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In This Issue of JAMA Dermatology
April 2018


JAMA Dermatol. 2018;154(4):385. doi:10.1001/jamadermatol.2017.3828


Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis characterized by sterile inflammatory pustules that rapidly expand into ulcers with violaceous, undermined borders. Although PG can be idiopathic, it is often associated with medical comorbidities. In this cohort study, Ashchyan et al demonstrate that patients with PG younger than 65 years are more likely to have associated inflammatory bowel disease, while those 65 years or older are more likely to have associated inflammatory arthritides, solid organ and hematologic malignancies, and hematologic disorders. These data may allow development of algorithms to prioritize evaluation recommendations based on age.

Editorial and Related Article

Dermoscopy may significantly increase the ability of clinicians to recognize early melanoma. Several dermoscopic criteria are associated with melanoma diagnosis, but the usefulness of these criteria for melanoma in situ (MIS) is unclear. In this retrospective study, Lallas et al demonstrate 5 dermoscopic features suggestive of MIS vs all other diagnoses and introduce 2 dermoscopic features indicative of MIS over atypical nevi. These findings enhance the accuracy in recognizing melanoma at the earliest possible stage.


The current model of posttreatment melanoma follow-up relies on clinician-led surveillance at scheduled office visits. About two-thirds of all recurrences and nearly half of all new primary melanomas are detected by patients or their partners between visits. In this survey study, Lim et al demonstrate that some patients may prefer fewer visits if they are supported in skin self-examinations and if there is rapid clinical review of any concerns. Online videos and smartphone apps may support this patient-led surveillance.

Pemphigus is a rare intraepithelial autoimmune blistering disease characterized by painful vesicobullous lesions on the skin and mucous membranes. The association of pemphigus with solid cancers is not established. In this cross-sectional study, Kridin et al demonstrate a greater prevalence of esophageal and laryngeal cancers in patients with pemphigus vs controls. A posited mechanism is that tumor-induced larynx or esophageal tissue damage and morphological alterations newly expose epithelial surface antigens triggering secondary autoimmune response. No significant associations between pemphigus and other solid cancers were observed.

Dapsone-induced hypersensitivity syndrome is a life-threatening drug reaction characterized by fever, skin reactions, and systemic involvement. Specific HLA genotype polymorphisms are known to be associated with adverse drug reactions, and dapsone-induced cutaneous adverse drug reactions (cADRs) in HLA genotypes have been investigated in epidemiologic studies. In this systematic review and meta-analysis, Tangamornsuksan and Lohitnavy demonstrate a significant association between HLA-B*1301 and dapsone-induced cADRs, which suggests that genetic screening for HLA-B*1301 may be warranted before dapsone therapy.

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