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In This Issue of JAMA Dermatology
November 2015


JAMA Dermatol. 2015;151(11):1159. doi:10.1001/jamadermatol.2014.2946


Lymphedema is a chronic, progressive, debilitating condition characterized by abnormal accumulation of fluid in tissues. Lymphedema cannot be cured, but targeted therapies can ameliorate the effects and progression of the disease. In the absence of robust comparative effectiveness data, the current standard of lymphedema care is a labor-intensive multimodal approach that includes manual lymph drainage, multilayer bandaging, decongestive exercise, skin care, and self-management education. In this retrospective analysis, Karaca-Mandic et al demonstrate that advanced pneumatic compression devices can reduce episodes of cellulitis as well as outpatient care and costs.


Neurotoxins, prepackaged fillers, and intralesional local anesthesia are delivered through small-caliber needles. Although injections are safe and well tolerated, a source of discomfort for patients is the sensation of the needle tip piercing the skin and ejecting the material into the surrounding tissues. Although it may seem intuitive that smaller needles would reduce clinically important pain, previous results have been equivocal. In this split-face, double-blinded randomized trial, Alam et al demonstrate that for glabellar and forehead injections of neurotoxin in saline, 30-gauge needles were associated with greater incidence of clinically significant pain than 32-gauge needles.


Psoriasis, psoriatic arthritis, and uveitis are inflammatory disorders with significant overlap in their inflammatory pathways. The data on the risk of uveitis in patients with psoriatic arthritis are inconsistent, and no data exist for psoriatic disease risk among patients with uveitis. In this cohort study, Egeberg et al demonstrate a bidirectional association between psoriatic disease and uveitis. Increased focus on eye symptoms in patients with psoriasis and psoriatic arthritis and on skin and joint symptoms in patients with uveitis may be appropriate.

Rosacea is a common and chronic skin disease characterized by facial flushing, papules and/or pustules, and visible blood vessels. The cause of rosacea remains poorly understood, although genetic and environmental factors likely contribute. Twin research has been instrumental during the past 20 years in demonstrating the heritability of disease such as psoriasis, eczema, and acne. In this cohort survey of identical and fraternal twins, Aldrich et al found that approximately half of rosacea symptoms could be attributed to genetics and half to the environment. Correlations between rosacea and UV radiation, alcohol use, smoking, skin cancer history, cardiac morbidity, and age were identified.

Continuing Medical Education

Patients with multiple cutaneous squamous cell carcinomas (CSCCs) present a management challenge to physicians. Although most CSCCs are curable, a small subset recur, metastasize, and cause death. The effect of multiple tumor formation on CSCC outcomes is poorly quantified. In this 10-year retrospective cohort study, Levine et al demonstrate that patients with more than 1 CSCC carried an elevated risk of local recurrence and nodal metastases. In particular, patients with 10 or more CSCCs demonstrated markedly elevated risks, warranting frequent follow-up to document CSCC sites, examine the scar sites, and perform lymph node examinations.

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