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Scleroderma is a connective tissue disease characterized by skin thickening and fibrosis. Irradiation with UV-A1 has been used to treat sclerotic skin conditions. In this case series, Wang et al treated patients with cutaneous sclerosis and healthy volunteers with UV-A1 phototherapy 3 times weekly. High-dose UV-A1 irradiation produced a modest decrease in induration, but subsequent skin darkening attenuated additional responses. To minimize skin darkening, medium-dose UV-A1 phototherapy was used with no less efficacy than higher-dose therapy.
Historically, tattoos are often thought of as masculine, yet rates for women with tattoos continue to range between 45% and 65% of the tattooed population. A subset of approximately 20% of tattoo wearers are dissatisfied, and an even smaller subset of 6% actually seek removal. In this descriptive exploratory study, Armstrong et al examine the motivations for tattoo removal among 196 patients in 2006. Women were more likely to seek tattoo removal, citing embarrassment, negative comments, and clothing problems as motivations that overcame the uniqueness and self-identity that was initially sought.
Venous malformations (VMs) are localized or diffuse slow-flow vascular malformations present at birth. Most are asymptomatic, but swelling and pain may occur. Localized intravascular coagulopathy (LIC) may occur in patients with extensive and painful VMs of limbs, characterized by elevated D-dimer levels. In this prospective case series, Dompmartin et al report that 42% of patients with VMs demonstrated coagulopathy as evidenced by elevated D-dimer levels in these otherwise healthy patients. In the setting of normal fibrinogen levels, this coagulopathy need not be treated, although surgical treatment is recommended for painful lesions, and elastic compression may minimize blood stasis. When fibrinogen concentration is low, the potential aggravation of LIC to disseminated intravascular coagulopathy should be managed preventively through the use of low-molecular-weight heparin.
Patients often develop erythematous eruptions following stem cell transplantation (SCT). One consideration in the broad differential diagnosis is reactivation of latent herpes simplex virus (HSV) and HSV-associated erythema multiforme (HAEM), a viral disease in which the skin lesions are virus free but contain HSV DNA fragments. In this descriptive case series of 20 patients with erythematous eruptions following SCT, Burnett et al demonstrate HSV DNA polymerase expression in the lesional skin of 79% of patients, suggesting that these eruptions may often be related to HAEM and that continuous high-dose antiviral therapy may permit cutaneous clearance of the causative DNA fragments.
Newer, targeted anticancer agents are associated with frequent cutaneous adverse effects. Sorafenib is a novel, orally active, multikinase inhibitor that has shown efficacy in treating renal cell carcinoma and hepatocellular carcinoma. Although generally well tolerated, cutaneous adverse effects have been reported. In this double-blind, prospective study, Autier et al demonstrated that more than 90% of patients receiving treatment experienced at least 1 cutaneous symptom. Hand-foot skin reactions occurred in more than 60% of patients and were the most common cutaneous event that influenced sorafenib tolerability. Patient education and early identification of these cutaneous adverse effects allow adequate preventive and curative symptomatic treatments.
This Month in Archives of Dermatology. Arch Dermatol. 2008;144(7):841. doi:10.1001/archderm.144.7.841