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In This Issue of JAMA Dermatology
September 2015


JAMA Dermatol. 2015;151(9):919. doi:10.1001/jamadermatol.2014.2936


Spironolactone is an androgen receptor antagonist that is an effective treatment for hormonally mediated acne. Although generally well tolerated, spironolactone use is associated with hyperkalemia among patients with heart failure taking additional drugs that interfere with potassium excretion. Although the US Food and Drug Administration recommends frequent potassium monitoring in patients taking spironolactone, it is unclear whether this guideline is applicable to healthy patients taking spironolactone for acne. In this retrospective study, Plovanich et al demonstrate that the rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population. These data suggest that routine potassium monitoring is unnecessary in this setting.


Early detection of melanoma may improve survival. Melanomas detected by deliberate skin self-examinations (SSEs) by lay people have more favorable outcomes than those detected incidentally, and training patients in SSEs with partners present in the office increases the frequency of SSEs. In this randomized clinical trial, Turrisi et al demonstrate that 3 alternative partner-based SSE training methods offered a sustainable approach to improve early detection of melanomas among high-risk individuals.

Topical fluorouracil has been demonstrated effective in reducing the number of actinic keratoses (AKs) for up to 6 months, but no randomized trials have demonstrated its long-term efficacy. Although AKs are not malignant in themselves, they do have malignant potential. In this randomized, double-blind, placebo-controlled trial, Pomerantz et al demonstrate that a single course of topical fluorouracil cream, 5%, led to a sustained reduction in both the number of AKs and the need for subsequent AK treatments for longer than 2 years in a population at high risk for squamous cell carcinoma.

Continuing Medical Education

Psoriasis is a chronic immune-mediated disorder that often requires long-term treatment, including conventional systemic therapies and biologic therapies. Although biologic therapy offers new treatment options, these treatments have immunomodulatory or immunosuppressive effects that may predispose patients to potential adverse events. The risk of serious infection associated with tumor necrosis factor inhibitors is noted in current international guidelines, but the risk is not differentiated across individual therapies. In this multicenter, longitudinal, disease-based registry study, Kalb et al demonstrate that adalimumab and infliximab carried a higher risk of serious infection than nonmethotrexate and nonbiologic therapies, whereas etanercept and ustekinumab did not.

Although surgical resection is curative in most patients with basal cell carcinoma (BCC), recurrent or more advanced disease may be treated with a combination of surgery and irradiation. Systemic vismodegib is a targeted systemic agent recently approved for treating patients with recurrent or locally advanced BCC. In this case series, Pollom et al describe 2 cases of recurrent, advanced BCC treated with concurrent radiotherapy and vismodegib. Concurrent treatment was well tolerated and efficacious, demonstrating the feasibility of combined use of currently available therapies for advanced BCC.