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In This Issue of JAMA Dermatology
June 2016


JAMA Dermatol. 2016;152(6):603. doi:10.1001/jamadermatol.2015.3261


Topical methyl 5-aminolevulinic acid (MAL) photodynamic therapy (PDT) is effective for the treatment of actinic keratoses (AKs), but pain may be a limiting factor for treating large fields. Daylight PDT solves this problem by reducing the application time of MAL to 30 minutes prior to light exposure so that low levels of protoporphyrin IX are generated and continuously photodegraded. In this prospective, randomized, split-scalp study, O’Gorman et al demonstrate that both methods were effective. Daylight PDT had the advantage of being almost pain free but required dry and warm weather conditions to be effective.


Continuing Medical Education

Pemphigus is a debilitating autoimmune disorder characterized by acantholytic blisters of the skin and mucous membranes. Although pemphigus is associated with significant morbidity and mortality, little is known about the inpatient burden. In this analysis of inpatient survey data, Hsu et al demonstrate that the inpatient burden of pemphigus is extensive. The cost of care and length of hospitalization were consistently higher for patients with pemphigus than for those without. Nonwhite race, lower income, and underinsured or uninsured status were associated with higher rates of hospitalization and increased length of stay.


Acne remains a common indication for referral to a dermatologist. Stepwise treatment algorithms for acne that can be implemented by primary care clinicians have been proposed both in the primary care and dermatology literature. In this study, Liu et al model 2 treatment algorithms to identify the most effective referral patterns and costs. Algorithm-based treatment of mild to moderate acne by primary care physicians was shown to potentially alter referral patterns, streamlining patient care by reducing wait times for treatment and lowering overall costs.

In addition to causing physical discomfort, psoriasis can cause missed time from work and can limit productivity at work. In addition to the cost of psoriasis treatment, there are costs associated with lost productivity and wages. Ixekizumab is an anti–interleukin 17A monoclonal antibody used to treat psoriasis. Using data from 3 multicenter randomized trials, Armstrong et al demonstrate that ixekizumab-treated patients reported short- and long-term improvements in work productivity. This could lead to reduced productivity-related costs among patients with psoriasis.

For most common types of nonmelanoma skin cancers (NMSCs), the current recommended excision margin is 4 to 5 mm. Immunosuppression (IS) increases the risk of NMSC, but it remains unclear whether IS patients are at risk for NMSCs with aggressive subclinical extension (NMSC-ASE) which may extend aggressively beyond conventional surgical margins. In this 6-year retrospective review, Song et al demonstrate an increased risk for NMSC-ASE associated with solid-organ transplant and hematologic malignancy but not with human immunodeficiency virus. These findings may help dermatologists optimize the extent of excisional margins, especially in settings where Mohs micrographic surgery is not available.