EditorAlthough the paraneoplastic nature of a subset of dermatomyositis (DM) cases is unquestionable, the factors that indicate the coexisting cancer still remain unclear. Several predictive signs have been postulated as a marker of underlying malignancy: older age, male gender, rapid onset of the disease, presence of cutaneous necrosis, increased erythrocyte sedimentation rate (ESR), and increase or normality of creatine phosphokinase (CPK). [1][2][3][4][5][6][7][8] In order to identify potential risk factors for associated cancer in patients with DM, we reviewed clinical and laboratory data of 32 patients with DM (17 females and 15 males, aged 11-78 years), who have been treated during a 23-year period . Diagnosis of DM was based on the criteria of Bohan and Peter. 9 Typical cutaneous signs and muscular involvement (proximal muscle weakness and/or elevated muscle enzymes and/or electromyography findings and/or muscle histology) were observed in all patients. The main recorded data included an association with a cancer, age at the time of the diagnosis, gender, a rapid onset of symptoms (considered if the diagnosis was made within 3 months after the appearance of initial symptoms), signs of severity (presence of dysphonia, dyspnoea and/or dysphagia), some clinical features such as cutaneous necrosis (defined as cutaneous and/or mucosal necrotic lesions or ulcerations) and periungual erythema, evaluated ESR (superior to 40 mm during the first hour), serum muscle enzymes levels -CPK, lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) -as well as presence of antinuclear autoantibodies. Statistical analysis using Fisher's exact test for qualitative data and Mann-Whitney's test for quantitative data were performed to investigate differences between patients with and without associated malignancy. The difference was considered significant at P < 0.05.Malignant tumours were detected in 8 patients (25%), with equal number of female and male patients. Malignancies included colon cancer (2 patients), ovarian cancer (2 patients) and the remaining cancers were those of lung, breast, pancreas and prostate.The prevalence of predicting factors of malignancy is listed in Table 1. Cutaneous necrosis was presenting sign in 76% of our patients with cancer and in only 8.3% of the patients without cancer. Some previously published studies have pointed out that cutaneous necrosis is highly predictive of an associated cancer. 3-6 Including our trial, cutaneous necrosis is thought to increase the probability of occult malignancies in 27 (61%) of cases associated with cancer, opposite to 7 (8%) cases of DM without cancer. Since there is no clear definition for the term 'cutaneous necrosis', as this skin sign comprises a wide range of symptoms, from small digital necrosis to extensive skin and mucosal necrosis, these results, as pointed out by Burnouf et al., 4 must be analysed with reserve.

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Acne vulgaris is a common, multifactorial, inflammatory skin disease affecting the pilosebaceous unit. Topical therapy is the first choice in the treatment of mild to moderate acne, and azelaic acid (AZA) is one of the most commonly used drugs. The aim of this study was to evaluate the safety and efficacy of a low-dose azelaic acid nanocrystal (AZA-NC) hydrogel in the treatment of mild to moderate facial acne. The study was designed as a double-blind, randomized controlled trial. Patients were randomized to treatment with AZA-NC hydrogel, 10%, or AZA cream, 20%, administered in quantities of approximately 1 g twice daily for 8 weeks. Efficacy of therapy was measured by the number of lesions and safety by the frequency and severity of adverse events. At week 8, the success rate of treatment with AZA-NC hydrogel, 10%, was 36.51% (p < 0.001) versus 30.37% (p < 0.001) with AZA cream. At week 8, treatment with AZA-NC hydrogel, 10%, resulted in a significant reduction in total inflammatory lesions from baseline of 39.15% (p < 0.001) versus 33.76% (p < 0.001) with AZA cream, and a reduction in non-inflammatory lesions from baseline of 34.58% (p < 0.001) versus 27.96% (p < 0.001) with AZA cream, respectively. The adverse event rate was low and mostly mild.

Systematic knowledge dissemination is important to make OSD prevention more effective and to close the gap between research and practice. This study provides guidance to identify stakeholders, strategies and dissemination channels for systematic knowledge dissemination which need to be adapted to country-specific structures, for example the social security system and healthcare systems. A key for successful knowledge dissemination is building linkages among different stakeholders, building strategic partnerships and gaining their support right from the inception phase of a project.