due to altitude-related exposure to UV and cosmic radiation. In this meta-analysis, Sanlorenzo et al demonstrate that pilots and cabin crew had approximately twice the incidence of melanoma compared with the general population. The mechanisms underlying this risk and methods for optimal occupational protection merit further study.

Indoor tanning is widespread in the United States despite evidence establishing it as a risk factor for skin cancer. Tanning salons are ubiquitous in US cities and are particularly concentrated near colleges. In this observational study, Pagoto et al demonstrate that approximately half of US colleges have indoor tanning facilities on campus or in off-campus housing and that campus cash cards could be used to purchase tanning for 14.4% of colleges. In step with tobacco-free policies, tanning-free policies on college campuses may have the potential to reduce skin cancer risk in young adults.