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Atopic Dermatitis and Academic Achievement—More to Learn
Katrina Abuabara, MD, MA, MSCE
doi : 10.1001/jamadermatol.2021.0007
JAMA Dermatol. 2021;157(6):637-638
Education is one of the strongest factors associated with long-term health and well-being.1 Chronic health conditions can affect multiple aspects of a child’s education, including school readiness, attention, learning, school experience and engagement, attendance, test scores, and graduation rates. Moreover, the consequences of chronic illness may persist even after the child’s health has recovered.2 Interventions designed to address the unique challenges of chronic health conditions can have important and long-lasting benefits.
Wildfire Smoke Pollution, Climate Change, and Skin Disease
Kenneth W. Kizer, MD, MPH
doi : 10.1001/jamadermatol.2021.0026
JAMA Dermatol. 2021;157(6):639-640
More than 90% of the world’s population lives in areas with unhealthy air, and air pollution ranks as the world’s greatest environmental hazard to human health. In 2019, air pollution (outdoor and indoor) was the fourth leading risk factor for premature death worldwide, accounting for some 7 million deaths, primarily from heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, and acute respiratory infections.1 The number of air pollution–related hospitalizations is estimated to be 10 times greater than the number of deaths.
Biosimilars in Dermatology
Mark Lebwohl, MD
doi : 10.1001/jamadermatol.2021.0219
JAMA Dermatol. 2021;157(6):641-642
Biosimilars are large complex molecules that are highly similar in structure and function to the approved brand-name molecules known as biologics. Biosimilars currently approved in the United States that could be used by dermatologists include those for rituximab, etanercept, adalimumab, and infliximab. Other approved biosimilars include those for pegfilgrastim, bevacizumab, trastuzumab, filgrastim, and epoetin alpha.
Association of Atopic Dermatitis Severity With Learning Disability in Children
Joy Wan, MD, MSCE; Nandita Mitra, PhD; Stephen R. Hooper, PhD; et al.
doi : 10.1001/jamadermatol.2021.0008
JAMA Dermatol. 2021;157(6):651-657
Importance Recent population-based data indicate that atopic dermatitis (AD) is associated with learning disability (LD) in children, but the association between AD severity and LD is unknown.
Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch
Raj P. Fadadu, MS; Barbara Grimes, PhD; Nicholas P. Jewell, PhD; et al.
doi : 10.1001/jamadermatol.2021.0179
JAMA Dermatol. 2021;157(6):658-666
Importance Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown.
Association Between Atopic Dermatitis and Educational Attainment in Denmark
Sigrun Alba Johannesdottir Schmidt, PhD; Aurélie Mailhac, MSc; Bianka Darvalics, MSc; et al.
doi : 10.1001/jamadermatol.2021.0009
JAMA Dermatol. 2021;157(6):667-675
Importance Atopic dermatitis (AD) may affect academic performance through multiple pathways, including poor concentration associated with itching, sleep deprivation, or adverse effects of medications. Because educational attainment is associated with health and well-being, any association with a prevalent condition such as AD is of major importance.
Outcomes Following a Mandatory Nonmedical Switch From Adalimumab Originator to Adalimumab Biosimilars in Patients With Psoriasis
Nikolai Loft, MD; Alexander Egeberg, MD, PhD; Mads Kirchheiner Rasmussen, MD, PhD; et al.
doi : 10.1001/jamadermatol.2021.0221
JAMA Dermatol. 2021;157(6):676-683
Importance The efficacy of adalimumab biosimilars is similar to that of brand-name adalimumab (Humira, hereinafter originator) in clinical trials. However, limited knowledge about real-world data exists for adalimumab biosimilars.
Long-term Outcomes and Prognosis in New-Onset Psoriasis
Axel Svedbom, MsC; Lotus Mallbris, MD; Per Larsson, MD; et al.
doi : 10.1001/jamadermatol.2021.0734
JAMA Dermatol. 2021;157(6):684-690
Importance Psoriasis is a heterogeneous disease. Improved understanding of prognosis and long-term outcomes in new-onset psoriasis may improve care.
Long-term Efficacy of Baricitinib in Adults With Moderate to Severe Atopic Dermatitis Who Were Treatment Responders or Partial RespondersAn Extension Study of 2 Randomized Clinical Trials
Jonathan I. Silverberg, MD; Eric L. Simpson, MD; Andreas Wollenberg, MD; et al.
doi : 10.1001/jamadermatol.2021.1273
JAMA Dermatol. 2021;157(6):691-699
Importance Baricitinib, an oral selective Janus kinase inhibitor, improved the clinical signs and symptoms of moderate to severe atopic dermatitis in the 16-week, phase 3 monotherapy studies, BREEZE-AD1 and BREEZE-AD2. Long-term efficacy has not yet been examined.
Clinical Characterization of Mogamulizumab-Associated Rash During Treatment of Mycosis Fungoides or Sézary Syndrome
Kelsey E. Hirotsu, MD; Tatiana M. Neal, BA; Michael S. Khodadoust, MD, PhD; et al.
doi : 10.1001/jamadermatol.2021.0877
JAMA Dermatol. 2021;157(6):700-707
Importance Mogamulizumab is a monoclonal antibody against CCR4 approved for treatment for mycosis fungoides (MF) and Sézary syndrome (SS). Mogamulizumab-associated rash (MAR) is difficult to differentiate from cutaneous MF or SS, which can lead to unnecessary discontinuation of drug use because of concern for severe drug reaction or incorrect presumption of disease relapse or progression in the skin.
Comparing the Effectiveness and Safety Associated With Infliximab vs Infliximab-abda Therapy for Patients With Hidradenitis Suppurativa
Linnea Lackstrom Westerkam, BA; Kelly Jo Tackett, MPH; Christopher John Sayed, MD
doi : 10.1001/jamadermatol.2021.0220
JAMA Dermatol. 2021;157(6):708-711
Importance Although limited effective and affordable treatment options exist for hidradenitis suppurativa, recent studies describe the effectiveness of a medical therapy, infliximab, for the treatment of hidradenitis suppurativa. Cost-saving biosimilar alternatives have recently become available, but no data currently exist on their safety and effectiveness.
Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Melissa Hoffman, MS; Peter B. Chansky, MD; Arjun R. Bashyam, BA; et al.
doi : 10.1001/jamadermatol.2021.1136
JAMA Dermatol. 2021;157(6):712-715
Importance Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is known to cause multiple end-organ complications in its acute phase, but less is known about the long-term association with patients’ mental health and quality of life.
Delayed Localized Hypersensitivity Reactions to the Moderna COVID-19 VaccineA Case Series
Margaret S. Johnston, MD; Anjela Galan, MD; Kalman L. Watsky, MD; et al.
doi : 10.1001/jamadermatol.2021.1214
JAMA Dermatol. 2021;157(6):716-720
Importance In response to the coronavirus disease 2019 (COVID-19) pandemic, 2 mRNA vaccines (Pfizer-BioNTech and Moderna) received emergency use authorization from the US Food and Drug Administration in December 2020. Some patients in the US have developed delayed localized cutaneous vaccine reactions that have been dubbed “COVID arm.”
Stewart-Treves Syndrome
Eduardo Bernia, MD; Elisa Rios-Vi?uela, MD; Celia Requena, MD
doi : 10.1001/jamadermatol.2021.0341
JAMA Dermatol. 2021;157(6):721
A woman in her 70s was referred to the dermatology department for evaluation of chronic lymphedema of the right arm that had become painful over the preceding 2 weeks. The patient had a history of invasive ductal carcinoma that was treated 18 years earlier with mastectomy and regional lymphadenectomy, followed by adjuvant chemotherapy and radiotherapy. No disease recurrence had been identified on annual clinical and radiologic examinations. Physical examination revealed signs of chronic lymphedema as well as diffuse yellow pigmentation and scattered ecchymotic lesions that affected the entire right upper extremity (Figure). Histological examination revealed diffuse dermal invasion by atypical sinusoidal vessels that dissected the collagen bundles. The neoplastic cells were pleomorphic, showing abundant mitotic figures, and had positive stain results for CD31, D2-40, ERG, and C-MYC. These findings were consistent with the diagnosis of Stewart-Treves syndrome.
Eosinophilic Granulomatosis With Polyangiitis
Abraham M. Korman, MD; Catherine G. Chung, MD
doi : 10.1001/jamadermatol.2020.2279
JAMA Dermatol. 2021;157(6):722
A man in his 50s had a pruritic rash, worsening asthma, and high fevers. His medical history included uncontrollable asthma. The rash started on his legs and spread to his arms. At examination, he had retiform to polycyclic, red to brown purpuric macules, and papules with vesiculation (Figure, A). Laboratory tests showed leukocytosis (22?920/?L) with marked eosinophilia (9860/?L). Results were negative for antineutrophilic cytoplasmic antibodies (ANCA), antinuclear antibodies, antiphospholipid antibodies, rheumatoid factor, anticyclic citrullinated peptide, cryoglobulins, and extractable nuclear antigen. Complement levels were normal. A punch biopsy specimen showed leukocytoclastic vasculitis (Figure, B) with prominent tissue eosinophilia. The constellation of retiform and purpuric macules and papules with leukocytoclastic vasculitis, tissue and peripheral eosinophilia, worsening asthma, and fever without evidence of infectious or neoplastic processes was consistent with eosinophilic granulomatosis with polyangiitis (EGPA). Treatment with tapered prednisone led to remission of disease.
Skin-Colored Papules on the Right Lower Back of an Elderly Man
Lu Yang, MD; Yue-Ping Zeng, MD
doi : 10.1001/jamadermatol.2021.0444
JAMA Dermatol. 2021;157(6):723-724
A man in his 60s presented to our dermatology outpatient department with a 5-year history of pruritic papules on the right side of his lower back. He was otherwise healthy, with no family history of a similar condition. Physical examination results showed multiple dome-shaped, skin-colored, firm papules on his right lower back, arranged in a blaschkoid distribution (Figure 1A). The lesions varied in size, with some coalescing into irregular-shaped, larger papules. Telangiectasis could be seen on some of the lesions. A skin biopsy was performed on his back and submitted for further histopathologic analysis (Figure 1B and C).
Facial Vegetating Lesions in a Patient With Kidney Failure
Joana Calv?o, MD; Filipe Santos Mira, MD; José Carlos Cardoso, MD
doi : 10.1001/jamadermatol.2021.1104
JAMA Dermatol. 2021;157(6):725-726
A woman in her 30s undergoing peritoneal dialysis for kidney failure who was also being investigated for severe hyperparathyroidism presented with multiple skin lesions 1 day after undergoing cervical computed tomography with iodinated contrast. Physical examination revealed a polymorphous cutaneous eruption characterized by nodular vegetating lesions on the lower lip and right nasal ala (Figure 1A); papulovesicular lesions, either umbilicated or with an erosive center, clustered on the left cheek (Figure 1B); and 2 papulovesicular lesions with an erythematous-to-violaceous halo at the cannula insertion sites on the back of the right hand and the inner side of the wrist. The patient reported that the lesions were painful, with the ones in the oral mucosa impairing feeding.
Keloids
Jared Jagdeo, MD, MS; Eva Kerby, MD; Donald Alexander Glass II, MD, PhD
doi : 10.1001/jamadermatol.2020.4705
JAMA Dermatol. 2021;157(6):744
Inconsistencies in Cutaneous Melanoma Staging Within SEER Registries
Christopher R. Cullison, BS; David X. Zheng, BA; Melissa A. Levoska, MD; et al.
doi : 10.1001/jamadermatol.2021.1098
JAMA Dermatol. 2021;157(6):727-729
Public cancer databases, such as the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, are increasingly used for cutaneous oncology research.1 However, coding discrepancies among staging variables in SEER data may inaccurately estimate patient outcomes.2 The objective of this cohort study was to explore inconsistences in cutaneous melanoma (CM) staging within the 18 population-based SEER registries for cancer incidence to determine if miscoding of staging variables related to CM would result in inconsistencies in final tumor staging.
Sunburn Injuries Admitted to Burn Services in Australia and New Zealand
Siobhan Connolly, MNSc (Burns Nursing); Monique Bertinetti, MBBS; Warwick J. Teague, DPhil; et al.
doi : 10.1001/jamadermatol.2021.1110
JAMA Dermatol. 2021;157(6):729-731
Excess exposure to UV radiation causes sunburn and is a risk factor for melanoma and other skin cancers. Australia and New Zealand have the highest incidence of melanoma worldwide (approximately 50 cases per 100?000 person-years).1 The majority of people with sunburns self-manage their injuries at home with simple creams and analgesics, and thus these injuries are often unreported. Characteristics of US patients with sunburns presenting to emergency departments and urgent care facilities have previously been reported.2 However, some patients with sunburns do present to and are managed in specialist burn services, typically as outpatients. This fact notwithstanding, there are still sunburn cases of sufficient severity and health impact that warrant inpatient treatment.3,4 There has not yet been a larger-scale study of patients with sunburn severe enough to warrant admission to specialist burn services across Australia and New Zealand. Information about the epidemiology of sunburn injuries on a broader scale is required to appropriately inform educational public health campaigns and initiatives.
Clinical Characteristics of Ulcerating Carpal Tunnel Syndrome Among Older Adults in Portugal
Tiago Fernandes Gomes, MD; Katarina Kieselova, MD; Vera Teixeira, MD; et al.
doi : 10.1001/jamadermatol.2021.1007
JAMA Dermatol. 2021;157(6):731-733
Ulcerating carpal tunnel syndrome (CTS) is a rare variant of CTS. The condition occurs in long-standing cases of untreated CTS and is characterized by severe damage to the motor, sensory and autonomic nerve fibers.1
Narrowing the Genomic Region of Autosomal-Dominant Congenital Generalized Hypertrichosis Terminalis
Ran Mo, MD; Zhe Xu, MD, PhD; Huijun Wang, PhD; et al.
doi : 10.1001/jamadermatol.2021.0748
JAMA Dermatol. 2021;157(6):733-735
Autosomal-dominant congenital generalized hypertrichosis terminalis (AD-CGHT) is an extremely rare disorder characterized by excessive growth of pigmented medullated terminal hair over the body with or without coarse face and gingival hyperplasia. Autosomal-dominant congenital generalized hypertrichosis terminalis has been associated with copy number variations (CNVs) on the chromosome (chr) 17q24.2-q24.3 that share a common genomic region encompassing 4 genes (ABCA6, ABCA10, ABCA5, and MAP2K6).1,2 However, to our knowledge, the exact underlying gene for AD-CGHT remains unknown. In this study, we reported a family with AD-CGHT and detected a genomic microdeletion encompassing the ABCA5, MAP2K6, and LINC01483 genes. Together with previously reported AD-CGHT cases,1,2 our study further narrows the overlapping genetic region for AD-CGHT to 2 genes: ABCA5 and MAP2K6.
Treatment of Severe Multicentric Reticulohistiocytosis With Upadacitinib
Omid Zahedi Niaki, MD; Erin Penn, MD, MS; Deborah A. Scott, MD; et al.
doi : 10.1001/jamadermatol.2021.0996
JAMA Dermatol. 2021;157(6):735-737
Multicentric reticulohistiocytosis (MRH) is a rare systemic disorder that is characterized by inflammatory histiocytic infiltrates that mainly affect the skin, subcutaneous tissues, and synovium. The disease course is often severe and can result in substantial disfigurement and disability. Treatment is challenging, and several therapeutic agents have been used with varying efficacy. We describe a severe case of MRH that was resistant to first-line therapies with marked improvement of cutaneous lesions and arthritis following treatment with upadacitinib.
Association of Hair Loss With Suicidality and Psychological Adverse Events vs Finasteride Use
Jee Woong Choi, MD, PhD; Chang Hun Huh, MD, PhD; Gwang Seong Choi, MD, PhD
doi : 10.1001/jamadermatol.2021.1001
JAMA Dermatol. 2021;157(6):737-738
To the Editor We read with great interest the article by Nguyen and colleagues1 and the accompanying Editorial by Ho.2 The authors proposed that suicidality and psychological adverse events were associated with finasteride use among young patients with alopecia, but rather, their results show an association between alopecia and adverse events. There are several unmentioned factors that the authors should have considered before establishing the relevance.
Association of Hair Loss With Suicidality and Psychological Adverse Events vs Finasteride Use—Reply
David-Dan Nguyen, MPH; Eugene B. Cone, MD; Quoc-Dien Trinh, MD
doi : 10.1001/jamadermatol.2021.0377
JAMA Dermatol. 2021;157(6):738
In Reply We thank Choi et al for their interest in our work. Our analysis identifies 2 avenues of investigation into the association of depression, anxiety, and suicidality with finasteride use in young patients with alopecia: mediation by adverse effects and confounding by stimulated reporting.1 Confounding by indication, while concerning, is mitigated by our comprehensive sensitivity analyses.
