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Resisting Racism in DermatologyA Call to Action
Jenna C. Lester, MD; Susan C. Taylor, MD
doi : 10.1001/jamadermatol.2020.5029
JAMA Dermatol. 2021;157(3):267-268
This Viewpoint discusses how dermatologists can work together to dismantle structural racism in dermatology.
Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis—Cumulative Dose and Duration Matter
Rebecca D. Jackson, MD
doi : 10.1001/jamadermatol.2020.4967
JAMA Dermatol. 2021;157(3):269-270
Glucocorticoids are used by an estimated 0.5% to 1.0% of adults for management of a range of conditions, from allergies and inflammatory diseases to cancer.1 Glucocorticoid use increases with age: more than 3% of adults older than 50 years and 5.2% older than 80 years use glucocorticoids.2 Despite the availability of a growing number of medications to modulate immune function and/or inflammation, evidence from the Danish National Patient Registry suggests that the prevalence of glucocorticoid use has remained remarkably stable for 17 years (1999-2016).3 Thus, any noteworthy adverse effects associated with glucocorticoid use could have substantial consequences not only for the individual, but also for public health.
Shared Decision-making in Dermatologic CareA Call for More Training and Resources
Carrie C. Coughlin, MD; Mary C. Politi, PhD
doi : 10.1001/jamadermatol.2020.5360
JAMA Dermatol. 2021;157(3):271-272
In this issue of JAMA Dermatology, Morrison and colleagues1 present a scoping literature review of shared decision-making (SDM) in dermatology. The authors analyze 29 articles about SDM and/or patient decision aids for dermatologic conditions. Their analysis suggests that SDM is useful and desired by almost all patients and many clinicians, but more work should explore how best to implement SDM into routine dermatologic care.
Association of Potent and Very Potent Topical Corticosteroids and the Risk of Osteoporosis and Major Osteoporotic Fractures
Alexander Egeberg, MD, PhD; Peter Schwarz, MD, DMSc; Torben Harsl?f, MD, PhD
doi : 10.1001/jamadermatol.2020.4968
JAMA Dermatol. 2021;157(3):275-282
This nationwide cohort study examines the association between cumulative exposure to potent and very potent topical corticosteroids and the risk of osteoporosis and major osteoporotic fracture among adults in Denmark.
The Risk of Anal Carcinoma After Anogenital Warts in Adults Living With HIV
Justin D. Arnold, MD, MMSc; Morgan E. Byrne, MPH; Anne K. Monroe, MD, MSPH
doi : 10.1001/jamadermatol.2020.5252
JAMA Dermatol. 2021;157(3):283-289
This cohort study assesses the risk of developing anal carcinoma in adults living with HIV who have a history of anogenital warts.
Incidence and Factors Associated With Acne Among Transgender Patients Receiving Masculinizing Hormone Therapy
Nick Thoreson, BS; Jason A. Park, SM; Chris Grasso, MPH
doi : 10.1001/jamadermatol.2020.5347
JAMA Dermatol. 2021;157(3):290-295
This cohort study examines the prevalence of acne in transgender individuals initiating masculinizing hormone therapy.
Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone
John S. Barbieri, MD, MBA; David J. Margolis, MD, PhD; Arash Mostaghimi, MD, MPA, MPH
doi : 10.1001/jamadermatol.2020.5468
JAMA Dermatol. 2021;157(3):296-300
This cohort study assesses the change in the rates of potassium level monitoring from 2008 to 2018 by clinicians overall and stratified by dermatologists, internists, nurse practitioners, and physician assistants in healthy young women treated for acne with spironolactone.
Pregnancy Outcomes in Women With Moderate-to-Severe Psoriasis From the Psoriasis Longitudinal Assessment and Registry (PSOLAR)
Alexa B. Kimball, MD, MPH; Lyn Guenther, MD; Sunil Kalia, MD, MHSc
doi : 10.1001/jamadermatol.2020.5595
JAMA Dermatol. 2021;157(3):301-306
This cohort study reports pregnancy outcomes observed among women enrolled in the Psoriasis Longitudinal Assessment and Registry.
Surgical Interventions for Patients With VitiligoA Systematic Review and Meta-analysis
Hyun Jeong Ju, MD; Jung Min Bae, MD, PhD; Ro Woo Lee, MD
doi : 10.1001/jamadermatol.2020.5756
JAMA Dermatol. 2021;157(3):307-316
This systematic review and meta-analysis investigates the treatment response of different surgical modalities in patients with vitiligo.
Brentuximab Vedotin for Relapsed or Refractory Sézary Syndrome
Daniel J. Lewis, MD; Paul L. Haun, MD; Sara S. Samimi, MD
doi : 10.1001/jamadermatol.2020.4901
JAMA Dermatol. 2021;157(3):317-321
This case series assesses the preliminary efficacy and tolerability of brentuximab vedotin for Sézary syndrome.
Changes in Use of Radiotherapy Among Dermatologists From 2013 to 2017
Khang D. Nguyen, MD, MS; Henry W. Chen, BS; Adewole S. Adamson, MD, MPP
doi : 10.1001/jamadermatol.2020.4931
JAMA Dermatol. 2021;157(3):322-325
This cross-sectional study examines changes in the use of radiotherapy, including superficial radiotherapy and electronic brachytherapy, over time by dermatologists.
The Role of Dermatologists in the Early HIV/AIDS EpidemicA Historical Review for the 40th Anniversary of HIV/AIDS
Heather Milbar, MD, MPH; William D. James, MD
doi : 10.1001/jamadermatol.2020.5545
JAMA Dermatol. 2021;157(3):326-329
This Special Communication reviews dermatology’s role in the investigation and treatment of HIV/AIDS over the past 40 years.
Shared Decision-making in DermatologyA Scoping Review
Tessalyn Morrison, MPH; Jacob Johnson, MA; Wenelia Baghoomian, BA
doi : 10.1001/jamadermatol.2020.5362
JAMA Dermatol. 2021;157(3):330-337
This scoping review discusses the use of shared decision-making between patients and physicians in dermatology practice.
Levamisole-Induced Vasculopathy
Cristina L?pez-S?nchez, MD; Eduardo Rozas-Mu?oz, MD; Juan Francisco Mir-Bonafé, MD
doi : 10.1001/jamadermatol.2020.4011
JAMA Dermatol. 2021;157(3):338
This case report describes man in his 40s who was a long-term cocaine user who presented with rapidly progressive painful skin lesions and malaise.
White Piedra
Amy Kalowitz Bieber, MD; Miriam Keltz Pomeranz, MD; Randie H. Kim, MD, PhD
doi : 10.1001/jamadermatol.2020.4266
JAMA Dermatol. 2021;157(3):339
This case report describes white and tubular concretions of proteinaceous materials that were tightly adherent to the hair shaft.
Follicular Papules in a Linear Distribution on a Child’s Face
Carolina Carvajal-Zu?iga, MD; Javiera Jerez, MD; Eduardo Rozas-Mu?oz, MD
doi : 10.1001/jamadermatol.2020.5588
JAMA Dermatol. 2021;157(3):340-341
A girl younger than 2 years presented with a 1-year history of slightly pruritic lesions involving her face. What is your diagnosis?
Hypertrichotic Plaque in a 17-Month-Old Boy
Gowri Kabbur, MD; Adarsh Ravishankar, BS; Sheilagh Maguiness, MD
doi : 10.1001/jamadermatol.2020.5665
JAMA Dermatol. 2021;157(3):342-343
A 17-month-old boy presents with a 15?×?5-cm indurated plaque with hypertrichosis on the left lower back in addition to blue-gray patches on the back and right hip and a small café au lait macule on the right lower back. The patient’s history is significant for dermal melanocytosis of the back and hip, increased head circumference, and expressive language delay. What is your diagnosis?
Allergic Contact Dermatitis
Brandon L. Adler, MD; Vincent A. DeLeo, MD
doi : 10.1001/jamadermatol.2020.5639
JAMA Dermatol. 2021;157(3):364
This Patient Page describes the symptoms, possible causes, and treatment of allergic contact dermatitis.
Moderate-to-Severe Acne and Mental Health Symptoms in Transmasculine Persons Who Have Received Testosterone
Hayley Braun, MPH; Qi Zhang, MSPH; Darios Getahun, MD, PhD, MPH
doi : 10.1001/jamadermatol.2020.5353
JAMA Dermatol. 2021;157(3):344-346
This survey study examines the association between acne and mental health outcomes for transmasculine persons who have received testosterone.
Hair Removal for Patients Undergoing Feminizing Surgeries in Oregon’s Medicaid Program
Janelle M. Downing, PhD; Kimberly Yee, MPH; Geolani Dy, MD
doi : 10.1001/jamadermatol.2020.5419
JAMA Dermatol. 2021;157(3):346-348
This cohort study assessed the use of preoperative hair removal among transgender individuals assigned male sex at birth enrolled in Oregon’s Medicaid program and their clinicians.
Incidence and Factors Associated With Androgenetic Alopecia Among Transgender and Gender-Diverse Patients Treated With Masculinizing Hormone Therapy
Nick Thoreson, BS; Chris Grasso, MPH; Jennifer Potter, MD
doi : 10.1001/jamadermatol.2020.5475
JAMA Dermatol. 2021;157(3):348-349
This cohort study examines the proportion of transgender and gender-diverse individuals patients receiving masculinizing hormone therapy who developed androgenetic alopecia.
Postoperative Radiotherapy for Cutaneous Squamous Cell Carcinoma in Patients With Microscopic Residual Disease
Alet J. G. Leus, MD; Estelle F. D. Perrels, MSc; Gyorgy B. Halmos, MD, PhD
doi : 10.1001/jamadermatol.2020.4828
JAMA Dermatol. 2021;157(3):349-352
This case series assesses data from patients with microscopic residual disease to examine postoperative radiotherapy outcomes.
Tofacitinib as Treatment for Nail Lichen Planus Associated With Alopecia Universalis
Matilde Iorizzo, MD, PhD; Eckart Haneke, MD, PhD
doi : 10.1001/jamadermatol.2020.4555
JAMA Dermatol. 2021;157(3):352-353
This case report describes opaque trachyonychia of all fingernails.
Treatment of Grover Disease With Dupilumab
Daniel C. Butler, MD; Alexander Kollhoff, BS; Tim Berger, MD
doi : 10.1001/jamadermatol.2020.5097
JAMA Dermatol. 2021;157(3):353-356
This case report describes 3 patients with focal acantholytic dyskeratosis.
Photodynamic Therapy and Medicare Expenditures
Rachel K. Lim; Martin A. Weinstock, MD, PhD
doi : 10.1001/jamadermatol.2020.5422
JAMA Dermatol. 2021;157(3):356-357
To the Editor We read with interest the article by Cheraghlou et al1 regarding trends in the cost of and access to photodynamic therapy (PDT) among Medicare beneficiaries. The authors note an increase in the number of dermatologists offering PDT and an annual growth rate of approximately 4% in Medicare reimbursements for PDT. They suggest that increased use of PDT may reduce the occurrence of keratinocyte cancers, and thus lead to lower Medicare expenditures. However, the existing literature indicates that PDT is not the most cost-efficient, nor most effective, preventive measure for keratinocyte cancer or for actinic keratosis (AK). To date, to our knowledge, only 1 randomized trial has documented an AK treatment that is effective for keratinocyte cancer reduction.2
Photodynamic Therapy and Medicare Expenditures—Reply
Shayan Cheraghlou, MD; Hao Feng, MD, MHS; Jeffrey M. Cohen, MD
doi : 10.1001/jamadermatol.2020.4657
JAMA Dermatol. 2021;157(3):357
In Reply We appreciate the comments of Ms Lim and Dr Weinstock on our analysis1 of recent trends in the access and cost of photodynamic therapy (PDT) in the Medicare population. While we agree that the present literature does not indicate that PDT is the most effective field therapy for actinic keratoses (AKs), it has several features that make it a valuable treatment modality for a subset of patients. In particular, the irritation caused by fluorouracil cream (FC) can be a substantial deterrent for patients' continued use of the medication. Indeed, studies directly comparing patient preferences between FC and PDT have found that most patients prefer PDT.2,3 As an in-office procedure, PDT also avoids certain challenges with adherence that are inherent to outpatient topical therapies and especially problematic for treatments that cause local irritation.
Pharmacogenomics of Fluoropyrimidines—A Personalized Approach for Treating and Preventing Keratinocyte Carcinomas
Ogechi Ikediobi, MD, PharmD, PhD
doi : 10.1001/jamadermatol.2020.5542
JAMA Dermatol. 2021;157(3):357-358
To the Editor I read the article by Schauder et al1 and thank the authors for highlighting this important area of therapeutic research. The authors state that the potential widespread use of capecitabine for chemoprevention and treatment of keratinocyte carcinomas may be severely hampered by its treatment-related toxicity.1 They conclude that future prospective trials are warranted, but do not provide any direction on how those trials should be designed. In this era of genomic-driven medicine, it would be important for the authors to acknowledge several key factors in trial design, including (1) the use of dihydropyrimidine dehydrogenase (DPYD) genetic testing in reducing capecitabine-related toxicity and (2) DPYD testing in ethnically diverse populations.
Pharmacogenomics of Fluoropyrimidines—a Personalized Approach for Treating and Preventing Keratinocyte Carcinomas—Reply
David M. Schauder, MD, PhD; Rajiv I. Nijhawan, MD
doi : 10.1001/jamadermatol.2020.5246
JAMA Dermatol. 2021;157(3):358
In Reply We thank Ikediobi for her interest in our study,1 as well as for her insightful suggestions on the design of future work in this area using her expertise in pharmacogenomics. The primary goal of our study was to systematically review what has been published on capecitabine’s association with keratinocyte carcinomas. In doing so, we highlighted not only the potential of capecitabine as a likely underused chemopreventative modality for patients with a high risk of developing keratinocyte carcinomas, particularly solid organ transplant recipients, but also the need for a prospective trial. We appreciate Ikediobi’s important points regarding how such a study should be designed.
JAMA Dermatology
doi : 10.1001/jamadermatol.2020.3866
JAMA Dermatol. 2021;157(3):264
Mission Statement: JAMA Dermatology publishes information concerning the skin, its diseases, and their treatment. Its mission is to explicate the structure and function of the skin and its diseases and the art of using this information to deliver optimal medical and surgical care to the patient. We attempt to enhance the understanding of cutaneous pathophysiology and improve the clinician’s ability to diagnose and treat skin disorders. This journal has a particular interest in publishing clinical and laboratory studies that reveal new information pertinent to the interests and needs of the medical dermatologist, dermatologic surgeon, and all those concerned with state-of-the-art care of cutaneous disease. We believe that knowledge derived from well-designed clinical trials and studies of cost-effectiveness are especially important for improving the practice of dermatology. Studies that increase the understanding of the outcome of treatment or the means by which the burden of dermatologic disease can be measured and reduced to promote the health of patients with skin disease will receive special priority. The journal regularly publishes reports on clinical investigations, editorials, and reviews. It also features reports and discussions on clinicopathologic correlations; clinical disorders of unique didactic value; pharmacologic, medical and surgical therapeutics; and ethical, moral, socioeconomic, and political issues.
