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Kim EJ, Hlobik M, Ho T. Effectiveness of dupilumab in pediatric patients with a nummular phenotype of atopic dermatitis. Pediatr Dermatol 2024; 41:455-457. [PMID: 38303143 DOI: 10.1111/pde.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024]
Abstract
The nummular phenotype of atopic dermatitis is clinically characterized by pruritic, coin-shaped plaques that are frequently recalcitrant to treatment. In this study, a retrospective chart review was conducted to evaluate the effectiveness and safety of dupilumab in children with nummular lesions of dermatitis. Twelve out of 14 patients demonstrated significant clinical improvement at a median time of 2.5 months (interquartile range, 1-4) after dupilumab initiation. A single case of paradoxical psoriasiform eruption was the only side effect reported in our cohort.
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Affiliation(s)
- Eun Jae Kim
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tina Ho
- Harvard Medical School, Boston, Massachusetts, USA
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
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2
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Facheris P, Da Rosa JC, Pagan AD, Angelov M, Del Duca E, Rabinowitz G, Gómez-Arias PJ, Rothenberg-Lausell C, Estrada YD, Bose S, Chowdhury M, Shemer A, Pavel AB, Guttman-Yassky E. Age of onset defines two distinct profiles of atopic dermatitis in adults. Allergy 2023; 78:2202-2214. [PMID: 37032461 DOI: 10.1111/all.15741] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND The incidence of adult-onset atopic dermatitis (AOAD) is increasing. However, the unique characteristics of AOAD compared to pediatric-onset AD persisting into adulthood (POAD) are underexplored, hampering the development of targeted-therapeutics for this growing population. We thus assessed the profile of AOAD in skin and blood compared to that of POAD. METHODS We collected skin biopsies and blood from adults with AOAD, POAD, and healthy controls (n = 15 in each group). Skin samples were analyzed by RNA sequencing, qRT-PCR, and immunohistochemistry, and Olink Proseek multiplex assay was used to identify the serum proteomic profile. RESULTS Compared to healthy controls, both AOAD and POAD showed cutaneous immune and barrier dysregulations with a shared Th2/Th22 hyperactivation. Overall, POAD showed greater inflammation in lesional skin, with more prominent expression of Th2/Th17/Th22 markers (CCL17/22, S100A8/9, IL-36A, PI3/Elafin, DEFB4) in POAD compared to AOAD (p-value < .05). In contrast, higher Th1-(IFN-γ, IL-2, IL-15, CCL5) upregulation and Th1-skewing were seen in AOAD. The epidermal barrier was also more compromised in POAD, with greater epidermal hyperplasia and lower expression of markers related to terminal differentiation, lipids, and cell adhesion. In parallel with increased rates of cardiovascular comorbidities, AOAD demonstrated many more significantly dysregulated proteins in serum (n = 148) compared to POAD (n = 86), including pro-inflammatory and cardiovascular-risk markers. Th1-related products showed significant correlations between their skin and blood expressions only in AOAD subjects. CONCLUSION Age-of-onset delineates two distinct endophenotypes in adult AD potentially suggesting the need for broader (beyond Th2) therapeutic targeting in AOAD.
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Affiliation(s)
- Paola Facheris
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Angel D Pagan
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Michael Angelov
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ester Del Duca
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Grace Rabinowitz
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Pedro Jesús Gómez-Arias
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Camille Rothenberg-Lausell
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Yeriel D Estrada
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Swaroop Bose
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Avner Shemer
- Department of Dermatology, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Ana B Pavel
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Olbrich H, Sadik CD, Ludwig RJ, Thaçi D, Boch K. Dupilumab in Inflammatory Skin Diseases: A Systematic Review. Biomolecules 2023; 13:biom13040634. [PMID: 37189381 DOI: 10.3390/biom13040634] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Dupilumab was first approved for the treatment of atopic dermatitis (AD) and blocks the signaling of interleukin (IL)-4 and -13. Several other chronic skin conditions share mechanistic overlaps with AD in their pathophysiology, i.e., are linked to type 2 inflammation. Most recently, dupilumab was approved by the U.S. Food and Drug Administration for prurigo nodularis (PN). Given its relatively good safety profile, effective off-label use of dupilumab has been reported for a multitude of dermatologic diseases and several clinical trials for dermatologic skin conditions are currently ongoing. We conducted a systematic review of applications of dupilumab in dermatology other than AD and PN by searching the databases PubMed/Medline, Scopus, Web of Science and Cochrane Library as well as the clinical trial registry ClinicalTrials.gov. We found several reports for effective treatment of bullous autoimmune diseases, eczema, prurigo, alopecia areata, chronic spontaneous urticaria, Netherton syndrome and a variety of other chronic inflammatory skin diseases.
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Affiliation(s)
- Henning Olbrich
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
| | | | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23566 Lübeck, Germany
| | - Diamant Thaçi
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
- Institute and Comprehensive Center for Inflammation Medicine, University-Hospital Schleswig-Holstein, 23566 Lübeck, Germany
| | - Katharina Boch
- Department of Dermatology, University of Lübeck, 23566 Lübeck, Germany
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Bosma AL, Ouwerkerk W, Heidema MJ, Prieto-Merino D, Ardern-Jones MR, Beattie P, Brown SJ, Ingram JR, Irvine AD, Ogg G, Patel P, Reynolds NJ, Hearn RR, Wan M, Warren RB, Woolf RT, Hyseni AM, Gerbens LA, Spuls PI, Flohr C, Middelkamp-Hup MA. Comparison of real-world treatment outcomes of systemic immunomodulating therapy in atopic dermatitis patients with dark and light skin types. JAAD Int 2023; 10:14-24. [PMID: 36387062 PMCID: PMC9661502 DOI: 10.1016/j.jdin.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types. Objective To investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type. Methods In an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated. Results A total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05). Limitations Unblinded, non-randomized. Conclusion Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.
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Key Words
- AD, atopic dermatitis
- AE, adverse event
- DLQI, Dermatology Life Quality Index
- DST, Dark Skin Type(s)
- EASI, Eczema Area and Severity Index
- IQR, interquartile range
- LST, Light Skin Type(s)
- NRS, Numerical Rating Scale
- POEM, Patient-Oriented Eczema Measure
- SD, Standard Deviation
- atopic dermatitis
- atopic eczema
- ciclosporin
- daily practice
- dupilumab
- effectiveness
- ethnicity
- methotrexate
- morphology
- race
- registry
- routine clinical care
- safety
- skin type
- systemic treatment
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Affiliation(s)
- Angela L. Bosma
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- NHRIS, National Heart Centre Singapore, Singapore
| | - Madeline J. Heidema
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - David Prieto-Merino
- Faculty of Medicine, Universidad de Alcalá, Madrid, Spain
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Michael R. Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Dermatology, University Hospitals NHS Foundation Trust, Southampton, UK
| | - Paula Beattie
- Department of Dermatology, Royal Hospital for Children NHS Trust, Glasgow, UK
| | - Sara J. Brown
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - John R. Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Alan D. Irvine
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Graham Ogg
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Prakash Patel
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Nick J. Reynolds
- Department of Dermatology, Institute of Cellular Medicine, Medical School, Newcastle University, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - R.M. Ross Hearn
- Department of Dermatology & Photobiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Mandy Wan
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Richard B. Warren
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical 17 Research Centre, University of Manchester, Manchester, UK
| | - Richard T. Woolf
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ariënna M. Hyseni
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Louise A.A. Gerbens
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Phyllis I. Spuls
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
| | - Maritza A. Middelkamp-Hup
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - TREAT NL registry and UK-Irish A-STAR Study Groups
- Department of Dermatology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- NHRIS, National Heart Centre Singapore, Singapore
- Faculty of Medicine, Universidad de Alcalá, Madrid, Spain
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King’s College London, London, UK
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Department of Dermatology, University Hospitals NHS Foundation Trust, Southampton, UK
- Department of Dermatology, Royal Hospital for Children NHS Trust, Glasgow, UK
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
- Department of Dermatology, Institute of Cellular Medicine, Medical School, Newcastle University, Royal Victoria Infirmary and NIHR Newcastle Biomedical Research Centre Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Dermatology & Photobiology, Ninewells Hospital and Medical School, Dundee, UK
- Pharmacy Department, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Institute of Pharmaceutical Science, King's College London, London, UK
- Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical 17 Research Centre, University of Manchester, Manchester, UK
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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McWhirter S, Foster R, Halbert A, Miller R, Morgan VA, Rademaker M, Robertson S, Scardamaglia L, Warren L, Wong LC, Zappala T, Orchard D. Discoid (nummular) eczema in the paediatric setting - An Australian/New Zealand narrative. Australas J Dermatol 2022; 63:e289-e296. [PMID: 36057946 DOI: 10.1111/ajd.13915] [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: 06/11/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
Discoid (nummular) eczema is a common and distinctive eczema variant, which has not been studied in depth. Although the principles of management are similar to that of classic atopic dermatitis, distinctions are made due to its unique presentation and persistent clinical course in children. Australian and New Zealand dermatologists with an interest in paediatric eczema developed a consensus narrative to assist clinicians in diagnosing and treating this subtype of eczema. Identifying triggers, potent topical corticosteroids under occlusion, skin barrier support and management of pruritus are first-line therapies, however, many eventually require systemic immunomodulatory agents.
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Affiliation(s)
| | - Rachael Foster
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Anne Halbert
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Robert Miller
- Townsville University Hospital, Townsville, Queensland, Australia
| | | | | | | | | | - Lachlan Warren
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Li-Chuen Wong
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Tania Zappala
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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Patruno C, Potestio L, Napolitano M. Clinical phenotypes of adult atopic dermatitis and related therapies. Curr Opin Allergy Clin Immunol 2022; 22:242-249. [PMID: 35786802 DOI: 10.1097/aci.0000000000000837] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To report current knowledge on the different clinical phenotypes of adult atopic dermatitis. Possible therapeutic intervention in relation to phenotype is also evaluated. RECENT FINDINGS Atopic dermatitis is a chronic inflammatory disease affecting up to 10% of adults. It can manifest with different clinical phenotypes, causing diagnostic difficulties. Long-term is often required and systemic drugs are needed for moderate-to-severe forms. However, few drugs are registered for atopic dermatitis in many countries. Furthermore, limited data exist regarding the treatment in relation to individual clinical phenotypes. SUMMARY Currently, the most relevant data are those for cyclosporine, alitretinoin, and dupilumab. Cyclosporine and dupilumab showed to be effective in the treatment of atopic dermatitis, although in trials and real-life experiences the different phenotypes treated are usually not reported. However, cyclosporine appears to be effective in prurigo nodularis. Alitretinoin is reported to be particularly efficacious for atopic dermatitis of the hands, while it is ineffective for other locations of the disease. Dupilumab demonstrated its efficacy in prurigo nodularis and nummular eczema phenotypes of atopic dermatitis; moreover, especially in elderly patients, its effectiveness seems to be faster if the folds of the limbs are involved.
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Affiliation(s)
- Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
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Leung AK, Lam JM, Leong KF, Leung AA, Wong AH, Hon KL. Nummular Eczema: An Updated Review. ACTA ACUST UNITED AC 2021; 14:146-155. [DOI: 10.2174/1872213x14666200810152246] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
Background:
Nummular eczema may mimic diseases that present with annular configuration
and the differential diagnosis is broad.
Objective:
This article aimed to provide an update on the evaluation, diagnosis, and treatment of
nummular eczema.
Methods:
A PubMed search was performed in using the key terms “nummular eczema”, “discoid
eczema”, OR “nummular dermatitis”. The search strategy included meta-analyses, randomized controlled
trials, clinical trials, observational studies, and reviews. The search was restricted to English
literature. The information retrieved from the above search was used in the compilation of the present
article. Patents were searched using the key terms “nummular eczema”, “discoid eczema”, OR
“nummular dermatitis” in www.google.com/patents and www.freepatentsonline.com.
Results:
Nummular eczema is characterized by sharply defined, oval or coin-shaped, erythematous,
eczematous plaques. Typically, the size of the lesion varies from 1 to 10cm in diameter. The
lesions are usually multiple and symmetrically distributed. Sites of predilection include the lower
limbs followed by the upper limbs. The lesions are usually intensely pruritic. The diagnosis is mainly
clinical based on the characteristic round to oval erythematous plaques in a patient with diffusely
dry skin. Nummular eczema should be distinguished from other annular lesions. Dermoscopy
can reveal additional features that can be valuable for correct diagnosis. Biopsy or laboratory tests
are generally not necessary. However, a potassium hydroxide wet-mount examination of skin scrapings
should be performed if tinea corporis is suspected. Because contact allergy is common with
nummular eczema, patch testing should be considered in patients with chronic, recalcitrant nummular
eczema. Avoidance of precipitating factors, optimal skin care, and high or ultra-high potency
topical corticosteroids are the mainstay of therapy. Recent patents related to the management of
nummular eczema are also discussed.
Conclusion:
With proper treatment, nummular eczema can be cleared over a few weeks, although
the course can be chronic and characterized by relapses and remissions. Moisturizing of the skin
and avoidance of identifiable exacerbating factors, such as hot water baths and harsh soaps may reduce
the frequency of recurrence. Diseases that present with annular lesions may mimic nummular
eczema and the differential diagnosis is broad. As such, physicians must be familiar with this condition
so that an accurate diagnosis can be made, and appropriate treatment initiated.
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Affiliation(s)
- Alexander K.C. Leung
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Joseph M. Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Amy A.M. Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H.C. Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam L. Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children’s Hospital, Kowloon Bay, Kowloon, Hong Kong
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