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Gautam A, Frieden IJ, Shah SD, Witman PM, Harfmann K, Bradley F, Blei F, Pope E, Alsumait A, Gupta D, Covelli I, Streicher JL, Cotton C, Tollefson M, Nguyen H, Hunt R, Buros A, Fernández Faith E. Clinical characteristics of infantile hemangiomas with aggressive, persistent, and destructive ulceration. Pediatr Dermatol 2023; 40:996-1002. [PMID: 37845188 DOI: 10.1111/pde.15444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND/OBJECTIVES Ulceration is a common complication of infantile hemangioma (IH). Severe, persistent ulceration occurs in a minority of patients. This study aims to characterize the clinical features of IH with aggressive ulceration (AU). METHODS Multicenter retrospective study of clinical features of IH with AU. RESULTS Thirty-five patients with AU were identified and included in the study. The majority of AU occurred in segmental IH (23/35, 65%). Segmental IH with AU were large (≥10 cm2 ; 16/23, 69%, p < .001) with a thin (<3 mm) superficial component (16/23, 69%, p < .001). Localized IH with AU had a thick (>3 mm) superficial component (11/12, 92%, p < .001). All diaper area IH with AU (9/35) were segmental with thin superficial component (100%, p = .02). IH with AU in the head/neck (10/35) were more commonly localized (67%) and mixed (62.5%), while segmental, thick superficial morphology was more common on trunk (9/35) and upper extremities (7/35). CONCLUSIONS IH resulting in AU differ in clinical features by anatomic site. Those in the diaper area are nearly always segmental with thin superficial component, whereas other sites tend to be localized, mixed, with thick superficial component. These distinct phenotypes may prove useful in the clinical setting for physicians to identify patterns of IH ulceration with increased risk of aggressive, persistent ulceration.
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Affiliation(s)
- Ayushi Gautam
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sonal D Shah
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Patricia M Witman
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katya Harfmann
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Flora Bradley
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Francine Blei
- Department of Pediatrics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anwar Alsumait
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Deepti Gupta
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabela Covelli
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jenna L Streicher
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colleen Cotton
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Buros
- Pediatric Dermatology Research Alliance, Portland, Oregon, USA
| | - Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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Dykman M, Coughlin C, Cotton C, Hawryluk E, Kirkorian AY, Silverman R, Castelo-Soccio L, Yu J, Faith EF, Siegel M, Arkin L, Ramien ML. Proceedings of the 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference. Pediatr Dermatol 2023; 40 Suppl 1:4-7. [PMID: 37088541 PMCID: PMC10775834 DOI: 10.1111/pde.15310] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 04/25/2023]
Abstract
The 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference occurred November 3-5, 2022 in Bethesda, Maryland. This conference was the first in-person PeDRA conference after 2 years of a virtual format due to COVID-19. Fittingly, given the effects of the pandemic, the conference theme was "Reimagining Community." The conference included presentations and panel sessions on finding individual and collective purpose, leveraging community in pursuit of a shared goal, and creating a community of resources in collaboration with NIH. The goal of this meeting was to connect clinicians, basic scientists, patients, patient advocates, and industry partners. The reimagined community of pediatric dermatology research is a synergistic space for all members to better understand, prevent, treat, and cure dermatologic diseases and conditions in children. This two-and-a-half-day conference with over 300 attendees featured educational seminars including a keynote address, didactic lecture and panel sessions, skill-building workshops, 13 topic-specific breakout sessions, and an interactive poster session where 108 active and finished research projects could be discussed.
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Affiliation(s)
- Morgan Dykman
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Carrie Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Colleen Cotton
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Elena Hawryluk
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A. Yasmine Kirkorian
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Robert Silverman
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jiade Yu
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Portland, Oregon, USA
| | - Lisa Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michele L. Ramien
- Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Fernández Faith E, Shah S, Witman PM, Harfmann K, Bradley F, Blei F, Pope E, Alsumait A, Gupta D, Covelli I, Streicher JL, Cotton C, Tollefson M, Nguyen H, Hunt R, Moore-Clingenpeel M, Frieden IJ. Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma. JAMA Dermatol 2021; 157:566-572. [PMID: 33787840 DOI: 10.1001/jamadermatol.2021.0469] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Ulceration is a common complication of infantile hemangioma (IH), which leads to substantial morbidity. Ulceration in IH has not been systematically studied since the advent of β-blocker therapy for IH. Objectives To examine treatment interventions used for ulceration in IH and identify clinical prognostic indicators of healing time. Design, Setting, and Participants A retrospective, multicenter cohort study was conducted on 436 consecutive patients with a clinical diagnosis of ulcerated IH and available clinical photographs. Patients receiving care at tertiary referral centers evaluated between 2012 and 2016 were included; statistical and data analysis were performed from February 7 to April 27, 2020. Exposures Clinical characteristics, treatment interventions, course, complications, and resource use were analyzed. Treatment interventions for ulceration in IH included local (wound care, topical), systemic (β-blocker, corticosteroids), and procedural (pulsed-dye laser). Main Outcomes and Measures The primary end point was time to complete or nearly complete ulceration healing. Clinical characteristics were analyzed to determine the responses to most common interventions and prognostic factors for healing of ulceration. Results Of the 436 patients included in the study, 327 were girls (75.0%); median age at ulceration was 13.7 weeks (interquartile range, 8.86-21.30 weeks). The median heal time was 4.79 weeks (95% CI, 3.71-5.86 weeks) with wound care alone, 5.14 weeks (95% CI, 4.57-6.00 weeks) with timolol, 6.36 weeks (95% CI, 5.57-8.00 weeks) with a systemic β-blocker, and 7.71 weeks (95% CI, 6.71-10.14 weeks) with multimodal therapy. After adjusting for IH size, a dose of propranolol less than or equal to 1 mg/kg/d was associated with shorter healing time compared with higher propranolol doses (hazard ratio, 2.04; 95% CI, 1.11 to 3.73; P = .02). Size of the IH was identified as a significant prognostic factor for healing time in multivariable analysis. Increasing size of IH portends a proportionately longer time to heal of the ulceration. Conclusions and Relevance Despite the use of β-blockers, this cohort study found that a subset of patients with IH ulceration continued to experience prolonged IH healing times. Larger IH size appears to be a poor prognostic factor for time to heal. For patients requiring systemic therapy, initiation of propranolol at lower doses (≤1 mg/kg/d) should be considered.
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Affiliation(s)
- Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Sonal Shah
- Department of Dermatology, School of Medicine, University of California, San Francisco.,Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Patricia M Witman
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Katya Harfmann
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus
| | - Flora Bradley
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Francine Blei
- Department of Pediatrics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Elena Pope
- Section of Pediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Anwar Alsumait
- Section of Pediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Deepti Gupta
- Department of Dermatology, University of Washington School of Medicine, Seattle
| | - Isabela Covelli
- Department of Dermatology, University of Washington School of Medicine, Seattle
| | - Jenna L Streicher
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Dermatology, Indiana University School of Medicine, Indianapolis
| | - Colleen Cotton
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Pediatric Dermatology, Medical University of South Carolina, Charleston
| | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | | | - Ilona J Frieden
- Department of Dermatology, School of Medicine, University of California, San Francisco
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