References1 Mehta RK, Burrows NP, Rowland Payne CME, Mendelsohn MM, Pope FM, Rytina E. Elastosis perforans serpiginosa and associated disorders. Clin Exp Dermatol 2001; 26: 521-524. 2 Vearrier D, Buka RL, Roberts B, Cunningham B, Eichenfield L, Friedlander S.What is the standard of care in the evaluation of elastosis perforans serpiginosa? A survey of pediatric dermatologists.

was increased to 80 mg/day, and he was started on mycophenolate mofetil, up to 3 g/day, but did not clear on this regimen after 3 months. He then developed fatigue, insomnia, weakness and weight gain, so prednisone was lowered to 60 mg/day, and mycophenolate mofetil was replaced with oral cyclophosphamide, 100 mg/day. On this regimen, all lesions gradually healed, and prednisone was slowly tapered off. He remained clear on 100 mg/day of cyclophosphamide, which was tapered off after 8 months with no recurrence. His psoriasis returned after prednisone was tapered off and was treated with weekly methotrexate after cyclophos-phamide was discontinued. He has done well at 5-month follow-up on 15 mg of methotrexate per week with no recurrence of PV.This patient is of interest because of the development of PV while taking etanercept, a TNF inhibitor that has been proposed as a treatment for PV. 5 Although PV may have occurred spontaneously, the development of PV for the first time in this patient while on etanercept and the exacerbation after re-initiating this drug suggests a relationship between PV and etanercept. Etanercept is being studied as a therapy for PV, since the keratinocyte-derived pro-inflammatory cytokine TNF-α has been implicated in the acantholysis characteristically seen in PV. 2 Etanercept and other TNF inhibitors represent an important breakthrough in the treatment of skin diseases, however, because these drugs are relatively new, long-term follow-up and reporting of potential side-effects is important in order to better understand the overall safety and efficacy of this class of drugs. References1 Ameglio F, D'Auria L, Cordiali-Fei P et al. Anti-intercellular substance antibody log titres are correlated with serum concentrations of interleukin-6, interleukin-15 and tumor necrosis factor-alpha in patients with Pemphigus vulgaris relationships with peripheral blood neutrophil counts, disease severity and duration and patients' age. J Biol Regul Homeost Agents 1999; 13: 220-224. 2 Feliciani C, Toto P, Amerio P et al. In vitro and in vivo expression of interleukin-1alpha and tumor necrosis factor-alpha mRNA in pemphigus vulgaris: interleukin-1alpha and tumor necrosis factor-alpha are involved in acantholysis, J Invest Dermatol 2000; 114: 71-77. 3 Alecu M, Alecu S, Coman G, Galatescu E, Ursaciuc C. ICAM-1, ELAM-1, TNF-alpha and IL-6 in serum and blister liquid of pemphigus vulgaris patients. Roum Arch Microbiol Immunol 1999; 58: 121-130. 4 Study of etanercept (Enbrel) in the treatment of pemphigus vulgaris. ClinicalTrials.gov. Accessed July 27, 2007. 5 Jacobi A, Schuler G, Hertl M. Rapid control of therapy-refractory pemphigus vulgaris by treatment with the tumour necrosis factor-α inhibitor infliximab. Br J Dermatol 2005; 153: 448-449.

Loffler et al. 3 found a significant association between perceived sensitive skin and nickel allergy. However, these authors found no significant differences between individuals who perceived they have sensitive skin and those who didn't in skin hydration, skin blood flow and transepidermal water loss tests. Therefore, it was proposed that self-perceived 'sensitive skin' is a fashionable, noncausative complaint. In this study, 2 a significant association has been demonstrated between self-perceived sensitive skin and self-reported skin allergies (an immunological link) and family history (a familial link).