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In This Issue of JAMA Dermatology
October 2017


JAMA Dermatol. 2017;153(10):959. doi:10.1001/jamadermatol.2016.1714

Because of its low cost, infrequent dosing, and favorable adverse effect profile, methotrexate sodium is widely used for severe psoriasis. However, methotrexate therapy is associated with hepatic fibrosis, which occurs at excess even among patients who are carefully prescreened for alcohol use and chronic viral hepatitis. Liver biopsy is the current standard for detecting and monitoring hepatic fibrosis among patients receiving long-term methotrexate therapy, but this invasive procedure carries important risks. In this cohort study, Bauer et al demonstrate the utility of a noninvasive test for nonalcoholic steatohepatitis (NASH), which may significantly reduce the need for liver biopsies.

Nonmelanoma skin cancer (NMSC) risk factors include white race, male sex, and sun exposure. The major etiologic agent for NMSC is UV-B, but UV-B also induces cutaneous vitamin D production, which exerts protective effects in several cancer types. More than 60 single-nucleotide polymorphisms (SNPs) in the vitamin D receptor have been detected. In this case-control study, Burns et al demonstrate that patients with the BsmI SNP were twice as likely to develop NMSC. Screening for BsmI may emphasize the need for early skin cancer prevention in individuals with this SNP.