Marta VanBeek

Individual drug sampling does not supplant the need for head-to-head trials in dermatology

A growing body of evidence has highlighted several risks and benefits associated with in-office sampling of prescription medications. While use-testing dermatologic medications from a sample closet may benefit some patients, it seems that the stunning lack of head-to-head trials comparing therapeutic options is a much larger and more important impediment to our determination of when the increased cost of newer agents is justified by superior efficacy, safety, or tolerability. If physicians are to retain the critical autonomy to make independent prescribing decisions in concert with our individual patients, we must take responsibility to call for and generate the comparative data we need to evaluate therapeutic options.

Numerous Facial Lesions in a 47-Year-Old Woman—Quiz Case

A 54-year-old woman presented with a 2-year history of a mildly pruritic, golden-brown rash that first developed on her palms and progressed to her shins and soles. The patient’s medical history and medications were unremarkable. Physical examination revealed dusky, reddish-brown patches on her bilateral soles and reddishbrown patches with scattered red puncta on the dorsum of her feet, shins, and palms (Figure 1 and Figure 2). Laboratory test results showed no abnormalities for full blood cell count, double-stranded DNA, antinuclear antibody, serum protein electrophoresis, and erythrocyte sedimentation rate. A shave biopsy specimen was obtained (Figure 3). What is your diagnosis?