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This Month in Archives of Dermatology
May 1, 2008

This Month in Archives of Dermatology

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Arch Dermatol. 2008;144(5):580. doi:10.1001/archderm.144.5.580

Family History as a Risk Factor for Herpes Zoster

Herpes zoster (HZ) represents reactivation of latent varicella zoster virus (VZV) residing in the dorsal root ganglia following primary infection. While age and immunosuppression represent risk factors for developing HZ, additional risk factors that may help direct preventive vaccination strategies remain unidentified. In this case-control study, Hicks et al demonstrate a strong association between the development of HZ and having a blood relative with a history of HZ, suggesting that targeting these at-risk individuals for vaccination may decrease both their chance of future HZ infection and health care expenditures toward HZ morbidity.

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Variations in Management of Stage I to Stage III Cutaneous Melanoma

The increasing incidence of cutaneous melanoma (CM) makes this cancer a significant public health concern in most developed countries. Clinical practice guidelines have been published in many countries with the aim of optimizing treatment and making it consistent. However, these guidelines often differ among countries, and important debates often arise regarding new methods of treatment and surveillance. In this retrospective, population-based study using survey techniques in France, Grange et al demonstrated that large disparities exist in the treatment of CM in France and discrepancies with current practice guidelines. These disparities depended on the medical and geographical environment more than characteristics of either the patients or the tumors.

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Possible Role of Borreliaburgdorferi Sensu Lato Infection in Lichen Sclerosus

Lichen sclerosus (LS) is a chronic inflammatory condition that most commonly affects the genito-anal skin of adult women. Because LS shares features with acrodermatitis chronic atrophicans (ACA), a chronic form of borreliosis, investigators have considered the possibility that Borrelia burgdorferi may serve as a common etiologic factor for both diseases. In this case-control study using focus-floating microscopy, Eisendle et al detected B burgdorferi in 63% of LS cases even in the setting of negative polymerase chain reaction findings, demonstrating the problematic role of this technique in reliably detecting B burgdorferi in tissue specimens. Borrelia burgdorferi or other similar strains may be specifically involved as a trigger for LS.

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Topical Corticosteroids in the Treatment of Acute Sunburn

Sunburn is the clinical manifestation of a complex inflammatory process in the skin that is most commonly encountered in fair-skinned individuals following UV radiation exposure. Clinically, erythema develops gradually in the 3 to 5 hours following sun exposure and may persist for more than 48 hours. Symptoms range from mild redness to painful erythema, edema, and blistering. Current therapeutic recommendations often include topical corticosteroids. In this randomized, double-blind, controlled clinical trial, Faurschou and Wulf demonstrate that treatment with moderate- or high-potency topical corticosteroids 6 or 23 hours after sunburn does not decrease the acute sunburn reaction. The authors suggest that this lack of clinical effect may be related to cellular functions being so severely disturbed by UV radiation that the corticosteroids are unable to bind to their intracytoplasmic receptors.

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Delayed Immune-Mediated Adverse Effects of Polyalkylimide Dermal Fillers

Various permanent and nonpermanent dermal and subdermal fillers are used by dermatologists to correct the effects of aging on the skin. Fillers may be classified by their origin and their longevity. Although claims have been made that many fillers are nontoxic and nonimmunogenic, adverse effects may occur with all of these compounds. In this prospective case series of patients injected with polyalkylamide implants (PAIs), Alijotas-Reig et al describe 25 patients with severe or persistent delayed adverse effects after PAI, including delayed granulomatous reactions and pseudoabscesses. Eleven patients demonstrated high levels of acute-phase reactants (C-reactive protein or fibrinogen), suggesting an underlying systemic inflammatory process.

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