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In This Issue of JAMA Dermatology
July 2014


JAMA Dermatol. 2014;150(7):685. doi:10.1001/jamadermatol.2013.6545


Pemphigus is a rare and potentially fatal autoimmune dermatologic disease that often requires long-term systemic treatment with corticosteroids or other immunosuppressive agents. Rituximab, a chimeric murine/human monoclonal antibody that induces B-cell apoptosis by targeting CD20 antigen, has been reported to effectively treat autoimmune bullous dermatoses. Optimal dosage regimens have not been determined. In this retrospective cohort study, Heelan et al demonstrate that a fixed-dose modified rheumatoid arthritis protocol for rituximab was effective and well tolerated by patients with pemphigus. These data suggest that rituximab may be considered as first-line therapy for autoimmune bullous disorders.

Mycosis fungoides and Sézary syndrome (MF/SS) are uncommon in children and young adults and have distinct clinical features, such as higher proportion of early-stage disease and superior disease-specific survival. In this population-based study, Weiyun et al demonstrate that although young patients with MF/SS were at elevated risk of second cancers (particularly melanoma and lymphoma), they generally had a favorable outcome. Continual monitoring of young patients with MF/SS may determine whether this risk is due to increased medical surveillance, long-term treatment, or underlying disease processes.

Merkel cell carcinoma (MCC) is a rare, aggressive, neuroendocrine-derived skin cancer with high recurrence and mortality rates. In their retrospective cohort study, Asgari et al found that many host, tumor, diagnostic, and treatment variables were associated with MCC outcomes. Immunosuppression was associated with a higher likelihood of disease-specific mortality, suggesting that clinicians should be more mindful of immunosuppressed patients with MCC. In addition, chemotherapy was not associated with recurrence or survival benefits, but radiation treatment may reduce locoregional recurrence and may be the preferred adjuvant treatment modality.

In the emergency department (ED), skin conditions account for 9.2% to 40% of consultations for children and up to 10% for adults. Comparisons of dermatologic diagnostic performances between primary care physicians and dermatologists reveal a significant difference, with 93% correct diagnoses for dermatologists vs 50% for nondermatologists. In this observational study of adults who consulted in the ED for a dermatologic condition, Duong et al demonstrate that teledermatology services invalidated, enlarged, or clarified ED physician diagnoses and management in 68.2% of cases and that mobile devices facilitated direct communication between physicians after image transfer.

Alopecia areata (AA) is a common autoimmune disease that causes hair loss on the scalp and other areas of the body. Impaired inhibitory function of circulating T regulatory (Treg) cells has been reported to play a role in this disorder. In this prospective open pilot study, Castela et al demonstrate partial hair regrowth in 4 of 5 patients with severe AA treated with subcutaneous interleukin 2. Clinical response was correlated recruitment of Treg cells within the affected skin. Further studies may optimize the protocol to enhance the Treg cell response and open new avenues of AA treatment.