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In This Issue of JAMA Dermatology
August 2015


JAMA Dermatol. 2015;151(8):807. doi:10.1001/jamadermatol.2014.2931

Facial erythema and telangiectasia are commonly associated with the erythematotelangiectatic subtype of rosacea (ETR), and it is important to differentiate this from telangiectatic photoaging (TP). In this case-control observational study, Helfrich et al demonstrate that telangiectatic photoaging is characterized by less transient and nontransient erythema, a more lateral distribution of erythema and telangiectasia, less neurogenic mast cell activation, and less matrix metalloproteinase (MMP)-mediated matrix remodeling than ETR. In TP, the altered collagen fibrils surrounding the vessels may permit vessel dilation, whereas in ETR, extracellular matrix alteration and upregulation of MMPs may contribute to vessel dilation.


Continuing Medical Education

Methotrexate is a first-line systemic agent for psoriasis treatment, although its onset of action is slower, and overall it is less effective than tumor necrosis factor blockers. In this single-center, randomized clinical trial, Goldminz et al characterize the genomic, immunohistochemical, and mRNA expressions that determine and differentiate responses of psoriasis to these medications. Clinical response to adalimumab was faster, more complete, and characterized by faster downregulation of CCL20 and IL22 mRNA compared with methotrexate. These cytokines are important disease mediators, and IL22- and CCL20-related signaling pathways are candidates for future drug development.

Early detection of malignant melanoma (MM) has been associated with thinner lesions and improved survival. Dermoscopy improves diagnostic accuracy of MM, yet it remains a difficult skill to acquire. In this prospective controlled trial, Boespflug et al demonstrate that a spaced education internet dermoscopy module combined with in-class training increases participant performances in dermoscopy. However, when e-learning questions were mainly visualized on smartphones or tablets, participants fared less well. Further studies are necessary to evaluate the place of smartphones in training modules.

Anogenital warts are a common sexually transmitted disease. Although not directly associated with cancer, lesions often are coinfected with multiple types of human papillomavirus (HPV), including carcinogenic types such as HPV16. In this multicenter, randomized clinical trial, Ormerod et al demonstrate that use of sodium nitrite, 6%, with citric acid, 9%, twice daily was more effective than placebo in treating genital warts. Treatment was associated with local irritant adverse effects, but lower doses were not more efficacious than placebo.

Adhesive strips are commonly used for cuticular wound closure following cutaneous surgical procedures, yet it remains unclear whether these provide additional benefit compared with dermal suturing alone. In this prospective, randomized split-wound study, Custis et al demonstrate that combination closure with adhesive strips and buried interrupted subcuticular suturing was not significantly associated with improved overall scar assessment compared with buried suturing alone. These data do not support the use of adhesive strips to improve cosmetic outcomes or reduce scar width.