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Brandling-Bennett HA, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies O, Siegfried EC. Executive summary: Consensus treatment guidelines for the use of methotrexate for inflammatory skin disease in pediatric patients. J Am Acad Dermatol 2024:S0190-9622(24)00310-4. [PMID: 38342248 DOI: 10.1016/j.jaad.2023.12.074] [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: 09/12/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Heather A Brandling-Bennett
- Seattle Children's Hospital, Seattle, Washington; Division of Dermatology, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yvonne E Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Leslie Castelo-Soccio
- Dermatology Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dominic O Co
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Megan L Curran
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin M Dalrymple
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Alan D Irvine
- Department of Paediatric Dermatology, Trinity College Dublin, Dublin, Ireland
| | - Susan Kim
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - A Yasmine Kirkorian
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia; Children's National Hospital, Washington, District of Columbia
| | - Irene Lara-Corrales
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa Reyes
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Rady Children's Hospital-San Diego, San Diego, California
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Ruth Ann Vleugels
- Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Lara Wine Lee
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
| | - Olivia Davies
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elaine C Siegfried
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
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2
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Chat VS, Ellebrecht CT, Kingston P, Bell S, Gondo G, Cordoro KM, Desai SR, Duffin KC, Feldman SR, Garg A, Gelfand JM, Gladman D, Green LJ, Gudjonsson J, Han G, Hawkes JE, Kircik L, Koo J, Langley R, Lebwohl M, Michael Lewitt G, Liao W, Martin G, Orbai AM, Reddy SM, Richardson V, Ritchlin CT, Schwartzman S, Siegel EL, Van Voorhees AS, Wallace EB, Weinberg JM, Winthrop KL, Yamauchi P, Armstrong AW. Vaccination Recommendations for Adults Receiving Biologics and Oral Therapies for Psoriasis and Psoriatic Arthritis: Delphi Consensus from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2024:S0190-9622(24)00243-3. [PMID: 38331098 DOI: 10.1016/j.jaad.2023.12.070] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/30/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND For psoriatic patients who need to receive non-live or live vaccines, evidence-based recommendations are needed regarding whether to pause or continue systemic therapies for psoriasis and/or psoriatic arthritis. OBJECTIVE To evaluate literature regarding vaccine efficacy and safety and to generate consensus-based recommendations for adults receiving systemic therapies for psoriasis and/or psoriatic arthritis receiving non-live or live vaccines. METHODS Using a modified Delphi process, 22 consensus statements were developed by the National Psoriasis Foundation Medical Board and COVID-19 Task Force, and infectious disease experts. RESULTS Key recommendations include continuing most oral and biologic therapies without modification for patients receiving non-live vaccines; consider interruption of methotrexate for non-live vaccines. For patients receiving live vaccines, discontinue most oral and biologic medications before and after administration of live vaccine. Specific recommendations include discontinuing most biologic therapies, except for abatacept, for 2-3 half-lives before live vaccine administration and deferring next dose 2-4 weeks after live vaccination. LIMITATIONS Studies regarding infection rates after vaccination are lacking. CONCLUSION Interruption of anti-psoriatic oral and biologic therapies is generally not necessary for patients receiving non-live vaccines. Temporary interruption of oral and biologic therapies before and after administration of live vaccines is recommended in most cases.
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Affiliation(s)
- Vipawee S Chat
- Department of Dermatology, Keck School of Medicine at USC, Los Angeles, California
| | - Christoph T Ellebrecht
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Paige Kingston
- Department of Dermatology, Keck School of Medicine at USC, Los Angeles, California
| | - Stacie Bell
- National Psoriasis Foundation, Portland, Oregon
| | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - Seemal R Desai
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas; Innovative Dermatology, Plano, Texas
| | | | - Steven R Feldman
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine, Hempstead, New York
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Dafna Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Johann Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - George Han
- Department of Dermatology, Donald and Barbara Zucker School of Medicine, Hempstead, New York
| | - Jason E Hawkes
- Department of Dermatology, University of California, Davis, Rocklin, California
| | | | - John Koo
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - Richard Langley
- Division of Clinical Dermatology & Cutaneous Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Wilson Liao
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | - George Martin
- Dr. George Martin Dermatology Associates, Kihei, Hawaii
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Soumya M Reddy
- Division of Rheumatology, NYU Grossman School of Medicine, New York, New York
| | - Veronica Richardson
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christopher T Ritchlin
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Sergio Schwartzman
- Division of Rheumatology, Weill Cornell Medical Center, New York, New York
| | - Evan L Siegel
- Department of Rheumatology, Arthritis and Rheumatism Associates, Rockville, Maryland
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Elizabeth B Wallace
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jeffrey M Weinberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kevin L Winthrop
- Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | - Paul Yamauchi
- Dermatology Institute & Skin Care Center, Santa Monica, California
| | - April W Armstrong
- Division of Dermatology, University of California Los Angeles, Los Angeles, California.
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3
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Pritchett EN, Cordoro KM, Ayers LA, Sokumbi O. Commitment to leadership development for underrepresented in medicine dermatologists. J Am Acad Dermatol 2024; 90:346-348. [PMID: 37804937 DOI: 10.1016/j.jaad.2023.10.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Ellen N Pritchett
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida.
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4
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Siegfried EC, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies OMT, Brandling-Bennett HA. Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines. Pediatr Dermatol 2023; 40:789-808. [PMID: 37316462 DOI: 10.1111/pde.15327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/19/2022] [Accepted: 03/26/2023] [Indexed: 06/16/2023]
Abstract
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off-label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off-label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence- and consensus-based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence- and consensus-based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence- and consensus-based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time-honored medication.
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Affiliation(s)
- Elaine C Siegfried
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lisa M Arkin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yvonne E Chiu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adelaide A Hebert
- UTHealth McGovern Medical School at Houston, Houston, Texas, United States
| | - Jeffrey P Callen
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Leslie Castelo-Soccio
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic O Co
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Megan L Curran
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Austin M Dalrymple
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Susan Kim
- University of California, San Francisco, California, USA
| | - A Yasmine Kirkorian
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Reyes
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Wynnis L Tom
- University of California, San Diego School of Medicine, San Diego, California, USA
- Rady Children's Hospital-San Diego, San Diego, California, USA
| | | | - Ruth Ann Vleugels
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Wine Lee
- Medical University of South Carolina, Charleston, South Carolina, USA
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5
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Eickstaedt J, Paller AS, Lund E, Murphrey M, Brandling-Bennett H, Maurano M, Fernandez Faith E, Holland KE, Ibler E, Liang MG, Todd PS, Siegfried E, Igelman S, Cordoro KM, Tollefson MM. Paradoxical Psoriasiform Eruptions in Children Receiving Tumor Necrosis Factor α Inhibitors. JAMA Dermatol 2023; 159:637-642. [PMID: 37043214 PMCID: PMC10099183 DOI: 10.1001/jamadermatol.2023.0549] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/12/2023] [Indexed: 04/13/2023]
Abstract
Importance Tumor necrosis factor α (TNF) inhibitor-induced psoriasiform eruption is well recognized in adults, but few reports document this paradoxical effect in children. Objective To characterize the clinical features and the clinical time course of TNF inhibitor-induced psoriasiform eruptions in children. Design, Setting, and Participants A multicenter retrospective case series of children younger than 18 years seen between January 1, 2000, and December 31, 2016, who developed a new-onset psoriasiform eruption while taking a TNF inhibitor for a nondermatologic disorder. Participating sites were members of the Pediatric Dermatology Research Alliance. Data were entered into a Research Electronic Data Capture database at the Mayo Clinic (ie, the coordinating center). Results Psoriasiform eruptions were identified in 103 TNF inhibitor-treated patients (median age, 13.8 years [IQR, 11.7-16.4 years]; 52 female patients [50%]; 57 White patients [55%]), with 67 patients (65%) treated with infliximab, 35 (34%) with adalimumab, and 1 (1%) with certolizumab pegol. Most patients had no personal history (101 [98%]) or family history of psoriasis (60 patients [58%]). Inflammatory bowel disease was the most common indication for treatment with TNF inhibitor (94 patients [91%]). The primary extracutaneous disease was under control in 95 patients (92%) who developed the eruption. Most patients (n = 85 [83%]) developed psoriasiform eruptions at multiple anatomic sites, with scalp involvement being most common (65 patients [63%]). Skin disease developed at a median of 14.5 months (IQR, 9-24 months) after TNF inhibitor initiation. To treat the psoriasiform eruption, topical steroidal and nonsteroidal medication was prescribed for all patients. Systemic therapy was added for 30 patients (29%): methotrexate for 24 patients (23%), oral corticosteroids for 8 patients (8%), and azathioprine for 1 patient (1%). For 26 patients (25%), suboptimal effectiveness with topical medications alone prompted discontinuation of the initial TNF inhibitor and a change to a second-line TNF inhibitor with cutaneous improvement in 23 patients (88%) by a median of 3 months (IQR, 2-4 months). Eight patients (31%) who started a second-line TNF inhibitor developed a subsequent TNF inhibitor-induced psoriasiform eruption at a median of 6 months (IQR, 4-8 months). Persistent skin disease in 18 patients (17%) prompted discontinuation of all TNF inhibitors; 11 patients changed to a non-TNF inhibitor systemic therapy, and 7 discontinued all systemic therapy. Conclusions and Relevance In this case series, paradoxical TNF inhibitor-induced psoriasiform eruptions were seen in children treated with TNF inhibitors for any indication, and there appears to be a class effect among the varying TNF inhibitors. The majority of these children were able to continue TNF inhibitor therapy with adequate skin-directed and other adjuvant therapies.
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Affiliation(s)
- Joshua Eickstaedt
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily Lund
- Department of Medicine, Section of Dermatology, University of Chicago, Chicago, Illinois
| | | | - Heather Brandling-Bennett
- Department of Pediatrics, Division of Dermatology, University of Washington School of Medicine, Seattle
| | - Megan Maurano
- Division of Dermatology, University of Washington School of Medicine, Seattle
| | - Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Ohio State University College of Medicine, Columbus
| | | | - Erin Ibler
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marilyn G. Liang
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Patricia S. Todd
- Division of Pediatric Dermatology, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Elaine Siegfried
- Division of Pediatric Dermatology, Department of Pediatrics, Saint Louis University School of Medicine, St Louis, Missouri
| | - Sean Igelman
- Wright State University School of Medicine, Dayton, Ohio
| | - Kelly M. Cordoro
- Department of Dermatology, Division of Pediatric Dermatology, University of California, San Francisco
| | - Megha M. Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Pelet del Toro N, Yahia R, Feldman SR, Van Voorhees A, Green L, Schwartzman S, Siegel E, Cordoro KM, Desai SR, Kircik L, Liao W, Hawkes JE, Weinberg J, Koo J, Wallace EB, Howard LM, Armstrong A, Han G. National Psoriasis Foundation Telemedicine Task Force Guidance for Management of Psoriatic Disease via Telemedicine. JAAD Int 2023. [DOI: 10.1016/j.jdin.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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7
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García-Romero MT, Tollefson M, Pope E, Brandling-Bennett HA, Paller AS, Keimig E, Arkin L, Wanat KA, Humphrey SR, Werth VP, Oza V, Jacobe H, Fett N, Cordoro KM, Medina-Vera I, Chiu YE. Development and Validation of the Morphea Activity Measure in Patients With Pediatric Morphea. JAMA Dermatol 2023; 159:299-307. [PMID: 36753150 PMCID: PMC9909574 DOI: 10.1001/jamadermatol.2022.6365] [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] [Received: 08/31/2022] [Accepted: 12/12/2022] [Indexed: 02/09/2023]
Abstract
Importance Morphea is an insidious inflammatory disorder of the skin and deeper tissues. Determining disease activity is challenging yet important to medical decision-making and patient outcomes. Objective To develop and validate a scoring tool, the Morphea Activity Measure (MAM), to evaluate morphea disease activity of any type or severity that is easy to use in clinical and research settings. Design, Setting, and Participants This pilot diagnostic study was conducted from September 9, 2019, to March 6, 2020, in 2 phases: development and validation. During the development phase, 14 morphea experts (dermatologists and pediatric dermatologists) used a Delphi consensus method to determine items that would be included in the MAM. The validation phase included 8 investigators who evaluated the tool in collaboration with 14 patients with pediatric morphea (recruited from a referral center [Medical College of Wisconsin]) during a 1-day in-person meeting on March 6, 2020. Main Outcomes and Measures During the development phase, online survey items were evaluated by experts in morphea using a Likert scale (score range, 0-10, with 0 indicating not important and 10 indicating very important); agreement was defined as a median score of 7.0 or higher, disagreement as a median score of 3.9 or lower, and no consensus as a median score of 4.0 to 6.9. During the validation phase, reliability (interrater and intrarater agreement using intraclass correlation coefficients), validity (using the content validity index and κ statistics as well as correlations with the modified Localized Scleroderma Severity Index and the Physician Global Assessment of Activity using Spearman ρ coefficients), and viability (using qualitative interviews of investigators who used the MAM tool) were evaluated. Descriptive statistics were used for quantitative variables. Data on race and ethnicity categories were collected but not analyzed because skin color was more relevant for the purposes of this study. Results Among 14 survey respondents during the development phase, 9 (64.3%) were pediatric dermatologists and 5 (35.7%) were dermatologists. After 2 rounds, a final tool was developed comprising 10 items that experts agreed were indicative of morphea activity (new lesion in the past 3 months, enlarging lesion in the past 3 months, linear lesion developing progressive atrophy in the past 3 months, erythema, violaceous rim or color, warmth to the touch, induration, white-yellow or waxy appearance, shiny white wrinkling, and body surface area). The validation phase was conducted with 14 patients (median age, 14.5 years [range, 8.0-18.0 years]; 8 [57.1%] female), 2 dermatologists, and 6 pediatric dermatologists. Interrater and intrarater agreement for MAM total scores was good, with intraclass correlation coefficients of 0.844 (95% CI, 0.681-0.942) for interrater agreement and 0.856 (95% CI, 0.791-0.901) for intrarater agreement. Correlations between the MAM and the modified Localized Scleroderma Severity Index (Spearman ρ = 0.747; P < .001) and the MAM and the Physician Global Assessment of Activity (Spearman ρ = 0.729; P < .001) were moderately strong. In qualitative interviews, evaluators agreed that the tool was easy to use, measured morphea disease activity at a single time point, and should be responsive to changes in morphea disease activity over multiple time points. Conclusions and Relevance In this study, the MAM was found to be a reliable, valid, and viable tool to measure pediatric morphea activity. Further testing to assess validity in adults and responsiveness to change is needed.
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Affiliation(s)
| | - Megha Tollefson
- Department of Pediatrics, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
- Department of Dermatology, Mayo Clinic and Mayo Clinic Children’s Center, Rochester, Minnesota
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Heather A. Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
- Department of Medicine, School of Medicine, University of Washington, Seattle
| | - Amy S. Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Northwestern University, Chicago, Illinois
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Lisa Arkin
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, Madison
| | - Karolyn A. Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Victoria P. Werth
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Dermatology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Vikash Oza
- Ronald O. Perelman Department of Dermatology, Grossman School of Medicine, New York University, New York
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Kelly M. Cordoro
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco
| | - Isabel Medina-Vera
- Department of Research Methodology, National Institute of Pediatrics, Mexico City
| | - Yvonne E. Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee
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8
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Affiliation(s)
- Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco
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9
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Lloyd-McLennan AM, Shimano KA, Dorsey M, Cordoro KM. Eczema and Petechiae in an Infant. Pediatr Rev 2022; 43:e19-e23. [PMID: 35773537 DOI: 10.1542/pir.2020-004900] [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: 11/24/2022]
Affiliation(s)
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California at San Francisco School of Medicine, San Francisco, CA
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10
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Ornelas J, Cordoro KM. Clinical Decisions in Pediatric Psoriasis. Dermatol Clin 2022; 40:145-166. [DOI: 10.1016/j.det.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Cordoro KM. Pediatric Dermatology Part II. Dermatol Clin 2022. [DOI: 10.1016/s0733-8635(22)00012-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cordoro KM. From Clinic to Hospital and Gold Standard to Substandard: The Complexities of Care of Pediatric Patients. Dermatol Clin 2022; 40:ix. [DOI: 10.1016/j.det.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Kohn LL, Braun M, Cordoro KM, McCalmont TH, Shah SD, Frieden IJ, Mathur AN. Skin and Mucosal Manifestations in NEMO Syndrome: A Case Series and Literature Review. Pediatr Dermatol 2022; 39:84-90. [PMID: 34989033 DOI: 10.1111/pde.14905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/12/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To characterize the skin and mucosal findings of NEMO syndrome. METHODS Retrospective review of clinical characteristics from a cohort of two families with mutations in IKBKG (the NEMO-encoding gene). A literature review identified 86 studies describing 192 patients with IKBKG mutations whose data were also included. SETTING Single center with literature review. PARTICIPANTS Patients with mutations in IKBKG from our center and reported in the literature. MAIN OUTCOMES AND MEASURES Skin and mucosal characteristics of patients with NEMO syndrome. RESULTS In addition to ectodermal dysplasia and recurrent infections, male patients had findings of ichthyosis, palmoplantar keratoderma, and inflammatory skin diseases. Both male and female patients had mucocutaneous ulcers and slow-to-heal chronic wounds. In combination with patients from the literature, 59% (85/144) of males had ectodermal dysplasia with anhidrosis (EDA) features, and 8% and 10% (12/144; 6/63) of males and females had dental findings, respectively. 4% (6/144) of males and 32% (20/63) of females had mucocutaneous ulcers. Ichthyosis/xerosis was present in 15% of males (21/144) but only 2% (1/63) females. Similarly, 13% (18/144) of male patients presented with dermatitis while this was reported in only 2% (1/63) of females. CONCLUSIONS Our results both confirm and expand upon the known spectrum of mucocutaneous findings in NEMO syndrome. Further genetic studies are needed to correlate specific mutations to clinical and morphologic subtypes.
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Affiliation(s)
- Lucinda L Kohn
- Department of Dermatology, University of Colorado, Denver, Colorado, USA.,Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Mitchell Braun
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Timothy H McCalmont
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.,Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Sonal D Shah
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.,Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Anubhav N Mathur
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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14
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Cordoro KM. Pediatric Dermatology PART I. Dermatol Clin 2022. [DOI: 10.1016/s0733-8635(21)00082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Cordoro KM. The Science, Art, and Delivery of Pediatric Dermatologic Care in the Twenty-First Century. Dermatol Clin 2021; 40:ix-x. [PMID: 34799041 DOI: 10.1016/j.det.2021.09.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kelly M Cordoro
- Division of Pediatric Dermatology, UCSF Dermatology, 1701 Divisadero Street, San Francisco, CA 94115, USA.
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16
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Freeman EE, Chamberlin GC, McMahon DE, Hruza GJ, Wall D, Meah N, Sinclair R, Balogh EA, Feldman SR, Lowes MA, Marzano AV, Naik HB, Castelo-Soccio L, Lara-Corrales I, Cordoro KM, Mahil SK, Griffiths CEM, Smith CH, Irvine AD, Spuls PI, Flohr C, French LE. Dermatology COVID-19 Registries: Updates and Future Directions. Dermatol Clin 2021; 39:575-585. [PMID: 34556247 PMCID: PMC8165090 DOI: 10.1016/j.det.2021.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
| | - Grace C Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - George J Hruza
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland; National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Nekma Meah
- St Helens & Knowsley NHS Trust, Marshalls Cross Road, St. Helens WA9 3DA, UK; Manchester University, Faculty of Biology, Medicine and Health, Oxford Road, Manchester, UK
| | - Rodney Sinclair
- Sinclair Dermatology, East Melbourne, Victoria 3002, Australia
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Irene Lara-Corrales
- Section of Pediatric Dermatology, Hospital for Sick Children, Toronto, Canada
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Satveer K Mahil
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany; Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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17
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Smith GA, Levinson AL, Galvin RT, Lalor LE, McCalmont T, Wang L, Geis MC, Odegaard K, Hupp M, Maguiness S, Turcotte LM, Cordoro KM, Hermiston ML. Concurrent Subcutaneous Panniculitis-like T-Cell Lymphoma and B-Cell Acute Lymphoblastic Leukemia in 2 Pediatric Patients. J Pediatr Hematol Oncol 2021; 43:e791-e794. [PMID: 32852399 PMCID: PMC9433225 DOI: 10.1097/mph.0000000000001921] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/25/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma is a cutaneous lymphoma characterized by CD8+ T-cell infiltrate in the subcutis that is rare in children. Acute lymphoblastic lymphoma is the most common pediatric malignancy and often presents with fevers and pancytopenia. Herein, we report 2 pediatric patients presenting with subcutaneous panniculitis-like T-cell lymphoma and B-cell acute lymphoblastic lymphoma, distinct hematologic malignancies arising from different lymphoid lineages, with no identifiable germline cancer predisposition.
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Affiliation(s)
- Geoffrey A Smith
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
| | - Anya L Levinson
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
| | | | | | | | - Linlin Wang
- Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Michael C Geis
- Department of Pathology, Sanford Health Pathology Clinic, Sioux Falls, SD
| | - Karah Odegaard
- Department of Pathology, Sanford Health Pathology Clinic, Sioux Falls, SD
| | | | | | - Lucie M Turcotte
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, MN
| | | | - Michelle L Hermiston
- Division of Hematology/Oncology, University of California San Francisco Benioff Children's Hospital
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18
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Provini LE, Omandac VT, Bahrani E, Aghdasi C, Cordoro KM. Cutaneous body image: A window into the adolescent experience of dermatologic disease. Pediatr Dermatol 2021; 38:851-858. [PMID: 34152034 DOI: 10.1111/pde.14618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/20/2020] [Revised: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Cutaneous body image (CBI) is a self-reported measure of an individual's satisfaction with their hair, skin, and nails using a psychometric survey described and validated in adult dermatology patient populations. As the CBI's clinical utility for pediatric dermatology patients has not yet been examined, we assessed the relationship between CBI scores, demographic, and clinical parameters among adolescents. METHODS Retrospective cohort of 293 patients ages 13-18 seen at the UCSF pediatric dermatology clinic from June 2017 to February 2019. An 11-question CBI survey was administered as part of routine clinical care, querying patient satisfaction with their skin, hair, and nails on a 10-point Likert-type scale, and experience with embarrassment, bullying, and mental health care. RESULTS Satisfaction with overall skin, skin of face, and hair significantly varied by patient age (P < .05), decreasing among subjects ages 13-16, and comparatively higher among patients ages 17-18. Mean total CBI scores did not significantly vary by sex, ethnicity, diagnosis, or new versus established patients. Mean total CBI scores were significantly higher among patients who did not report embarrassment (27.5) than among those who did (20.5) (P < .01), and among patients who had not experienced bullying (25.7) than among those who had (22.0) (P < .01). CONCLUSIONS Objective CBI scores among adolescents correlate with reported negative experiences of skin disease (embarrassment and bullying) and with age. The CBI provides insight into the psychosocial impact of skin disease among adolescents, validates the patient's subjective perspective of their disease, and informs patient-centered discussions and management in the pediatric dermatology clinic setting.
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Affiliation(s)
- Lauren E Provini
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Venea T Omandac
- University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Eman Bahrani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Carmel Aghdasi
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Kelly M Cordoro
- Department of Dermatology and Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
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19
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Chiu YE, Shmuylovich L, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom WL, Bond K, Ahmad RC, Garcia-Romero MT, Irfan M, Kollman K, Hunt R, Stein SL, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennett HA, Cordoro KM, Bercovitch L, Rangel SM, Liu X, Szabo A, Paller AS. Body site distribution of pediatric-onset morphea and association with extracutaneous manifestations. J Am Acad Dermatol 2021; 85:38-45. [PMID: 33689776 DOI: 10.1016/j.jaad.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The distribution of pediatric-onset morphea and site-based likelihood for extracutaneous complications has not been well characterized. OBJECTIVE To characterize the lesional distribution of pediatric-onset morphea and to determine the sites with the highest association of extracutaneous manifestations. METHODS A retrospective cross-sectional study was performed. Using clinical photographs, morphea lesions were mapped onto body diagrams using customized software. RESULTS A total of 823 patients with 2522 lesions were included. Lesions were more frequent on the superior (vs inferior) anterior aspect of the head and extensor (vs flexor) extremities. Linear morphea lesions were more likely on the head and neck, whereas plaque and generalized morphea lesions were more likely on the trunk. Musculoskeletal complications were more likely with lesions on the extensor (vs flexor) extremity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.4), whereas neurologic manifestations were more likely with lesions on the anterior (vs posterior) (OR, 2.8; 95% CI, 1.7-4.6) and superior (vs inferior) aspect of the head (OR, 2.3; 95% CI, 1.6-3.4). LIMITATIONS Retrospective nature and the inclusion of only patients with clinical photographs. CONCLUSION The distribution of pediatric-onset morphea is not random and varies with body site and within individual body sites. The risk stratification of extracutaneous manifestations by body site may inform decisions about screening for extracutaneous manifestations, although prospective studies are needed.
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Affiliation(s)
- Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Leonid Shmuylovich
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Tina Kiguradze
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Cathryn Sibbald
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Kelsie Bond
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Regina-Celeste Ahmad
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | | | - Mahwish Irfan
- Department of Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kaitlyn Kollman
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sarah L Stein
- Departments of Medicine and Pediatrics, Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Lisa Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Vivian Wong
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena Pope
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Heather A Brandling-Bennett
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephanie M Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuerong Liu
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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20
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Castelo-Soccio L, Lara-Corrales I, Paller AS, Bean E, Rangu S, Oboite M, Flohr C, Ahmad RC, Calberg V, Gilliam A, Pope E, Reynolds S, Sibbald C, Shin HT, Berger E, Schaffer J, Siegel MP, Cordoro KM. Acral Changes in pediatric patients during COVID 19 pandemic: Registry report from the COVID 19 response task force of the society of pediatric dermatology (SPD) and pediatric dermatology research alliance (PeDRA). Pediatr Dermatol 2021; 38:364-370. [PMID: 33742457 PMCID: PMC8250200 DOI: 10.1111/pde.14566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE In spring 2020, high numbers of children presented with acral pernio-like skin rashes, concurrent with the coronavirus disease 2019 (COVID-19) pandemic. Understanding their clinical characteristics/ infection status may provide prognostic information and facilitate decisions about management. METHODS A pediatric-specific dermatology registry was created by the Pediatric Dermatology COVID-19 Response Task Force of the Society for Pediatric Dermatology (SPD) and Pediatric Dermatology Research Alliance (PeDRA) and was managed by Children's Hospital of Philadelphia using REDCap. RESULTS Data from 378 children 0-18 years entered into the registry between April 13 and July 17, 2020 were analyzed. Data were drawn from a standardized questionnaire completed by clinicians which asked for demographics, description of acral lesions, symptoms before and after acral changes, COVID-19 positive contacts, treatment, duration of skin changes, laboratory testing including SARS-CoV-2 PCR and antibody testing, as well as histopathology. 229 (60.6%) were male with mean age of 13.0 years (± 3.6 years). Six (1.6%) tested positive for SARS-CoV-2. Pedal lesions (often with pruritus and/or pain) were present in 96%. 30% (114/378) had COVID-19 symptoms during the 30 days prior to presentation. Most (69%) had no other symptoms and an uneventful course with complete recovery. CONCLUSIONS AND RELEVANCE Children with acral pernio-like changes were healthy and all recovered with no short-term sequelae. We believe these acral changes are not just a temporal epiphenomenon of shelter in place during the spring months of the first wave of the COVID-19 pandemic and may be a late phase reaction that needs further study.
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Affiliation(s)
- Leslie Castelo-Soccio
- Department of Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Bean
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sneha Rangu
- Department of Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle Oboite
- Department of Pediatrics, Section of Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carsten Flohr
- St. John's Institute of Dermatology, King's College London, London, UK
| | - Regina-Celeste Ahmad
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Valerie Calberg
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amy Gilliam
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sean Reynolds
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Cathryn Sibbald
- Section of Dermatology, Division of Pediatric Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Helen T Shin
- Department of Dermatology, Pediatric Dermatology, The Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Emily Berger
- Department of Dermatology, Pediatric Dermatology, The Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Julie Schaffer
- Department of Dermatology, Pediatric Dermatology, The Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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21
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Bronckers IMGJ, Paller AS, West DP, Lara-Corrales I, Tollefson MM, Tom WL, Hogeling M, Belazarian L, Zachariae C, Mahé E, Siegfried E, Blume-Peytavi U, Szalai Z, Vleugels RA, Holland K, Murphy R, Puig L, Cordoro KM, Lambert J, Alexopoulos A, Mrowietz U, Kievit W, Seyger MMB. A Comparison of Psoriasis Severity in Pediatric Patients Treated With Methotrexate vs Biologic Agents. JAMA Dermatol 2020; 156:384-392. [PMID: 32022846 DOI: 10.1001/jamadermatol.2019.4835] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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
Importance Few studies have compared the use of methotrexate and biologics, the most commonly used systemic medications for treatment of moderate to severe psoriasis in children. Objective To assess the real-world, 6-month reduction in psoriasis severity and long-term drug survival (rate and duration of adherence to a specific drug) of methotrexate vs biologics in plaque psoriasis in children. Design, Setting, and Participants A retrospective medical records review was conducted at 20 European and North American centers. Treatment response was based on site-reported Psoriasis Area and Severity Index (PASI) and/or Physician Global Assessment (PGA) scores at baseline and within the first 6 months of treatment. Participants included all 234 consecutively seen children with moderate to severe psoriasis who received at least 3 months of methotrexate or biologics from December 1, 1990, to September 16, 2014, with sufficient data for analysis. Data analysis was performed from December 14, 2015, to September 1, 2016. Main Outcomes and Measures PASI, with a range from 0 to 72 (highest score indicating severe psoriasis), and/or PGA, with a scale of 0 (clear), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), and 5 (very severe). Results Of 234 pediatric patients (103 boys [44.0%]; 131 girls [56.0%]) treated with methotrexate and/or biologics, 163 patients (69.7%) exclusively received methotrexate, 47 patients (20.1%) exclusively received biologics, and 24 children (10.2%) received methotrexate and biologics sequentially. Of the latter cohort, 23 children were treated initially with methotrexate. Mean (SD) age at initiation was 11.6 (3.7) years for methotrexate and 13.3 (2.9) years for biologics (73.2% for etanercept) (P = .002). Among patients evaluated by a scoring method at 6-month follow-up, 75% or greater improvement in PASI (PASI75) was achieved in 12 of 30 patients (40.0%) receiving methotrexate and 20 of 28 patients (71.4%) receiving biologics, and PGA was clear/almost clear (PGA 0/1) in 41 of 115 patients (35.6%) receiving methotrexate and 18 of 37 patients (48.6%) receiving biologics. Achieving PASI75 and/or PGA 0/1 between baseline and 6 months was more likely with biologics than methotrexate (PASI75: odds ratio [OR], 4.56; 95% CI, 2.02-10.27; P < .001; and PGA 0/1: OR, 2.00; 95% CI, 0.98-4.00; P = .06). Decreased mean PASI and PGA scores were associated with biologics more than with methotrexate (PASI effect, -3.13; 95% CI, -4.33 to -1.94; P < .001; and PGA effect, -0.31; 95% CI, -0.56 to -0.06; P = .02). After 1, 3, and 5 years of use, overall drug survival rates for methotrexate were 77.5%, 50.3%, and 35.9%, and for biologics, the rates were 83.4%, 64.3%, and 57.1%, respectively. Biologics were associated with a better confounder-corrected drug survival than methotrexate (hazard ratio [HR], 2.23; 95% CI, 1.21-4.10; P = .01). Discontinuation owing to lack of response was comparable (HR, 1.64; 95% CI, 0.80-3.36; P = .18). Conclusions and Relevance Methotrexate and biologics appear to be associated with improvement in pediatric psoriasis, although biologics seem to be associated with greater reduction in psoriasis severity scores and higher drug survival rates than methotrexate in the real-world setting. Additional studies directly comparing these medications should be performed for confirmation.
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Affiliation(s)
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Irene Lara-Corrales
- Department of Pediatric Medicine, Dermatology Section, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Wynnis L Tom
- Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego.,Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego
| | - Marcia Hogeling
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona.,now with the Department of Dermatology, UCLA (University of California, Los Angeles)
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Elaine Siegfried
- Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri.,Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité- Universitätsmedizin, Berlin, Germany
| | - Zsuzsanna Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Ruth Ann Vleugels
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Ruth Murphy
- Paediatric Dermatology Department, Nottingham University Hospitals, Nottingham, England
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco Medical Center, San Francisco.,Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Alex Alexopoulos
- First Department of Pediatrics, Agia Sofia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, the Netherlands
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22
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Kittler NW, Cordoro KM. Pediatric Psoriasis Comorbidities. Skin Therapy Lett 2020; 25:1-6. [PMID: 33196156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While the association between psoriasis and various comorbidities is well documented in adults, questions remain as to whether the same relationships exist in the pediatric population. However, psoriasis develops in childhood or adolescence in approximately 40% of patients, suggesting that the risk of comorbidities may also begin early in life. This presents an opportunity for prevention, early detection and intervention for children who may suffer from, or be at risk of, comorbidities. The pediatric psoriasis Comorbidity Screening Initiative, a multidisciplinary panel, devised and published consensus-based screening recommendations for pediatric psoriasis patients in 2017. As these guidelines closely align with the routine age-related screening recommendations for healthy children set forth by the American Academy of Pediatrics, in the absence of signs and symptoms of comorbidities prompting additional evaluation, dermatologists should partner with patients' primary care physicians to ensure up-to-date, routine, and age-based screening.
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23
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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24
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Freeman EE, McMahon DE, Hruza GJ, Irvine AD, Spuls PI, Smith CH, Mahil SK, Castelo-Soccio L, Cordoro KM, Lara-Corrales I, Naik HB, Alhusayen R, Ingram JR, Feldman SR, Balogh EA, Kappelman MD, Wall D, Meah N, Sinclair R, Beylot-Barry M, Fitzgerald M, French LE, Lim HW, Griffiths CEM, Flohr C. International collaboration and rapid harmonization across dermatologic COVID-19 registries. J Am Acad Dermatol 2020; 83:e261-e266. [PMID: 32562840 PMCID: PMC7833847 DOI: 10.1016/j.jaad.2020.06.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - George J Hruza
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
| | - Catherine H Smith
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Satveer K Mahil
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Irene Lara-Corrales
- Section of Pediatric Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Raed Alhusayen
- Sunnybrook Research Institute, Dermatology Division, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology & Academic Wound Healing, Cardiff University, Cardiff, United Kingdom
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland; National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - Nekma Meah
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | - Marie Beylot-Barry
- French Society of Dermatology and Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, National Institute for Health Research, Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
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25
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Abstract
BACKGROUND/OBJECTIVES A recent marked increase in pediatric and adult patients presenting with purpuric acral lesions concerning for ischemia, thrombosis and necrosis has been observed in COVID-19 prevalent regions worldwide. The clinical and histopathological features and relationship to COVID-19 have not been well described. The objective of this case series is to describe the clinical features and determine the histopathologic findings and clinical implications of the clusters of acral perniosis cases identified in pediatric patients. METHODS We describe six otherwise healthy adolescents-three siblings per family from two unrelated families-presented within a 48-hour period in April, 2020, with acral perniosis-like lesions in the context of over 30 similar patients who were evaluated within the same week. RESULTS Affected patients had mild symptoms of viral upper respiratory infection (URI) or contact with symptomatic persons 1-2 weeks preceding the rash. They all presented with red to violaceous macules and dusky, purpuric plaques scattered on the mid and distal aspects of the toes. Skin biopsies performed on each of the six patients demonstrated near identical histopathologic findings to those of idiopathic perniosis, with a lymphocytic inflammatory infiltrate without evidence of thromboembolism or immune complex vasculitis. While SARS-CoV-2 polymerase chain reaction was negative, testing was performed 1-2 weeks after URI symptoms or sick contact exposure. CONCLUSION We offer a clinical approach to evaluation of patients with this presentation and discuss the possibility that these skin findings represent a convalescent-phase cutaneous reaction to SARS-CoV-2 infection.
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Affiliation(s)
- Kelly M Cordoro
- Department of Dermatology and Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Sean D Reynolds
- Department of Dermatology and Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Rachel Wattier
- Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
| | - Timothy H McCalmont
- Department of Dermatology and Pathology, University of California San Francisco, San Francisco, CA, USA
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26
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Reynolds SD, Mathur AN, Chiu YE, Brandling-Bennett HA, Pope E, Siegel MP, Holland KE, Paller AS, Siegfried EC, Tom WL, Lara-Corrales I, Tollefson MM, Maguiness S, Eichenfield LF, Sugarman J, Frieden IJ, Oza VS, Cipriano SD, Huang JT, Shah SD, Lauren CT, Castelo-Soccio L, McMahon P, Cordoro KM. Systemic immunosuppressive therapy for inflammatory skin diseases in children: Expert consensus-based guidance for clinical decision-making during the COVID-19 pandemic. Pediatr Dermatol 2020; 37:424-434. [PMID: 32320494 DOI: 10.1111/pde.14202] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES The COVID-19 pandemic has raised questions about the approach to management of systemic immunosuppressive therapies for dermatologic indications in children. Change to: Given the absence of data to address concerns related to SARS-CoV-2 infection and systemic immunosuppressive therapies in an evidence-based manner, a Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to offer time-sensitive guidance for clinicians. METHODS A survey was distributed to an expert panel of 37 pediatric dermatologists on the PDCRTF to assess expert opinion and current practice related to three primary domains of systemic therapy: initiation, continuation, and laboratory monitoring. RESULTS Nearly all respondents (97%) reported that the COVID-19 pandemic had impacted their decision to initiate immunosuppressive medications. The majority of pediatric dermatologists (87%) reported that they were pausing or reducing the frequency of laboratory monitoring for certain immunosuppressive medications. In asymptomatic patients, continuing therapy was the most popular choice across all medications queried. The majority agreed that patients on immunosuppressive medications who have a household exposure to COVID-19 or test positive for new infection should temporarily discontinue systemic and biologic medications, with the exception of systemic steroids, which may require tapering. CONCLUSIONS The ultimate decision regarding initiation, continuation, and laboratory monitoring of immunosuppressive therapy during the pandemic requires careful deliberation, consideration of the little evidence available, and discussion with families. Consideration of an individual's adherence to COVID-19 preventive measures, risk of exposure, and the potential severity if infected must be weighed against the dermatological disease, medication, and risks to the patient of tapering or discontinuing therapies.
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Affiliation(s)
- Sean D Reynolds
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Anubhav N Mathur
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather A Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael P Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana, USA
| | - Kristen E Holland
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | | | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Jeffrey Sugarman
- 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
| | - Vikash S Oza
- Ronald O Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah D Cipriano
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer T Huang
- Dermatology Program, Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonal D Shah
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Christine T Lauren
- Departments of Dermatology and Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Patrick McMahon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
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27
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Affiliation(s)
- Olivia Twu
- Department of Dermatology, Division of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | - Thaddeus Mully
- Department of Dermatology and Pathology, University of California San Francisco, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, Division of Pediatric Dermatology, University of California San Francisco, San Francisco, California
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28
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Menter A, Gelfand JM, Connor C, Armstrong AW, Cordoro KM, Davis DMR, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Prater EF, Rahimi RS, Rupani RN, Siegel M, Stoff B, Strober BE, Tapper EB, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies. J Am Acad Dermatol 2020; 82:1445-1486. [PMID: 32119894 DOI: 10.1016/j.jaad.2020.02.044] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).
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Affiliation(s)
| | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Diego, California
| | | | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- Central Connecticut Dermatology, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Elliot B Tapper
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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29
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Menter A, Cordoro KM, Davis DM, Kroshinsky D, Paller AS, Armstrong AW, Connor C, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol 2020; 82:161-201. [DOI: 10.1016/j.jaad.2019.08.049] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/29/2022]
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30
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Ford AR, Siegel M, Bagel J, Cordoro KM, Garg A, Gottlieb A, Green LJ, Gudjonsson JE, Koo J, Lebwohl M, Liao W, Mandelin AM, Markenson JA, Mehta N, Merola JF, Prussick R, Ryan C, Schwartzman S, Siegel EL, Van Voorhees AS, Wu JJ, Armstrong AW. Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. JAMA Dermatol 2019; 154:934-950. [PMID: 29926091 DOI: 10.1001/jamadermatol.2018.1412] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases. Objective To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation. Evidence Review We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of patients with psoriasis or psoriatic arthritis. The quality of included studies was assessed using the Newcastle-Ottawa scale for observational studies and the Cochrane Risk of Bias Tool for interventional studies. We made evidence-based dietary recommendations, which were voted on by the National Psoriasis Foundation Medical Board. Findings We identified 55 studies meeting the inclusion criteria for this review. These studies represent 77 557 unique participants of which 4534 have psoriasis. Based on the literature, we strongly recommend dietary weight reduction with a hypocaloric diet in overweight and obese patients with psoriasis. We weakly recommend a gluten-free diet only in patients who test positive for serologic markers of gluten sensitivity. Based on low-quality data, select foods, nutrients, and dietary patterns may affect psoriasis. For patients with psoriatic arthritis, we weakly recommend vitamin D supplementation and dietary weight reduction with a hypocaloric diet in overweight and obese patients. Dietary interventions should always be used in conjunction with standard medical therapies for psoriasis and psoriatic arthritis. Conclusions and Relevance Adults with psoriasis and/or psoriatic arthritis can supplement their standard medical therapies with dietary interventions to reduce disease severity. These dietary recommendations from the National Psoriasis Foundation Medical Board will help guide clinicians regarding the utility of dietary interventions in adults with psoriatic diseases.
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Affiliation(s)
- Adam R Ford
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco.,Department of Pediatrics, University of California San Francisco
| | - Amit Garg
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Alice Gottlieb
- New York Medical College at Metropolitan Hospital, New York.,Hudson Dermatology, Somers, New York
| | - Lawrence J Green
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | - John Koo
- Department of Dermatology, University of California San Francisco
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco
| | - Arthur M Mandelin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph A Markenson
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York
| | - Nehal Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joseph F Merola
- Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Ronald Prussick
- Department of Dermatology, George Washington University School of Medicine, Washington, DC
| | | | - Sergio Schwartzman
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York
| | - Evan L Siegel
- Arthritis and Rheumatism Associates, PC, Rockville, Maryland.,Georgetown University School of Medicine, Washington, DC
| | | | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles
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31
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Elmets CA, Lim HW, Stoff B, Connor C, Cordoro KM, Lebwohl M, Armstrong AW, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kivelevitch D, Korman NJ, Kroshinsky D, Leonardi CL, Lichten J, Mehta NN, Paller AS, Parra SL, Pathy AL, Farley Prater EA, Rupani RN, Siegel M, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol 2019; 81:775-804. [PMID: 31351884 DOI: 10.1016/j.jaad.2019.04.042] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/12/2023]
Abstract
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
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Affiliation(s)
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | | | | | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probidity Medical Research, Waterloo, Ontario, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kavanaugh A, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Rupani RN, Siegel M, Wong EB, Wu JJ, Hariharan V, Elmets CA. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol 2019; 80:1029-1072. [PMID: 30772098 DOI: 10.1016/j.jaad.2018.11.057] [Citation(s) in RCA: 432] [Impact Index Per Article: 86.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
Psoriasis is a chronic, inflammatory multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations based on the available evidence. The treatment of psoriasis with biologic agents will be reviewed, emphasizing treatment recommendations and the role of the dermatologist in monitoring and educating patients regarding benefits as well as associated risks.
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Affiliation(s)
| | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Ontario, Canada
| | | | | | | | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, Department of Dermatology, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York
| | | | | | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, Armstrong AW, Connor C, Cordoro KM, Elewski BE, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kivelevitch D, Kiselica M, Korman NJ, Kroshinsky D, Lebwohl M, Lim HW, Paller AS, Parra SL, Pathy AL, Prater EF, Rupani R, Siegel M, Stoff B, Strober BE, Wong EB, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol 2019; 80:1073-1113. [PMID: 30772097 DOI: 10.1016/j.jaad.2018.11.058] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [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: 11/07/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/08/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the US population. This guideline addresses important clinical questions that arise in psoriasis management and care, providing recommendations on the basis of available evidence.
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Affiliation(s)
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Nehal N Mehta
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of MedicineSan Francisco, California
| | | | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | | | | | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | | | - Reena Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Bruce E Strober
- University of Connecticut, Farmington, Connecticut; Probity Medical Research, Waterloo, Canada
| | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Siegfried EC, Igelman S, Jaworski JC, Antaya RJ, Cordoro KM, Eichenfield LF, Levy ML, Paller AS. Use of dupilumab in pediatric atopic dermatitis: Access, dosing, and implications for managing severe atopic dermatitis. Pediatr Dermatol 2019; 36:172-176. [PMID: 30675938 DOI: 10.1111/pde.13707] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Elaine C Siegfried
- Saint Louis University, Saint Louis, Missouri.,Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | | | | | | | - Kelly M Cordoro
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Lawrence F Eichenfield
- Rady Children's Hospital, San Diego and University of California San Diego, School of Medicine, San Diego, California
| | - Moise L Levy
- Dell Children's Medical Center of Central Texas and Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Amy S Paller
- Feinberg School of Medicine, Northwestern University and Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
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35
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Yan D, Afifi L, Jeon C, Cordoro KM, Liao W. A cross-sectional study of the distribution of psoriasis subtypes in different ethno-racial groups. Dermatol Online J 2018; 24:13030/qt5z21q4k2. [PMID: 30261563] [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] [Received: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023] Open
Abstract
Skin of colored patients with psoriasis are more likely to remain undiagnosed and experience a greater impact on quality of life than their white counterparts. A better understanding of the ethno-racial differences in the presentation of psoriasis can help address these disparities. To compare the prevalence of psoriatic subtypes (plaque, guttate, pustular, erythrodermic, palmoplantar, and inverse) and lesion locations in Caucasian, Asian, and Hispanic/Latino patients, we analyzed cross-sectional, patient-reported, physician-reviewed survey data from 882 adult and 16 pediatric psoriasis patients seen at the University of California, San Francisco Department of Dermatology between 2006 and 2016. Multivariate logistic regression was used to compare the prevalence of psoriasis subtypes and lesional distributions amongst the ethno-racial groups. Asians and Hispanics/Latinos had higher odds of having pustular psoriasis compared to Caucasians (OR=4.36 [95%CI: 1.24-17.62], P=0.026; and OR=5.94 [95%CI: 1.03-31.03], P=0.036, respectively). Asians also had a higher frequency of erythrodermic psoriasis (OR=5.56 [95%CI: 1.41-27.17], P=0.018), but a lower frequency of inverse psoriasis compared to Caucasians (OR=0.26 [95%CI: 0.06-0.80], P=0.036). These differences may relate to genetic or environmental factors or access to care. Clinician awareness of ethno-racial differences in psoriasis subtype and lesion location can facilitate earlier diagnosis and therapeutic intervention.
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Affiliation(s)
- Di Yan
- Department of Dermatology, University of California-San Francisco, San Francisco, California
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Abstract
Tularemia is a rare and potentially life-threatening infection caused by the highly infectious gram-negative coccobacillus Francisella tularensis. We present the case of an 11-year old girl who presented with erythema multiforme minor in the setting of an indolent but progressive soft tissue infection and was found to have tularemia. We review the role of dermatologists in identifying the features of and complications associated with this rare zoonosis and discuss the potential effect of climate change on its incidence.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Benjamin Briggs
- Department of Pediatric Infectious Diseases, University of California, San Francisco, CA, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
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Abstract
We present cases of localized alopecia on the vertex scalp of two girls after elaborate professional hairstyling marketed as the "Princess Package" at a major U.S. theme park. Localized alopecia followed pain, erythema, and delayed crusting due to necrosis of the scalp. The majority of the affected alopecic areas had evidence of regrowth at interval follow-up, but small areas of scarring alopecia remained. We propose that these cases represent a type of alopecia caused by a combination of pressure ischemia and acute traction alopecia.
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Affiliation(s)
- Bree Zimmerman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Marta Ivars
- Departamento de Dermatología, Clínica, Universidad de Navarra, Pamplona, Spain
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
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38
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Eichenfield LF, Paller AS, Tom WL, Sugarman J, Hebert AA, Friedlander SF, Siegfried E, Silverberg N, Cordoro KM. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol 2018; 35:170-181. [PMID: 29314219 DOI: 10.1111/pde.13382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Adelaide A Hebert
- Pediatric Dermatology, McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Department of Dermatology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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Craiglow BG, Boyden LM, Hu R, Virtanen M, Su J, Rodriguez G, McCarthy C, Luna P, Larralde M, Humphrey S, Holland KE, Hogeling M, Hidalgo-Matlock B, Ferrari B, Fernandez-Faith E, Drolet B, Cordoro KM, Bowcock AM, Antaya RJ, Ashack K, Ashack RJ, Lifton RP, Milstone LM, Paller AS, Choate KA. CARD14-associated papulosquamous eruption: A spectrum including features of psoriasis and pityriasis rubra pilaris. J Am Acad Dermatol 2018; 79:487-494. [PMID: 29477734 PMCID: PMC6098739 DOI: 10.1016/j.jaad.2018.02.034] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 11/20/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heterozygous mutations in caspase recruitment domain family member 14 gene (CARD14) have been shown to be associated with psoriasis and familial pityriasis rubra pilaris (PRP). Many subjects with CARD14 mutations display features of both disorders, which can result in diagnostic uncertainty. In addition, these eruptions are often recalcitrant to conventional psoriasis therapies such as methotrexate, oral retinoids, and tumor necrosis factor-α inhibitors. OBJECTIVE We sought to describe the clinical characteristics, family history, and response to therapy in subjects with papulosquamous eruptions due to mutations in CARD14. METHODS Subjects were referred for genetic testing as part of a registry of subjects with inherited disorders of keratinization. DNA was isolated from blood or saliva, and multiplex targeted sequencing or whole exome sequencing was performed. Clinical histories of subjects with CARD14 mutations were reviewed. RESULTS We identified 15 kindreds with CARD14-associated papulosquamous eruption (CAPE). Characteristic features of CAPE include early age of onset; prominent involvement of the cheeks, chin, and ears; family history of psoriasis or PRP; minimal response to conventional topical and systemic psoriasis therapies; and improvement with ustekinumab. LIMITATIONS Relatively small sample size. CONCLUSIONS Many subjects with CARD14 mutations display characteristics of both psoriasis and PRP. We propose the term CARD14-associated papulosquamous eruption to describe this spectrum of disease. Subjects with clinical features suggestive of CAPE should undergo CARD14 sequencing and may benefit from treatment with ustekinumab.
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Affiliation(s)
- Brittany G Craiglow
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Lynn M Boyden
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Ronghua Hu
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Marie Virtanen
- Department of Dermatology, Uppsala University Hospital, Uppsala, Sweden
| | - John Su
- Department of Dermatology, Monash University, Eastern Health, Melbourne, Australia; Department of Pediatrics, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Gabriela Rodriguez
- Department of Dermatology, University of Costa Rica, San Jose, Costa Rica
| | - Catherine McCarthy
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Paula Luna
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Margarita Larralde
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Stephen Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kristen E Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marcia Hogeling
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California
| | | | - Bruno Ferrari
- Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Esteban Fernandez-Faith
- Department of Pediatrics and Dermatology, The Ohio State University Medical Center, Columbus, Ohio; Department of Pediatrics and Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Beth Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California
| | - Anne M Bowcock
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genome Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard J Antaya
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Kurt Ashack
- Department of Dermatology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | | | - Richard P Lifton
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Leonard M Milstone
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Keith A Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Department of Genetics, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Yale University School of Medicine, New Haven, Connecticut.
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Walsh R, North J, Cordoro KM, Rodríguez Bandera AI, Kristal L, Frieden IJ. Midline anterior neck inclusion cyst: A novel superficial congenital developmental anomaly of the neck. Pediatr Dermatol 2018; 35:55-58. [PMID: 29266365 DOI: 10.1111/pde.13371] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES A variety of congenital developmental anomalies arise on the neck because of the many fusion planes and complex embryologic structures in this region. We describe a series of seven patients with a novel type of superficial midline congenital anomaly. METHODS Retrospective case series. Clinical and histopathologic features were compared and used to describe this entity. RESULTS Seven patients with nearly identical clinical findings were identified. In all cases, a small superficial cyst resembling a giant milium was observed at birth. There were no significant changes during infancy and no evidence of underlying abnormalities. The histopathologic findings were identical to those of an infundibular follicular cyst. CONCLUSION We have termed this entity midline anterior neck inclusion cyst. We believe it is a superficial developmental anomaly, probably a forme fruste of a midline fusion developmental defect, which has not to our knowledge, previously been described.
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Affiliation(s)
- Rabina Walsh
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey North
- Department of Dermatopathology, University of California, San Francisco, San Francisco, CA, USA
| | - Kelly M Cordoro
- Division of Pediatric Dermatology, Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Leonard Kristal
- Department of Dermatology, Stony Brook University, Stony Brook, NY, USA
| | - Ilona J Frieden
- Division of Pediatric Dermatology, Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
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41
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Yan D, Afifi L, Jeon C, Cordoro KM, Liao W. A cross-sectional study of the distribution of psoriasis subtypes in different ethno-racial groups. Dermatol Online J 2018. [DOI: 10.5070/d3247040909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Cordoro KM, Hitraya-Low M, Taravati K, Sandoval PM, Kim E, Sugarman J, Pauli ML, Liao W, Rosenblum MD. Skin-infiltrating, interleukin-22-producing T cells differentiate pediatric psoriasis from adult psoriasis. J Am Acad Dermatol 2017; 77:417-424. [PMID: 28624119 PMCID: PMC9206409 DOI: 10.1016/j.jaad.2017.05.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence from adult psoriasis studies implicates an imbalance between regulatory and effector T cells, particularly TH-17-producing T cells, in the pathogenesis of psoriasis. Little is known about the immunopathology of psoriasis in children. OBJECTIVE We sought to functionally characterize the inflammatory cell profiles of psoriatic plaques from pediatric patients and compare them with healthy, age-matched controls and adult psoriasis patients. METHODS Skin samples from pediatric psoriasis patients and healthy controls were analyzed by multiparameter flow cytometry to determine the dominant immune cell subsets present and cytokines produced. RESULTS Lesional tissue from pediatric psoriasis patients had significantly increased interleukin (IL) 22 derived from CD4+ and CD8+ cells compared with the tissues from healthy pediatric controls and adult psoriasis patients. Tissue from pediatric psoriasis patients had significantly less elevation of IL-17 derived from CD4+ and CD8+ cells compared with the tissue from adult psoriasis patients. In contrast with the lesions from adult patients, lesional skin in pediatric patients with psoriasis did not have increases in regulatory T cells. LIMITATIONS This is a pilot study, thus the sample size is small. CONCLUSION Significant differences in IL-17 and IL-22 expression were observed in the pediatric psoriasis patients compared with pediatric healthy controls and adult psoriasis patients. IL-22 might be relevant in the pathogenesis of pediatric psoriasis and represents a potential treatment target unique to pediatric psoriasis.
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Affiliation(s)
- Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California.
| | - Maria Hitraya-Low
- San Francisco School of Medicine, University of California, San Francisco, California
| | - Keyon Taravati
- Department of Dermatology, University of California, San Francisco, California
| | | | - Esther Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, San Francisco, California
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, California
| | - Mariela L Pauli
- Department of Dermatology, University of California, San Francisco, California
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, California
| | - Michael D Rosenblum
- Department of Dermatology, University of California, San Francisco, California
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Yuan JT, Zimmerman B, Cordoro KM. Pediatric Dermatology Photoquiz: A 14-Year-Old Boy with Abrupt-Onset Hair Changes. Pediatr Dermatol 2017; 34:617-618. [PMID: 28884906 DOI: 10.1111/pde.13243] [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: 11/28/2022]
Affiliation(s)
- Joyce T Yuan
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Bree Zimmerman
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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Osier E, Wang AS, Tollefson MM, Cordoro KM, Daniels SR, Eichenfield A, Gelfand JM, Gottlieb AB, Kimball AB, Lebwohl M, Mehta NN, Paller AS, Schwimmer JB, Styne DM, Van Voorhees AS, Tom WL, Eichenfield LF. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol 2017; 153:698-704. [PMID: 28514463 DOI: 10.1001/jamadermatol.2017.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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
Importance Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health. Objective To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. Evidence Review A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence. Findings Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation. Conclusions and Relevance Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.
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Affiliation(s)
- Emily Osier
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | - Audrey S Wang
- Division of Dermatology, Sharp Rees-Stealy Medical Group, San Diego, California
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Kelly M Cordoro
- Division of Pediatric Dermatology, Department of Dermatology, University of California San Francisco, San Francisco
| | - Stephen R Daniels
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Andrew Eichenfield
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Mark Lebwohl
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Nehal N Mehta
- Division of Intramural Research, Section of Inflammation and Cardiometabolic Diseases, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego
| | - Dennis M Styne
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
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45
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Theiler M, Oza VS, Mathes EF, Dvorak CC, McCalmont TH, Yeh I, Sidbury R, Cordoro KM. Eosinophilic Pustular Folliculitis in Children after Stem Cell Transplantation: An Eruption Distinct from Graft-Versus-Host Disease. Pediatr Dermatol 2017; 34:326-330. [PMID: 28317161 DOI: 10.1111/pde.13108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/29/2022]
Abstract
Eosinophilic pustular folliculitis (EPF) is a rare cutaneous disorder that typically occurs in three clinical contexts: men, individuals who are immunosuppressed or have human immunodeficiency virus, and infants. A fourth subtype occurring 2 to 3 months after hematopoietic stem cell transplantation (HSCT) has recently been described in several adults. We report two cases of EPF arising in children after HSCT. It is important to recognize this form of EPF after HSCT and differentiate it from graft-versus-host disease since it responds readily to topical steroids and appears to have an excellent prognosis.
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Affiliation(s)
- Martin Theiler
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Vikash S Oza
- Ronald O. Perelman Department of Dermatology, School of Medicine, New York University, New York, New York
| | - Erin F Mathes
- Department of Pediatrics, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
| | | | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California.,Department of Pathology, University of California, San Francisco, California
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, California.,Department of Pathology, University of California, San Francisco, California
| | - Robert Sidbury
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington
| | - Kelly M Cordoro
- Department of Pediatrics, University of California, San Francisco, California.,Department of Dermatology, University of California, San Francisco, California
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46
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Cordoro KM, Ucmak D, Hitraya-Low M, Rosenblum MD, Liao W. Response to Interleukin (IL)-17 Inhibition in an Adolescent With Severe Manifestations of IL-36 Receptor Antagonist Deficiency (DITRA). JAMA Dermatol 2017; 153:106-108. [DOI: 10.1001/jamadermatol.2016.3490] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kelly M. Cordoro
- Department of Dermatology, University of California–San Francisco School of Medicine, San Francisco
| | - Derya Ucmak
- Department of Dermatology, University of California–San Francisco School of Medicine, San Francisco
| | - Maria Hitraya-Low
- Department of Dermatology, University of California–San Francisco School of Medicine, San Francisco
| | - Michael D. Rosenblum
- Department of Dermatology, University of California–San Francisco School of Medicine, San Francisco
| | - Wilson Liao
- Department of Dermatology, University of California–San Francisco School of Medicine, San Francisco
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47
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Affiliation(s)
- Maria Hitraya-Low
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Regina-Celeste Ahmad
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, School of Medicine, University of California, San Francisco, San Francisco, California
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48
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Abstract
We present two cases of Netherton syndrome mimicking pustular psoriasis and discuss potential pathomechanisms of clinical and histologic similarities between Netherton syndrome and pustular psoriasis and implications for management.
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Affiliation(s)
- Alison M Small
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Pediatrics, University of California, San Francisco, San Francisco, California
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49
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Abstract
Atopic dermatitis (AD) and acne vulgaris are among the most-prevalent skin diseases in children. Both have been well documented in the literature to have significant negative effects on quality of life. Herein, we discuss the results of a comprehensive literature review aimed at assessing the impact of acne and AD on self-esteem and identity. We highlight clinical tools for their assessment and offer coping strategies for patients and families. Multiple factors including relationships with parents and classmates, sports participation, and the sex of the patient contribute to the development of self-esteem and identity in individuals with AD and acne. Atopic dermatitis was found to have significant behavioral effects on children, ultimately resulting in a lack of opportunity to develop proper coping. AD had a more-prominent role in identity formation and gender roles in girls. Acne vulgaris was found to have a more direct effect on self-esteem, self-confidence and identity, especially in girls. The Cutaneous Body Image Scale is reviewed and offered as an easy and reliable tool to evaluate a patient's mental perception of the appearance of their skin. Coping strategies that may be offered to patients and families include empowerment and cognitive adaptation.
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Affiliation(s)
- Catherine M Nguyen
- School of Medicine, University of California, Irvine, Irvine, California
| | - John Koo
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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50
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Affiliation(s)
- Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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