Skin conditions that bring patients to emergency departments.

Comment. Previous case reports (6 total patients in 3 reports) describe uniformly effective results for the use of etanercept in PV. Our randomized, controlled study suggests that the response to etanercept is heterogeneous, although the small sample size precludes definitive conclusions. We observed 2 meaningful responses in the 4 patients who received etanercept and completed the study, although the use of azathioprine 1 month before etanercept initiation confounds the results for 1 of these 2 patients. It is possible that a higher dose of etanercept (eg, 50 mg twice weekly) might have conferred additional efficacy. The apparent placebo response is complicated by concurrent initiation of topical therapy in one patient and a questionably meaningful improvement in the other. Oneweaknessofourstudy is the lackofawell-validated endpoint—wenotedcasesofdiscordancebetweenchanges in lesion number and physician global assessment. Since this study was designed, an international consensus statementhasemergedregardingdefinitionsofdiseaseendpoints and response, and, in addition, 2 novel outcome instruments for PV have been partially validated.