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In This Issue of JAMA Dermatology
June 2017


JAMA Dermatol. 2017;153(6):487. doi:10.1001/jamadermatol.2016.1686
Molecular Profiling of Multiple Primary MCCs

In rare cases, Merkel cell carcinoma (MCC) may develop at more than 1 site, consistent with an independent primary MCC tumor rather than a cutaneous metastasis. Given the rarity of multiple primary MCCs, genetic relatedness has been evaluated in only a few cases. In this case series, Harms et al demonstrate that patients with MCC may develop a second genetically distinct primary tumor. These findings underscore the importance of distinguishing a second primary MCC from an isolated cutaneous metastasis. This distinction has critically important staging, prognostic, and therapeutic implications.


Systemic Immunomodulating Therapies for SJS/TEN

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, severe cutaneous adverse reactions associated with high mortality. Because of the underlying immune-mediated mechanism, systemic immunomodulating treatments are often prescribed to stop the progression of skin necrosis. In this meta-analysis, Zimmermann et al found that glucocorticoids and cyclosporine were associated with a survival benefit, but supportive care, intravenous immunoglobulin, plasmapheresis, thalidomide, cyclophosphamide, hemoperfusion, tumor necrosis factor inhibitors, and granulocyte colony–stimulating factor were not associated with survival benefits. Prospective high-quality studies remain necessary to better evaluate SJS/TEN treatments.

Consultations for Inflammatory Skin Diseases

Dermatologic conditions remain an important reason for hospitalization in the United States, yet they are commonly misdiagnosed by nondermatologists. In this study of patients with dermatology-related International Classification of Diseases, Ninth Revision codes on admission or discharge, Milani-Nejad et al show that inpatient dermatology consultations were associated with a decreased 1-year readmission rate for inflammatory skin disease as well as shorter hospital stays. Inconvenience of travel to hospitals, poor reimbursements, and hospital credentialing requirements are important barriers to inpatient dermatologic consultations, and these data suggest that hospitals may improve outcomes by removing these barriers.

Propranolol vs Steroid for Infantile Hemangioma

Infantile hemangioma (IH) is the most common tumor of infants and young children. Although small IH lesions typically do not cause problems, they may require treatment because of associated complications such as abnormal eye development, vision problems, airway obstruction, or bowel obstruction. In this noninferiority randomized clinical trial, Kim et al demonstrate that propranolol administration, 2 mg/kg/d, for 16 weeks was noninferior to steroid treatment in therapeutic effects in IH, and there was no difference in safety outcomes. These data suggest that propranolol can be used as a first-line treatment for IH.

Dermatologic Features of Classic Movie Villains

Symbolic dermatologic depictions are prevalent in movies and pervade virtually all genres. Although abnormal skin can also be presented sympathetically, its most prominent use is to illustrate underlying moral depravity. In this cross-sectional study, Croley et al found that the top 10 film villains (as identified from the American Film Institute Heroes and Villains List) were found to display a significantly higher incidence of dermatologic conditions than the top 10 heroes. Alopecia, periorbital pigmentation, rhytids, scars, verruca, and rhinophyma, among others, were presented on film as visual representations of the dichotomy of good and evil. These images may foster prejudice and facilitate misunderstandings of dermatologic disease.