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In This Issue of JAMA Dermatology
March 2015


JAMA Dermatol. 2015;151(3):245. doi:10.1001/jamadermatol.2014.2906


Purse-string suture is a wound closure technique often used for complete or partial closure of circular postoperative defects in cutaneous surgery. Proponents claim this technique reduces scar area, expedites healing, enhances homeostasis, and improves aesthetic outcome. In this prospective, randomized, blinded clinical trial, Joo et al demonstrate that purse-string closure results in cosmetic outcomes, scar sizes, and pain levels similar to those of second-intention would healing for circular or oval wounds on the trunk or extremities. Healing time might be faster with purse-string, and scar relief at 3 months might be better with second-intention healing. A larger clinical trial might clarify these trends.


Cosmetic dermatology is a well-developed field that includes various procedures that are, individually, safe and effective. Combining these procedures may produce results comparable to those associated with more invasive cosmetic procedures. Reliable incidence data regarding adverse event rates are not well described. In this multicenter prospective cohort study, Alam et al demonstrate that noninvasive to minimally invasive cosmetic dermatologic procedures are safe when performed by experienced, board-certified dermatologists. Adverse events occurred in less than 1% of patients, and most were minor and transient.

Acne and subsequent scarring affect patients of all ages and ethnicities and can cause severe psychological effects. Fractional laser technology is routinely used in the treatment of acne scarring, with thermal injury resulting in collagen synthesis and remodeling. In this single-center, prospective study, Brauer et al demonstrate that the use of a picosecond-pulse duration laser with a diffractive lens array produced improvement in texture and appearance at 3 months with objective findings similar to those published for fractional ablative techniques. Improvement in scarring from this treatment went beyond remodeling of collagen.

Early detection, correct categorization, and accurate identification of skin lesions are pivotal for the successful treatment of skin diseases. Educators use a variety of practices to train laypersons, medical students, residents, and primary care clinicians to diagnose skin lesions. Although these methods have been used for decades, there have been few attempts to catalog their scope or effectiveness. In this meta-analysis, Rourke et al demonstrate that the most effective approaches engaged participants in a number of coordinated activities over an extended period.

Ear, nose, and throat (ENT) lesions are frequently seen in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and mucous membrane lesions precede skin detachment in 80% of patients. In this retrospective study of patients with SJS/TEN, Bequignon et al demonstrate that dyspnea or dysphonia was significantly associated with a severe ENT form of SJS/TEN that carries a risk of airway obstruction and pulmonary infection. Nasal fiberoptic endoscopy at a patient’s bedside is a simple, noninvasive method to detect severe ENT lesions.