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In This Issue of JAMA Dermatology
February 2014


JAMA Dermatol. 2014;150(2):115. doi:10.1001/jamadermatol.2013.6520


The demand for cosmetic procedures continues to increase, and to continue as innovators and leaders in the safe performance of these procedures, future dermatologists must be properly trained. Barriers to incorporating cosmetic dermatology training into residency curricula include high supply costs, physician resistance to addressing aesthetic concerns in the academic setting, lack of dermatology training among core faculty, and unavailability of patients willing to be treated by inexperienced residents. In this online survey of dermatology residency program directors, Bauer et al demonstrate that although almost every training program provided hands-on cosmetic dermatology training, these barriers remain and must be addressed to ensure continued patient safety.

Related Editorial

Adalimumab is a human monoclonal IgG1 antibody and tumor necrosis factor antagonist that is a valuable treatment option for patients with moderate to severe psoriasis. Antibodies against adalimumab are associated with nonresponse and loss of initial response to adalimumab. In this multicenter cohort study, Menting et al demonstrate that antidrug antibody (ADA) formation is most likely to occur in the first 24 weeks of treatment and showed a strong negative correlation with adalimumab serum trough levels. Dose interval shortening may be useful in the absence of ADAs but may not be useful in their presence.

Invited Commentary

Continuing Medical Education

Skin disorders are common in the general population, ranging from mild, transient ailments to stable, chronic conditions. The use of daily skin products may affect the appearance and severity of skin conditions. In this large descriptive epidemiological survey, Naldi et al confirmed this large magnitude of skin problems, particularly of nonspecific itchy eruptions. Furthermore, almost 47% of patients reported that because of skin irritations, they avoided daily use of products such as cosmetics, soaps, shampoos, and household products.

UV radiation (UVR) is the primary environmental risk factor for developing cutaneous malignant melanoma (CMM). Patients with CMM are at an increased risk of developing a second primary melanoma, and reducing recreational sun exposure may lower this risk. In this prospective observational case-control study, Idorn et al use personal electronic UVR dosimeters and sun diaries to demonstrate that patients with CMM do not maintain cautious sun behaviors. Increases in daily UVR doses on holidays were seen from the first to third summer after diagnosis, reaching the same level as controls.

Pigmented purpuric dermatoses (PPDs) are a group of histologically similar skin eruptions characterized by a perivascular lymphocytic infiltrate with extravasated erythrocytes. In this case report, Kaplan et al describe a case of purpura annularis telangiectodes of Majocchi (PATM) induced by isotretinoin. Histologically, drug-induced cases of PPDs lack epidermal involvement and a lichenoid infiltrate when compared with idiopathic PPDs. Clinically, drug-induced PPDs are more likely to be generalized, although most still present with the classic lower-extremity involvement. Drug-induced cases of PPD may be cleared simply by removal of the offending substance.