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In This Issue of JAMA Dermatology |

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JAMA Dermatol. 2015;151(7):695. doi:10.1001/jamadermatol.2014.2926.
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Tuberous sclerosis complex (TSC) is an autosomal dominant disorder leading to aberrant activation of the mammalian target of rapamycin complex 1. Although the efficacy of mammalian target of rapamycin complex 1 inhibitors against tumors in patients with TSC are well described, their efficacy against hypomelanotic macules in patients with TSC is unknown. In this prospective, controlled trial, Wataya-Kaneda et al demonstrate that topical rapamycin treatment is safe and effective against hypomelanotic macules, improving the impaired melanogenesis in TSC melanocytes.

Melanoma accounts for most skin cancer–related deaths. Surgical delay increases morbidity and mortality for other malignant neoplasms, and in this retrospective cohort study, Lott et al demonstrate that approximately 1 in 5 Medicare beneficiaries experience melanoma surgical delay longer than 1.5 months. Minimizing surgical delay is an important patient-centered objective of high-quality care, especially in light of the potential harms of psychological stress associated with untreated neoplasms. Patients undergoing biopsy and surgery by dermatologists have the lowest risk for delay, highlighting potential opportunities for improved access to and coordination of dermatologic care.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that causes morbidity, quality-of-life impairment, and increased health care costs. Although the prevalence of adult eczema is similar to that of childhood eczema (10.2%), little is known about the direct and indirect costs of eczema care in this population. Using 2 population-based studies, Silverberg demonstrates a large health burden of eczema in adults and suggests substantial out-of-pocket costs, indirect costs from lost workdays and sick days, and increased health care utilization.

Psoriasis and atopic dermatitis (AD) are common chronic inflammatory skin diseases mediated by polar helper T-cell subtypes 1 and 2, respectively. Clinically, acute exacerbations of psoriasis and AD can result in erythroderma, and the nature of the underlying dermatosis is notoriously difficult to determine using routine histologic analysis. In this retrospective study, Moy et al confirm that the helper T-cell subtype skewed phenotypes of chronic psoriasis and AD, but the immune phenotype could not discriminate between these inflammatory diseases in the erythrodermic phase. Distinct cytokine profiles, however, may lead to improved therapeutic strategies.

Instructional methods for the simple suture technique vary widely and are seldom based on educational research. In this controlled study of medical students, Routt et al demonstrate that spaced reinforcement of the simple suture technique is critical for retention of skills. Even when total teaching time was the same, students not engaged in spaced reinforcement of skills lacked proficiency at the end of a 30-day elective, demonstrating a flaw in the single-session model of teaching clinical skills. This lack of procedural skill compromises further learning opportunities for students in their clinical rotations, endangers the welfare of poorly trained students, and translates to worse patient outcomes.





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