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In This Issue of JAMA Dermatology |

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JAMA Dermatol. 2014;150(4):349. doi:10.1001/jamadermatol.2013.6530.
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Isotretinoin is the most effective antiacne therapy, but its teratogenicity is well known. Many initial risk-reduction efforts were ineffective, and the US Food and Drug Administration strictly regulates its distribution to female patients of childbearing potential. In this survey study, Werner et al document women’s experiences with isotretinoin risk-reduction counseling. While women clearly understood the teratogenic potential of isotretinoin, they had less understanding of contraceptive methods that effectively prevent pregnancy. For many, iPLEDGE was their first introduction to contraception. Patients may benefit from revision of iPLEDGE education materials, updates to prescribing physicians, or referral to local family planning specialists.

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The incidence of melanoma continues to increase in the United States, Australia, and Europe, and early detection remains an important strategy to reduce the morbidity and mortality rates associated with melanoma. This can be achieved through skin self-examination (SSE) or clinical skin examination (CSE). In this randomized clinical trial, Janda et al demonstrate that video-based skin cancer awareness educational materials directed toward men older than 50 years increased whole-body CSE and skin cancer diagnosis among older men. These data support implementation of behavioral interventions to encourage skin cancer awareness among men 50 years or older.

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Primary cutaneous mucinous carcinoma (PCMC) is a rare, low-grade malignant neoplasm believed to be of eccrine origin. These tumors grow slowly, and they arise on the face, axilla, scalp, and trunk of middle-aged and older patients. No standard of care for surgical treatment of PCMC exists. In this systematic review and meta-analysis of observational studies, Kamalpour et al demonstrate that PCMC tumors on the trunk were associated with poorer outcomes, as was larger initial tumor size. Asians with PCMD had better outcomes than whites. Development of a central registry for rare tumors would help to confirm or negate these data.

Solar UV irradiation causes photoaging characterized by skin wrinkling and laxity due mainly to alterations in the dermal extracellular matrix (ECM), especially type I collagen fibrils. In this in vivo biochemical analysis, Wang et al demonstrate that repeated irradiation with low levels of UV-A1 promotes photoaging by affecting collagen breakdown. This type of exposure might be encountered during 2-hour sessions of sun exposure daily, and progressive skin darkening (tanning) during these exposures failed to prevent the UV-A1–induced collagenolytic changes.

Many hospitals do not have inpatient dermatologic consultative services, and most have reduced availability of services during off-hours. Dermatologists based in outpatient settings find it challenging to determine the urgency with which they need to evaluate inpatients when consultations are requested. Teledermatology could expand access to timely dermatologic services in these settings. In this prospective study, Barbieri et al demonstrate that a store-and-forward teledermatology system is reliable for the triage of inpatient dermatology consultations, offering the potential to reduce travel time and increase efficiency for a community dermatologist.





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