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• Notice of Retraction: "Early Depth Assessment of Local Burns by Dermoscopy: A New Frontier of Dermoscopic Evaluation" (Arch Dermatol. Published online April 16, 2012. doi:10.1001/archdermatol.2012.418).

  Authors: June K Robinson

  Archives of dermatology.

• Primary Cutaneous Follicular Helper T-cell Lymphoma: A New Subtype of Cutaneous T-cell Lymphoma Reported in a Series of 5 Cases.

  Authors: Marie Beylot-Barry, Hervé Bachelez, Jacqueline Rivet, Béatrice Vergier, Martine Bagot, Maxime Battistella

  Archives of dermatology.

  BACKGROUND: Peripheral nodal follicular T-cell lymphomas expressing follicular helper T-cell (T(FH)) markers have recently been identified. Such lymphomas are characterized by a nodal neoplasticBACKGROUND: Peripheral nodal follicular T-cell lymphomas expressing follicular helper T-cell (T(FH)) markers have recently been identified. Such lymphomas are characterized by a nodal neoplastic T-cell proliferation accompanied by numerous reactive B cells and demonstrate some overlap with nodal angioimmunoblastic T-cell lymphoma (AITL). We identified 5 cases of cutaneous T-cell lymphoma with a peculiar pathologic aspect and expression of T(FH) markers. OBSERVATIONS: The mean age of the patients was 61 years (range 33-78). Four patients had multiple papules, plaques, and nodules predominating on the trunk and the head. One had a nodular plaque on the face. Lesional T-cell clonality was found in all 5 patients, and blood T-cell clonality in 4 of the 5. Nodal involvement was never found. Patients had no systemic symptoms and no biological signs of AITL. In 3 cases, findings from skin biopsy specimens were initially misdiagnosed as primary cutaneous follicle B-cell lymphoma due to major B-cell infiltrate and CD10 positivity. Rituximab-containing therapies were ineffective in these cases, and biopsy specimens after treatment with rituximab showed medium- to large-sized atypical T-cell skin infiltrate expressing T(FH) markers (CD10, Bcl-6, PD-1, CXCL13, ICOS). The final diagnosis proposed for all patients was cutaneous T(FH) lymphoma. The patient with localized disease was successfully treated with radiotherapy. Patients with diffuse disease showed marked resistance to treatments, with only 1 case of complete remission after allogeneic hematopoietic stem cell transplantation followed by bortezomib and donor-lymphocyte infusion. Bexarotene, methotrexate, thalidomide, interferon alfa, gemcitabine, liposomal doxorubicin, or multiagent chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) were either ineffective or induced transitory partial remission. CONCLUSIONS: We describe an original clinicopathologic series of primary cutaneous lymphomas with T(FH) phenotype, suggesting the existence of a new entity among cutaneous T-cell lymphomas. Relations of these lymphomas with the provisional entity of primary cutaneous small to medium CD4(+) pleomorphic T-cell lymphoma need to be further addressed.

• A Pilot Study of an Oral Phosphodiesterase Inhibitor (Apremilast) for Atopic Dermatitis in Adults.

  Authors: Aman Samrao, Trista M Berry, Renato Goreshi, Eric L Simpson

  Archives of dermatology.

  OBJECTIVE: To investigate the preliminary safety and efficacy of apremilast, an oral phosphodiesterase 4 inhibitor, for atopic dermatitis. DESIGN: This investigator-initiated, open-label pilot studyOBJECTIVE: To investigate the preliminary safety and efficacy of apremilast, an oral phosphodiesterase 4 inhibitor, for atopic dermatitis. DESIGN: This investigator-initiated, open-label pilot study evaluated 2 doses of apremilast in patients with atopic dermatitis. Differential gene analysis was performed from peripheral whole blood using data before and after treatment. SETTING: University-based dermatology clinical research unit. Patients Sixteen adult patients with atopic dermatitis. Intervention A specific phosphodiesterase 4 inhibitor, apremilast. MAIN OUTCOME MEASURES: The primary outcome was incidence of adverse events. Secondary outcomes included the differences in pruritus, Dermatology Life Quality Index (DLQI), and Eczema Area and Severity Index (EASI) scores between the baseline visit and end-of-study visit for each cohort. RESULTS: The group receiving apremilast, 20 mg twice daily, displayed a significant reduction from baseline of pruritus (P = .02) and the DLQI (P = .003) at 3 months. The group receiving apremilast, 30 mg twice daily, displayed a significant reduction of the EASI (P = .008) and the DLQI (P = .01) at 3 months. At 6 months, there was a significant reduction of the EASI (P = .002), the visual analog scale (P = .03), and the DLQI (P = .03). Gene ontologic analyses comparing baseline with samples during treatment revealed alterations in immune response pathways, especially those related to cyclic adenosine monophosphate-mediated signaling. CONCLUSIONS: These results support further development of apremilast for treatment of atopic dermatitis. Larger randomized controlled studies are needed to more adequately evaluate both safety and efficacy. Limitations include the small sample size and absence of a control. Trial Registration clinicaltrials.gov Identifier: NCT01393158.

• Early Depth Assessment of Local Burns by Dermoscopy: A New Frontier of Dermoscopic Evaluation.

  Authors: Kyomi Mihara, Hajime Shindo, Hiroya Mihara, Minako Ohtani, Kotaro Nagasaki, Norito Katoh

  Archives of dermatology.

  OBJECTIVE: To investigate the effectiveness of early depth assessment of local burns, the depth of which is difficult to assess with the naked eye, by dermoscopy. DESIGN: The morphological findingsOBJECTIVE: To investigate the effectiveness of early depth assessment of local burns, the depth of which is difficult to assess with the naked eye, by dermoscopy. DESIGN: The morphological findings of burn wounds were prospectively evaluated by dermoscopy and videomicroscopy. Prior to dermoscopic and videomicroscopic measurement, clinical assessment was performed. All patients received conservative treatment for 21 days after injury. SETTING: A burns unit at a primary care hospital. PARTICIPANTS: Thirty-two patients with 41 intermediate-depth local burn wounds were included. Inclusion criteria were time to presentation greater than 24 hours after injury and total burn size greater than 1% and less than 10% of the total body surface area. MAIN OUTCOME MEASURES: Primary healing within 21 days (superficial partial thickness) and failure of primary healing within 21 days (deep partial thickness). The accuracy, sensitivity, and specificity of the assessment according to the algorithm proposed in this study were evaluated by dermoscopy, and the accuracy of the dermoscopic measurements was compared with videomicroscopic measurements and clinical assessments. RESULTS: The results of dermoscopic measurements according to the proposed algorithm showed an accuracy of 93%, sensitivity of 86%, and specificity of 100%. The dermoscopic measurements were significantly more accurate compared with clinical assessment (P = .01). CONCLUSIONS: Dermoscopy is a noninvasive, portable, relatively inexpensive, and effective approach for assessment of the burn wound healing potential. It is more accurate if compared with clinical observation in burn depth assessment. It has a broader utility and is equally or more accurate compared with the more expensive videomicroscopy.

• Cutaneous B-Cell Neoplasms Mimicking Granulomatous Rosacea or Rhinophyma.

  Authors: Aviv Barzilai, Hana Feuerman, Pietro Quaglino, Michael David, Meora Feinmesser, Marisa Halpern, Edit Feldberg, Carlo Tomasini, Hilla Tabibian-Keissar, Ninette Amarilgio, Emmilia Hodak

  Archives of dermatology.

  BACKGROUND: Unlike T-cell neoplasms, B-cell lymphoproliferative disorders have a limited clinical spectrum of skin involvement. Cutaneous B-cell neoplasms mimicking rosacea or rhinophyma are rare.BACKGROUND: Unlike T-cell neoplasms, B-cell lymphoproliferative disorders have a limited clinical spectrum of skin involvement. Cutaneous B-cell neoplasms mimicking rosacea or rhinophyma are rare. OBSERVATIONS: We described 12 patients with B-cell lymphoproliferative neoplasms presenting with a facial eruption clinically mimicking rosacea or rhinophyma. Eleven patients were women; ages ranged from 36 to 81 years. The clinical presentation included small papules on the nose and cheeks and around the eyes mimicking granulomatous rosacea; nodules on the nose, cheeks, chin, or forehead mimicking phymatous rosacea; or a combination of both. Three patients had preexisting erythematotelangiectatic rosacea and 1 had rhinophyma. Based on a clinicopathologic correlation and B-cell clonality analysis, the diagnosis was primary cutaneous follicular center B-cell lymphoma in 4 cases, primary cutaneous marginal zone lymphoma in 6, and skin involvement of chronic lymphocytic leukemia in 2. All patients had an indolent course as expected for their disease. CONCLUSIONS: Cutaneous involvement of B-cell neoplasms may mimic granulomatous rosacea or rhinophyma. This unusual clinical presentation is more common in women and appears in the setting of preexisting rosacea or as a new eruption. Proliferative B-cell disorders should be added to the differential diagnosis of symmetric papular or papulonodular eruptions of the face.

• Ocular Adverse Effects of Systemic Treatment With Isotretinoin.

  Authors: Meira Neudorfer, Inbal Goldshtein, Orna Shamai-Lubovitz, Gabriel Chodick, Yuval Dadon, Varda Shalev

  Archives of dermatology.

  OBJECTIVE: To examine whether isotretinoin therapy could result in deleterious ocular effects, as previously described in case report studies. DESIGN: Retrospective cohort study. SETTING: The studyOBJECTIVE: To examine whether isotretinoin therapy could result in deleterious ocular effects, as previously described in case report studies. DESIGN: Retrospective cohort study. SETTING: The study was conducted using the electronic medical databases of a large health maintenance organization in Israel. Patients The study population consisted of 14 682 adolescents and young adults who were new users of isotretinoin for acne and 2 age- and sex-matched comparison groups (isotretinoin-naive patients with acne and acne-free patients). MAIN OUTCOME MEASURES: Ocular adverse effects (AEs) or purchases of ophthalmic medications within 1 year after the first dispensed isotretinoin prescription. RESULTS: In total, 13.8% of the isotretinoin group experienced ocular AEs vs 9.6% of the isotretinoin-naive group and 7.1% of the acne-free group. During a 1-year follow-up period, the isotretinoin group had significantly higher risk for any ocular AEs (hazard ratio, 1.70; P < .001) compared with the acne-free group. No such increased risk was observed for the isotretinoin-naive group. The isotretinoin group had higher relative risks for inflammatory and structural AEs. Conclusion Isotretinoin use may be associated with short-term ocular events, especially conjunctivitis, underscoring the importance of educating patients and caregivers about these potentially important AEs of the therapy.

• Pronounced Allelic Imbalance at D9S162 in Skin Squamous Cell Carcinoma of Organ Transplant Recipients.

  Authors: Beda Mühleisen, Ivaylo Petrov, Simona Frigerio, Piotr Dziunycz, Lars E French, Günther F L Hofbauer

  Archives of dermatology.

  OBJECTIVE: To evaluate chromosomal instability at 9p21-22 with p16 protein expression in organ transplant recipients (OTRs) compared with immunocompetent patients with squamous cell carcinoma (SCC).OBJECTIVE: To evaluate chromosomal instability at 9p21-22 with p16 protein expression in organ transplant recipients (OTRs) compared with immunocompetent patients with squamous cell carcinoma (SCC). DESIGN: In a select population of intraepithelial and subsequent invasive SCC from the same anatomic region of the same patient at different times, we assessed loss of heterozygosity at 3 microsatellites-IFNA, D9S162, and D9S925-in the course of carcinogenesis in OTRs and immunocompetent patients. SETTING: Department of Dermatology, University Hospital Zurich. Patients Immunocompetent patients and OTRs with SCC on sun-damaged skin. Main Outcome Measure Chromosomal allelic balance in SCC of OTRs and immunocompetent patients. RESULTS: Reduced allelic balance at IFNA, D9S162, and D9S925 in intraepithelial forms of SCC and similar allelic imbalance in invasive forms of SCC were found. Allelic balance at D9S162 was reduced for SCC in OTRs compared with SCC in immunocompetent patients. The study revealed broadly reduced allelic balance at 9p21-22 in all cutaneous SCCs, and OTRs presented a further reduced allelic balance for D9S162, suggesting a common trait for SCC in OTRs. Actinic keratosis and Bowen disease differed in allelic balance at D9S162, suggesting substantial differences in their carcinogenesis. Conclusion Reduced allelic balance around locus D9S162 is a genomic correlate for enhanced carcinogenesis in OTRs.

• Botulinum toxin-a for the treatment of raynaud syndrome.

  Authors: Lauren Smith, David Polsky, Andrew G Franks

  Archives of dermatology. 148(4):426-8.

• Risk of Serious Adverse Events Associated With Biologic and Nonbiologic Psoriasis Systemic Therapy: Patients Ineligible vs Eligible for Randomized Controlled Trials.

  Authors: Ignacio Garcia-Doval, Gregorio Carretero, Francisco Vanaclocha, Carlos Ferrandiz, Esteban Daudén, Jose-Luis Sánchez-Carazo, Mercé Alsina, Enrique Herrera-Ceballos, Francisco-José Gómez-García, Marta Ferrán, Jose-Luis López-Estebaranz, Jose-Manuel Hernanz, Isabel Belinchón-Romero, Jaime Vilar-Alejo, Raquel Rivera, Jose-Manuel Carrascosa, Cristina Carazo

  Archives of dermatology. 148(4):463-70.

  To describe the use of systemic therapy for psoriasis (biologic and nonbiologic [classic] drugs) in patients not adequately represented in randomized controlled trials (RCTs) and the risk of seriousTo describe the use of systemic therapy for psoriasis (biologic and nonbiologic [classic] drugs) in patients not adequately represented in randomized controlled trials (RCTs) and the risk of serious adverse events (SAEs) in these patients. A registry inception cohort was used. Thirteen dermatology departments in Spain participated. Patients A consecutive sample of patients treated with biologics and a systematic sample of patients treated with classic systemic therapy were evaluated. A total of 1042 patients (2179 person-years) were included. Exposure Inadequate representation in trials was defined as the presence of any of the following factors: elderly age (>70 years); type of psoriasis other than chronic plaque psoriasis; history of infection caused by hepatitis B, hepatitis C, or human immunodeficiency virus; history of cancer (excluding nonmelanoma skin cancer); and chronic renal or hepatic disease. Serious adverse events as defined by the International Conference on Harmonization were evaluated. In all, 29.8% of patients receiving systemic therapy for psoriasis would not have been eligible for RCTs. These individuals had an increased risk of SAEs (incidence rate ratio, 2.7; 95% CI, 1.5-4.7). Patients exposed to biologics had an adjusted increased risk of SAEs (incidence rate ratio, 2.3; 95% CI, 1.1-4.8) that was similar in patients eligible and ineligible for RCTs. Patients ineligible for RCTs are an important proportion (30%) of those receiving systemic therapy for psoriasis. These patients have a higher risk of SAEs and should be closely monitored. Patients exposed to biologics (whether these patients are eligible for RCTs or ineligible) are susceptible to the same increase in risk of SAEs, but biologics add to a higher baseline risk in patients who are ineligible for RCTs. The risk-benefit ratio in ineligible patients receiving biologics might be different from the ratio in eligible patients.

• Use of mohs micrographic surgery for the treatment of nonmelanoma skin cancer: comment on "mohs micrographic surgery and surgical excision for nonmelanoma skin cancer treatment in the medicare population".

  Authors: June K Robinson

  Archives of dermatology. 148(4):477-8.

• Dermatogeographical synonyms for syphilis.

  Authors: Antonio Tagarelli, Giuseppe Tagarelli, Paolo Lagonia, Anna Piro

  Archives of dermatology. 148(4):484.

• Dermatology for Poets and Bird-watchers.

  Authors: Leonard J Hoenig

  Archives of dermatology. 148(4):494.

• Pitfalls of evidence-based medicine: the example of actinic keratosis therapy.

  Authors: Barbara A Gilchrest, George Martin

  Archives of dermatology. 148(4):528-30.

• An unusual variant of confluent and reticulated papillomatosis masquerading as tinea versicolor.

  Authors: Kristin D Hudacek, Maryam S Haque, Abby L Hochberg, Carrie Ann Cusack, Christina Lee Chung

  Archives of dermatology. 148(4):505-8.

  Confluent and reticulated papillomatosis (CARP), also known as Gougerot-Carteaud syndrome, is a rare disorder. It usually presents as hyperkeratotic brown papules that coalesce into plaques with aConfluent and reticulated papillomatosis (CARP), also known as Gougerot-Carteaud syndrome, is a rare disorder. It usually presents as hyperkeratotic brown papules that coalesce into plaques with a reticulated periphery on the central trunk of young adults. Confluent and reticulated papillomatosis is most often clinically confused with tinea versicolor and usually does not respond to therapy with antifungals. Minocycline is the treatment of choice. Four cases of CARP with the unusual presentation of hypopigmented lesions masquerading as tinea versicolor in dark-skinned (Fitzpatrick skin types IV-V) patients are presented. All cases exhibited characteristic features of CARP on biopsy results and responded to minocycline of several months' duration. Two of the cases were also treated with adjuvant topical tazarotene. The hypopigmented variant of CARP in dark-skinned patients makes the clinical differentiation from tinea versicolor extremely challenging. Physicians encountering darkly pigmented individuals with hypopigmented plaques unresponsive to antifungals should have a high clinical suspicion for the hypopigmented variant of CARP.

• Erythematous annular plaques on the trunk--quiz case.

  Authors: Lindsay Lapresto, Lee Cranmer, Christof P Erickson, Lynne Morrison, Clara Curiel-Lewandrowski

  Archives of dermatology. 148(4):531-6.

• Multiple brown macules and papules on a female teenager--quiz case.

  Authors: Mark Jean-Aan Koh, Amy Forman-Taub, Anthony J Mancini

  Archives of dermatology. 148(4):531-6.

• Poor Benefit/Risk Balance of Intravenous Immunoglobulins in DRESS.

  Authors: Pascal Joly, Baptiste Janela, Florence Tetart, Sylvie Rogez, Damien Picard, Michel D'Incan, Vincent Descamps, Evelyne Collet, Jean Claude Roujeau, Philippe Musette

  Archives of dermatology. 148(4):543-4.

• Topical Psoralen Plus UV-A Therapy for Tyrosine Kinase Inhibitor-Induced Hand-Foot Syndrome.

  Authors: Willemijn E M Bos, Tamar E C Nijsten, Maja J A de Jonge, A P Hamberg

  Archives of dermatology. 148(4):546-7.

• The Need to Examine the Risks and Benefits of Intravenous Immunoglobulin Therapy in Severe Cutaneous Adverse Reactions: Comment on "Poor Benefit/Risk Balance of Intravenous Immunoglobulins in DRESS".

  Authors: Cindy England Owen

  Archives of dermatology. 148(4):545a-545.

• Top-accessed article: cantharidin revisited.

  Authors: Amy Yuntzu-Yen Chen, Michael P Heffernan

  Archives of dermatology. 148(4):454.

• Mohs micrographic surgery and surgical excision for nonmelanoma skin cancer treatment in the medicare population.

  Authors: Kate V Viola, Mamta B Jhaveri, Pamela R Soulos, Ryan B Turner, Whitney L Tolpinrud, Daven Doshi, Cary P Gross

  Archives of dermatology. 148(4):473-7.

  Objectives To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographicObjectives To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. A retrospective analysis of Medicare beneficiaries. Surveillance, Epidemiology, and End Results database. Patients Patients undergoing MMS or other surgical intervention for the treatment of NMSC from January 1, 2001, through December 31, 2006. Surgical treatment, patient, and lesion characteristics. A total of 26 931 operations were performed for the treatment of NMSC from 2001 through 2006, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period (1.8 vs 2.1 per 100 Medicare beneficiaries), the rate of MMS doubled (0.75 vs 1.5 per 100 Medicare beneficiaries). In 46.9% of facial lesions, MMS was performed, whereas MMS was used to treat 14.7% of total body lesions. Atlanta, Georgia, had the highest proportion of patients treated with MMS (45.1%); Louisiana had the lowest (11.0%). Age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use (all P < .001). Surgical treatment of NMSC increased substantially from 2001 through 2006, primarily because of a doubling in the rate of MMS procedures. Significant differences in surgical rates, depending on patient age, race, lesion location, and geographic region, of treatment were found.

• Low blood concentration of hydroxychloroquine in patients with refractory cutaneous lupus erythematosus: a French multicenter prospective study.

  Authors: Camille Francès, Anne Cosnes, Pierre Duhaut, Noël Zahr, Boutros Soutou, Saskia Ingen-Housz-Oro, Didier Bessis, Jacqueline Chevrant-Breton, Nadège Cordel, Dan Lipsker, Nathalie Costedoat-Chalumeau

  Archives of dermatology. 148(4):479-84.

  To study the relation between blood concentration of hydroxychloroquine and the clinical efficacy of hydroxychloroquine sulfate in a series of patients with cutaneous lupus erythematosusTo study the relation between blood concentration of hydroxychloroquine and the clinical efficacy of hydroxychloroquine sulfate in a series of patients with cutaneous lupus erythematosus (CLE). Prospective multicenter study. A staff dermatologist blinded to blood hydroxychloroquine concentrations performed a standardized review of medical records and assessment of hydroxychloroquine efficacy in the following 3 categories: complete remission, partial remission (clearing of >50% of skin lesions), or treatment failure. Whole-blood samples were collected for measurement of blood hydroxychloroquine concentration. Fourteen French university hospitals. Patients Three hundred consecutive patients with subacute or chronic CLE who had been treated with hydroxychloroquine for at least 3 months. The statistical significance of correlation between blood hydroxychloroquine concentration and efficacy of hydroxychloroquine and the statistical associations in univariate and multivariate analyses of complete remission with several variables. The study included 300 patients with discoid lupus erythematosus (n = 160), subacute CLE (n = 86), lupus erythematosus tumidus (n = 52), chilblain lupus (n = 26), and lupus panniculitis (n = 16); 38 of these patients had 2 or more associated forms. Median blood hydroxychloroquine concentration was significantly higher in patients with complete remission (910 [range, <50 to 3057] ng/mL) compared with partial remission (692 [<50 to 2843] ng/mL) and treatment failure (569 [<50 to 2242] ng/mL) (P = .007). In the multivariate analysis, complete remission was associated with higher blood hydroxychloroquine concentrations (P = .005) and the absence of discoid lesions (P = .004). Thirty patients (10.0%) had very low blood hydroxychloroquine concentrations (<200 ng/mL) and may be considered nonadherent to the treatment regimen. Conclusion Monitoring hydroxychloroquine blood concentrations might improve the management of refractory CLE.

• Comparative effectiveness of commonly used systemic treatments or phototherapy for moderate to severe plaque psoriasis in the clinical practice setting.

  Authors: Joel M Gelfand, Joy Wan, Kristina Callis Duffin, Gerald G Krueger, Robert E Kalb, Jamie D Weisman, Brian R Sperber, Michael B Stierstorfer, Bruce A Brod, Stephen M Schleicher, Bruce F Bebo, Andrea B Troxel, Daniel B Shin, Jane M Steinemann, Jennifer Goldfarb, Howa Yeung, Abby S Van Voorhees

  Archives of dermatology. 148(4):487-94.

  To compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis. A cross-sectional design was used. Ten outpatient dermatologyTo compare the effectiveness of biologic systemic therapy, nonbiologic systemic therapy, and phototherapy for treatment of psoriasis. A cross-sectional design was used. Ten outpatient dermatology sites across the United States participating in the Dermatology Clinical Effectiveness Research Network contributed to the study. A total of 713 patients with plaque psoriasis receiving systemic monotherapy (ie, methotrexate sodium, adalimumab, etanercept, or ustekinumab) or narrowband UV-B phototherapy. The primary outcome of the study was clear or almost clear skin on the Physician Global Assessment scale. Secondary outcomes were score on the Psoriasis Area and Severity Index, affected body surface area, and score on the Dermatology Life Quality Index. The proportion of patients with clear or almost clear ratings on the Physician Global Assessment scale differed among treatments: methotrexate (23.8%), adalimumab (47.7%), etanercept (34.2%), ustekinumab (36.1%), and narrowband UV-B (27.6%) (P < .001). In adjusted analyses, patients receiving adalimumab (relative response rate, 2.15; 95% CI, 1.60-2.90), etanercept (1.45; 1.06-1.97), and ustekinumab (1.57; 1.06-2.32) were more likely to have clear or almost clear skin vs patients receiving methotrexate. Patients receiving phototherapy showed no significant difference (1.35; 95% CI, 0.93-1.96) compared with those receiving methotrexate. No response difference was observed with respect to quality of life. Treatment doses were double the recommended doses in 36.1% of patients taking etanercept and 11.8% of those taking adalimumab;10.6% of patients undergoing phototherapy received the recommended treatment frequency. The effectiveness of psoriasis therapies in clinical practice may be lower than that reported in previous trials. Although relative differences in objective response rates among therapies may exist, absolute differences are small and may not be clinically significant. Dosing of common therapies varied from trial recommendations. These results provide novel benchmarks emphasizing the critical importance of studying effectiveness in real-world practice.

• Halo nevi association in nonsegmental vitiligo affects age at onset and depigmentation pattern.

  Authors: Khaled Ezzedine, Abou Diallo, Christine Léauté-Labrèze, Julien Seneschal, Djavad Mossalayi, Khalid Alghamdi, Sorilla Prey, Serge Bouchtnei, Muriel Cario-André, Franck Boralevi, Thomas Jouary, Alain Taieb

  Archives of dermatology. 148(4):497-502.

  To compare factors associated with halo nevi with nonsegmental vitiligo (NSV) vs NSV alone. Prospective observational study in 553 patients with a confirmed diagnosis of NSV attending a vitiligoTo compare factors associated with halo nevi with nonsegmental vitiligo (NSV) vs NSV alone. Prospective observational study in 553 patients with a confirmed diagnosis of NSV attending a vitiligo clinic between January 1, 2006, and July 1, 2010. Vitiligo Clinic at the Department of Dermatology, University Hospital Center of Bordeaux, Bordeaux, France. Patients The Vitiligo European Task Force questionnaire was informed for each patient attending the clinic with a confirmed diagnosis of NSV after the exclusion of other forms of vitiligo (focal, mucosal, and not classifiable). Thyroid function and antithyroid antibodies were screened if not obtained in the previous year. Extent of disease and markers of autoimmunity or autoinflammation. Of the 553 patients, 130 had halo nevi-NSV and 423 had NSV. Family history of premature hair graying (odds ratio, 1.74; P < .01) was positively associated with halo nevi-NSV by univariate analysis. Using multivariate analysis, age at onset younger than 18 years, phototype, total body area, localization on the trunk, involvement of hands and feet, and total staging were found to be independent factors. Age at onset younger than 18 years; phototypes I, II, and III; trunk involvement; and staging were positively associated with halo nevi-NSV, whereas this association was negative for total affected area and involvement of hands and feet. Halo nevi association in NSV affects age at onset and depigmentation pattern and has a stronger link with familial premature hair graying, suggesting that premature hair graying may involve, at least partly, an autoimmune pathway.

• Safety of topical corticosteroid use during pregnancy.

  Authors: Bénédicte Lebrun-Vignes, Laurence Le Cleach, Bruno Giraudeau, Olivier Chosidow

  Archives of dermatology. 148(4):525-7.

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