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In This Issue of JAMA Dermatology
May 2019


JAMA Dermatol. 2019;155(5):519. doi:10.1001/jamadermatol.2018.3513


Psoralen–UV-A (PUVA) therapy is standard first-line treatment for early mycosis fungoides (MF), but much remains unknown about optimal dosing, duration, or use as maintenance therapy. In this randomized clinical trial of 27 patients with early-stage MF, Vieyra-Garcia et al found that low-dose, low-frequency PUVA therapy appears to be highly effective at achieving disease-free remission, and that its use as maintenance therapy might extend that outcome. Guitart provides an Editorial.


Since linear porokeratosis (LP) manifests in the lines of Blaschko, the dorsoventral migration patterns of keratinocyte precursors, postzygotic mutation might underlie the disease, but no genetic evidence has been reported. In whole-exome sequencing study of LP-affected skin with blood/saliva in 3 patients, Atzmony et al found evidence that LP was associated with postzygotic mutations in genes that encode enzymes within the mevalonate biosynthesis pathway (PMVK and MVD). Happle provides an Editorial.


Data from small studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but long-term, population-based studies are lacking. In this report from a large, ongoing, long-term study, Ramirez et al found that, while child sleep disturbances did not fully explain maternal sleep disturbances, having a child with AD was significantly associated with impaired maternal sleep quality, subjectively insufficient sleep, and increased daytime exhaustion.

Audio Author Interview

Many assessment tools and classification systems have been applied to alopecia areata (AA), but their prognostic values are limited. In this cluster analysis of a cohort of 321 participants, Lee et al define the Topography-based Alopecia areata Severity Tool (TOAST), and used it to identify 5 characteristic phenotypes of patients with AA. They found that temporal area AA involvement should be independently measured for better prognostic stratification.

While topical medication is the central treatment for patients with AD, choices are limited. Phosphodiesterase 4 (PDE4) inhibitors represent a new option for treating AD. In this systematic review and meta-analysis of 7 double-blind randomized clinical trials, Yang et al found that topical application of PDE4 inhibitors was associated with a significant improvement in both target lesion score and investigators’ assessment of AD compared with the control vehicles.

Continuing Medical Education