Editors' Picks

        A reason to scratch

        Yosipovitch and Bernhard recently described the presentation of chronic pruritus and documented the evidence in support of various strategies for treating this condition. Chronic pruritus can be categorized by dermatologic, systemic, neuropathic, and psychogenic causes, and the mechanisms underlying these causes are complex. Recent studies have indicated that chronic pruritus negatively affects quality of life to a degree similar to that for debilitating chronic pain. Evaluation of chronic pruritus patients should involve not only a medical history and physical examination but also a differential blood count, chest X-ray, and tests of hepatic, renal, and thyroid function. In the case of persistence in the face of first-line treatment with mild cleansers, emollients, topical anesthetics, and coolants, sedating antihistamines may be used to aid sleep, and glucocorticoids, anticonvulsants, antidepressants, and μ-opioid antagonists may be helpful alternative options. (N Engl J Med 368:1625–34, 2013) Selected by B. Gilchrest

        Recommended vaccine

        Herpes zoster occurs in more than 1 million individuals in the United States each year, and the associated postherpetic neuralgia (PHN) is a considerable problem for older individuals. Vaccine efficacy (VE) has been reported in a selected insured population and in individuals with specific immune-mediated diseases, but, in response to a lack of adherence to published guidelines indicating that immunosuppressed individuals should avoid the live herpes zoster vaccine, Langan and colleagues recently assessed VE against both incident herpes zoster and PHN in an unselected older population including immunosuppressed individuals. In this study in 766,330 eligible participants, VE was found to be 48% against incident shingles and approximately 60% against PHN. In immunosuppressed individuals, VE against incident disease was 37%. The associated reductions in both incident zoster and PHN following vaccination will surely impact future efforts to increase vaccine use in routine care of the elderly because current vaccination rates remain disappointingly low. (PLoS Med 10:e1001420, 2013) Selected by H. Williams

        DC alarmin

        Alarmins function in cutaneous immune responses by stimulating dendritic cell (DC) maturation, chemotaxis, and secretion of T helper type 17 (Th17)-biasing cytokines. Killeen and colleagues recently demonstrated that the alarmin ATP signals through the purinergic P2X7 receptor (P2X7R) to induce innate and adaptive immune responses that lead to the differentiation of Th17 cells in human skin explants ex vivo and cutaneous DCs. Furthermore, P2X7R was found to be present in psoriatic skin, a result that is not surprising because psoriasis is a Th17-dependent autoimmune disease. This P2X7R signaling is probably involved in the initiation of psoriasis, owing to the increase in key innate inflammatory markers, IL-6, IL-1β, and tumor necrosis factor-α, cytokines that are characteristic of psoriasis lesions. Mechanistically, this contribution may involve the mir-21 angiogenesis pathway. Thus, one potential trigger for psoriatic lesions is the release of extracellular ATP from commensal bacteria or as a result of trauma and subsequent signaling through purinergic receptors. (J Immunol 190:4324–36, 2013) Selected by S. Hwang

        One-stop shop for eczema

        Atopic eczema (AE), one of the most prevalent skin diseases, is understandably the focus of considerable research. The Global Resource of Eczema Trials (GREAT) has recently become a depository for the ever-increasing number of randomized controlled trials (RCTs); however, reliance on a single RCT is fraught with potential trouble. Systematic reviews (SRs) are therefore generated to collate information from multiple studies to provide reliable evidence critical for health-care providers. Futamura and colleagues generated an online SR resource that included 128 SRs published from 2000 through 2012 in an effort to provide a “one-stop shop” for information supporting the practice of evidence-based dermatology for treating AE. The majority of these SRs focused on treatment, although prevention of AE has recently become more common. This resource will decrease the time spent by professionals searching for information, reduce redundancy in research, facilitate generation of clinical guidelines, and ultimately improve patient care. (PLoS One 8:e58484, 2013) Selected by B. Gilchrest

        Beneath the surface

        The microbiome of the human epithelial surface has been studied, but traditional views have assumed that the underlying layers were devoid of microbial communities in the absence of skin trauma. Recently, Nakatsuji and colleagues presented evidence of a physical interaction between commensal bacteria and dermal cells. Indeed, the presence of vast microbial communities was discovered in deep dermal stroma and superficial adipose tissue. DNA that encodes for 16S rRNA genes, bacterial antigens, and bacterial rRNA were detected throughout the subcutaneous regions of human skin samples, revealing communities quite distinct from those at the surface. Thus, the skin microbiome is poised to influence host behavior, such as that of dermal cells and the immune system. Importantly, these findings indicate that the microbial ecology of the skin may have an impact on AE, psoriasis, and rosacea—disease conditions that are associated with altered skin barrier function and possibly altered microbiota. (Nat Commun, published online 5 February 2013; doi:10.1038/ncomms2441) Selected by M. Amagai