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This Month in Archives of Dermatology
Nov 2011

This Month in Archives of Dermatology

Arch Dermatol. 2011;147(11):1254. doi:10.1001/archdermatol.2011.339

A wide range of psoriasis treatment options are available, but the trial and error and inefficiencies of identifying an effective and acceptable treatment regimen all contribute to low patient compliance. In this computer-based conjoint analysis, Schaarschmidt et al demonstrate that, when choosing among treatment options, individuals with psoriasis were willing to accept treatment-related adverse effects to obtain process attributes compatible with their personal and professional lives. Incorporating these preferences in shared decision making may facilitate treatment adherence.

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The incidence of cutaneous melanoma continues to rise. Despite novel approaches in the treatment of advanced melanoma, survival and prognosis have not improved over the past 3 decades. Early recognition of melanoma remains the best means to ensuring favorable prognosis. In this single-center cohort study, Kovalyshyn et al demonstrate that established patients in an academic dermatology practice had more in situ disease and thinner invasive melanomas than new patients. These data support the assertion that physician-based screening leads to higher rates of physician-detected melanoma and detection of thinner melanoma.

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Although up to 50% of patients with alopecia areata (AA) recover within 1 year of treatment, spontaneous remissions and frequent relapses are common. Initial hair regrowth may reveal a smaller shaft size and pigment alterations, but the shape of the new hair usually remains unchanged. In this case report, Valins et al describe a patient whose hair regrowth from AA was straight in contrast to the curly shape seen on the rest of the patient's scalp. This textural change persisted at a 1-year follow-up visit. Elucidating triggers in hair texture change could help further understand AA and could have a major impact on the world of hair grooming.

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Primary hyperoxalurias are rare autosomal recessive metabolic disorders associated with overproduction and tissue deposition of serum oxalate. Cutaneous findings relate to vascular deposition and include livedo reticularis, ulceration, and peripheral gangrene. In this case report, Blackmon et al describe a patient with end-stage renal disease and persistent acral sores and livedo of her extremities. Findings of physical examination suggested calciphylaxis or nephrogenic systemic fibrosis, but skin biopsy specimens revealed rectangular, birefringent crystalline material within the dermis, subcutis, and vessels. These findings and subsequent workup suggested primary hyperoxaluria, highlighting the importance of including this in the differential diagnosis in this setting.

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Antimalarial drugs have long been used for cutaneous lupus erythematosus (CLE). The benefits of hydroxychloroquine and chloroquine have been demonstrated by randomized controlled trials, but the use of quinacrine has declined. In this prospective longitudinal cohort study, Chang et al demonstrate that in patients for whom hydroxychloroquine monotherapy failed to control CLE, addition of quinacrine to the regimen improved their condition. Some initial nonresponders ultimately did improve with continuation of their therapy, supporting the concept of continuing antimalarial therapy beyond 2 months, even if patients do not initially improve.

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