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In This Issue of JAMA Dermatology
August 2018


JAMA Dermatol. 2018;154(8):857-980. doi:10.1001/jamadermatol.2017.3848


Lentigo maligna (LM) is commonly found on the head and neck in relatively older patients, where staged excision may result in significant cosmetic morbidity. Imiquimod cream, 5%, has been used off-label as monotherapy for LM and may be used before staged excision to reduce surgical margins. In this retrospective medical record review, Donigan et al determined that 81% of patients with LM had clear margins after 1 stage. Among these patients, residual LM was seen in only 18%, suggesting that 82% were free of detectable LM. These data support the use of neoadjuvant topical imiquimod cream prior to conservatively staged excision for LM.


Subungual melanoma in situ (SMIS) may be difficult to differentiate from benign longitudinal melanonychia, and clinical examination alone may provide insufficient diagnostic criteria. Although dermoscopy cannot replace histologic diagnosis, magnified morphologic patterns of the nail unit may aid in the detection of SMIS. In this cohort study, Ohn et al used clinical and dermoscopic features to develop a predictive scoring model for SMIS that supports informed decision making regarding the management of longitudinal melanonychia.

Sun-protective behaviors are typically assessed in an additive manner, presupposing that engaging in more isolated behaviors is better. This approach fails to capture current recommendations that sunscreen be used as a supplement to other sun safety behaviors and rarely links these behaviors to indices of sun overexposure such as sunburn. In this cross-sectional survey of US adults, Morris and Perna demonstrate that a decision tree model was superior to a composite score in predicting patterns of sun-protective behaviors that were associated with likelihood of sunburn.

Although the onset of atopic dermatitis (AD) is often in early childhood, symptoms commonly persist into adulthood. There remain substantial gaps in our understanding of the impact of AD on the lives of adults. In this cross-sectional study, Simpson et al demonstrate that inadequate disease control was common among patients with moderate to severe AD. Patients reported frequent itching, which drives the burden of AD and affects sleep as well as daily activities. Pain, sleep disturbances, and mental health issues contributed to the multidimensional patient burden in adults with AD. These data highlight the need for more effective therapies to better control AD.

Clinical Review & Education

To evaluate if dietary practices might reduce disease severity in adults with psoriasis or psoriatic arthritis, Ford et al conducted a systematic review of 55 studies evaluating dietary recommendations in 4534 patients. The strongest evidence was for weight reduction via a hypocaloric diet in overweight and obese patients with psoriasis. The utility of a gluten-free diet and supplementation with vitamin D varied by subpopulations, and evidence was low for the utility of specific foods, nutrients, and dietary patterns in reducing disease activity. All dietary interventions should be used in conjunction with standard medical therapies.

Continuing Medical Education