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This Month in Archives of Dermatology
January 2009

This Month in Archives of Dermatology

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Arch Dermatol. 2009;145(1):11. doi:10.1001/archdermatol.2008.573

Twelve-Year Analysis of Severe Cases of Drug Reaction With Eosinophilia and Systemic Symptoms

Drug reaction with eosinophilia and systemic symptoms (DRESS) manifests with severe drug-induced symptoms that occur 3 to 6 weeks after initiation of therapy. Manifestations include high fever, facial edema, erythroderma, eosinophilia, lymphadenopathy, and elevated liver function tests. Although DRESS may occasionally be severe and life-threatening, prognostic factors have not yet been identified. In this retrospective series of severe cases of DRESS, Eshki et al suggest that some medications, including allopurinol and minocycline, are more likely to produce a more severe form of the disease. They also confirm the role of early human herpesvirus 6 reactivation in the development of severe DRESS syndrome.


Subcutaneous Trigger Point Causing Radiating Postsurgical Pain

The differential diagnoses of postsurgical incisional pain include acute hematoma, edema, and infection. In this case report, Hendi et al describe a patient with unusually severe intraoperative and postoperative pain attributable to a subcutaneous thoracic trigger point that was noted during excision of a nevus. The pain was associated with marked incisional erythema, hyperesthesia, and referred pain extending down the ipsilateral arm to the hand. Successful treatment of this patient's myofascial pain syndrome included cyclobenzaprine and conservative physical therapy, including stretches and TENS (transcutaneous electrical nerve stimulation).


Estrogen Receptor Expression in Cutaneous Melanoma

The role of estrogens in the pathophysiology of many cancers is well documented, but the question of whether melanoma tumors express estrogen receptors (ERs) remains intensely debated. Epidemiologic data certainly suggest that melanomas may be hormonally responsive tumors. In this prospective study, de Giorgi et al demonstrate that all melanocytic lesions express detectable levels of ERα and ERβ messenger RNA as well as the ERβ protein. Thicker, more invasive melanomas were found to have lower ERα and ERβ messenger RNA levels as well as lower ERβ protein levels, suggesting a role for ERs in the metastatic process and the possibility that ERβ may be used as a prognostic indicator of melanoma.


Non–Sexually Related Acute Genital Ulcers in 13 Pubertal Girls

The most common causes of acute genital ulcers (AGUs) are herpes simplex virus and aphthosis. In this case series, Farhi et al describe the clinical and microbiological features of AGUs in a series of immunocompetent patients without any context of sexually transmitted disease or aphthosis. One third of these cases were associated with Epstein-Barr virus primary infection, confirming that this is the most frequently reported infectious agent associated with a first flare of nonherpetic AGU. Such patients may be reassured that this rare form of acute mononucleosis is self-limited and seldom relapses, requiring only supportive care.


The Role of Online Support Communities

Psoriasis affects approximately 0.6% to 4.8% of the world's population. In addition to the well-recognized skin and joint manifestations, psoriasis impairs many aspects of individual well-being, including emotional, physical, sexual, and financial status. Patient support groups provide a valuable source of psychological support, but geographic barriers, time constraints, and embarrassment may prevent patient access. In this Internet-based cross-sectional survey of people involved with online support groups, Idriss et al demonstrate that virtual communities offer users valuable educational resources as well as psychological and social support that may well be leveraged by the dermatology community in delivering personalized and integrated medical care to patients affected by psoriasis.