1
|
Abstract
Acne is a disease that primarily affects adolescents but it may also be seen in neonates, children and adults. The main areas of involvement are the face, chest and back. Many individuals with acne are embarrassed by their condition, and even refuse to go to school and become socially withdrawn. Early treatment can prevent the devastating physical and emotional sequelae of acne. There are numerous effective therapies, and it is not necessary for patients to go through the trauma that plagued previous generations.
Collapse
Affiliation(s)
- B R Krafchik
- Division of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| |
Collapse
|
2
|
Uziel Y, Feldman BM, Krafchik BR, Laxer RM, Yeung RSM. Increased serum levels of TGFbeta1 in children with localized scleroderma. Pediatr Rheumatol Online J 2007; 5:22. [PMID: 18053185 PMCID: PMC2233624 DOI: 10.1186/1546-0096-5-22] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 12/03/2007] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are neither sensitive nor specific laboratory tests for measuring disease activity in localized scleroderma (LS). Monitoring is done almost exclusively by clinical assessment. Our aim was to determine whether serum concentrations of TGFbeta1 are a good biomarker of disease activity in children with LS. METHODS 55 pediatric patients with LS were divided into sub-types according to their main lesion; morphea, generalized morphea, linear scleoderma affecting a limb or the face. The lesions were further categorized by overall clinical assessment into active, inactive, and indeterminate groups according to disease activity. Serum TGFbeta1 concentration levels were measured by enzyme linked immunosorbent assay (ELISA), analyzed and correlated with disease subtypes and disease activity. RESULTS The mean TGFbeta1 concentration were significantly higher in the patient group (51393 +/- 33953 pg/ml) than in the control group (9825 +/- 5287 pg/ml) (P < 0.001). The mean concentration were elevated in all the disease subtypes, and did not correlate with disease duration or activity. CONCLUSION Serum concentration of TGFbeta1 were elevated in patients with all subtypes of LS irrespective of clinical disease activity. Although TGFbeta1 may play an important role in the pathogenesis of local skin fibrosis, circulating blood levels of molecules known to act locally may not be useful biomarkers of disease activity.
Collapse
Affiliation(s)
- Yosef Uziel
- Divisions of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada.
| | - Brian M Feldman
- Divisions of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada,Departments of HPME and PHS, University of Toronto, Toronto, Canada
| | - Bernice R Krafchik
- Divisions Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Ronald M Laxer
- Divisions of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Rae SM Yeung
- Divisions of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada,Departments of Immunology and Medical Sciences, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Pope E, Krafchik BR, Macarthur C, Stempak D, Stephens D, Weinstein M, Ho N, Baruchel S. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics 2007; 119:e1239-47. [PMID: 17485449 DOI: 10.1542/peds.2006-2962] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [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: 11/24/2022] Open
Abstract
OBJECTIVES Oral systemic corticosteroids are the mainstay of treatment for problematic hemangiomas; however, current information is based on anecdotal experience and retrospective studies. We aimed to determine whether systemic steroids are efficacious in proliferating hemangioma and to compare the efficacy and safety of 2 corticosteroid treatment modalities. PATIENTS AND METHODS Twenty patients with problematic hemangiomas of infancy were randomly assigned to either daily oral prednisolone or monthly intravenous pulses of methylprednisolone. Their clinical outcomes (improvement using a visual analog score) and adverse events were compared at 3 months from baseline and 1 year of age. Data on possible surrogate markers of angiogenesis were available for the first 3 months. RESULTS At 3 months, orally treated patients had a median visual analog score of 70 compared with 12 in the intravenous group. This response pattern was similar at the patients' first birthday: 50.0 vs -1.5. Additional treatment beyond 3 months was needed for 65% of the patients (7 in the intravenous and 6 in the oral group). Six of 8 patients with impaired vision at enrollment had an improved function at 1 year (4 patients in the intravenous group and 3 patients in the oral group). Of the 4 surrogate markers of angiogenesis measured (plasma basic fibroblast growth factor, vascular endothelial growth factor, vascular cellular adhesion molecule 1, endoglin, and urine basic fibroblast growth factor), the only 2 that decreased over time were vascular cellular adhesion molecule 1 and endoglin. Patients in the oral group had a higher rate of adverse effects, such as hypertension (18.6% vs 13.1%), abnormal cortisol (78% vs 60%), and growth retardation. CONCLUSIONS Systemic corticosteroids are efficacious in stopping the proliferation of hemangiomas. The oral corticosteroids offered more clinical and biological benefit than the pulse steroids with higher risk of adverse effects.
Collapse
Affiliation(s)
- Elena Pope
- University of Toronto, Section of Dermatology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Krueger GG, Eichenfield L, Goodman JJ, Krafchik BR, Carlin CS, Pang ML, Croy R, Holum ME, Jaracz E, Sawamoto T, Keirns J. Pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adult and pediatric patients with moderate to severe atopic dermatitis. J Drugs Dermatol 2007; 6:185-93. [PMID: 17373177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To characterize the pharmacokinetics of tacrolimus after topical application in adult and pediatric patients with moderate to severe atopic dermatitis from all clinical trials in which tacrolimus blood levels were obtained. METHODS Tacrolimus ointment 0.03% or 0.1% was applied twice daily. In the adult and pediatric pharmacokinetic studies, serial blood samples were obtained after single and repeated topical application. During the 12 clinical efficacy trials of tacrolimus ointment, single blood samples were obtained at various times relative to tacrolimus ointment application. RESULTS In the pharmacokinetic studies, 89% to 95% of tacrolimus whole blood concentration samples were less than 1 ng/mL; mean maximum concentrations ranged from 0.2 to 1.6 ng/mL and mean area under the blood concentration-time curves (0-12 hours) ranged from 1.4 to 13.1 ng x hr/mL. Likewise, in the clinical efficacy trials, the majority (85%-99%) of tacrolimus concentration samples were less than 1 ng/mL. CONCLUSIONS Tacrolimus ointment is associated with minimal systemic absorption and no evidence of systemic accumulation in patients with moderate to severe atopic dermatitis and extensive disease.
Collapse
Affiliation(s)
- Gerald G Krueger
- University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Abstract
Infantile pedal papules are symmetric, painless, flesh-colored nodules on the medial aspects of an infant's heels. Although the medical literature suggests they are uncommon, a survey of 269 newborns and 189 infants indicates the incidence of these to be 5.9% in newborns and 39.4% in infants.
Collapse
Affiliation(s)
- Saul Greenberg
- Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
6
|
Krafchik BR. Therapeutic approach to selected neonatal eruptions. Dermatol Ther 2005; 18:184-9. [PMID: 15953147 DOI: 10.1111/j.1529-8019.2005.05017.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Management of numerous neonatal eruptions has been modified over the past 10 years. In this article, traditional and developing therapeutic insights are applied to both common and uncommon neonatal conditions.
Collapse
|
7
|
Affiliation(s)
- S Alexander Holme
- Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
8
|
|
9
|
Hanifin JM, Cooper KD, Ho VC, Kang S, Krafchik BR, Margolis DJ, Schachner LA, Sidbury R, Whitmore SE, Sieck CK, Van Voorhees AS. Guidelines of care for atopic dermatitis, developed in accordance with the American Academy of Dermatology (AAD)/American Academy of Dermatology Association "Administrative Regulations for Evidence-Based Clinical Practice Guidelines". J Am Acad Dermatol 2004; 50:391-404. [PMID: 14988682 DOI: 10.1016/j.jaad.2003.08.003] [Citation(s) in RCA: 274] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jon M Hanifin
- American Academy of Dermatology, PO Box 4014, Schaumburg, IL 60168-4014, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
|
11
|
Affiliation(s)
- Michelle Murphy
- Department of Pediatric Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
12
|
Abstract
Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare, chronic skin condition that begins in early childhood. We present two children with ILVEN and arthritis, a previously undescribed association. We discuss the relevance of this association and suggest appropriate management for this arthritis.
Collapse
Affiliation(s)
- S Al-Enezi
- Division of Rheumatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
13
|
Abstract
We evaluated the self-esteem and quality of life of 47 children with morphea with the use of the Harter self-perception profile for children and Visual Analog Scale. Most children with morphea have normal self-worth and a high quality of life. Morphea, like some other childhood chronic illnesses, does not impair self-esteem.
Collapse
Affiliation(s)
- Y Uziel
- Department of Pediatrics, the Divisions of Rheumatology and Dermatology, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
14
|
|
15
|
Albers SE, Taylor G, Huyer D, Oliver G, Krafchik BR. Vulvitis circumscripta plasmacellularis mimicking child abuse. J Am Acad Dermatol 2000; 42:1078-80. [PMID: 10827417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Vulvitis circumscripta plasmacellularis (VCP) is a rare, benign vulvar disorder that is typically described in adult women. Our case occurred in an 8-year-old girl. The primary diagnostic concern was sexual abuse. VCP may also mimic lichen sclerosus, extramammary Paget's disease, pemphigus vulgaris, fixed drug eruption, squamous cell carcinoma, candidiasis, allergic contact dermatitis, and herpes simplex infection. Evaluation should include a biopsy because the histopathologic features of VCP are distinctive.
Collapse
Affiliation(s)
- S E Albers
- Section of Dermatology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
16
|
|
17
|
Abstract
INTRODUCTION Localized scleroderma (LS) can cause permanent disability, and there is no universally accepted effective treatment. Methotrexate (MTX) has been shown to be effective in the treatment of systemic sclerosis. OBJECTIVES To determine the efficacy and tolerability of MTX and corticosteroid therapy in patients with LS. METHODS MTX, 0.3 to 0.6 mg/kg per week, was given to 10 patients (6 girls, 4 boys; mean age, 6.8 years; mean disease duration before starting treatment, 4 years) with active LS. In addition, pulse intravenous methylprednisolone, 30 mg/kg for 3 days monthly for 3 months, was given to 9 patients at the initiation of therapy. RESULTS One patient discontinued taking MTX after a month; the remaining 9 patients responded. The median time to response was 3 months (95% CI, 1.15-4.85). One responder discontinued taking MTX after a year because of leukopenia; the LS worsened within 2 months. In another patient LS flared up after 10 months and responded to an increased dose of MTX and intravenous methylprednisolone. At the last follow-up visit, all patients who continued to receive MTX therapy had inactive skin lesions. CONCLUSION Treatment with MTX and corticosteroids appears to be effective in the treatment of LS and is generally well tolerated. A placebo-controlled study is necessary to confirm the efficacy of MTX therapy in LS.
Collapse
Affiliation(s)
- Y Uziel
- Division of Rheumatology and Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
18
|
Arnett FC, Tan FK, Uziel Y, Laxer RM, Krafchik BR, Antohi S, Bona C. Autoantibodies to the extracellular matrix microfibrillar protein, fibrillin 1, in patients with localized scleroderma. Arthritis Rheum 1999; 42:2656-9. [PMID: 10616014 DOI: 10.1002/1529-0131(199912)42:12<2656::aid-anr22>3.0.co;2-n] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Serum autoantibodies to fibrillin 1, the major component of microfibrils in the extracellular matrix, recently have been reported to occur in the tight skin mouse and in patients with systemic sclerosis, but not in patients with other connective tissue diseases. This study was undertaken to determine whether antifibrillin 1 antibodies could be detected in patients with localized forms of scleroderma. METHODS Sera from 50 patients with localized scleroderma (27 with linear scleroderma and 23 with morphea) and 51 normal controls were tested for IgG and IgM antifibrillin 1 autoantibodies, using a radioimmunoassay (RIA) and a human recombinant fibrillin 1 protein (rFbn-1). RESULTS Both in patients with linear scleroderma and in those with morphea, mean levels of IgM and IgG binding to rFbn-1 were significantly higher than in controls. Eight patients with linear scleroderma (30%) and 6 patients with morphea (26%) had IgG autoantibodies to fibrillin 1 (rFbn-1) by RIA, compared with 3 controls (6%) (P = 0.006 and P = 0.022, respectively). No correlations between antifibrillin 1 antibodies and active skin disease or antinuclear antibody positivity were found. CONCLUSION Autoantibodies to fibrillin 1 occur in patients with both forms of localized scleroderma (linear scleroderma and morphea). The clinical and pathogenetic significance of this autoimmune response remains to be determined.
Collapse
Affiliation(s)
- F C Arnett
- Division of Rheumatology and Immunogenetics, University of Texas Medical School, Houston 77030, USA
| | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
Subcutaneous fat necrosis (SFN) of the newborn is uncommon and usually occurs in the first weeks of life following a complicated delivery. The frequency with which hypercalcemia develops as a complication is uncertain. We report the clinical features of SFN in 11 patients seen between 1991 and 1998. Ten were born by cesarean section and fetal distress was present in the majority. It was not possible to distinguish SFN from sclerema neonatorum by time of onset or related infant diseases. Hypercalcemia developed in four infants up to 7 weeks after the onset of SFN. Infants with this condition should be carefully monitored for hypercalcemia.
Collapse
Affiliation(s)
- A D Burden
- Department of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
20
|
Abstract
Single café-au-lait macules (CALMs) are common in the pediatric population and in most children represent a normal finding. It is important to recognize whether the presence of multiple CALMs in a particular patient is normal or indicates an association with a multisystem disorder. This article addresses issues concerning the prevalence, genetics, and natural history of CALMs in the general population and reviews disorders in which CALMs are present as a characteristic trait.
Collapse
Affiliation(s)
- M Landau
- Division of Dermatology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | |
Collapse
|
21
|
Abstract
Erosive adenomatosis of the nipple (EAN) is a rare, benign neoplasm of breast lactiferous ducts. Peak incidence is in the fifth decade in women. Clinically, it may be mistaken for Paget's disease and, histologically, for adenocarcinoma. Some authors have proposed an association with breast carcinoma and fibrocystic breast changes. Erosive adenomatosis of the nipple is extremely rare in children. Treatment is usually local excision of the nipple. This is the first formal English language case report of EAN in the pediatric age group. It is important for dermatologists to be familiar with this entity to prevent unwarranted breast removal.
Collapse
Affiliation(s)
- S E Albers
- Section of Dermatology, The Hospital for Sick Children, The University of Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
22
|
Affiliation(s)
- B R Krafchik
- Department of Dermatology, Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
23
|
Abstract
Neonatal lupus is categorized by typical clinical features and the presence of maternal auto-antibodies. Mothers are uncommonly affected with clinical disease. The major clinical manifestations in neonates are cardiac, dermatological and hepatic, with rare instances of haemolytic anaemia and thrombocytopenia. The major morbidity and mortality result from complete congenital heart block. Dermatological manifestations occur mainly over the face and present with plaques of erythema with central atrophy, a mid-facial erythema, atrophy around the eyes and a telangiectatic variety. The long term outcome is usually excellent.
Collapse
Affiliation(s)
- B R Krafchik
- Hospital for Sick Children, Department of Dermatology, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Abstract
We are following 60 patients with morphea and/or linear scleroderma at the Hospital for Sick Children, Toronto. Lesions may vary in depth from epidermal changes resembling lichen sclerosis, to superficial and deep dermal changes. The subcutaneous tissue, bone and muscle may be involved. There is no good clinical marker of the disease. Because of the variation in the time to cure, it is difficult to evaluate treatment regimens. We are currently using methotrexate weekly either orally or subcutaneously and monthly pulsed steroids for three months.
Collapse
Affiliation(s)
- B R Krafchik
- Hospital for Sick Children, Department of Dermatology, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, Lewis CW, Pariser DM, Webster SB, Whitaker DC, Butler B, Lowery BJ, Raimer SA, Krafchik BR, Olsen E, Weston WL. Guidelines of care for the use of topical glucocorticosteroids. American Academy of Dermatology. J Am Acad Dermatol 1996; 35:615-9. [PMID: 8859293 DOI: 10.1016/s0190-9622(96)90690-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
26
|
Krafchik BR. Commentary on Nagaraja, Kanwar, Dhar, and Singh: frequency and significance of minor clinical features in various age-related subgroups of atopic dermatitis in children. Pediatr Dermatol 1996; 13:61-2. [PMID: 8919530 DOI: 10.1111/j.1525-1470.1996.tb01192.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- B R Krafchik
- Department of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Rosenberg AM, Uziel Y, Krafchik BR, Hauta SA, Prokopchuk PA, Silverman ED, Laxer RM. Antinuclear antibodies in children with localized scleroderma. J Rheumatol 1995; 22:2337-43. [PMID: 8835572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the prevalence and antigenic specificities of antinuclear antibodies (ANA) in children with localized scleroderma. METHODS The ANA profiles of 27 children with localized scleroderma were determined. The study group comprised 21 children with linear scleroderma, 5 with morphea, and 1 with combined linear scleroderma and morphea. Sera were evaluated for the presence of ANA by indirect immunofluorescence and for reactivity with specific nuclear antigens by ELISA and immunoblotting. RESULTS Seventeen patients (63%) had positive tests for ANA. Of these sera 10 displayed a finely speckled pattern, 5 a combined nucleolar and finely speckled nuclear pattern, and 2 a nucleolar pattern only. Fourteen of 21 (67%) with linear scleroderma were ANA positive. Three of 5 patients with morphea (60%) had ANA. The 1 patient with both linear scleroderma and morphea was ANA negative. Fifteen sera (56%) contained antibodies to denatured DNA (dDNA). Eleven sera (41%) had antibodies to one or more high mobility group (HMG) proteins, 4 (15%) reacted with one or more histones and 1 serum (4%) reacted with topoisomerase I (Sc1-70). CONCLUSION ANA are present in most children with localized scleroderma and frequently have specificity for dDNA and HMG proteins. Children with localized scleroderma, like patients with systemic sclerosis (SSc), commonly have ANA and antibodies to dDNA. Unlike patients with SSc, however, childhood localized scleroderma is uncommonly associated with antibodies to certain specific nuclear and nucleolar constituents that typically occur in association with SSc.
Collapse
Affiliation(s)
- A M Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Topical steroids have been used with great success since the early 1950s. Knowledge of the mode of action, development of tests of potency, and manipulation of side chains have added to our understanding of these agents. Vehicles influence their rate of absorption. In the last three decades, topical and systemic side effects have been recognized with their inappropriate use. These side effects are seldom seen in children and should not preclude the correct use of topical steroids in inflammatory disorders of the skin, particularly atopic dermatitis.
Collapse
Affiliation(s)
- B R Krafchik
- Department of Pediatrics, University of Toronto, Ontario, Canada
| |
Collapse
|
29
|
Affiliation(s)
- V Bertucci
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
30
|
Affiliation(s)
- T Costa
- Division of Genetics, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | |
Collapse
|
31
|
Bertucci V, Krafchik BR. What syndrome is this? Fetal alcohol syndrome. Pediatr Dermatol 1994; 11:178-80. [PMID: 8041663 DOI: 10.1111/j.1525-1470.1994.tb00577.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- V Bertucci
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
32
|
Uziel Y, Krafchik BR, Feldman B, Silverman ED, Rubin LA, Laxer RM. Serum levels of soluble interleukin-2 receptor. A marker of disease activity in localized scleroderma. Arthritis Rheum 1994; 37:898-901. [PMID: 8003062 DOI: 10.1002/art.1780370618] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine whether circulating serum levels of soluble interleukin-2 receptor (sIL-2R) are elevated in patients with localized scleroderma, and if levels of sIL-2R can differentiate between active and inactive disease. METHODS Seventeen patients with localized scleroderma were categorized by overall physician assessment into active, inactive, and indeterminate groups, according to disease activity. Serum sIL-2R levels were analyzed and correlated with disease activity. RESULTS The mean sIL-2R level was significantly higher (P = 0.005) in those with active disease (1,675 +/- 823 units/ml) than in those with inactive disease (722 +/- 218 units/ml). CONCLUSION Serum sIL-2R levels are elevated in patients with localized scleroderma. When present, elevated sIL-2R levels appear to be able to differentiate active from inactive disease. This fact also suggests cell-mediated immune activation in this condition. Further serial studies are required to assess the value and sensitivity of sIL-2R levels in measuring changes in disease activity.
Collapse
Affiliation(s)
- Y Uziel
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
Localized scleroderma (LS), a rare disease that occurs primarily in the pediatric age group, differs from systemic sclerosis (SSc) in that it is usually limited to the skin and subcutaneous tissue and is only rarely associated with systemic manifestations. The authors' experience with pediatric LS seen in 30 patients at a tertiary care center was reviewed: 26 had linear scleroderma, 19 on an extremity and 7 on the face; 3 had morphea; and 1 had generalized morphea. Antinuclear antibodies were present in 76% and rheumatoid factor in 39%. Five of 19 patients with linear scleroderma that involved an extremity had growth failure in that limb, and 1 required surgery. Sclerodermatous involvement over a joint resulted in limited range of movement in 6 patients, and 1 required surgery. One of the 30 patients developed SSc and polymyositis. There was difficulty in evaluating disease activity and hence in evaluating treatment. This experience with a large patient population suggests that LS, although usually a self-limiting disease, can result in significant morbidity.
Collapse
Affiliation(s)
- Y Uziel
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
34
|
Abstract
A number of important therapeutic agents have recently become available for the treatment of infectious and inflammatory skin diseases. Five of these drugs, calcipotriol, EMLA (eutectic mixture of local anesthetics), interferon-alpha 2a, cyclosporine, and acyclovir, are reviewed. Calcipotriol, a vitamin D analogue, has been shown to be useful but not curative in chronic stable plaque psoriasis in adults. Its use in children is being studied. EMLA is proving to be useful in the prevention of pain prior to minor procedures. The use of interferon-alpha 2a promises to be highly effective in the treatment of the complications of vascular lesions. Cyclosporine is a powerful immunomodulating agent. It has been used in the treatment of atopic dermatitis and psoriasis. Adverse effects limit its widespread use as a systemic agent. Topical cyclosporine has limited efficacy due to its poor penetration. Acyclovir has revolutionized the treatment of herpes simplex virus infections, particularly in reducing the morbidity and mortality of neonatal herpes. Whether it is indicated in varicella infection in normal children is questionable.
Collapse
Affiliation(s)
- A Davis
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
35
|
Harvey E, Bell CH, Paller AS, LaVoo EJ, Hanna W, Balfe JW, Krafchik BR. Pseudoporphyria cutanea tarda: two case reports on children receiving peritoneal dialysis and erythropoietin therapy. J Pediatr 1992; 121:749-52. [PMID: 1359046 DOI: 10.1016/s0022-3476(05)81909-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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: 10/24/2022]
Abstract
Pseudoporphyria cutanea tarda occurred in two children undergoing peritoneal dialysis and receiving erythropoietin therapy. The mechanism whereby erythropoietin might lead to photosensitization is unknown, but physicians should be aware of this possible association.
Collapse
Affiliation(s)
- E Harvey
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
36
|
Affiliation(s)
- B R Krafchik
- Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Krafchik BR. Localized cutaneous scleroderma. Semin Dermatol 1992; 11:65-72. [PMID: 1550717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Localized scleroderma in children includes morphea mainly on the trunk and linear scleroderma on the limbs, scalp, and face. Progressive systemic sclerosis is very rare in children and change from localized to progressive disease is extremely rare. Laboratory abnormalities occur with localized scleroderma, including eosinophilia, positive antinuclear factor (ANF), and increased immunoglobulin (Ig)G. The diseases are usually self limited, but involvement over bones may lead to marked functional impairment. Those on the face may be associated with underlying abnormalities and, occasionally, seizures. Treatment regimens are difficult to assess as there is no chemical marker, but penicillamine has gained wide use. It has numerous side effects and patients should be carefully monitored, particularly with regard to renal function. Other modalities have been used with variable success, but series of patients are small. Many medications produce skin softening in patients with progressive systemic sclerosis. The pathogenesis of skin sclerosis involves complicated interactions between vascular responses, lymphokines, and connective tissue proliferation. The etiology is completely unknown, despite a few cases associated with increased Borrelia titers.
Collapse
Affiliation(s)
- B R Krafchik
- University of Toronto, Hospital for Sick Children, Ontario, Canada
| |
Collapse
|
38
|
Affiliation(s)
- P A Hogan
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
39
|
Affiliation(s)
- P A Hogan
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | |
Collapse
|
40
|
Affiliation(s)
- P A Hogan
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
41
|
Affiliation(s)
- T Costa
- Hospital for Sick Children, Toronto, Ontario
| | | |
Collapse
|
42
|
Krafchik BR. The syndrome page. X-linked dominant chondrodysplasia punctata (Conradi-Hünermann syndrome). Pediatr Dermatol 1989; 6:150-1. [PMID: 2748475 DOI: 10.1111/j.1525-1470.1989.tb01015.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
43
|
|
44
|
|
45
|
Abstract
Despite considerable information and discussion about the risk of serious complications in patients with systemic mastocytosis undergoing general anaesthesia, little is known specifically about the risk to patients with isolated cutaneous mastocytosis. The experience of 29 general anaesthetics in 12 children with urticaria pigmentosa and three with solitary cutaneous mastocytoma was reviewed. No major complications were encountered and the four minor problems seen were self-limiting. The data from this study do not suggest that patients with urticaria pigmentosa or solitary cutaneous mastocytoma are at increased risk of life-threatening complications under general anaesthesia.
Collapse
Affiliation(s)
- P D James
- Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario
| | | | | |
Collapse
|
46
|
Caputo RV, Frieden I, Krafchik BR, Lane AT, Lucky A, Paller A, Raimer SS, Rasmussen JE, Schachner LA, Spraker MK. Diet and atopic dermatitis. J Am Acad Dermatol 1986; 15:543-5. [PMID: 3760290 DOI: 10.1016/s0190-9622(86)70205-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Prevention or modification of the onset of atopic dermatitis has been difficult to document through prolonged breast feeding or delayed introduction of solid foods. Dietary management of established atopic dermatitis is not routinely indicated for the majority of patients. Dietary management of atopic dermatitis should not be continued indefinitely. Gradual reintroduction of the offending food(s) is often appropriate. The foods most commonly avoided in the management of atopic dermatitis are cow's milk, wheat, eggs, and nuts. Severe or prolonged dietary restrictions should not be instituted without full consideration of their impact on the patient's general health.
Collapse
|
47
|
Dover JS, Phillips TJ, Burns DA, Krafchik BR. Disseminated superficial actinic porokeratosis. Coexistence with other porokeratotic variants. Arch Dermatol 1986; 122:887-9. [PMID: 3740871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The coexistence of disseminated superficial actinic porokeratosis (DSAP) with other variants of porokeratosis is rare. We report three such cases: DSAP with porokeratosis of Mibelli; DSAP with linear porokeratosis; and DSAP occurring in the mother of a girl with linear porokeratosis. Although different areas of skin and different family members usually express the same morphological variant, we suggest that the simultaneous expression of two closely linked gene loci could explain the coexistence of different porokeratotic variants.
Collapse
|
48
|
Norins AL, Caputo RV, Lucky AW, Krafchik BR, Rasmussen JE, Rhodes AR, Schachner LA, Weinberg S, Williams ML. Genital warts and sexual abuse in children. J Am Acad Dermatol 1984. [DOI: 10.1016/s0190-9622(84)80385-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
49
|
Abstract
Five infants under 1 year of age were reported with a syndrome of recurrent crops of pruritic papulopustules of the scalp. In three children there were also intermittent outbreaks on the trunk and extremities. Cultures showed the pustules to be sterile. Biopsies of scalp and skin tissues showed eosinophilic folliculitis. Some patients had eosinophilia during outbreaks of pustules. These cases are similar to the eosinophilic pustular folliculitis reported in a few adult patients with the exception that there was predominant scalp involvement in the children. We propose that eosinophilic pustular folliculitis of infancy is a distinct pustular dermatosis.
Collapse
|
50
|
|