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Antibiotic Prescription in Dermatology
Dermatologists prescribe more oral antibiotic courses per clinician than any other specialty, and such use puts patients at risk of antibiotic-resistant infections and antibiotic-associated adverse events. In this cross-sectional analysis of data from 2008 through 2016, Barbieri et al found a decrease in overall antibiotic prescribing from 3.36 to 2.13 courses per 100 visits but an increase in prescribing associated with surgical visits from 3.92 to 6.65 courses per 100 visits. While overall antibiotic use by dermatologists is declining, the use of postoperative oral antibiotics should be carefully evaluated. Kirby and Lim provide an Editorial.
Author Audio Interview
HLA Antigen Mismatch and Posttransplant Skin Cancer
Skin cancer risk factors after solid-organ transplant can inform clinical care, but data on these risk factors are limited. In this secondary analysis of a cohort study by Gao et al of organ transplant recipients, HLA antigen mismatch between transplant donor and recipient was associated with a protective effect against posttransplant skin cancer. Tumor surveillance mechanisms may be activated by HLA antigen mismatch, and so well-matched transplant recipients may have a higher risk of skin cancer after transplant.
Suture Spacing and Wound Cosmesis
There is a lack of data on the effect of suture spacing on cosmetic outcomes. In this randomized clinical trial of 50 adults, Sklar et al found no significant differences in wound cosmesis 3 months postoperatively between 2-mm and 5-mm running cutaneous suture spacing. When deciding on suture spacing, dermatologic surgeons may consider that running cutaneous sutures spaced 2 vs 5 mm apart result in similar cosmetic outcomes.
Narrowband UV-B vs PUVA for Early-Stage MF
Phototherapy is a mainstay of treatment for early mycosis fungoides (MF). The most common modalities are psoralen–UV-A (PUVA) and narrowband UV-B, but are they comparably effective? In this systematic review and meta-analysis, Phan et al found that early-stage MF response rates were similar between PUVA and narrowband UV-B, nor were significant differences found in terms of adverse effects. These results suggest that narrowband UV-B is a viable and safe alternative to PUVA for treatment of early-stage MF.
Clinical Review and Education
Imatinib for Locally Advanced or Metastatic DFSP
Dermatofibrosarcoma protuberans (DFSP) has the potential for local destruction and recurrence, and for cases untreatable by resection, imatinib therapy has been used. However, data are scarce on its effectiveness. In this systematic review, Navarrete-Dechent et al report that imatinib was associated with a complete or partial DFSP response in more than 60% of advanced cases, regardless of 400-mg or 800-mg daily dose. Severe adverse events occurred in about 15% of all cases. Imatinib should be considered a safe and effective therapy for advanced DFSP at a 400-mg/d starting dose.
Continuing Medical Education
Highlights. JAMA Dermatol. 2019;155(3):269. doi:10.1001/jamadermatol.2018.3503
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