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In This Issue of JAMA Dermatology
December 2014


JAMA Dermatol. 2014;150(12):1247. doi:10.1001/jamadermatol.2013.6570


Hidradenitis suppurativa (HS) is a chronic debilitating skin disease producing inflamed nodules in apocrine gland–bearing skin. Treatment is often inadequate, and pain and suppuration lead to inactivity, depression, and impaired quality of life. The pandemic cluster of cardiovascular risk factors called the metabolic syndrome (MetS) occurs more commonly with chronic inflammatory diseases. In this cross-sectional study, Miller et al demonstrate that HS appears to be associated with MetS, indicating substantial comorbidities. These data suggest that patients with HS require general medical attention beyond the skin.


Actinic keratoses (AKs) are widely recognized as having the potential to transform to cutaneous squamous cell carcinomas (SCCs). Many treatments exist, and photodynamic therapy (PDT) has become increasingly popular, with reported high rates of efficacy and claims of improved cosmetic outcomes. In this meta-analysis, Patel et al demonstrate that PDT has a 14% better chance of complete lesion clearance at 3 months than cryotherapy for thin AKs on the face and scalp. The long-term efficacy of these techniques in reducing the incidence of SCCs remains unproven.

Invited Commentary

Continuing Medical Education

Vitiligo is a condition typified by loss of pigment cells and is believed to be primarily autoimmune in nature. The worldwide prevalence is estimated to range from 0.5% to 2% of the population, but little more is known regarding the epidemiology and population-based and environmental risk factors of vitiligo. In this prospective questionnaire-based study, Silverberg et al demonstrate that patients with vitiligo born outside the United States had lower odds of greater than 25% affected body surface area (BSA). Significant statewide and intercontinental variation for rates of extensive vitiligo suggest that previously unrecognized regional environmental risk factors may play an important pathologic role.

Sebaceous neoplasms (SNs) define the Muir-Torre variant of Lynch syndrome (LS), which is associated with increased risk of colon and other cancers. Identifying LS is clinically valuable because of the availability of cancer risk–reducing strategies. Lynch syndrome is caused by germline mutations in DNA mismatch repair (MMR) pathway genes. In this retrospective study, Everett et al conclude that immunohistochemical screening of SNs is effective in identifying patients with germline MMR mutations and can be used as a first-line test when LS is suspected.

Isotretinoin is the standard treatment for refractory severe nodulocystic acne. A possible association between isotretinoin exposure and inflammatory bowel disease (IBD) has been a subject of debate in medical literature. In this retrospective cohort study, Rashtak et al demonstrate that isotretinoin was associated with a decreased risk of IBD development. Based on this study and a review of previous studies, there is little evidence that isotretinoin has any causal effect for IBD, and clinicians should not avoid prescribing this effective therapy based on this unfounded or meager association.