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In This Issue of JAMA Dermatology
June 2015


JAMA Dermatol. 2015;151(6):577. doi:10.1001/jamadermatol.2014.2921


Atopic dermatitis (AD) is a common chronic inflammatory dermatitis of the skin. The topical calcineurin inhibitors tacrolimus and pimecrolimus are some of the few topical agents that have been approved by the US Food and Drug Administration for the treatment of AD in children. An unfortunate risk associated with oral use of these agents is an increased risk of cancer. In this longitudinal cohort postmarketing surveillance study using the Pediatric Eczema Elective Registry (PEER), Margolis et al demonstrate that pimecrolimus use did not appear to be associated with an increased risk of cancer.

Continuing Medical Education


Androgenic alopecia (AGA) involves scalp vertex balding and temporal hairline recession due to 5α-dihydrotestosterone–dependent miniaturization of hair follicles. Although sexual dysfunction remains an adverse event of concern, meta-analyses to date have concluded that finasteride treatment of AGA is safe. However, of the 34 studies in this systematic review by Belknap et al, none had adequate safety reporting, providing no description of the duration or severity of sexual dysfunction, and they failed to distinguish between mild, reversible vs severe, permanent sexual dysfunction.

Audio Author Interview


The number of multiple primary cancers is increasing, and 3.5% of patients with an initial melanoma developed multiple primary melanomas (MPMs). Family and personal history of melanoma are known risk factors for MPM. The probability of CDKN2A mutations is elevated for patients with 3 or more melanomas. In this prospective population-based cohort study, Chen et al demonstrate a stable 2- to 3-times elevated risk by number of previous melanomas for patients with either familial or sporadic melanoma. This was especially true for young patients with familial melanoma, indicating that clinical genetic testing may be important in this population.

Adalimumab is a large-protein tumor necrosis factor–inhibiting molecule that has proven effective in suppressing psoriasis disease activity. Despite extensive interindividual variations in pharmacokinetics, adalimumab is administered in a standard fixed dose. Serum levels and antidrug antibodies to adalimumab are not generally measured. In this multicenter prospective trial, Menting et al describe a therapeutic range of adalimumab trough levels that correspond with optimal clinical effect. In one-third of patients, trough levels exceeded the therapeutic range. Validation of this range may allow a therapeutic algorithm to guide treatment in a rational manner.

Nonadherence to a treatment regimen is pervasive in all fields of medicine, especially in chronic conditions. Acne has a low secondary adherence rate because patients miss doses and discontinue treatment. There is less information on how often patients do not begin treatment. In this patient survey, Anderson et al demonstrate that 27% of patients did not fill all of their prescriptions. Primary adherence was lowest among patients prescribed more than 1 treatment. Reasons for primary nonadherence included cost, forgetfulness, disagreement with treatment regimen, and improvement before filling the prescription.