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In This Issue of JAMA Dermatology
November 2017


JAMA Dermatol. 2017;153(11):1081. doi:10.1001/jamadermatol.2016.1721


Moisturizers improve skin barrier function, reduce transepidermal water loss, and decrease cutaneous inflammation. Moisturizers free of irritants or allergens are a mainstay of prevention and treatment for irritant or allergic contact dermatitis. In this cohort study, Xu et al evaluate 174 best-selling whole-body moisturizers by price, presence of ingredients represented in the North American Contact Dermatitis Group, presence of cross-reactors for fragrances, and vehicle type. Few moisturizers were free of potential skin allergens, and dermatologists must be prepared to provide specific product and manufacturer recommendations to guide patients toward the best products. Zirwas provides the Editorial.


Surgical excision for melanoma is often curative. Delays in treatment can result in increased morbidity and mortality. In this retrospective cohort study, Adamson et al demonstrate that Medicaid patients were significantly more likely to experience surgical delays compared with privately insured patients. Significant proportions of Medicare and privately insured individuals also experienced a delay of greater than 6 weeks before definitive surgical excision of their melanomas. Surgical delays were less prevalent among patients diagnosed or treated by dermatologists, suggesting that reduction in delays may be achieved through better access to specialty care. Lott provides the Editorial.


Author Audio Interview

Renal transplantation is considered the only long-term curative treatment for end-stage renal disease, but patients must cope with lifelong immunosuppressive treatments, rendering them susceptible to skin cancers. In this cohort study, Ascha et al demonstrate that renal transplant recipients have a greater risk of melanoma than their non–renal transplant counterparts. Longer life expectancy after renal transplantation permits greater duration of immunosuppressive therapy, with sirolimus and cyclosporine conferring particular risk. Melanoma-specific risk factors include older age at transplantation, skin type, sun exposure burden, and duration of immunosuppression. Annual dermatological assessment is recommended for all renal transplant patients.

Pneumocystis pneumonia (PCP) is a potentially lethal opportunistic infection, and primary prophylaxis among immunocompromised patients most frequently involves trimethoprim-sulfamethoxazole. Risks of routine prophylaxis include hyperkalemia, hypoglycemia, photosensitivity, thrombocytopenia, and other rare reactions. An incidence of at least 3.5% has been proposed as a cutoff to justify prophylaxis. In this retrospective analysis, Amber et al demonstrate that patients with autoimmune blistering disease seem to have a lower risk of PCP than the general population of immunosuppressed dermatology patients. The PCP incidence rate was only 0.1%, suggesting that routine PCP prophylaxis is not indicated for these patients.