You can't get USD on a Decentralized Exchange
There's BitUSD (market pegged asset) available in BitShares (first decentralized exchange).
Either you get BitUSD on a centralized exchange and move it into the BitShares blockchain, or you can trade BTS, BitBTC (the market pegged BTC), BitCNY, BitEUR, BitGOLD, BitSILVER for BitUSD.
Some markets are low liquidity though.
The gateways are being setup where you can get an IOU for your USD and trade with it in BitShares exchange (just like IOUs issued by a centralized exchange). However, if the gateway is busted, so are your IOUs.
adding new coins to trade will always be a headache,
In BitShares you can easily issue a UIA (user issued asset) and if you provide a gateway/bridge to another coin blockchain, I think, you can easily 'add' any coin.
... and since there won't be any censorship, scamming with new, random, 2 day old altcoins will be abundant, among other things ...
It is the free market: do your own research.
Decentralized Exchanges sound good in theory, but in practice it just isn't plausible.
I'm sure there are lots of other issues with decentralized approach (scalability etc).
it would be interesting to see how they develop.