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In This Issue of JAMA Dermatology
March 2018


JAMA Dermatol. 2018;154(3):239. doi:10.1001/jamadermatol.2017.3823


Pemphigus is a rare autoimmune blistering disease characterized by painful vesicobullae on the skin and mucous membranes. Parkinson disease (PD) has been significantly associated with pemphigus, and other neurologic disorders may be similarly associated. In this population-based cross-sectional study, Kridin et al demonstrate a 2-fold higher prevalence rate of dementia, epilepsy, and PD among patients with pemphigus than age-, sex-, and ethnicity-matched controls. Multiple sclerosis was not associated with pemphigus. Physicians who care for patients with pemphigus should be aware of this association, and patients with pemphigus should be carefully screened for comorbid disorders. Linder and colleagues provide the Editorial.


Continuing Medical Education

Psoriasis is a common inflammatory condition affecting skin, nails, and joints. Adult patients with psoriasis are at risk for metabolic comorbidities, but while the incidence of psoriasis is rising in the pediatric population, this association has not been well studied. In this large, retrospective cohort study, Tollefson et al demonstrate that children with psoriasis have higher rates of obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, nonalcoholic liver disease, and elevated liver function test results than children without psoriasis. Psoriasis was a small independent risk factor, but obesity was demonstrated to be a much stronger contributor to these comorbidities.

The human microbiome plays a role in health and disease and in the development of our immune system. In atopic dermatitis (AD), the skin microbiome is dominated by Staphylococcus aureus and is less diverse than in healthy skin. In this case-control study, Clausen et al demonstrate that bacterial diversity of the skin microbiome in patients with AD was inversely correlated with disease severity for both lesional and nonlesional skin. Microbiome composition in AD nonlesional skin was also linked to filaggrin gene mutations. Further research into modulation of the microbiome may reveal treatment strategies for AD.

Palmoplantar pustulosis (PPP) is a chronic relapsing inflammatory skin disease characterized by multiple sterile pustules and vesicles with erythematous scaling on the palms and soles. Tobacco smoking, focal infections, and seasonal conditions have been identified as common risk factors. While PPP has been considered distinct from palmoplantar psoriasis, recent evidence suggests a role for the interleukin (IL)-23 and IL-17 axis in its molecular pathogenesis. In this randomized clinical trial, Terui et al demonstrate that the anti–IL-23 monoclonal antibody guselkumab was safe and effective for treating PPP.

The opioid epidemic in the United States has been fueled by prescription opioids, and clinicians in all specialties are evaluating their prescribing patterns. Even a short course of opioids can place patients at risk for addiction. Current dermatology guidelines recommend oral opioids as second-line agents after a trial of nonsteroidal anti-inflammatory drugs and/or acetaminophen after dermatologic surgery. In this cross-sectional study, Cao et al demonstrate that opioid prescriptions by dermatologists were few and were concentrated among dermatologists in surgical practices. When clinically appropriate, dermatologists should follow current guidelines using nonopioid agents alone for pain control after surgery.