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In This Issue of JAMA Dermatology
March 2014


JAMA Dermatol. 2014;150(3):225. doi:10.1001/jamadermatol.2013.6525


Atopic dermatitis (AD) is a common chronic, relapsing, inflammatory skin disease associated with intense pruritus and eczematous plaques. The pathophysiology of AD may be associated skin barrier dysfunction related to filaggrin defects followed by allergic sensitization. Thymic stromal lymphopoietin (TSLP) is a cytokine that promotes type 2 helper T-cell differentiation, and increased TSLP has been strongly associated with AD and other allergic diseases. In this prospective cohort study, Margolis et al demonstrate that a TSLP variant was associated with a less persistent form of AD, making TSLP overexpression a promising therapeutic target for AD.

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Biofilms have been demonstrated in AD lesions, and the eccrine ducts in AD lesions may be occluded with biofilms. In this case-control study, Allen et al demonstrate that all AD-affected samples contained multidrug resistant staphylococci, positive for extracellular polysaccharide and biofilm, and that the eccrine sweat ducts were occluded. Immunopathologic findings showed activation of the innate immune system via toll-like receptor 2 immediately adjacent to the gram-positive bacteria and their biofilms occluding the sweat ducts. These data suggest that topical antibacterial measures (such as bleach baths) may be more reasonable than oral antibiotics in treating AD.

Homelessness is a major social and public health problem worldwide. The prevalence of body lice in sheltered homeless persons varies from 7% to 22%, and decreasing the burden of body lice infestation among homeless persons may prevent infectious disease outbreaks. Classic therapeutic measures for body lice infestation have shown little success. In this randomized, double-blind, placebo-controlled trial, Benkouiten et al demonstrate that permethrin-impregnated underwear reduced body lice infestations at day 14, but this was not sustained by day 45. The use of permethrin may have increased permethrin resistance in body lice, and the authors suggest that this strategy should be avoided.

Chronic urticaria is often refractory to conventional therapies. Recently, omalizumab, an anti-IgE antibody approved for the treatment of moderate to severe asthma, has emerged as an effective treatment for antihistamine-resistant chronic urticaria. Many study patients who achieved benefit from omalizumab experienced relapse after completion of their clinical trial. Off-label omalizumab treatments are commonly limited to trials of only a few months’ duration; many of these patients experience relapse as well. In this retrospective analysis, Metz et al demonstrate that omalizumab is safe and effective as retreatment for patients who had previously benefited from it.

The Coalition of Skin Diseases (CSD) currently comprises 15 patient advocacy organizations, and they have been instrumental in characterizing the burden of skin disease in the scientific, clinical, and political arenas. The Skin Advocate iPhone app was developed as a mechanism to connect CSD member organizations with the young dermatologists they were hoping to reach. In this blinded survey study, Kourosh et al demonstrate that physician awareness and referrals to patient advocacy organizations in the CSD improved after implementing this app. Increased patient registrations with the member organizations also increased.