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A Day at the Beach While on Tropical Vacation
Skin cancer incidence and mortality attributable to outdoor exposure to UV radiation (UVR) has risen rapidly over the past 3 decades. Frequent, intermittent overexposure to UVR has been reported to result in significant increases in basal cell carcinoma and melanoma. Tropical vacations present the potential for high levels of intense, episodic sun exposure in high-risk environments like beaches where sun-intense activities are preferred. In this multiple-measure assessment of levels of UVR exposure and the range of sun protection behaviors of beachgoers at a popular vacation destination, O’Riordan et al demonstrated that beachgoers were exposed to 5 times the UVR dose required to result in erythema among unprotected fair-skinned populations. Three subgroups of beachgoers were identified, some of whom would benefit from targeted, population-based interventions aimed at reducing skin cancer risks while encouraging outdoor leisure-time activities and sun-safe practices.
See page 1449
Recalcitrant Psoriasis and Indigo Naturalis
Traditional Chinese medicine is one of the most frequently chosen alternative therapies in China and Taiwan. Psoriasis vulgaris has been treated for centuries with topical and oral preparations of indigo naturalis, a powder prepared from the plant Strobilanthes formosanus. Long-term systemic use has been occasionally associated with gastrointestinal irritation and adverse hepatic effects. In this randomized, observer-blinded, vehicle-controlled trial, Lin et al demonstrate the safety and efficacy of a novel topical indigo naturalis ointment for long-term therapy of plaque-type psoriasis.
See page 1457
The Association of Lichen Sclerosus and Erosive Lichen Planus of the Vulva With Autoimmune Disease
Although the possibility that lichen sclerosus has an autoimmune cause has been considered, the evidence thus far has been inconclusive. In this case-control study, Cooper et al demonstrate that autoimmune disorders were more frequent among patients with lichen sclerosus and erosive lichen planus of the vulva than among age- and sex-matched controls. Surprisingly, the number of circulating autoantibodies was elevated among patients with erosive lichen planus but not lichen sclerosus. These data support the concept that, while autoantibodies may play a transient or amplifying pathogenetic role, these conditions are more likely to be T-cell–mediated autoimmune disorders.
See page 1432
Treatment of Chronic Leg Ulcers With Topical Activated Protein C
Chronic wounds and ulcers present increasing therapeutic challenges as our population ages. Some chronic wounds become locked in the inflammatory phase and are unable to progress to form granulation tissue. Evidence is now emerging that activated protein C (APC) contributes to wound repair through a complex mechanism that involves inhibition of inflammation, angiogenesis, antiapoptotic properties, and reepithelialization. In this series of 4 cases of nonhealing lower limb skin ulcers, Whitmont et al demonstrate that weekly topical APC application can produce a rapid and sustained wound-healing response. These data present compelling evidence that APC provides a safe, efficacious, and well-tolerated therapeutic option for recalcitrant chronic wounds.
See page 1479
Two Pediatric Cases of Nonbullous Histiocytoid Neutrophilic Dermatitis Presenting as a Cutaneous Manifestation of Lupus Erythematosus
Neutrophilic dermatoses are commonly seen in association with connective tissue disease but only infrequently as a manifestation of lupus erythematosus (LE). In this case report, Camarillo et al describe 2 pediatric patients with nonbullous neutrophilic dermatitis as a cutaneous manifestation of LE. Both of these cases demonstrated unique histopathologic features that resembled a recently named variant of neutrophilic dermatosis, histiocytoid Sweet syndrome, although neither fulfilled the strict diagnostic criteria for classic Sweet syndrome. These cases support the inclusion of nonbullous neutrophilic dermatitis as a possible skin manifestation of LE.
See page 1495
This Month in Archives of Dermatology. Arch Dermatol. 2008;144(11):1423. doi:10.1001/archderm.144.11.1423
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