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Treatment of Severe Pemphigus With Rituximab
Pemphigus is a mucocutaneous blistering disease mediated by circulating autoantibodies directed against desmogleins. Systemic steroids remain the mainstay of therapy, but adverse effects of corticosteroids and complications from long-term immunosuppressive therapy contribute substantially to the morbidity and mortality from this disease. Additional therapies include pulsed steroid administration, cyclophosphamide, plasmapheresis, intravenous immunoglobulins, and mycophenolate mofetil. In this case series, Cianchini et al demonstrate the safety, efficacy, and tolerability of the chimeric murine-human anti-CD20 monoclonal antibody rituximab in treating patients with pemphigus resistant to conventional therapy.
Nephrogenic Systemic Fibrosis
Nephrogenic systemic fibrosis (NSF) is an acquired, progressive, systemic fibrosing disorder that develops in the setting of renal disease. Plaquelike woody induration of the skin may involve deeper tissues as well as systemic sites such as skeletal muscle, pericardium, lung, and dura mater. The fact that NSF appeared only within the past 10 years suggests a causal link to a new medication or chemical or infectious agent. In this case series, Richmond et al describe a cohort of 8 patients with NSF and an etiologic link with gadolinium contrast dye exposure, specifically gadodiamide. Extracorporeal photopheresis therapy proved useful by some objective measures of response.
Narrowband UV-B Phototherapy, Alefacept, and Clearance of Psoriasis
The classic erythematous plaques of psoriasis are clinical signs of chronic skin inflammation accompanied by hyperproliferation of keratinocytes and dermal infiltration by certain lymphocyte subtypes. A new generation of antipsoriatic drugs specifically target the T-cell–mediated pathways involved in the pathogenesis of this disease. Alefacept is an immunomodulatory, recombinant, fully human, fusion protein that targets the memory-effector T-cells implicated in sustaining psoriatic lesions. In this randomized half-side comparison study, Legat et al demonstrate the synergistic effect of alefacept with narrowband UV-B therapy in the treatment of psoriasis.
Distance to Diagnosing Provider as a Measure of Access for Patients With Melanoma
Survival for patients with melanoma is dependent on stage at diagnosis, and early diagnosis may substantially improve patient outcomes. Because melanoma can only be diagnosed definitively based on biopsy findings, diagnosis requires detection of suspicious lesions and subsequent biopsy. Although some primary care providers perform diagnostic biopsies, many prefer to refer patients to dermatologists or surgeons. Thus early diagnosis is dependent on access to specialists comfortable with diagnosing melanoma. In this analysis of all incident cases of melanoma in 2000 from 42 North Carolina counties, Stitzenberg et al demonstrate that Breslow thickness at diagnosis was directly related to distance to diagnosing provider, increasing 0.6% for every 1-mile increase in distance away from diagnosing provider. Once barriers to melanoma care are identified, interventions can be developed to minimize the effect of travel distance on access to melanoma care.
Skin Cancer Awareness and Sun Protection Behaviors in White Hispanic and White Non-Hispanic High School Students in Miami, Florida
Increasing incidence and delayed diagnosis of skin cancer in the rapidly growing Hispanic population in the United States represent an emerging health issue. While there are substantial data describing sun protection practices in white populations, data on awareness and risk perception in Hispanic populations are lacking. In this pilot survey study, Ma et al demonstrate that white Hispanic (WH) high school students were more likely to tan deeply than white non-Hispanic (WNH) students, and they were less likely to have heard of or been told how to perform skin self-examination. In additions, WH students were less likely to wear sun-protective clothing or sunscreens and were 2.5 times more likely than WNH students to have used a tanning bed. These disparities in knowledge, perceived risk, and sun-protective behaviors between WH and WNH students signal the need for primary and secondary prevention strategies directed toward Hispanic patients.
This Month in Archives of Dermatology. Arch Dermatol. 2007;143(8):974. doi:10.1001/archderm.143.8.974
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