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In This Issue of JAMA Dermatology
June 2014


JAMA Dermatol. 2014;150(6):583. doi:10.1001/jamadermatol.2013.6540


Atopic dermatitis (AD) is a common skin disease that commonly begins in early childhood and has a waxing and waning course. The natural history of AD is often described as resolving soon after the first decade of life. In this cross-sectional and cohort study of a long-term AD registry, Margolis et al demonstrate that AD-associated symptoms persist well into the second decade of life and likely even longer. These data suggest that AD may be a lifelong illness, and that physicians treating patients with AD should inform children and their caregivers of this expected long-term course.


Continuing Medical Education

In many parts of the world, there is a severe shortage of dermatologic specialists. In these regions, clinicians and rural health workers with limited dermatologic training often provide care. To determine whether mobile teledermatology in patients with human immunodeficiency virus (HIV) was reliable in outpatient and public inpatient settings in Botswana, Azfar et al performed a cross-sectional study of patients with skin or mucosal conditions that had not been evaluated by a dermatologist. Cell-phone mediated store-and-forward evaluations demonstrated significant potential for improving access to care, but adapting this technology to larger scales requires additional technology and optimization and validation.

Dermatologic surgery has been an integral part of dermatology residency training for decades, and there has been continued growth in the quantity and breadth of procedures in which residents participate. In recent years, there has been an emerging consensus that evaluation of surgical skills in trainees can be performed systematically and objectively. In this multirater, blinded review and rating of taped video recordings of elliptical excisions, Alam et al demonstrate that senior dermatology residents preparing for surgery fellowships are highly skilled in performing these excisions and bilayered repairs.

The scourge of chronic pruritus should not be underestimated. The factors mediating the relationship between chronic pruritus and quality of life remain poorly understood. In this cross-sectional study based on a nationwide telephone survey, Carr et al demonstrate that multiple patient demographic and personality characteristics (eg, age, race, marital status, extroversion, neuroticism) and pruritus characteristics (eg, severity, duration, frequency, anatomic location) influence quality of life. Understanding these characteristics more clearly may improve the clinical evaluation and treatment of chronic pruritus.

Lichen sclerosus (LS) is a connective tissue disease that predominantly affects the anogenital region. Although vulvar LS is relatively common and may have substantial psychological and emotional consequences, only a few therapies have been evaluated in controlled trials. The “gold standard” of treatment remains high-potency topical corticosteroids, and other therapeutic options include topical calcineurin inhibitors, surgery, or cryotherapy. In this randomized trial, Terras et al demonstrate that UV-A1 phototherapy treatment results in clinical improvement in LS, but it was inferior to high-potency topical corticosteroid with respect to practicability, relief of itch, and improvement in quality of life.