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Colmenero-Sendra M, Del Boz-González J, Baselga Torres E, Bernabéu-Wittel J, Roé-Crespo E, Vicente A, Valdivieso-Ramos M, Martín-Santiago A, Palencia-Pérez SI, Montserrat-García MT, Azón-Masoliver A, Dañino M, Tubau Prims C, Prat C, Giacaman A, Domínguez-Cruz JJ, Bauzá Alonso A, Grau-Pérez M, Descalzo MÁ, García-Doval I. Parental Assessment of Infantile Hemangioma Cosmetic Clinical Outcomes: Results of the Spanish Hemangioma Nationwide Prospective Cohort. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00601-X. [PMID: 39032773 DOI: 10.1016/j.ad.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Functional impairment is the main consideration when it comes to choosing therapy for infantile hemangiomas (IH). However, since most hemangiomas are treated for cosmetic reasons, it is important to know the cosmetic outcome assessed by the parents. OBJECTIVE To evaluate the aesthetic outcomes of IH, considering the characteristics of the lesions and the treatments used. PATIENTS AND METHODS The Spanish Infantile Hemangioma Nationwide Prospective Cohort (2016-2022) recruited all consecutive patients diagnosed with IH in 12 Spanish hospitals. The children included had two photos of the IH lesion (at both baseline and at the end of the study). A panel of parents blindly assessed all available photos using a scale from 0 (worst cosmetic outcomes) to 10 (best cosmetic outcomes). The different scores - both before and after treatment - as well as the outcomes percent considered excellent (>9) were described and compared. We analyzed the effect of receiving different therapies and performed causal model analyses estimating the mean treatment effect of parents' assessments. RESULTS The median follow-up was 3.1 years. A total of 824 photos were evaluated. Baseline aesthetic impact was higher in the propranolol group vs the topical timolol and observation treatment groups (1.85 vs 3.14 vs 3.66 respectively; p<0.001). After treatment, the aesthetic impact was similar between both treatment groups (7.59 vs 7.93 vs 7.90; p>0.2). The causal model could only be applied to the comparison between topical timolol and observation, revealing no differences whatsoever. CONCLUSION This is the first prospective cohort to analyze the aesthetic outcome of IH. The final aesthetic results of the three therapies were similar, with nearly 40% of patients achieving excellent aesthetic outcomes.
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Affiliation(s)
- M Colmenero-Sendra
- Dermatology Department, Hospital Costa del Sol, Marbella, Spain; Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Spain
| | - J Del Boz-González
- Dermatology Department, Hospital Regional Universitario de Málaga, Spain.
| | - E Baselga Torres
- Dermatology Department, Hospital Sant Joan de Déu, Universitat Autònoma de Barcelona, Spain
| | - J Bernabéu-Wittel
- Dermatology Department, Hospital Virgen del Rocío, Sevilla, Spain; Dermatology Department, Hospital Viamed Santa Ángela de la Cruz, Sevilla, Spain
| | - E Roé-Crespo
- Dermatology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - A Vicente
- Dermatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - A Martín-Santiago
- Dermatology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | | | - M T Montserrat-García
- Dermatology Department, Hospital Virgen del Rocío, Sevilla, Spain; Dermatology Department, Hospital Viamed Santa Ángela de la Cruz, Sevilla, Spain
| | - A Azón-Masoliver
- Dermatology Department, Hospital Sant Joan de Reus, Tarragona, Spain
| | - M Dañino
- Dermatology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - C Tubau Prims
- Dermatology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - C Prat
- Dermatology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Giacaman
- Dermatology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - J J Domínguez-Cruz
- Dermatology Department, Hospital Virgen del Rocío, Sevilla, Spain; Dermatology Department, Hospital Viamed Santa Ángela de la Cruz, Sevilla, Spain
| | - A Bauzá Alonso
- Dermatology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | - M Grau-Pérez
- Research Unit, Fundación Piel Sana AEDV, Madrid, Spain; Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - M Á Descalzo
- Research Unit, Fundación Piel Sana AEDV, Madrid, Spain
| | - I García-Doval
- Research Unit, Fundación Piel Sana AEDV, Madrid, Spain; Dermatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Colmenero M, Del Boz J, Bernabeu Wittel J, Roé E, Feito-Rodríguez M, Vicente-Villa MA, Martín-Santiago A, Palencia Pérez SI, Azon A, Valdivielso-Ramos M, Torrelo A, Sánchez Moya AI, Campos-Domínguez M, Garnacho-Saucedo G, Azaña Defez JM, Vera Casaño Á, Tercedor-Sánchez J, Alcalá R, González-Enseyat MA, Giacaman A, Hernández-Martin Á, Monserrat García MT, Bauzá A, Domínguez-Cruz J, García-Doval I, Grau-Pérez M. Inter- and intra-observer variability in the selection of therapy for infantile hemangiomas among pediatric dermatologists in Spain. Pediatr Dermatol 2022; 39:557-562. [PMID: 35504688 DOI: 10.1111/pde.15015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/01/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines and expert recommendations on infantile hemangiomas (IH) are aimed at increasing homogeneity in clinical decisions based on the risk of sequelae. OBJECTIVE The objective was to analyze the inter- and intra-observer agreement among pediatric dermatologists in the choice of treatment for IH. METHODS We performed a cross-sectional inter-rater and intra-rater agreement study within the Spanish infantile hemangioma registry. Twenty-seven pediatric dermatologists were invited to participate in a survey with 50 clinical vignettes randomly selected within the registry. Each vignette contained a picture of an infantile hemangioma with a clinical description. Raters chose therapy among observation, topical timolol, or oral propranolol. The same survey reordered was completed 1 month later to assess intra-rater agreement. Vignettes were stratified into hemangioma risk categories following the Spanish consensus on IH. The agreement was measured using kappa statistics appropriate for the type of data (Gwet's AC1 coefficient and Gwet's paired t test). RESULTS Twenty-four dermatologists completed the survey. Vignettes represented 7.8% of the Spanish hemangioma registry. The inter-rater agreement on the treatment decision was fair (AC1 = 0.39, 95% confidence interval [CI]: 0.30-0.47). When stratified by risk category, good agreement was reached for high-risk hemangiomas (AC1 = 0.77, 95% CI: 0.51-1.00), whereas for intermediate- and low-risk categories, the agreement was only fair (AC1 0.31, 95% CI: 0.16-0.46 and AC1 = 0.38, 95% CI: 0.27-0.48, respectively). Propranolol was the main option for high-risk hemangiomas (86.4%), timolol for intermediate-risk (36.8%), and observation for low-risk ones (55.9%). The intra-rater agreement was good. The inter-rater agreement between pediatric dermatologists on the treatment of IH is only fair. Variability was most significant with intermediate- and low-risk hemangiomas.
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Affiliation(s)
- María Colmenero
- Dermatology Department, Hospital Costa del Sol, Marbella, Spain
| | - Javier Del Boz
- Dermatology Department, Hospital Universitario Regional, Málaga, Spain
| | | | - Esther Roé
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Antoni Azon
- Dermatology Department, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | | | - Antonio Torrelo
- Dermatology Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | - Ángel Vera Casaño
- Dermatology Department, Hospital Universitario Regional, Málaga, Spain
| | | | - Rebeca Alcalá
- Dermatology Department, Hospital de Sagunto, Valencia, Spain
| | | | - Aniza Giacaman
- Dermatology Department, Hospital Son Espases, Mallorca, Spain
| | | | | | - Ana Bauzá
- Dermatology Department, Hospital Son Espases, Mallorca, Spain
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