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Physicians and insurance companies use clinical practice guidelines (CPGs) to make decisions about patient care. These guidelines include recommendations derived from a systematic review of research evidence and careful consideration of benefits and harms associated with medical interventions. In this cross-sectional study of 49 CPG authors, Checketts et al reveal that 40 had received industry payments, and 22 did not accurately disclose their industry relationships. Changes are recommended for panel composition, disclosure policies, and development practices to promote transparency and minimize bias.
Chronic urticaria (CU) affects 0.1% to 0.3% of children and is defined by the occurrence of wheals or angioedema lasting more than 6 weeks. It is often considered a self-limited disease in adults, but data on the natural history of CU in children are scarce. In this cohort study, Netchiporouk et al demonstrate that the yearly resolution rate of CU in children was only 10%. Basopenia and positive results from a basophil activation test (CD63 <1.8%) were associated with higher resolution rates. Clarifying the mechanisms accounting for these associations may allow development of appropriate management strategies.
Pediatric dermatologists are in short supply. Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that rely on parent-provided photographs has not been formally compared with diagnoses made in person. In this prospective cohort study, O’Connor et al demonstrate that the overall concordance between photograph-based vs in-person diagnoses was 83%. Concordance was 89% in a subgroup of cases with photographs of high enough quality to make a diagnosis.
Reticular veins are flat, bluish subdermal veins less than 4 mm in diameter in the lower limbs. Sclerotherapy treatment improves aesthetics, prevents disease progression, and relieves local symptoms. Currently available sclerosing agents include hyperosmolar agents (hypertonic glucose [HG] and saline), detergents (polidocanol and sodium tetradecyl sulfate), and chemical irritants (glycerin). No consensus has been reached regarding the optimal sclerosant. In this randomized clinical trial, Bertanha et al determine that sclerotherapy of reticular veins with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone. Pigmentation was the most common minor adverse event and occurred in both groups.
The high risk of skin cancer after solid organ transplantation remains a major clinical challenge, but it is unclear whether the risk has changed during the last decades. In this population-based cohort study, Rizvi et al found that the risk of squamous cell carcinoma (SCC) in kidney, heart, lung, and liver transplant recipients peaked in patients who underwent transplantation from 1983 through 1987 and declined in those who underwent transplantation in 1993 and later. Less aggressive and more individualized immunosuppressive treatment may explain this decline in risk, but close dermatological follow-up of transplant recipients remains essential.
Highlights. JAMA Dermatol. 2017;153(12):1207. doi:https://doi.org/10.1001/jamadermatol.2016.1728
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