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In This Issue of JAMA Dermatology |

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JAMA Dermatol. 2014;150(9):921. doi:10.1001/jamadermatol.2013.6555.
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Cost control in health care requires a focus on value, or the quality of health outcomes for resources used. Hidradenitis suppurativa (HS) is a disease that lacks coordination of care, defined outcomes, and an understanding of costs. Anecdotally, treatments do not deliver on value. In this cohort cost-identification study, Kirby et al demonstrate that HS affects a younger, predominantly female population who more frequently use high-cost settings such as the emergency department and inpatient care. Educational interventions for patients with HS and nondermatologists may reduce unnecessary high-cost care, and defining meaningful outcome measures for patients may improve the value of health care for patients.

Alopecia areata (AA) is a common autoimmune form of nonscarring alopecia. Although the peribulbar “swarm of bees” lymphocytic infiltrate is considered the diagnostic histopathologic feature of AA, it may be subtle or absent in chronic AA. The presence of eosinophils around the hair bulbs or within the fibrous tracts has been reported as a helpful diagnostic feature in the absence of a peribulbar lymphocytic infiltrate. In this retrospective review of scalp biopsy specimens, Yoon et al demonstrate that this eosinophilic infiltrate was not a common finding in chronic AA, limiting its diagnostic usefulness.

Psoriasis is a chronic, common, immune-mediated systemic disease affecting more than 125 million individuals worldwide. It is associated with an increased risk of cardiovascular disease and hypertension, but the temporal association remains unclear. In this prospective cohort study, Wu et al demonstrate that long-term hypertension is associated with an increased risk of psoriasis. Among antihypertensive medications, only long-term use of β-blockers was found to be associated with increased psoriasis risk.

Infantile hemangioma (IH) is a common benign tumor of infancy, affecting nearly 10% of children. Lesions of IH may range from superficial papules to large tumors that interfere with vital organ function or cause permanent disfigurement. Accurate assessment of IH proliferation and involution may assist in making appropriate treatment recommendations and evaluating treatment efficacy. In this prospective cohort study, Mohammed et al demonstrate the reliability and validity of infrared thermography (IRT) measurement of IH growth. Noninvasive, convenient, and well-tolerated by infants, IRT offers real-time objective results that are useful in routine IH monitoring and in evaluating IH treatment efficacy.

Vismodegib is a Hedgehog pathway inhibitor used to treat advanced basal cell carcinoma (BCC). In animal models, decreased Hedgehog signaling has been shown to predispose to squamous cell carcinoma (SCC), and recently, 4 cases of vismodegib-associated SCC at sites distant from the BCC have been reported. In this report, Zhu et al describe 2 cases of SCC within the tumor bed of locally advanced BCC during vismodegib treatment, highlighting the importance of repeated biopsy in locally advanced BCCs if an area within the tumor responds differently to vismodegib therapy or if vismodegib stops suppressing tumor progression.





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