Pemphigus and Osteoporosis

Pemphigus is a rare, potentially fatal mucocutaneous autoimmune bullous disease. Systemic corticosteroids remain the mainstay of therapy despite the risk of substantial adverse effects. Glucocorticoid-induced osteoporosis is a skeletal disorder characterized by compromised bone strength that predisposes patients to fracture. In this case-control study, Wohl et al demonstrate an association of pemphigus with osteoporosis even after controlling for glucocorticoid therapy, perhaps related to immunopathogenic processes and proinflammatory cells and cytokines shared by these 2 disorders. Compliance with current detection, prevention, and treatment guidelines for osteoporosis were suboptimal, suggesting that patients with pemphigus need improved evaluation, monitoring, and treatment for osteoporosis at the time of their pemphigus diagnosis and throughout their course of glucocorticoid therapy.

Pityriasis versicolor is a common superficial infection of the skin caused by Malassezia furfur. Although this saprophytic yeast is part of the normal skin flora, a number of conditions may trigger conversion to the mycelial form associated with clinical disease. Most patients are asymptomatic, although mild pruritus may be encountered. A number of topical and systemic treatment options exist, but no summary or consensus regarding the comparative efficacy of these options exists. In this systematic review, Hu and Bigby report that most agents were effective compared with placebo, but that randomized, controlled clinical trials are lacking. The relative efficacy and optimal regimens for treatment of pityriasis versicolor have not been established.

Hepatitis C virus (HCV) infection presents a therapeutic challenge in patients with severe psoriasis. Systemic agents' usefulness is limited owing to hepatotoxic effects. In this case report, Gandhi et al describe a patient with severe psoriasis and HCV infection who was forced to discontinue methotrexate therapy. Because tumor necrosis factor (TNF) is implicated in hepatocyte destruction during chronic HCV infection, the possibility exists that anti-TNF therapy may show benefit against both HCV and psoriasis. A critical appraisal of the topic amplifies the consensus that anti-TNF therapy merits strong consideration in this setting: the patient's psoriasis almost cleared under etanercept treatment, and HCV-RNA was undetectable.

Acral melanocytic nevi are relatively common, and differentiation from acral cutaneous melanoma (CM) presents a challenge to clinicians. In this point prevalence survey, Palicka and Rhodes demonstrate that acral nevi appeared to be associated with ethnicity, pigmentation, age, and CM risk factors. While relatively large or darkly pigmented acral nevi appeared to be more common in blacks than in whites, diffusely black acral nevi were uncommon in both groups.

Vitamin D deficiency is associated with an increased risk of autoimmune disease, fractures, cancer, and cardiovascular disease. Although relatively common in white patients, vitamin D deficiency may be even more common in subgroups including elderly, dark-skinned, overweight, and nursing home patients as well as those inhabiting low-UV exposure areas. In this retrospective cohort study, Tang et al demonstrate that patients with basal cell nevus syndrome may be at increased risk for vitamin D deficiency, depending on their adherence to photoprotection practices, thus highlighting the potential need for dermatologists to recommend oral supplementation in these settings.