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In This Issue of JAMA Dermatology
July 2018


JAMA Dermatol. 2018;154(7):747. doi:10.1001/jamadermatol.2017.3843

Hyaluronic acid (HA) fillers are essential tools in the field of noninvasive cosmetic dermatology. One attractive feature of HA fillers is their reversibility in response to hyaluronidase injections. Most of the anecdotal literature on hyaluronidase use for the management of filler complications focuses on relatively high-dose injections. In this randomized clinical trial, Alam et al demonstrate that small unit doses of hyaluronidase allowed removal of minute quantities of filler without removing the entire implant. Clinicians may thus fine-tune filler-associated contour without complete removal of HA filler from the treatment site.


Continuing Medical Education

Facial angiofibromas occur in approximately 75% of individuals with tuberous sclerosis complex (TSC). Rapamycin is an mTOR inhibitor that has demonstrated positive results for TSC-related conditions, but oral mTOR inhibitors can be associated with serious adverse effects. In this randomized clinical trial, Koenig et al demonstrate that topical rapamycin produced clinically meaningful and statistically significant improvement in the appearance of TSC-related facial angiofibromas. Topical rapamycin was well tolerated, and systemic absorption was not observed. Prophylactic, early, and long-term uses of topical rapamycin merit further study.


Author Audio Interview

Previous studies have shown differences in pigmentation phenotype between male and female persons, with a stronger effect of MC1R variants on skin phototype seen in females. In this case-control study, Wendt et al identified MC1R red hair variants as significant risk factors for melanoma in females but not in males. This observation of sex-dependent variation in pigmentation phenotype and melanoma risk indicate the need for further studies elucidating the effect of sex hormones on skin pigmentation and skin cancer.

Systemic sclerosis (SSc) is a rare, severe connective tissue disease characterized by microvascular damage, immunologic abnormalities, and sclerosis of skin and internal organs. Telangiectases (TAs) may represent a vascular manifestation of SSc, reflecting aberrant neoangiogenesis. In this cross-sectional study of patients with SSc, Jouvray et al demonstrate that TAs were predominantly located on the face, hands, and upper trunk and were associated with vasculopathy, such as pulmonary hypertension, microvascular abnormalities, pulmonary embolism, and renal involvement. A positive association of TA number with soluble endoglin levels was noted, suggesting involvement of this angiogenic factor in the development of TAs.

Impetigo is the most common bacterial skin infection in children. Controlling impetigo not only relieves symptoms but also minimizes scarring and prevents rare but serious systemic complications such as glomerulonephritis or rheumatic heart disease. Topical therapies are preferred for localized, uncomplicated impetigo, but resistance rates to commonly used topical antibiotics are rising. In this randomized clinical trial, Rosen et al demonstrate that the novel topical antibiotic ozenoxacin cream, 1%, was effective and well tolerated for treating impetigo in patients 2 months and older.