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In This Issue of JAMA Dermatology
August 2017


JAMA Dermatol. 2017;153(8):735. doi:10.1001/jamadermatol.2016.1700


Rising US pharmaceutical costs are a source of increasing financial burden for payers and patients. Increased pharmaceutical costs are often attributed to novel agents that require funding for development and testing. In this retrospective cost analysis of Medicare Part D participants who filled prescriptions for topical steroids, Song et al demonstrate that most topical steroids prescribed were generic drugs. The sharp increase in Medicare and out-of-pocket spending on topical steroids has been driven by higher costs for generics. Clinical decision support tools to enable lower-cost generic topical steroid substitutions from the corresponding potency class may reduce drug expenditures.


Continuing Medical Education

Hidradenitis suppurativa (HS) is a debilitating, painful chronic inflammatory disease for which sparse epidemiologic data exist. The inherent unpredictability with respect to disease course and response to treatment poses significant challenges for patients. In this retrospective case cohort analysis, Garg et al demonstrate that HS is an uncommon, but not rare, disease in the United States that disproportionately affects female patients, young adults, and African American and biracial patients. Costs and utilization of services among patients with HS rival or exceed those of patients with psoriasis.

Atopic dermatitis (AD) and allergic contact dermatitis (ACD) are 2 of the most commonly recognized pediatric inflammatory skin disorders, but they have a dynamic relationship that is poorly understood. For patients with AD, undiagnosed ACD may result in treatment-resistant disease. In this retrospective case review, Jacob et al demonstrate that children with AD had statistically increased frequency of reactions to cocamidopropyl betaine, wool alcohol, lanolin, and tixocortol pivalate, commonly found in their skin care preparations. The interplay between AD and ACD requires continued investigation to optimize care of pediatric patients with these conditions.

Most cutaneous squamous cell carcinomas (CSCCs) can be cured surgically, but perineural invasion (PNI) has been associated with poor prognosis, with local recurrence rates of 16% to 45% and nodal metastasis rates of 10% to 50%. Patients with PNI may present with clinical symptoms or radiologic evidence, but PNI is often found incidentally on histologic examination. In this systematic review, Karia et al demonstrate that patients with CSSC and clinical PNI had a significantly higher risk of local recurrence and death than did patients with incidentally noted PNI. Patients with CSSC and clinical PNI may benefit from enhanced long-term surveillance.

Author Audio Interview

Autosomal recessive erythropoietic protoporphyria and X-linked protoporphyria are rare photodermatoses presenting with variable degrees of painful phototoxic effects that markedly affect quality of life. The baseline characteristics and determinants of disease severity of these conditions remain poorly characterized. In this prospective observational cohort study, Balwani et al demonstrate that higher erythrocyte protoporphyrin (ePPIX) levels were correlated with earlier age of symptom onset, decreased sun tolerance, and increased risk of liver dysfunction. Patients with higher ePPIX levels (>2000 μg/dL) should be monitored more closely for evidence of liver disease.