The Official Publication of the American Academy of Dermatology

EDITOR
Bruce H. Thiers, MD
Medical University of South Carolina
Charleston, South Carolina

DEPUTY EDITOR
Dirk M. Elston, MD
Geisinger Medical Center
Danville, Pennsylvania

EDITORIAL OFFICE
Melissa Derby, Managing Editor
Journal of the American Academy of Dermatology
482 Southbridge St, Ste 266
Auburn, MA 01501
Phone: 508-476-2724; Fax: 508-476-7479
E-mail: mderby@aad.org

PUBLISHER
Elsevier Inc.
11830 Westline Industrial Dr.
St. Louis, MO 63146-3318

Susan M. Kell, Senior Issue Manager
Phone: 215-239-3380; Fax: 215-239-3388
E-mail: s.kell@elsevier.com





All manuscripts must be submitted via the Elsevier Electronic System (EES) ( http://ees.elsevier.com/jaad/ ).

The Information for Authors undergoes continuous revision. The most current version can be found at www.eblue.org. All manuscripts for the Journal of the American Academy of Dermatology must be submitted electronically through the Web-based EES program. EES may be accessed by visiting http://ees.elsevier.com/jaad/ . The site provides instructions for manuscript submission as well as a tutorial for authors. Word, WordPerfect, RTF, and Text files will be accepted; Word and WordPerfect are preferred. All tracking and follow-up will be done through EES ( http://ees.elsevier.com/jaad/). Questions about the program may be addressed to mderby@aad.org. All manuscript submissions must include the copyright transfer form, the conflict of interest disclosure form, the authorship statement (attestation) form, and the manuscript submission checklist. These forms can be copied from the January or July issues of the Journal and/or downloaded from either our Web site ( http://www.eblue.org ) or EES ( http://ees.elsevier.com/jaad/ ). Please scan the completed forms and upload them to EES with your submission. If this presents a problem, please contact Melissa Derby at mderby@aad.org.

Editorial policies. The Journal of the American Academy of Dermatology is a refereed journal designed to meet the continuing education needs of the Academy members and the international dermatologic community. The Journal bases its policies on the guidelines set forth by the International Committee of Medical Journal Editors ( http://www.icmje.org ).

Disclaimer. Statements and opinions expressed in the articles and communications herein are those of the author(s) and not necessarily those of the Editor(s), publisher, or Academy. The Editor(s), publisher, and Academy disclaim any responsibility or liability for such material and do not guarantee, warrant, or endorse any products or services advertised in this publication, nor do they guarantee any claim made by the manufacturer of such products or services.

Conflict of interest. The Journal requires all authors to acknowledge, in the comments section of EES ( http://ees.elsevier.com/jaad/ ), all funding sources that supported their work as well as all institutional or corporate affiliations of the authors. The title page must also include a publishable statement disclosing any associations, current and over the past 5 years, that might pose a conflict of interest. These include but are not limited to employment, royalties, consultant arrangements with commercial entity, stock or other equity ownership, stock options, patent licensing arrangements, payments for conducting or publicizing a produc or study, and consulting relationships with investment companies. In addition, authors are required to disclose similar associations with companies that make a competing product. When no conflicting or competing interests are present, this should be indicated in the publishable disclosure statement. If the authors have competing or conflicting interests that cannot be disclosed in publishable statements, authors should list them in the comments section of EES ( http://ees.elsevier.com/jaad/ ). They should also explain these interests as well as the reason for the need for confidentiality in a statement to the Editor. The Editor asks each reviewer to disclose any competing interests or conflicts of interest that might interfere with one's objectivity (or to recuse oneself from acting as a reviewer). The Editors and members of the editorial staff have registered their competing interests, if any, with the officers of the American Academy of Dermatology. The Editors and members of the editorial staff will ensure that all conflicts are appropriately resolved. Conflicts that cannot be appropriately resolved will result in rejection of the manuscript or reviewi. Undisclosed conflicts may result in sanctions to include published statements of retraction or removal of a manuscript from the archived journal table of contents and Medline database.

An authorship statement and conflict of interest statement must be submitted with each manuscript. Both forms are included in the January and July issues of the Journal (see last page of Contents for page number) and are available for download from the JAAD Web site( http://www.eblue.org ).

Authorship. The Journal's authorship criteria are adapted from those of the International Committee of Medical Journal Editors and are delineated on the Authorship Statement, which must be signed by each author.

Role of writers, "ghost writers," and other "third parties" involved in manuscript development and production: The involvement, nature of involvement, and affiliation or support of any medical writers, "ghost writers," or other individuals or companies or third parties participating in the development or writing of any papers must be noted and explained in the cover letter and in a publishable statement on the manuscript title page. (This does not include tasks such as typing or photocopying.) This statement will be published as part of the first-page footnotes. All individuals involved in the preparation and writing of each paper who meet the JAAD's authorship criteria (see our Authorship Statement) must be listed as authors. The names, highest academic degree, and affiliations of any persons who contributed to writing the paper or analyzing the data who do not meet authorship criteria must be included in the paper's Acknowledgements along with a disclosure of any pertinent conflicts of interest. Individuals listed in the Acknowledgements because of such contributions to the work should provide written consent. The use of "ghpst writers" or any author employed by an entity with a commercial interest in any product discussed is rarely appropriate for any m anuscript and is strictly prhoibited for any CME-accredited activity.

Special requirements for studies involving live human or animal subjects. Studies involving live human or animal subjects must have been approved by the authors' Institutional Review Board or its equivalent. A copy of the IRB approval letter must be included with the submission or sent to the Journal office under separate cover. If applicable, IRB approval must be mentioned in the methods section of all manuscripts. Patients must not be identified by nameor initials; numbers should be used. No other information, including clinical photos or family trees, from which a patient could be identified is permitted unless express written permission from the patient/family is provided at the time of manuscript submission. All clinical investigations must have been conducted according to the Declaration of Helsinki principles. If the Methods section is not sufficiently clear, authors may be asked to provide the editors with a copy of IRB-approved research protocols for the use of our reviewers.

Special requirements for submission of survey research. Submissions of survey research must include: 1. A copy of the letter documenting Human Subject Institutional Review Board (IRB) approval. 2. A copy of the survey instrument. (The editors, in consultation with the authors, will determine if the survey instrument should be published and whether it should be published as an online-only Appendix.) The manuscript's Methods section must: 1. Attest that the use of any proprietary sampling contact information (eg, mailing list) was approved by its owner. 2. Provide IRB protocol approval number and date. 3. Describe how the survey instrument was developed and piloted, and whether/ how the survey was validated. During the review process, editors and reviewers may request a copy of the approved study protocol to aid in their evaluation of the study.

Randomized trials. Randomized trials must be submitted in a format consistent with the CONSORT statement, along with a completed CONSORT manuscript submission checklist. The word "random" or "randomized" should be in the title. The updated CONSORT guidelines can be accessed by visiting http://www.consort-statement.org . A copy of the "CONSORT Checklist for Authors Submitting Reports of Randomized Controlled Trials" may be downloaded from the JAAD Web site ( http://www.eblue.org ).

Any reports of clinical trials submitted after January 1, 2008 must be registered by the time of submission; any study that enrolled the first patient after January 1, 2008 must have been prospectively registered, ie, registered before the first patient was enrolled. The registry must meet ICMJE criteria (available at http://www.icmje.org ). The registry at http://www.clinicaltrials.gov meets such requirements. When submitting a manuscript that reports a clinical trial, authors are asked to provide the date the first patient enrolled, the date the study was registered, and the registration number.

Priority claims, "firstedness." Please do not claim that your report is the first reported case. If such a claim is deemed necessary, authors should explain their reasoning in the cover letter and provide a detailed Appendix describing how they came to this conclusion. Describe search strategies, search terms, databases queried, and how far back these were checked. Also list textbooks and monographs that were searched to substantiate the claim.

Trade names. Trade names and brand names of drugs and devices may not be used in the title of the paper. They may appear only once in the paper and should follow the generic name in parentheses; this use should preferably be in the abstract or in a table of brand names and generic names, if that is a more reasonable way to proceed. Thereafter, only generic names should be used throughout the article.

On brevity and other matters of style. Brevity is appreciated. Authors should avoid repeating the same information in the abstract, introduction, and discussion.

Copyright transfer. In accordance with the Copyright Act of 1976, which became effective January 1, 1978, the following statement signed by each author must accompany the manuscript submitted: "I, the undersigned author, transfer all copyright ownership of the manuscript referenced above to the American Academy of Dermatology, in the event the work is published. I warrant that the article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal, and has not been published previously. I have reviewed and approve the submitted version of the manuscript and agree to its publication in the Journal of the American Academy of Dermatology." A copyright transfer form is included in the January and July issues of the Journal (see last page of Contents for page number) and may be downloaded from the JAAD Web site ( http://www.eblue.org ). Author(s) will be consulted, whenever possible, regarding republication of material.

Special Subject Repositories: Certain repositories such as PubMed Central ("PMC") are authorized under special arrangement with Elsevier to process and post certain articles, such as those funded by the National Institutes of Health, under its Public Access policy (see elsevier.com for more detail on the policy). Articles accepted for publication in an Elsevier journal from authors who have indicated that the underlying research reported in their articles was supported by an NIH grant will be sent by Elsevier to PMC for public access posting 12 months after final publication. The version of the article provided by Elsevier will include peer-review comments incorporated by the author into the article.

Sections/article type guidelines
Continuing Medical Education (CME): In-depth, substantiated, educational articles presenting core information for the continuing medical education of the practicing dermatologist. CME articles should not be simply reviews but should present new information not readily available in textbooks. In order to avoid duplication, authors may wish to contact the managing editor (mderby@aad.org) early on in the development of the article. A bulleted capsule summary should outline the clinical significance of the article (see "Preparation of Manuscripts"). In addition, bulleted key points should precede each major section Summary tables should be included when possible, as should separate algorithms for evaluation and management when appropriate. Recommended tests should have an impact on therapy and should be supported by outcomes data.

The level of evidence should be cited whenever recommendations are made. Level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from at least one randomized controlled trial; level IIA evidence includes evidence from at least one controlled study without randomization; level IIB evidence includes evidence from at least one other type of experimental study; level III evidence includes evidence from nonexperimental descriptive studies, such as comparative studies, correlation studies, and case-control studies; and level IV evidence includes evidence from expert committee reports or opinions or clinical experience of respected authorities, or both. All therapeutic recommendations should be accompanied by a table indicating their level of evidence, with a definition of the different levels included as a footnote.

Authors must provide 3 learning objectives that identify practice gaps pertinent to the material being presented, and, in their cover letter, specify how the gaps were identified. The learning objectives should address those practice gaps. The learning objectives should be measurable and written in active terms. The following verbs are suggested for consideration in writing objectives: apply, assess, categorize, choose, compare, diagnose, differentiate, distinguish, manage, measure, prescribe, recognize, select, test, treat, use, and utilize. Learning objectives should be listed in the following format: Following this activity, the participant will be able to: 1. ____________; 2. ____________; and 3. ____________. (For example, Following this activity, the participant will be able to: 1. diagnose fungal skin diseases more effectively; 2. order the most appropriate test for herpetic skin infections; and 3. select the best treatment for the patient with impetigo herpetiformis.) Note that the learning objective must specify a change in physician behavior, not simply knowledge that was acquired.

As an example for a CME article on tropical dermatology, a pertinent practice gap might be that dermatologists believe they lack the skill to diagnose leishmaniasis, although they may now see it in travelers and soldiers returning from overseas. This gap became evident from discussions with a group of local dermatologists during a grand rounds session where such a patient was presented. Thus, one appropriate learning objective might be: At the completion of this activity, the participant will be able to... "take the appropriate steps to confirm the diagnosis of leishmaniasis."

In order to qualify for CME credit, authors must provide 2 clinical vignettes, each followed by 2 or 3 questions, that evaluate clinical competence acquired as a result of the CME activity. The questions should reflect appropriate clinical practice rather than simply testing factual knowledge. Appropriate questions will commonly assess the learner's ability to diagnose or treat a condition appropriately after reading the CME article. Guidelines for question writing can be found at http://www.eblue.org/content/auth_page .

DOS AND DON'TS OF WRITING CME QUESTIONS AND ANSWERS

The JAAD typically commences with a CME article, which is followed by questions that may be answered and submitted for CME credit. Two clinical vignettes should be submitted, each with two or three questions. One or both vignettes may be chosen for publication with the article. The questions should assess a known practice gap and changes in clinical behavior that will occur as a result of participating in the CME activity. In other words, the questions should address something the physician is likely to have done suboptimally in the past and will do better after reading your article.

The questions should test something the clinician should do, not merely knowledge obtained.

For more instructions about submitting good questions, see the American Board of Dermatology question-writing guide.

Dos
-Do be sure that answers to questions can clearly be found in the text.
The answer should be more correct than
any of the other options.
-Do focus on important topics addressed in the CME article.
-Do include 5 options (and no more) for each question.
-Do check to be sure that the answer key is correct.
-Do check for spelling or grammatical errors within the questions and answers.

Don'ts
-Don't test on minutia.
-Don't use true/false format for any questions.
-Don't use negative questions. For example, "All of the following are correct except..." or "Which of the following is incorrect?"
-Don't include "none of the above" or "all of the above" as an option.
-Don't use vague words such as "rarely," "occasionally," or "frequently."
-Don't use multiple answers in the options. For example, "both B and D" or "A, B, and C."

Original Articles: Original, in-depth clinical and investigative laboratory research papers. A structured abstract and capsule summary should be included (See "Preparation of Manuscripts"). Authors of randomized control trials are strongly urged to follow the guidelines presented in the CONSORT statement ( http://www.consort-statement.org/). Similar guidelines for authors of epidemiologic studies are included in the STROBE statement ( http://www.strobe-statement.org/Checklist.html).

Therapy: This section has been eliminated. Authors may wish to submit novel findings in the Original Articles section.

Clinical Reviews: This section has been eliminated. Authors should submit all reviews as Reviews.

Reviews: A current review of a disease or treatment.

Case Reports: This section has been eliminated. Authors should submit all cases as Case Letters. Cases for which a "review of the literature" seems warranted may be considered for publication in the Case & Review section (see below).

Case & Review: This section has been eliminated. Depending on the emphasis of the manuscript, authors should submit all cases as Case Letters and all reviews as Reviews.

Dermatologic Surgery: Articles emphasizing the surgical aspect of dermatology. A structured abstract and capsule summary should be included (See "Preparation of Manuscripts").

Dermatopathology: Articles emphasizing the histopathological changes in skin disease. A structured abstract and capsule summary should be included (See "Preparation of Manuscripts").

Commentaries: Brief, provocative, opinionated communications, not necessarily documented, on a limited subject.

Current Issues & Opinion: This section has been eliminated. Authors should submit all such discussions as Commentaries.

Letters: Notes & Comments, Research Letters, and Case Letters: The Letters department has three sections. Letters commenting on material previously published in the Journal will be considered for the Notes & Comments section. New or preliminary research findings may be considered for publication as Research Letters. Conclusions based on uncontrolled trials and/or limited experience should be stated in appropriately tentative terms. Concise descriptions detailing one or two patients, early reports of therapeutic trials in one or several patients, and early reports of new drug reactions will be considered for the Case Letters section. Repetition of introductory, textbook type information should be avoided. Manuscripts should center on the case at hand, and should not take the form of a lengthy "Case and Review." All patient information in Case Letters must be adequately de-identified. If identifying information or figures are included, express written permission from the patient(s) must be provided at the time of manuscript submission. Letters must not exceed 500 words and should not cite more than five references. Up to two figures or tables may be included. Letters on articles that have appeared in the Journal will be sent for response to the authors of the article drawing comment. This response may be published or sent directly to the commentator at the discretion of the editor. Questions or comments that could be addressed directly to authors (including complaints about missed citations) should be sent directly to the author, rather than involving the Journal as an intermediary.

Book Reviews: Books and monographs (domestic and foreign) will be reviewed depending on their interest and value to subscribers. Send books to the Editor, Bruce H. Thiers, MD, Journal of the American Academy of Dermatology, 482 Southbridge St, Ste #266, Auburn, MA 01501. No books will be returned. Journal guidelines for writing book reviews are available onljne ( http://www.eblue.org/article/S0190-9622(08)00647-6/fulltext ).

Images in Dermatology: This an online-only feature that consists of 1-3 clinical or histologic images along with a short (100 word or less) description of any relevant history. Short (up to 1 minute) video clips are also acceptable. Included are 3 questions, each with 5 answer choices. Each of the 5 choices must be accompanied by a 1 or 2 sentence discussion explaining why it is correct or incorrect. The discussion of all 5 choices is limited to a total of 250 words for each question. Authors may cite up to 5 references. The submitted title, consisting of less than 8 words, should be descriptive and not indicate the diagnosis or correct answer choice. All submissions must be through EES. If identifying information or figures are included, express written permission from the patient must be provided at the time of manuscript submission. Material may not have been submitted or published elsewhere. If you are currently working on a submission for this feature, please contact Melissa Derby at mderby@aad.org for an example of the desired format.

Video
For editorial and peer review of an initial submission, submit videos according to the following specifications:

• Acceptable file formats: MPEG-1 or MPEG-2 (.mpg), Quicktime (.mov), or Compuserve GIF (.gif). Please contact the publisher about the use of other formats.
• Maximum file size: 10MB
• Maximum length: 8 minutes
• Verify that the videos are viewable in QuickTime or Windows Media Player.
• Concise legends (typed on a separate page) must accompany each video clip or computer graphic presentation.
• All videos or graphics submitted must be of the highest quality possible.

An original, edited CD-ROM or DVD-R in Windows-compatible format will be the standard format for submission of videos and computer graphics (ie, slide presentations with or without animation).

Three copies of the disk containing the video/computer graphics should be submitted by mail or courier when the manuscript is submitted. Be sure to include the manuscript title and date of submission so that the disks can be crossreferenced to the manuscript submission. Please indicate the video component on the submission cover page.

If the article is accepted for publication, the video will be digitized and permanently archived on the Journal of the American Academy of Dermatology website ( http://www.eblue.org/ ).

Supplements
The Journal follows the guidelines for supplements established by the International Committee of Medical Journal Editors. These guidelines are included in the document entitled "Uniform Requirements for Manuscripts Submitted to Biomedical Journals," which can be found at http://www.icmje.org . Supplements undergo peer review and are processed in the same fashion as regular submissions to the Journal. All manuscript submission requirements, including clear disclosure of authorship contributions, must be satisfied for each paper. Inquiries about proposed supplements should be directed to the Editor before submitting the supplement. Please note Journal policy on the use of the word "unrestricted" in the description of educational grants: The use of the term "unrestricted" will be limited to situations in which the granting institution has no influence on the selection of the subject, speakers, or authors. In circumstances in which the granting institution has had such influence (as, for example, in organizing a symposium or supplement on a particular subject), it is nonetheless required that the granting organization have no influence over the content of the articles. It is also understood that the authors assume full responsibility for the content of the articles and for complete disclosure of all funding sources, potential conflicts of interest, role of any sponsor, and role of any third parties involved in the preparation or writing of the papers.

Electronic publication at www.eblue.org
Articles in Press: On a routine basis most reports are now "published-ahead-of-print" in our Articles in Press section in the JAAD Online at www.eblue.org. Some articles are published online only in our JAAD Online section ("online only publication"). Please note that online publication is considered a bonafide form of publication and can be cited using the DOI number located in the footnotes on the first page of each article.

The full content of each regular monthly issue is routinely posted online at www.eblue.org.

PREPARATION OF MANUSCRIPTS
Original manuscripts will be considered for publication.
Correct preparation of the manuscript will expedite the review and publication procedures. Please note the following requirements.
The original page-numbered copy of the manuscript must be double-spaced. The title page should be numbered page 1. Please line number all submissions before creating the PDF. This continuous line numbering will help our reviewers with writing their comments and should speed the peer-review process. To add line numbers to your Word manuscript file, select File/Page Setup/Layout/Line Numbering/Add line numbering/Continuous, and save the changes.

Style
Manuscripts must conform to acceptable English usage. Consult the latest edition of The Chicago Manual of Style by The University of Chicago Press or the Manual of Style by the American Medical Association for current usage. Abbreviations must be limited primarily to those in general usage. Weights and measurements must be expressed in metric units. Temperatures must be expressed in degrees centigrade.

Title page: On the title page, include the title, authors' full names, highest earned academic degrees, and institutional affiliations and locations. The title page must also include a statement of all funding sources for the work as well as a publishable conflict of interest statement (see above for details). Designate one author as correspondent (provide address, telephone and fax numbers, and e-mail address) to receive communications from the Editorial Office and galley proofs from the publisher. The name and address of the author who will receive reprint requests should be noted if different from the correspondent. The corresponding author should promptly inform the managing editor (mderby@aad.org) of any change in e-mail or mailing address.

Abstract: Unless otherwise stated, all articles must be accompanied by a typed, double-spaced abstract not exceeding 150 words. Abstracts of papers submitted for publication in the Original Articles, Dermatopathology, and Dermatologic Surgery sections may be up to 250 words and should be structured as follows:

Background: What is the major problem that prompted the study?
Objective: What is the purpose of the study?
Methods: How was the study done?
Results: What are the most important findings?
Limitations: What are the limitations of the study?
Conclusion: What is the single most important conclusion?

Key words: A list of 6-10 key words (eg, Key words: sunscreen; UVA protection; UVB protection) should appear after the Abstract.

Classifications: Select at least 6 classifications to facilitate matching the manuscript with reviewers. You can do this in EES by clicking 'Select Document Classifications' to open a window containing a list of the classifications pertaining to the Journal. Then click the check-box next to any classification you wish to select. Click 'Submit' when you are done.

Capsule summary: Papers submitted for publication in the Continuing Medical Education, Original Articles, Review, Dermatologic Surgery, and Dermatopathology sections must include a capsule summary of up to 75 words. The capsule summary should be comprised of 3-4 bulleted statements outlining the clinical significance of the contribution.

Abbreviations and acronyms: Only standard abbreviations are to be used. Consult Scientific Style and Format by the Council of Biology Editors or the Manual of Style by the American Medical Association. Abbreviations in the title are not acceptable and they should be avoided in the abstract whenever possible. A laboratory or chemical term or a disease process must be spelled out at first mention, with the acronym or abbreviation following in parentheses. List all abbreviations and acronyms on a separate page.

Histologic/microscopic figures: The legend must specify stain. Arrows and arrowheads should be used freely to clarify findings.

References: Personal communications should not be cited in the reference list but may appear parenthetically in the text. References must be identified in the text bysuperscript Arabic numerals in order of their mention. The reference list should be typed double-spaced at the end of the text in numeric sequence. The format should conform to that set forth by the International Committee of Medical Journal Editors and the National Library of Medicine ( http://www.nlm.nih.gov/bsd/uniform_requirements.html ). Journal titles should conform to the abbreviations in Cumulated Index Medicus.

EXAMPLES OF REFERENCES
List the first six authors followed by et al.:

For journal articles:
Kofler H, Wambacher-Gasser B, Topar G, Weinlich G, Schuler G, Hintner H, et al. Intravenous immunoglobulin treatment in therapy-resistant epidermolysis bullosa acquisita. J Am Acad Dermatol 1997;36:331-5.

For books:
Hunt TK, editor. Wound healing and wound infection: theory and surgical practice. New York: Appleton-Century- Crofts; 1980.


For chapters in books:
McNutt NS, Fishman PM. Metastatic tumors. In: Farmer ER, Hood AP, editors. Pathology of the skin. Norwalk (CT): Appleton & Lange; 1990. p. 465-78.

For electronic media:
Bhatia A, Prakash S. Topical phenytoin for wound healing. Dermatology Online Journal. Available at: http://dermatology.cdlib.org . Accessed November 3, 2004.

Illustrations and tables: Tables, figures, and legends should supplement, not duplicate, the text. A reasonable number of halftone photographs and line drawings will be published at no extra charge to the author. Color illustrations will be reviewed by the Editor and those considered appropriate will be published free of charge to the authors. Figures must be cited in the text and numbered in order of mention. Figures must have an arrow marking the top edge and they must be numbered consecutively (ie, 1, 2, 3). Multi-part figures must be marked clearly (ie, 1A, 1B, 1C). For graphics files, use Adobe Photoshop and save the files in either TIF or EPS format. DO NOT SUBMIT figures in PowerPoint or Excel formats. If they have not already done so, authors will be contacted to provide print-quality figuresafter their articles have been accepted.

Policy on image alteration: any image alteration from the original using programs such as Photoshop must be explained and justified in the legend.

Black and white graphs must be legible and clearly printed. The fill for bar graphs or pie charts should be distinctive; avoid shading or dotted patterns. Use thick, solid lines and bold, solid type. Place lettering on a white background; avoid reverse type (white lettering on a dark background). All lettering must be done professionally and should be in proportion to the drawing, graph, or photograph. Typewritten or freehand lettering is unacceptable. Consistency in size within the article is strongly preferred. Any special instructions regarding sizing should be clearly noted.

For color photographs, if prints have been enhanced, a preference for reproduction should be noted. The quality of the reproduction depends entirely on the quality of the illustrations submitted. Please note that 35 mm transparencies are normally enlarged to twice their original size. If it is important to deviate from this standard, please indicate when file material is submitted. Top for each print (and transparency) must be noted.

Patient consent must accompany recognizable photographs of patients at the time of submission. Photographs and text (such as details in the case report or genetic pedigree) must be deidentified to protect patient confidentiality unless patient consent has been documented, please crop the photo and/or obstruct the eye region so the patient cannot be recognized. In the event that patient consent has not been documented. The altered figure must be unidentifiable unless documentation of patient consent is provided.

Figures may be submitted in electronic format. All images should be at least 5 inches wide. Images should be provided in TIF, EPS, or JPEG format. Graphics software such as Photoshop and Illustrator, not presentation software such as Microsoft Word, PowerPoint, CorelDraw, or Harvard Graphics , should be used in the creation of the art. Color images must be CMYK and at least 300 DPI. Gray scale images should be at least 300 DPI. Combinations of gray scale and line art should be at least 1200 DPI. Line art (black and white or color) should be at least 1200 DPI.

Legends should be typed double-spaced and inserted after the references. If an illustration has been published previously, full credit to the original source must be given in the legend.

Tables should be self-explanatory and numbered sequentially in Roman numerals in order of their mention in the text. Tables should be submitted in Word, WordPerfect, RTF, or Text formats; Word and WordPerfect are preferred. A brief title should be provided for each. If a table, or any data therein, has been published previously, full credit to the original source must be given in a footnote.

Permissions and patient consent forms: Direct quotations, tables, or illustrations that have appeared in copyrighted material must be accompanied upon submission by written permission for their use from the copyright owner and the original author along with complete information as to their source .

Patient consent forms for publication of recognizable photographs must be sent to the Editorial Office upon submission of the article. Patients must be identified by numbers and/or letters, not by name, initials, or hospital record number. Institutional consent must also be available.

Reprints. Reprint order forms will be sent to authors after the manuscript has been accepted. The provision of reprints by the author is optional.

Procedure for review
The Journal employs a confidential and anonymous peer review process to evaluate submitted papers for possible publication. A small number of papers are rejected after in-house editorial review when editors deem that the paper is not appropriate for the Journal or is not of sufficient quality to warrant further evaluation. The overall acceptance rate is less than 50%.

The author may suggest several reviewers for the manuscript. We will attempt to use at least one suggested reviewer. The editorial staff will review the manuscript and will ordinarily send it to at least two reviewers. Reviewers will pay particular attention to scientific accuracy, relevance, novelty, importance, appropriate style, and quality of illustrations. First decisions (accept, revise, reject) are usually made within four to six weeks; longer delays are possible. Some degree of manuscript revision should be expected and regarded as constructive. A request to submit a revised manuscript does not guarantee that it will be accepted, only that it will be reconsidered, perhaps after additional peer review. Because space in the Journal is limited, the final editorial decision rests not only on the validity of the report and the opinions of the reviewers, but also on the editors' judgment of a paper's novelty, clarity, importance, and likely degree of interest to the readership.

Expedited review and publication
Authors who feel that their paper should receive expedited review and/or rapid publication should request it and explain their rationale in the Comments section of EES ( http://ees.elsevier.com/jaad/ ). They should also send a separate explanatory e-mail to the managing editor: mderby@aad.org. The time frame for rapid review is ordinarily 2 to 4 weeks; for expedited online publication, 3 to 6 weeks from the date of acceptance of the final revision. Authors are reminded that as a monthly clinical journal, we do not operate on the time frame of a weekly and do not ordinarily publish "news" items.



Updated November 2009