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Puar NK, Canty KM, Newell BD, Nopper AJ, Reynolds S, Horii KA. An evaluation of pediatric dermatology curbside consultations in an academic center: A prospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00206-8. [PMID: 38311238 DOI: 10.1016/j.jaad.2023.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/26/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Neha K Puar
- Division of Dermatology, University of Kansas Hospital, Kansas City, Kansas.
| | - Kristi M Canty
- Division of Dermatology, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Brandon D Newell
- Division of Dermatology, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Amy J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Sean Reynolds
- Division of Dermatology, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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2
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Amudhavalli SM, Paolillo V, Lawson C, Patterson M, Kussmann J, Nopper AJ, Lypka M, Saunders C. Novel blended SNRPE-related spliceosomopathy phenotype characterized by microcephaly and congenital atrichia. Am J Med Genet A 2023; 191:1425-1429. [PMID: 36814386 DOI: 10.1002/ajmg.a.63149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
Variants in genes encoding core components of the spliceosomes are associated with craniofacial syndromes, collectively called craniofacial spliceosomopathies. SNRPE encodes a core component of pre-mRNA processing U-rich small nuclear ribonuclear proteins (UsnRNPs). Heterozygous variants in SNRPE have been reported in six families with isolated hypotrichosis simplex in addition to one case of isolated non syndromic congenital microcephaly. Here, we report a patient with a novel blended phenotype of microcephaly and congenital atrichia with multiple congenital anomalies due to a de novo intronic SNRPE deletion, c.82-28_82-16del, which results in exon skipping. As discussed within, this phenotype, which we propose be named SNRPE-related syndromic microcephaly and hypotrichosis, overlaps other craniofacial splicesosomopathies.
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Affiliation(s)
- Shivarajan M Amudhavalli
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - V Paolillo
- Clinical Genetics and Genomics Laboratory, Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Caitlin Lawson
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,Clinical Genetics and Genomics Laboratory, Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Melanie Patterson
- Clinical Genetics and Genomics Laboratory, Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - J Kussmann
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - A J Nopper
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Dermatology, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - M Lypka
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Carol Saunders
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Clinical Genetics and Genomics Laboratory, Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
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3
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Davies OMT, Ng AT, Tran J, Blumenthal S, Arkin LM, Nopper AJ, Cottrell CE, Garzon M, Siegel DH, Frieden IJ, Drolet BA. Early-onset hypertension associated with extensive cutaneous capillary malformations harboring postzygotic variants in GNAQ and GNA11. Pediatr Dermatol 2022; 39:914-919. [PMID: 36440997 PMCID: PMC10087926 DOI: 10.1111/pde.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES Cutaneous capillary malformations (CMs) describe a group of vascular birthmarks with heterogeneous presentations. CMs may present as an isolated finding or with other associations, including glaucoma and leptomeningeal angiomatosis (i.e., Sturge-Weber syndrome) or pigmentary birthmarks (i.e., phakomatosis pigmentovascularis). The use of targeted genetic sequencing has revealed that postzygotic somatic variations in GNAQ and GNA11 at codon 183 are associated with CMs. We report five patients with early-onset hypertension and discuss possible pathogenesis of hypertension. METHODS Twenty-nine patients with CMs, confirmed GNAQ/11 postzygotic variants, and documented past medical history were identified from a multi-institutional vascular anomalies study. Early-onset hypertension was defined as hypertension before the age of 55 years. Clinical data were reviewed for evidence of hypertension, such as documentation of diagnosis or elevated blood pressure measurements. RESULTS Five of the 29 patients identified as having GNAQ/11 postzygotic variants had documented early-onset hypertension. Three individuals harbored a GNAQ p.R183Q variant, and two individuals harbored a GNA11 p.R183C variant. All individuals had extensive cutaneous CMs involving the trunk and covering 9%-56% of their body surface area. The median age of hypertension diagnosis was 15 years (range 11-24 years), with three individuals having renal abnormalities on imaging. CONCLUSIONS Early-onset hypertension is associated with extensive CMs harboring somatic variations in GNAQ/11. Here, we expand on the GNAQ/11 phenotype and hypothesize potential mechanisms driving hypertension. We recommend serial blood pressure measurements in patients with extensive CMs on the trunk and extremities to screen for early-onset hypertension.
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Affiliation(s)
- Olivia M T Davies
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashley T Ng
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jennifer Tran
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shoshana Blumenthal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy J Nopper
- Department of Dermatology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Catherine E Cottrell
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Maria Garzon
- Department of Dermatology, Columbia University, New York, New York, USA
| | - Dawn H Siegel
- Departments of Dermatology and (by courtesy) Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California-San Francisco, San Francisco, California, USA
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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4
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Maher MC, Nopper AJ, Newell BD, Fleming E, Gannon JL, Zhou D, Horii KA. Diagnostic outcomes from a combined Pediatric Dermatology-Genetics clinic. Pediatr Dermatol 2022; 39:587-589. [PMID: 35613693 DOI: 10.1111/pde.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/01/2022] [Indexed: 11/27/2022]
Abstract
Multispecialty clinics can be exceedingly helpful for diagnostically challenging and clinically complicated patients. This study highlights the diagnostic outcomes of the multispecialty Pediatric Dermatology-Genetics clinic at Children's Mercy-Kansas City over a 5-year period.
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Affiliation(s)
- Maeve C Maher
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Amy J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Brandon D Newell
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Emily Fleming
- Division of Clinical Genetics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Jennifer L Gannon
- Division of Clinical Genetics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Dihong Zhou
- Division of Clinical Genetics, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri, USA
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5
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Ramien ML, Bahubeshi A, Lara-Corrales I, Pope E, Levy ML, Nopper AJ, Shear NH, Eichenfield L. Blistering severe cutaneous adverse reactions in children: proposal for paediatric-focused clinical criteria. Br J Dermatol 2021; 185:447-449. [PMID: 33730370 DOI: 10.1111/bjd.20063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M L Ramien
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,University of Ottawa, Ottawa, ON, Canada
| | | | - I Lara-Corrales
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - E Pope
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - M L Levy
- Department of Pediatrics and Medicine (Dermatology), Dell Medical School, University of Texas, Austin, TX, USA.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, TX, USA
| | - A J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - N H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, University of California, San Diego, CA, USA
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6
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Frieden IJ, Püttgen KB, Drolet BA, Garzon MC, Chamlin SL, Pope E, Mancini AJ, Lauren CT, Mathes EF, Siegel DH, Gupta D, Haggstrom AN, Tollefson MM, Baselga E, Morel KD, Shah SD, Holland KE, Adams DM, Horii KA, Newell BD, Powell J, McCuaig CC, Nopper AJ, Metry DW, Maguiness S. Management of infantile hemangiomas during the COVID pandemic. Pediatr Dermatol 2020; 37:412-418. [PMID: 32298480 PMCID: PMC7262142 DOI: 10.1111/pde.14196] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMA-approved monitoring guidelines, clinical practice guidelines, and relevant, up-to-date publications regarding initiation and monitoring of beta-blocker therapy were used to inform the recommendations. Clinical decision-making guidelines about when telehealth is an appropriate alternative to in-office visits, including medication initiation, dosage changes, and ongoing evaluation, are included. The importance of communication with caregivers in the context of telemedicine is discussed, and online resources for both hemangioma education and propranolol therapy are provided.
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Affiliation(s)
- Ilona J Frieden
- University of California San Francisco, San Francisco, California, USA
| | | | - Beth A Drolet
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Maria C Garzon
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Sarah L Chamlin
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elena Pope
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Anthony J Mancini
- Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christine T Lauren
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Erin F Mathes
- University of California San Francisco, San Francisco, California, USA
| | - Dawn H Siegel
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deepti Gupta
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | | | - Kimberly D Morel
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Sonal D Shah
- University of California San Francisco, San Francisco, California, USA
| | | | | | - Kimberly A Horii
- University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Brandon D Newell
- University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Catherine C McCuaig
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, QC, Canada
| | - Amy J Nopper
- University of Missouri - Kansas City, Kansas City, Missouri, USA
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7
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Caylor RC, Grote L, Thiffault I, Farrow EG, Willig L, Soden S, Amudhavalli SM, Nopper AJ, Horii KA, Fleming E, Jenkins J, Welsh H, Ilyas M, Engleman K, Abdelmoity A, Saunders CJ. Incidental diagnosis of tuberous sclerosis complex by exome sequencing in three families with subclinical findings. Neurogenetics 2018; 19:205-213. [PMID: 29926239 DOI: 10.1007/s10048-018-0551-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous disorder characterized by lesions and benign tumors in multiple organ systems including the brain, skin, heart, eyes, kidneys, and lungs. The phenotype is highly variable, although penetrance is reportedly complete. We report the molecular diagnosis of TSC in individuals exhibiting extreme intra-familial variability, including the incidental diagnosis of asymptomatic family members. Exome sequencing was performed in three families, with probands referred for epilepsy, autism, and absent speech (Family 1); epileptic spasms (Family 2); and connective tissue disorders (Family 3.) Pathogenic variants in TSC1 or TSC2 were identified in nine individuals, including relatives with limited or no medical concerns at the time of testing. Of the nine individuals reported here, six had post-diagnosis examinations and three met clinical diagnostic criteria for TSC. One did not meet clinical criteria for a possible or definite diagnosis of TSC, and two had only a possible clinical diagnosis following post-diagnosis workup. These individuals as well as their mothers demonstrated limited features that would not raise concern for TSC in the absence of molecular results. In addition, three individuals exhibited epilepsy with normal brain MRIs, and two without seizures or intellectual disability had MRI findings fulfilling major criteria for TSC highlighting the difficulty providers face when relying on clinical criteria to guide genetic testing. Given the importance of a timely TSC diagnosis for clinical management, such cases demonstrate a potential benefit for clinical criteria to include seizures and an unbiased molecular approach to genetic testing.
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Affiliation(s)
- R C Caylor
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - L Grote
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - I Thiffault
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - E G Farrow
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - L Willig
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Nephrology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - S Soden
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - S M Amudhavalli
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
| | - A J Nopper
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Dermatology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - K A Horii
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Dermatology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - E Fleming
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - J Jenkins
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - H Welsh
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - M Ilyas
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Neurology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - K Engleman
- Division of Clinical Genetics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - A Abdelmoity
- Department of Pediatrics, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA
- Division of Neurology, Children's Mercy Hospitals, Kansas City, MO, 64108, USA
| | - C J Saunders
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals, Kansas City, MO, 64108, USA.
- Center for Pediatric Genomic Medicine, Children's Mercy Hospitals, 2420 Pershing Rd., Kansas City, MO, 64108, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, 64108, USA.
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8
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Abstract
Decreasing wait time for pediatric dermatology appointments is important to patients. We retrospectively examined the effect of a referral-only policy on patient wait time for an initial appointment in an academic pediatric dermatology clinic and found a statistically significant decrease in wait time after the policy was instituted.
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Affiliation(s)
- Tiffany J Herd
- Division of Dermatology, Children's Mercy Hospitals & Clinics, Kansas City, Missouri
| | - Amy J Nopper
- Division of Dermatology, Children's Mercy Hospitals & Clinics, Kansas City, Missouri
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospitals & Clinics, Kansas City, Missouri
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9
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Abstract
The precise etiology and subtype of vessels constituting angiokeratomas is poorly understood. We sought to characterize the vessels by studying prospero-related homeobox gene-1 and D2-40 expression in 22 pediatric solitary angiokeratomas. Routine histologic examination demonstrated a mix of lymph-containing vessels and erythrocyte-filled small vessels. Our results suggest that angiokeratomas may in part be comprised of vessels with lymphatic differentiation.
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Affiliation(s)
- Brea Prindaville
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Hillary Lawrence
- Department of Dermatology, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Vivekanand Singh
- Department of Pathology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Amy J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
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10
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Prindaville B, Nguyen T, Nopper AJ. Tense, Pruritic Acral Bullae in an Infant. Pediatr Dermatol 2016; 33:557-8. [PMID: 27595875 DOI: 10.1111/pde.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brea Prindaville
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri.
| | - Tony Nguyen
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Amy J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
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11
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Greco MF, Frieden IJ, Drolet BA, Garzon MC, Mancini AJ, Chamlin SL, Metry D, Adams D, Lucky A, Wentzel MS, Horii KA, Baselga E, McCuaig CC, Powell J, Haggstrom A, Siegel D, Morel KD, Cordisco MR, Nopper AJ, Krol A. Infantile Hemangiomas in Twins: A Prospective Cohort Study. Pediatr Dermatol 2016; 33:178-83. [PMID: 26863906 DOI: 10.1111/pde.12781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Twins have a higher-than-expected risk of infantile hemangiomas (IHs), but the exact reasons for this association are not clear. Comparing concordant and discordant twin pairs might help elucidate these factors and yield more information about IH risk factors. METHODS A prospective cohort study of twin pairs from 12 pediatric dermatology centers in the United States, Canada, Argentina, and Spain was conducted. Information regarding maternal pregnancy history, family history of vascular birthmarks, zygosity (if known), and pregnancy-related information was collected. Information regarding twins (N = 202 sets) included birthweight, gestational age (GA), presence or absence of IHs, numbers and subtypes of IHs, presence of other birthmarks, and other medical morbidities. RESULTS Two hundred two sets of twins were enrolled. Concordance for IH was present in 37% of twin pairs. Concordance for IH was inversely related to gestational age (GA), present in 42% of GA of 32 weeks or less, 36% of GA of 33 to 36 weeks, and 32% of GA of 37 weeks or more. Twins of GA of 34 weeks or less were more than two and a half times as likely to be concordant as those of GA of 35 weeks or more (odds ratio (OR) = 2.66, 95% confidence interval (CI) = 1.42-4.99; p < 0.01). In discordant twins, lower birthweight conferred a high risk of IH; of the 64 sets of twins with 10% or greater difference in weight, the smaller twin had IH in 62.5% (n = 40) of cases, versus 37.5% (n = 24) of cases in which the higher-birthweight twin was affected. Zygosity was reported in 188 twin sets (93%). Of these, 78% were dizygotic and 22% monozygotic. There was no statistically significant difference in rates of concordance between monozygotic twins (43%, 18/42) and dizygotic twins (36%, 52/146) (p = 0.50). In multivariate analysis comparing monozygotic and dizygotic twins, adjusting for effects of birthweight and sex, the likelihood of concordance for monozygotic was not appreciably higher than that for dizygotic twins (OR = 1.14, 95% CI = 0.52-2.49). Female sex also influenced concordance, confirming the effects of female sex on IH risk. The female-to-male ratio was 1.7:1 in the entire cohort and 1.9:1 in those with IH. Of the 61 concordant twin sets with known sex of both twins, 41% were female/female, 43% were female/male, and 16% were male/male. CONCLUSIONS These findings suggest that the origin of IHs is multifactorial and that predisposing factors such as birthweight, sex, and GA may interact with one another such that a threshold is reached for clinical expression.
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Affiliation(s)
- M Fernanda Greco
- Division of Pediatric Dermatology, Department of Pediatrics, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ilona J Frieden
- Department of Dermatology, School of Medicine, University of California at San Francisco, San Francisco, California.,Department of Pediatrics, School of Medicine, University of California at San Francisco, San Francisco, California
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - María C Garzon
- Department of Dermatology, Columbia University, New York, New York
| | - Anthony J Mancini
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah L Chamlin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Denise Adams
- Division of Hematology and Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Lucky
- Division of Pediatric Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Kimberly A Horii
- Section of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catherine C McCuaig
- Department of Pediatrics Dermatology, Dermatology Service, CHU, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Julie Powell
- Department of Pediatrics Dermatology, Dermatology Service, CHU, Sainte-Justine Hospital, Montreal, Quebec, Canada
| | - Anita Haggstrom
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, Indiana.,Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Dawn Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kimberly D Morel
- Department of Dermatology, Columbia University, New York, New York
| | - M Rosa Cordisco
- Division of Pediatric Dermatology, Hospital de Pediatria Prof. Dr. JP Garrahan, Buenos Aires, Argentina
| | - Amy J Nopper
- Section of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | - Alfons Krol
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon.,Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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12
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Abstract
Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the unique ability to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. Unfortunately, a subset of IHs rapidly develop complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary clinician has the task of determining which lesions require early consultation with a specialist. Although several recent reviews have been published, this clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH. Its purpose is to update the pediatric community regarding recent discoveries in IH pathogenesis, treatment, and clinical associations and to provide a basis for clinical decision-making in the management of IH.
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Abstract
There is controversy regarding precise definitions for Stevens-Johnson syndrome (SJS) and erythema multiforme (EM) major because of overlap in clinical presentations. SJS and EM major associated with Mycoplasma pneumoniae have been reported to occur in children, but Mycoplasma is more commonly reported with SJS. We sought to further characterize Mycoplasma-associated mucocutaneous disease. Through retrospective chart review over 10 years, six children hospitalized with a diagnosis of SJS who also tested positive for Mycoplasma infection were reviewed. Using documented physical examinations and photographs, diagnoses of SJS or EM major were retrospectively made based upon cutaneous lesional morphology employing the classification system proposed by Bastuji-Garin et al. The majority of patients were boys, with limited acral cutaneous lesions. All patients required prolonged hospitalization because of mucosal involvement and had good short-term outcomes. When the classification system was retrospectively applied, five of the six patients were reclassified with a diagnosis of EM major instead of SJS. Children with Mycoplasma-associated EM major and SJS in our small retrospective series appeared to have significant mucosal involvement but more limited cutaneous involvement with lesional morphology, which is more characteristic of EM major.
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Affiliation(s)
- Brea Prindaville
- Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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Prindaville B, Nopper AJ, Lawrence H, Horii KA. Chronic granulomatous disease presenting with ecthyma gangrenosum in a neonate. J Am Acad Dermatol 2014; 71:e44-5. [PMID: 25037808 DOI: 10.1016/j.jaad.2013.12.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/22/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022]
Affiliation(s)
| | - Amy J Nopper
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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16
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Haggstrom AN, Beaumont JL, Lai JS, Adams DM, Drolet BA, Frieden IJ, Garzon MC, Holland KE, Horii KA, Lucky AW, Mancini AJ, Metry DW, Morel KD, Newell BD, Nopper AJ, Siegel D, Swigonski NL, Cella D, Chamlin SL. Measuring the severity of infantile hemangiomas: instrument development and reliability. ACTA ACUST UNITED AC 2012; 148:197-202. [PMID: 22351819 DOI: 10.1001/archdermatol.2011.926] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To develop instruments that measure the severity of infantile hemangiomas (Hemangioma Severity Scale [HSS]) and the complications of infantile hemangiomas for longitudinal use (Hemangioma Dynamic Complication Scale [HDCS]). DESIGN Instrument development and reliability study. SETTING Academic research. PARTICIPANTS The HSS and the HDCS were developed through the collaborative effort of members of the Hemangioma Investigator Group Research Core, an expert multi-institutional research group. After development of the scales, 13 pediatric dermatologists used the HSS to score 20 different hemangiomas. In addition, 12 pediatric dermatologists used the HDCS to score hemangioma-related complications for 24 clinical scenarios. Interrater and intrarater reliability was measured for both scales. MAIN OUTCOME MEASURES Interrater and intrarater reliability. RESULTS For the HSS, interrater reliability and intrarater reliability exceeded 99%. Similarly, the HDCS had a high rate of interrater agreement; for individual items, agreement among raters was 67% to 100%, with most clinical scenarios demonstrating greater than 90% agreement. Intrarater reliability was excellent for all individual items of the HDCS. CONCLUSION The HSS and the HDCS are reliable scales that can be used to measure the severity of infantile hemangiomas, including the severity of complications for longitudinal use.
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Affiliation(s)
- Anita N Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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17
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Schumacher WE, Drolet BA, Maheshwari M, Horii KA, Nopper AJ, Newell BD, Metry DW, Garzon MC, Morel KD, Chamlin SL, Mancini AJ, Frieden IJ, Johnson CM. Spinal dysraphism associated with the cutaneous lumbosacral infantile hemangioma: a neuroradiological review. Pediatr Radiol 2012; 42:315-20. [PMID: 22138893 DOI: 10.1007/s00247-011-2262-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Spinal dysraphism is suspected in patients with midline abnormalities, especially in those with lumbosacral cutaneous markings. A recent prospective study demonstrated that isolated cutaneous infantile hemangiomas (IH) of the lumbosacral region have one of the highest risks (relative risk of 438) of associated spinal dysraphism. OBJECTIVE The specific types of dysraphism and radiological findings associated with cutaneous IH of the lumbosacral region have not been described in detail, to the best of our knowledge. The aim of this multicenter study is to retrospectively classify types of spinal anomalies associated with the cutaneous lumbosacral IH. MATERIALS AND METHODS The radiological images of 20 cases of lumbosacral infantile hemangioma associated with spinal dysraphism were reviewed. RESULTS Tethered cord was found in 60% of the 20 cases, spinal lipoma was present in 50% and 45% had intraspinal hemangiomas. Sinus tract was found in 40% of the children. CONCLUSION A range of spinal anomalies is associated with cutaneous lumbosacral infantile hemangiomas and MRI can be used to characterize these abnormalities.
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Affiliation(s)
- Wendy E Schumacher
- Department of Dermatology, Children's Hospital of Wisconsin, Medical College of Wisconsin, P. O. Box 1997, Milwaukee, WI 53201-1997, USA.
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Affiliation(s)
- Jennifer L Goldman
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, USA.
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Horii KA, Drolet BA, Frieden IJ, Baselga E, Chamlin SL, Haggstrom AN, Holland KE, Mancini AJ, McCuaig CC, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Garzon MC. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 2011; 28:245-53. [PMID: 21517952 DOI: 10.1111/j.1525-1470.2011.01420.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple cutaneous infantile hemangiomas have been associated with hepatic hemangiomas. Screening of infants with five or more cutaneous infantile hemangiomas with abdominal ultrasound is often recommended. The aim of this study was to determine the frequency with which hepatic hemangiomas occur in infants with five or more cutaneous infantile hemangiomas compared to those with one to four cutaneous infantile hemangiomas and to characterize the clinical features of these hepatic hemangiomas. A multicenter prospective study of children with cutaneous infantile hemangiomas was conducted at pediatric dermatology clinics at Hemangioma Investigator Groups sites in the United States, Canada, and Spain between October 2005 and December 2008. Data were collected, and abdominal ultrasonography was performed on infants younger than 6 months old with five or more cutaneous infantile hemangiomas and those with one to four cutaneous infantile hemangiomas. Twenty-four (16%) of the 151 infants with five or more cutaneous infantile hemangiomas had hepatic hemangiomas identified on abdominal ultrasound, versus none of the infants with fewer than five (p = 0.003). Two of the 24 infants with hepatic hemangiomas received treatment specifically for their hepatic hemangiomas. Infants with five or more cutaneous infantile hemangiomas have a statistically significantly greater frequency of hepatic hemangiomas than those with fewer than 5. These findings support the recommendation of five or more cutaneous infantile hemangiomas as a threshold for screening infants younger than 6 months old for hepatic hemangiomas but also demonstrate that the large majority of these infants with hepatic hemangiomas do not require treatment.
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Affiliation(s)
- Kimberly A Horii
- Section of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
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Drolet BA, Chamlin SL, Garzon MC, Adams D, Baselga E, Haggstrom AN, Holland KE, Horii KA, Juern A, Lucky AW, Mancini AJ, McCuaig C, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Frieden IJ. Prospective study of spinal anomalies in children with infantile hemangiomas of the lumbosacral skin. J Pediatr 2010; 157:789-94. [PMID: 20828712 DOI: 10.1016/j.jpeds.2010.07.054] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/13/2010] [Accepted: 07/28/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prospectively evaluate a cohort of patients with infantile hemangioma in the midline lumbosacral region for spinal anomalies to determine the positive predictive value of infantile hemangioma for occult spinal anomalies and to make evidence-based recommendations for screening. STUDY DESIGN A multicenter prospective cohort study was performed at 9 Hemangioma Investigator Group sites. RESULTS Intraspinal abnormalities were detected in 21 of 41 study participants with a lumbosacral infantile hemangioma who underwent a magnetic resonance imaging evaluation. The relative risk for all patients with lumbosacral infantile hemangiomas for spinal anomalies was 640 (95% confidence interval [CI], 404-954), and the positive predictive value of infantile hemangioma for spinal dysraphism was 51.2%. Ulceration of the hemangioma was associated with a higher risk of having spinal anomalies. The presence of additional cutaneous anomalies also was associated with a higher likelihood of finding spinal anomalies; however, 35% of the infants with isolated lumbosacral infantile hemangiomas had spinal anomalies, with a relative risk of 438 (95% CI, 188-846). The sensitivity for ultrasound scanning to detect spinal anomalies in this high-risk group was poor at 50% (95% CI, 18.7%-81.3%), with a specificity rate of 77.8% (95% CI, 40%-97.2%). CONCLUSIONS Infants and children with midline lumbosacral infantile hemangiomas are at increased risk for spinal anomalies. Screening magnetic resonance imaging is recommended for children with these lesions.
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Affiliation(s)
- Beth A Drolet
- Department of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA.
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Choate KA, Lu Y, Zhou J, Choi M, Elias PM, Farhi A, Nelson-Williams C, Crumrine D, Williams ML, Nopper AJ, Bree A, Milstone LM, Lifton RP. Mitotic recombination in patients with ichthyosis causes reversion of dominant mutations in KRT10. Science 2010; 330:94-7. [PMID: 20798280 DOI: 10.1126/science.1192280] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Somatic loss of wild-type alleles can produce disease traits such as neoplasia. Conversely, somatic loss of disease-causing mutations can revert phenotypes; however, these events are infrequently observed. Here we show that ichthyosis with confetti, a severe, sporadic skin disease in humans, is associated with thousands of revertant clones of normal skin that arise from loss of heterozygosity on chromosome 17q via mitotic recombination. This allowed us to map and identify disease-causing mutations in the gene encoding keratin 10 (KRT10); all result in frameshifts into the same alternative reading frame, producing an arginine-rich C-terminal peptide that redirects keratin 10 from the cytokeratin filament network to the nucleolus. The high frequency of somatic reversion in ichthyosis with confetti suggests that revertant stem cell clones are under strong positive selection and/or that the rate of mitotic recombination is elevated in individuals with this disorder.
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Affiliation(s)
- Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510, USA
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Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW, Nopper AJ, Frieden IJ. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 2008; 122:360-7. [PMID: 18676554 DOI: 10.1542/peds.2007-2767] [Citation(s) in RCA: 400] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Infantile hemangiomas often are inapparent at birth and have a period of rapid growth during early infancy followed by gradual involution. More precise information on growth could help predict short-term outcomes and make decisions about when referral or intervention, if needed, should be initiated. The objective of this study was to describe growth characteristics of infantile hemangioma and compare growth with infantile hemangioma referral patterns. METHODS A prospective cohort study involving 7 tertiary care pediatric dermatology practices was conducted. Growth data were available for a subset of 526 infantile hemangiomas in 433 patients from a cohort study of 1096 children. Inclusion criteria were age younger than 18 months at time of enrollment and presence of at least 1 infantile hemangioma. Growth stage and rate were compared with clinical characteristics and timing of referrals. RESULTS Eighty percent of hemangioma size was reached during the early proliferative stage at a mean age of 3 months. Differences in growth between hemangioma subtypes included that deep hemangiomas tend to grow later and longer than superficial hemangiomas and that segmental hemangiomas tended to exhibit more continued growth after 3 months of age. The mean age of first visit was 5 months. Factors that predicted need for follow-up included ongoing proliferation, larger size, deep component, and segmental and indeterminate morphologic subtypes. CONCLUSIONS Most infantile hemangioma growth occurs before 5 months, yet 5 months was also the mean age at first visit to a specialist. Recognition of growth characteristics and factors that predict the need for follow-up could help aid in clinical decision-making. The first few weeks to months of life are a critical time in hemangioma growth. Infants with hemangiomas need close observation during this period, and those who need specialty care should be referred and seen as early as possible within this critical growth period.
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Affiliation(s)
- Linda C Chang
- Department of Dermatology, University of California, San Francisco, California, USA
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Minzer-Conzetti K, Garzon MC, Haggstrom AN, Horii KA, Mancini AJ, Morel KD, Newell B, Nopper AJ, Frieden IJ. Information about infantile hemangiomas on the Internet: How accurate is it? J Am Acad Dermatol 2007; 57:998-1004. [PMID: 17689833 DOI: 10.1016/j.jaad.2007.06.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/28/2007] [Accepted: 06/29/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We sought to measure the type, content, and quality of World Wide Web sites retrieved when conducting an Internet search for infantile hemangiomas. METHODS Fifty World Wide Web sites from a Google search for "hemangioma" were examined. Relevant sites were characterized, and content was evaluated by 8 pediatric dermatologists. RESULTS The most accurate subjects were the description of risk factors and natural history, whereas the least accurate areas were photographic representation of the disease and presentation of treatment options. Four sites were considered accurate, and the majority of raters would recommend these sites to parents. LIMITATIONS Internet sites and search results change. CONCLUSIONS An Internet search for information about infantile hemangiomas yields few sites that accurately depict the full disease spectrum from innocuous to severe. Online educational resources containing a broader overview of the real disease spectrum of infantile hemangiomas are needed. Such sites should include large numbers of photographs, evidence-based content, and resources for parental support.
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Affiliation(s)
- Karen Minzer-Conzetti
- Department of Dermatology, University of California, San Francisco, California 94143-0316, USA
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Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW, Newell B, Nopper AJ, Frieden IJ. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 2007; 150:291-4. [PMID: 17307549 DOI: 10.1016/j.jpeds.2006.12.003] [Citation(s) in RCA: 312] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 10/04/2006] [Accepted: 12/04/2006] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To characterize demographic, prenatal, and perinatal features of patients with infantile hemangiomas and to determine the importance of these factors in predicting rates of complication and treatment. STUDY DESIGN We conducted a prospective study at 7 U.S. pediatric dermatology clinics. A consecutive sample of 1058 children, aged 12 years and younger, with infantile hemangiomas was enrolled between September 2002 and October 2003. A standardized questionnaire was used to collect demographic, prenatal, perinatal, and hemangioma-specific data. National Vital Statistic System Data (NVSS) was used to compare demographic variables and relevant rates of prenatal events. RESULTS In comparison with the 2002 United States National Vital Statistics System birth data, we found that infants with hemangiomas were more likely to be female, white non-Hispanic, premature (P < .0001) and the product of a multiple gestation (10.6% versus 3.1%; P < .001). Maternal age was significantly higher (P < .0001), and placenta previa (3.1%) and pre-eclampsia (11.8%) were more common. CONCLUSIONS Infants with hemangiomas are more likely to be female, white non-Hispanic, premature, and products of multiple gestations. Prenatal associations include older maternal age, placenta previa, and pre-eclampsia. No demographic, prenatal, and perinatal factors predicted higher rates of complications or need for treatment.
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Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, Lucky AW, Mancini AJ, Metry DW, Newell B, Nopper AJ, Frieden IJ. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 2006; 118:882-7. [PMID: 16950977 DOI: 10.1542/peds.2006-0413] [Citation(s) in RCA: 352] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Infantile hemangiomas are the most common tumor of infancy. Risk factors for complications and need for treatment have not been studied previously in a large prospective study. This study aims to identify clinical characteristics associated with complications and the need for therapeutic intervention. PATIENTS AND METHODS We conducted a prospective cohort study at 7 US pediatric dermatology clinics with a consecutive sample of 1058 children, aged < or = 12 years, with infantile hemangiomas enrolled between September 2002 and October 2003. A standardized questionnaire was used to collect data on each patient and each hemangioma, including clinical characteristics, complications, and treatment. RESULTS Twenty-four percent of patients experienced complications related to their hemangioma(s), and 38% of our patients received some form of treatment during the study period. Hemangiomas that had complications and required treatment were larger and more likely to be located on the face. Segmental hemangiomas were 11 times more likely to experience complications and 8 times more likely to receive treatment than localized hemangiomas, even when controlled for size. CONCLUSIONS Large size, facial location, and/or segmental morphology are the most important predictors of poor short-term outcomes as measured by complication and treatment rates.
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Affiliation(s)
- Anita N Haggstrom
- Department of Dermatology, University of California, San Francisco, California, USA
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Frieden IJ, Haggstrom AN, Drolet BA, Mancini AJ, Friedlander SF, Boon L, Chamlin SL, Baselga E, Garzon MC, Nopper AJ, Siegel DH, Mathes EW, Goddard DS, Bischoff J, North PE, Esterly NB. Infantile hemangiomas: current knowledge, future directions. Proceedings of a research workshop on infantile hemangiomas, April 7-9, 2005, Bethesda, Maryland, USA. Pediatr Dermatol 2005; 22:383-406. [PMID: 16190987 DOI: 10.1111/j.1525-1470.2005.00102.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ilona J Frieden
- University of California School of Medicine, San Francisco, California, 94143-0316, USA.
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Affiliation(s)
- K J Warren
- Department of Dermatology, Medical College of Wisconsin, Milwaukee 53226, USA
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Abstract
OBJECTIVE Premature infants have an ineffective epidermal barrier. The aim of this study was to investigate the cutaneous and systemic effects of preservative-free topical ointment therapy in premature infants. STUDY DESIGN We conducted a prospective, randomized study of 60 infants less than 33 weeks' estimated gestational age. The treated infants received therapy for 2 weeks with twice-daily preservative-free topical ointment therapy while the control group received no topical treatment or as-needed therapy with a water-in-oil emollient. Data collection included transepidermal water loss (TEWL) measurement, skin condition evaluations, fungal and quantitative bacterial skin cultures, analysis of fluid requirements, patterns of weight low or gain, and the incidence of blood and cerebrospinal fluid cultures positive for microorganisms. RESULTS We found that topical ointment therapy significantly decreased TEWL during the first 6 hours after the initial application. TEWL was decreased by 67% (p = 0.0001) when measured 30 minutes after application and 34% (p = 0.001) when measured 4 to 6 hours after application. We also observed significantly superior skin condition scores in the treated group on study days 7 and 14 (p = 0.001) and 0.0004, respectively). Quantitative bacterial cultures revealed significantly less colonization of the axilla on day 2, 3, or 4 and on day 14 (p = 0.008 and 0.04, respectively). The incidence of positive findings in blood and/or cerebrospinal fluid cultures was 3.3% in the treated group of infants versus 26.7% in the control group (p = 0.02). There was no statistical difference in the fluid requirements or patterns of weight gain or loss during the 2 weeks of the study. CONCLUSIONS Preservative-free topical ointment therapy decreased TEWL for 6 hours after application, decreased the severity of dermatitis, and decreased bacterial colonization of axillary skin. Infants treated with ointment had fewer blood and cerebrospinal fluid cultures positive for microorganisms. These data support the use of topical ointment therapy in very premature infants during the first weeks after birth.
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Affiliation(s)
- A J Nopper
- Department of Dermatology, Stanford University School of Medicine, California 94305-5334, USA
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