Tara Bronsnick

Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.

Outcomes of Biopsies and Excisions of Dysplastic Acral Nevi: A Study of 187 Lesions

BACKGROUND Despite their frequency in clinical practice, controversy exists regarding the significance and management of dysplastic nevi (DN). Although the perception of DN as precursors to melanoma is questionable, excisions of biopsy‐proven DN are commonplace in clinical practice. The management of dysplastic acral nevi is of interest given the challenge of surgery at acral sites. OBJECTIVE To determine the outcomes of biopsies of clinically atypical acral nevi and excisions of histologically dysplastic acral nevi (HDN). MATERIALS AND METHODS Retrospective review of consecutive patients at a private dermatology practice who had a biopsy of an atypical acral nevus from December 2004 to July 2012. RESULTS One hundred eighty‐seven atypical acral nevi were biopsied from 168 patients (77 (41%) HDN, 108 (58%) common nevi). Based on initial histology, 30 (39%) HDN were recommended for excision and eight (10%) for clinical observation. Twenty‐seven of the 77 HDN were excised; 23 (85%) revealed scar only, and four (15%) revealed residual DN not involving the margin. CONCLUSION Routine excision of biopsy‐proven dysplastic acral nevi may not be necessary.

Diet in dermatology

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.

Response to: “Evidence on pseudoallergen-free diet for chronic urticaria”

To the Editor: We thank Drs Yeung and Swerlick for their comments on our continuing medical education article ‘‘Diet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis.’’ We agree that the benefits of a pseudoallergen-free diet are controversial. Additionally, a pseudoallergen elimination diet may be of limited utility in the majority of chronic urticaria patients. Indeed, it is important to emphasize that a recent trial found sensitivity to pseudoallergens in less than 1% of a cohort of 100 patients with chronic urticaria. Prospective interventional studies have reported improvement of chronic urticaria symptoms in 28% to 73% of participants adopting a pseudoallergen-free diet. Doubleblind, placebo-controlled oral challenges with individual pseudoallergens, the current gold standard for diagnosing food allergy, yield reproducible urticaria symptoms following a pseudoallergen-free diet in only 1% to 19% of patients. We agree that while these studies do not confirm the efficacy of pseudoallergen elimination diets in improving chronic urticaria, they suggest that distinct pseudoallergens may trigger reproducible chronic urticaria symptoms in some patients. A summary statement from a recent systematic review from the American Academy of Allergy, Asthma, and Immunology concludes that the evidence supporting pseudoallergen-free diets in chronic urticaria is weak. Furthermore, adhering to a pseudoallergen-free diet may be burdensome and difficult for some patients. Given its low cost and relative safety, however, a pseudoallergen elimination diet can be considered in a small subset of chronic urticaria patients. Isolationofpseudoallergensdirectly

Continuing medical educationDiet in dermatology: Part II. Melanoma, chronic urticaria, and psoriasis

The roles of dietary factors in aggravating, preventing, or treating skin diseases are common questions encountered in dermatology practice. Part II of this two-part series reviews dietary modifications that can potentially be utilized in the management of melanoma, chronic urticaria, and psoriasis patients. Specifically, we examine the effect of alcohol consumption and supplementation with vitamins D and E, polyunsaturated fatty acids, selenium, green tea, resveratrol, and lycopene on melanoma risk. The relationships between chronic urticaria symptoms and dietary pseudoallergens, gluten, and vitamin D are analyzed. We explore weight loss, reduced alcohol consumption, and gluten avoidance as means of reducing psoriasis-associated morbidity, as well as the possible utility of supplementation with polyunsaturated fatty acids, folic acid, vitamin D, and antioxidants. With proper knowledge of the role of diet in these cutaneous disease processes, dermatologists can better answer patient inquiries and consider implementation of dietary modifications as adjuncts to other treatments and preventative measures.

Tungiasis in Haiti: a case series of 383 patients

Tungiasis is endemic in poverty‐stricken communities of South and Central America, Africa, Asia, and the Caribbean. This ectoparasitosis, caused by the female sand flea Tunga penetrans, is associated with considerable longterm morbidity in severely affected patients, including toe deformation and limited mobility. In Haiti, tungiasis is poorly documented but is known to occur. This study is the first formal investigation of tungiasis in Haiti.

Teen With Lesion on Nasal Sidewall

A 15-year-old male presented to the dermatology clinic with a lesion that had been present on his right nasal sidewall since birth. At puberty, the lesion expanded in size, became irritated, and developed a papillated, rough texture. The patient otherwise had no significant med i ca l h i s to r y and was in good health. On physical examination, there was a 3.6-cm × 1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall (Figure). Quiz at jamapediatrics.com Figure. Clinical photograph of a 3.6-cm × 1.5-cm verrucous skin-colored to light-brown plaque on the right nasal sidewall.