Research Original Investigation
Afamelanotide and NB–UV-B Therapy for Vitiligo
19. Cha YC, Lee HJ, Lee SJ, Na GY, Chung SL. The expression of the α-melanocyte stimulating hormone (α-MSH) and melanocortin-1 receptor (MC1r) in the epidermis of the vitiligo. Korean J Dermatol. 2003;41(6):690-695.
tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140(6):677-683.
20. Grimes PE, Hamzavi I, Lebwohl M, Ortonne JP, Lim HW. The efficacy of afamelanotide and narrowband UV-B phototherapy for repigmentation of vitiligo. JAMA Dermatol. 2013;149(1):68-73.
22. Taieb A, Alomar A, Böhm M, et al; Vitiligo European Task Force (VETF); European Academy of Dermatology and Venereology (EADV); Union Européenne des Médecins Spécialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5-19.
21. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative
23. Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. Ann Math Stat. 1947;18(1):50-60.
24. Fisher RA. Statistical Methods for Research Workers. 14th ed. Edinburgh, Scotland: Oliver & Boyd; 1970. 25. Fleiss JL. Statistical Methods for Rates and Proportions. 3rd ed. Hoboken, NJ: John Wiley & Sons Inc; 2003. 26. Conover WJ. Practical Nonparametric Statistics. 3rd ed. New York, NY: John Wiley & Sons Inc; 1999. 27. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50(3):163-170.
NOTABLE NOTES
Trending Elizabeth M. Marchionne, BS; Michael W. Cashman, MD; Scott A. Norton, MD, MPH
When my father was in second grade, a fellow student dared him to walk across a wooden board that spanned a large puddle after a heavy rainstorm. To the crowd’s amusement, the board snapped when he was halfway across, submerging him in murky water. Soaking wet, embarrassed, and tearful, he had to call his mother from the principal’s office to ask for a change of clothes. So starts a story told by one of this article’s authors (E.M.M.). Playground rites of passage—daring feats and failures—go back to the dawn of, well, the dawn of playgrounds. For the Millennial Generation and today’s Generation Z, schoolyard dares have spread to social media. YouTube, Facebook, and Twitter are platforms for these fads and a conduit for virtual peer pressure. In an Internet dare—dubbed a “challenge”—someone posts a video attempting a task and calls on friends to replicate it. A popular example is the “cinnamon challenge,” in which participants attempt to swallow a spoonful of powdered cinnamon in less than a minute. A YouTube search (on August 21, 2014) for cinnamon challenge returned more than a million videos, including one with nearly 40million views. Most of these videos end with uncontrolled coughing and a spectacular spewed cloud of cinnamon. Not harmless, this challenge has prompted calls to poison control centers and to the hospitalization (with ventilator support) of some participants.1 Other challenges may be riskier. The “salt-and-ice challenge” is rapidly enticing the nation’s youth (Figure). In this challenge, table salt is placed on the skin, then an ice cube placed firmly over it. An endothermic reaction quickly freezes the underlying skin tissues, producing a paradoxical burning sensation.2 Participants are generally unaware that this causes a frostbite-like condition that damages underlying tissues. The typical result is a well-demarcated reddish brown plaque with central tense blister. The clinical findings may resemble a bullous disease, but a wary adolescent might not volunteer a full history.2 At least 1 child, a teenage boy, required hospitalization in a burn unit after enduring the burning pain for 20 minutes.3 Even more startling, teenage participants of “fire challenge,” which was highly publicized in the summer of 2014, douse their bare skin with acetone (or another flammable liquid) and then set themselves ablaze. The goal is to capture on video an instant, dramatic burst of flame—and then to extinguish it within a few seconds, leaving behind unscathed skin and a world-class YouTube clip.
50
Figure. “Salt-and-Ice Challenge” Participant
The forearm of an adolescent boy with several well-demarcated reddish brown plaques after attempting the salt-and-ice challenge.
Evidently, the obvious potential to cause serious burns is unrecognized, ignored, or denied in the baffling pursuit of Internet fame. Dares on social media have become quickly popular and highly shared, a process known as “trending.” These challenges raise concern for factitial dermatoses and self-inflicted injuries that physicians may encounter, and their recognition by dermatologists is one way to stay on trend. Author Affiliations: University of Nevada School of Medicine, Reno (Marchionne); Medstar Washington Hospital Center, Washington, DC (Cashman); Georgetown University Hospital, Washington, DC (Cashman); Children’s National Medical Center, Washington, DC (Norton). Corresponding Author: Elizabeth M. Marchionne, BS, University of Nevada School of Medicine, 2040 W Charleston Ave, Ste 504 Las Vegas, NV 89102 ([email protected]). 1. Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and aspirating dry cinnamon by children and adolescents: the “cinnamon challenge.” Pediatrics. 2013;131(5):833-835. 2. Zack JM, Fults M, Saxena H, Green B. Factitial dermatitis due to the “salt and ice challenge.” Pediatr Dermatol. 2014;31(2):252-254. 3. Templeton D. Boy, 12, badly injured in “salt-and-ice” challenge. Pittsburgh PostGazette. June 29, 2012. http://www.post-gazette.com/neighborhoods-city/2012 /06/29/Boy-12-badly-injured-in-salt-and-ice-challenge/stories/201206290188. Accessed August 13, 2014.
JAMA Dermatology January 2015 Volume 151, Number 1
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a University of Georgia User on 05/30/2015
jamadermatology.com
Afamelanotide and NB–UV-B Therapy for Vitiligo
19. Cha YC, Lee HJ, Lee SJ, Na GY, Chung SL. The expression of the α-melanocyte stimulating hormone (α-MSH) and melanocortin-1 receptor (MC1r) in the epidermis of the vitiligo. Korean J Dermatol. 2003;41(6):690-695.
tool: the Vitiligo Area Scoring Index. Arch Dermatol. 2004;140(6):677-683.
20. Grimes PE, Hamzavi I, Lebwohl M, Ortonne JP, Lim HW. The efficacy of afamelanotide and narrowband UV-B phototherapy for repigmentation of vitiligo. JAMA Dermatol. 2013;149(1):68-73.
22. Taieb A, Alomar A, Böhm M, et al; Vitiligo European Task Force (VETF); European Academy of Dermatology and Venereology (EADV); Union Européenne des Médecins Spécialistes (UEMS). Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol. 2013;168(1):5-19.
21. Hamzavi I, Jain H, McLean D, Shapiro J, Zeng H, Lui H. Parametric modeling of narrowband UV-B phototherapy for vitiligo using a novel quantitative
23. Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. Ann Math Stat. 1947;18(1):50-60.
24. Fisher RA. Statistical Methods for Research Workers. 14th ed. Edinburgh, Scotland: Oliver & Boyd; 1970. 25. Fleiss JL. Statistical Methods for Rates and Proportions. 3rd ed. Hoboken, NJ: John Wiley & Sons Inc; 2003. 26. Conover WJ. Practical Nonparametric Statistics. 3rd ed. New York, NY: John Wiley & Sons Inc; 1999. 27. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50(3):163-170.
NOTABLE NOTES
Trending Elizabeth M. Marchionne, BS; Michael W. Cashman, MD; Scott A. Norton, MD, MPH
When my father was in second grade, a fellow student dared him to walk across a wooden board that spanned a large puddle after a heavy rainstorm. To the crowd’s amusement, the board snapped when he was halfway across, submerging him in murky water. Soaking wet, embarrassed, and tearful, he had to call his mother from the principal’s office to ask for a change of clothes. So starts a story told by one of this article’s authors (E.M.M.). Playground rites of passage—daring feats and failures—go back to the dawn of, well, the dawn of playgrounds. For the Millennial Generation and today’s Generation Z, schoolyard dares have spread to social media. YouTube, Facebook, and Twitter are platforms for these fads and a conduit for virtual peer pressure. In an Internet dare—dubbed a “challenge”—someone posts a video attempting a task and calls on friends to replicate it. A popular example is the “cinnamon challenge,” in which participants attempt to swallow a spoonful of powdered cinnamon in less than a minute. A YouTube search (on August 21, 2014) for cinnamon challenge returned more than a million videos, including one with nearly 40million views. Most of these videos end with uncontrolled coughing and a spectacular spewed cloud of cinnamon. Not harmless, this challenge has prompted calls to poison control centers and to the hospitalization (with ventilator support) of some participants.1 Other challenges may be riskier. The “salt-and-ice challenge” is rapidly enticing the nation’s youth (Figure). In this challenge, table salt is placed on the skin, then an ice cube placed firmly over it. An endothermic reaction quickly freezes the underlying skin tissues, producing a paradoxical burning sensation.2 Participants are generally unaware that this causes a frostbite-like condition that damages underlying tissues. The typical result is a well-demarcated reddish brown plaque with central tense blister. The clinical findings may resemble a bullous disease, but a wary adolescent might not volunteer a full history.2 At least 1 child, a teenage boy, required hospitalization in a burn unit after enduring the burning pain for 20 minutes.3 Even more startling, teenage participants of “fire challenge,” which was highly publicized in the summer of 2014, douse their bare skin with acetone (or another flammable liquid) and then set themselves ablaze. The goal is to capture on video an instant, dramatic burst of flame—and then to extinguish it within a few seconds, leaving behind unscathed skin and a world-class YouTube clip.
50
Figure. “Salt-and-Ice Challenge” Participant
The forearm of an adolescent boy with several well-demarcated reddish brown plaques after attempting the salt-and-ice challenge.
Evidently, the obvious potential to cause serious burns is unrecognized, ignored, or denied in the baffling pursuit of Internet fame. Dares on social media have become quickly popular and highly shared, a process known as “trending.” These challenges raise concern for factitial dermatoses and self-inflicted injuries that physicians may encounter, and their recognition by dermatologists is one way to stay on trend. Author Affiliations: University of Nevada School of Medicine, Reno (Marchionne); Medstar Washington Hospital Center, Washington, DC (Cashman); Georgetown University Hospital, Washington, DC (Cashman); Children’s National Medical Center, Washington, DC (Norton). Corresponding Author: Elizabeth M. Marchionne, BS, University of Nevada School of Medicine, 2040 W Charleston Ave, Ste 504 Las Vegas, NV 89102 ([email protected]). 1. Grant-Alfieri A, Schaechter J, Lipshultz SE. Ingesting and aspirating dry cinnamon by children and adolescents: the “cinnamon challenge.” Pediatrics. 2013;131(5):833-835. 2. Zack JM, Fults M, Saxena H, Green B. Factitial dermatitis due to the “salt and ice challenge.” Pediatr Dermatol. 2014;31(2):252-254. 3. Templeton D. Boy, 12, badly injured in “salt-and-ice” challenge. Pittsburgh PostGazette. June 29, 2012. http://www.post-gazette.com/neighborhoods-city/2012 /06/29/Boy-12-badly-injured-in-salt-and-ice-challenge/stories/201206290188. Accessed August 13, 2014.
JAMA Dermatology January 2015 Volume 151, Number 1
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a University of Georgia User on 05/30/2015
jamadermatology.com
