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Strategy for Early Pemphigoid Diagnosis
Many patients with bullous pemphigoid (BP) develop no skin blisters and may not receive the correct diagnosis. Diagnostic criteria and are needed for early recognition and trials. In this diagnostic accuracy study of patients with suspected BP or nonbullous pemphigoid (NBP), Meijer et al found that 1 in 5 patients with a pemphigoid diagnosis had no skin blistering. Diagnosis could be made using direct immunofluorescence (IF) microscopy on a skin biopsy specimen and/or indirect IF on human salt-split skin substrate in serum. Both direct and indirect IF would aid in the diagnosis of both BP and NBP. Temel and Murrell provide an Editorial.
Atopic Dermatitis and Suicidality
Atopic dermatitis (AD) is associated with many psychiatric comorbidities, but the association between AD and suicidality is not well established. In this systematic review and meta-analysis, Sandhu et al analyzed 15 studies including 310 681 patients with AD and found a 44% increased odds of suicidal ideation and a 36% increased odds of suicide attempts compared with patients without AD. Dermatologists should understand this risk, monitor for it, and make referrals to mental health clinicians when appropriate.
Continuing Medical Education
Subsequent Primary Melanoma Risk Factors
Risk factors for subsequent melanomas in patients with melanoma are not well understood. In this case-control study of patients with melanoma, Müller et al found that internal factors (family history and genetic variants), number of nevi, and actinic damage on the back were more often associated with the development of subsequent melanomas than skin phototype or hair color. They also found that patients with many nevi were younger at the time of diagnosis of their first melanoma. These findings could help clinicians identify persons at increased risk of multiple primary melanomas.
Epidermolysis Bullosa Milestone Clinical Events
Epidermolysis bullosa (EB) is rare in children, but it has high morbidity and mortality rates. Improved understanding of the milestone events for EB, including age at diagnosis and at major clinical events, could help refine treatment and improve patient life quality clinical outcomes. In this cohort study of patients with EB, Feinstein et al demonstrate that diagnostic testing is more common among severe phenotypes. Earlier testing across phenotypes may enable improved characterizations of patients so that appropriate counseling and clinical care may be offered.
Author Audio Interview
Early Combination Treatment for Stable Vitiligo
Noncultured epidermal suspension (NCES) is used for vitiligo that has not responded to medical therapy. However, NCES is generally performed in cases with disease stability (DS) of at least 12 months because DS is vital in determining NCES outcome. In this randomized clinical trial, Thakur et al assess the use of combination NCES plus noncultured dermal cell suspension for vitiligo with shorter DS (3-6 months). In these shorter DS cases, 100% of patients receiving combination therapy achieved 75% repigmentation, while only 30% of those receiving NCES alone achieved this benchmark. This combination therapy may be used to treat stable vitiligo earlier than 12 months.
Highlights. JAMA Dermatol. 2019;155(2):137. doi:10.1001/jamadermatol.2018.3498
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