Quality of life in neurofibromatosis 1: development and validation of a tool dedicated to cutaneous neurofibromas in adults

BACKGROUND

Cutaneous neurofibromas (cNF), present in 95% of individuals with neurofibromatosis 1 (NF1), are considered as one of the greatest medical burden because of physical disfigurement. No specific score evaluates their impact on quality of life (QoL).

OBJECTIVE

To develop a specific score assessing cNF-related QoL.

METHODS

Through a multidisciplinary workshop including 10 patients, 3 expert-in-NF1 physicians, 3 health care workers (nurses and psychologist) and 1 methodologist, the French version of the Skindex-16 was modified by adding 3 items. The new cNF-Skindex was validated among patients with NF1 recruited in the ComPaRe online cohort, in France (N=284). Construct validity was assessed by comparing it with the EQ-5D-5L, its visual analog scale and the MYMOP2 and by assessing its association with patients' characteristics. Reliability was assessed by a test-retest. An English version of the tool was developed using a back forward translation.

RESULTS

A total of 228 individuals with NF1, with cNF answered the 19-item questionnaire. These items fitted into 3 domains: emotions, symptoms, functioning. One was dropped during analysis because >90% responders were not concerned. The cNF-Skindex significantly correlated with the EQ-5D-5L (N=193) and MYMOP2 (N=210) indicating good external validity: rs 0.38 (p<0.001), and 0.58 (p<0.001) respectively. Having >50 cNF was the only independent variable associated with the total score cNF-Skindex (β=15.88, 95%CI 6.96 - 24.81, p=0.001), and with the 3 sub-scores: "functioning" (β=2.65, 95%CI 0.71 - 4.59, p=0.008), "emotions" (β=17.03, 95%CI 4.11 - 29.96, p=0.010) and "symptoms" (β=3.90, 95%CI 1.95 - 5.85, p<0.001). Test-retest reliability (N=133) found an ICC at 0.96 demonstrating good reproducibility.

CONCLUSION

The cNF-Skindex demonstrated excellent psychometric properties. The global and sub-scores were increased with higher number of cNF arguing for its use in further trials aiming to reduce their number or prevent their development. Cross-cultural validation and evaluation of its responsiveness are the next steps.

Skin manifestations of COVID-19 in children: Part 2

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults, as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discussed one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions. In this part of the review, we describe other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In Part 3, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.

Acute acral eruptions in children during the COVID-19 pandemic: Characteristics of 103 children and their family clusters

Background

A marked increase in frequency of acute acral eruptions (AAE) was observed in children during the COVID-19 pandemic in the spring period.

Objectives

In this observational multicenter study, based on children with AAE, we aimed to assess the proportion of household members possibly infected by SARS-CoV-2.

Methods

We collected data from all children observed with AAE, prospectively from April 7, 2020 to June 22, 2020, and retrospectively since February 28, 2020. The primary outcome was the household infection rate, defined as the proportion of family clusters having at least one member with COVID-19 infection other than the child with AAE (“index child”). The definition of a case was based on characteristic clinical signs and a positive PCR or serology.

Results

The study included 103 children in 10 French departments and in Quebec. The median age was 13 years and the interquartile range [8–15], with a female-to-male ratio of 1/1.15. In children with AAE, all PCR tests were negative (n = 18), and serology was positive in 2/14 (14.3%) cases. We found no significant anomalies in the lab results. A total of 66 of the 103 families (64.1%) of included children had at least one other infected member apart from the index child. The total number of household members was 292, of whom 119 (40.8%) were considered possibly infected by SARS-CoV-2. No index children or households exhibited severe COVID-19.

Discussion

Among the 103 households included, 64.1% had at least one infected member. Neither children with AAE nor their households showed severe COVID-19.

Pseudo-engelures de l’enfant et SARS-CoV-2 : quel lien ?

Introduction

L’augmentation des manifestations cutanées acrales pendant l’épidémie de SARS-CoV-2 interroge. Notre objectif était d’analyser un éventuel lien au travers de 3 tests biologiques diagnostiques SARS-CoV-2.

Matériel et méthodes

Du 08/04 au 03/06/2020 ont été inclus les enfants adressés en consultation de dermatologie pédiatrique pour des manifestations cutanées aiguës, inhabituelles chez le patient, et associées à des symptômes évocateurs de COVID-19 : signes systémiques chez l’enfant et/ou chez un parent au 1^er degré, pendant le pic épidémique de SARS-CoV-2.

Résultats

Trente patients et 37 apparentés symptomatiques au 1^er degré étaient inclus. Dix-sept patients présentaient des lésions de pseudo-engelures, survenant après des manifestations systémiques (60 %, délai moyen : 22 j). Une rémission complète était notée chez 11/17 patients dans les 10 à 50 jours. Les autres manifestations cutanées observées étaient des lésions à type de : urticaire parfois linéaire, exanthème maculo-papuleux (EMP), livédo. Parmi les 37 apparentés, des manifestations cutanées étaient observées au cours de la même période : pseudo-engelures (n = 3 ; 37 %), EMP (n = 3 ; 37 %), urticaires (n = 3 ; 37 %). Un syndrome inflammatoire était présent chez 11/30 enfants (37 %) dont 8/17 avec pseudo-engelures (47 %) : élévation de CRP et/ou élévation des concentrations de cytokines inflammatoires. Parmi les 17 patients avec pseudo-engelures, 8 avaient des concentrations sériques d’IL-1, IL-6, TNF-α ou IFN de type 1 augmentées, et ce parfois plusieurs semaines après les manifestations systémiques. Les 3 PCR nasales réalisées chez les patients symptomatiques (fièvre ou toux) étaient négatives. Parmi les 16/17 patients avec pseudo-engelures prélevés, un seul avait une sérologie SARS-CoV-2 positive (IgG, technique Abbott ARCHITECT®). Des explorations immunologiques complémentaires témoignant d’un contact direct avec le virus (dont ELISPOT®) sont en cours de vérification de résultats.

Discussion

Tous les patients, sauf un, avaient des tests négatifs pour le SARS-CoV-2. L’élévation persistante d’IL-1 et de la CRP pourrait refléter une réaction immunologique post-virale intense. Malgré l’absence de détection du SARS-CoV-2, les données épidémiologiques, les manifestations cliniques évocatrices et l’élévation des cytokines chez nos patients suggèrent un lien entre ce virus et les manifestations cutanées motivant la poursuite des explorations immunologiques.

Skin manifestations of COVID-19 in children: Part 3

The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID‐19, chilblain‐like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children for both COVID‐19 and any other pre‐existing conditions.

Click here for the corresponding questions to this CME article.

Skin manifestations of COVID-19 in children: Part 1

The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestation of COVID‐19, chilblain‐like lesions. In Part 2, we review other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome, while in Part 3, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children, for both COVID‐19 and any other pre‐existing conditions.

Click here for the corresponding questions to this CME article.

Efficacy and satisfaction of surgical treatment for hidradenitis suppurativa

BACKGROUND

Surgery is a radical treatment for hidradenitis suppurativa (HS) and may be considered as the only one potentially curative.

OBJECTIVES

To characterize HS recurrence in patients after surgery and assess the risk factors of recurrence.

METHODS

We conducted a monocentric retrospective cohort study. All consecutive patients who had surgery (January 1, 2012 to March 31, 2017) were included. We estimated the rate of recurrence of HS lesions after surgery (<1 cm from the scar), and recurrence-associated factors were analysed by univariate then multivariate logistic regression, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 75 patients [median age 31.4 years (range 16-71); 36 females], corresponding to 115 interventions were included. The Hurley score at surgery was III for 70 (60%) patients. In total, 61/115 (53%) interventions involved wide excision and 50 (43%) limited local excision. The localizations were axillary folds (n = 46; 40%), buttocks (n = 15, 13%), genital area (n = 13; 11%), perineal area (n = 12; 10%) and inguinal folds (n = 18; 16%). We observed 11 (10%) complications and 40 (35%) recurrences. On multivariate analysis, probability of recurrence was associated with only one-stage surgical closure [OR 3.2 (95% CI 1.4-7.3), P = 0.005]. Overall, 44 (52%) patients were completely satisfied and 22 (26%) partially satisfied, and most (81%) considered the surgery the best treatment.

CONCLUSIONS

Hidradenitis suppurativa recurrence in our study was 35% and associated with one-stage surgical closures, but two-thirds of patients were satisfied with surgical treatment and would recommend surgery.

Vulvar vestibulitis syndrome

Vulvar Vestibulitis Syndrome (VVS) is a condition characterized by dyspareunia, introital erythema, and tenderness. A subset of vulvodynia, VVS may be acute or chronic. If acute, a specific underlying cause is often identified, and when properly treated the condition is likely to fully resolve. In contrast, chronic VVS is less well understood and is often multifactorial. Treatment is aimed at providing symptomatic relief and should begin with the least invasive approaches such as the use of topical xylocaine, oral antiviral therapy, acupuncture, and hypnotherapy. Interferon injections may be tried as last line medical therapy. Surgery has no role in treatment of acute VVS and is considered a last resort therapy for management of chronic VVS. Effort should be made to support the patient throughout the lengthy management process, encouraging patient participation, including negotiation of the treatment plan, and providing ongoing counselling and education.

Cervex-Brush and Cytobrush. Comparison of their ability to sample abnormal cells for cervical smears

A study was designed to test specimen adequacy and the detection of disease using two new cervical cytologic sampling devices, the Cervex-Brush and Cytobrush plus a modified Ayre spatula. Two clinicians used each device at random. The laboratory was blind to the sampling method, and the results were compared with those from control samples (Ayre spatula with cotton swab or alone). The 567 test samples were compared with 569 age-matched control samples. The Cervex-Brush and Cytobrush plus spatula were comparable in detecting disease, and both were improvements over the control method. Both the Cervex-Brush and Cytobrush plus spatula produced more consistent good smear quality across the age range studied than did the control method, which resulted in a lower percentage of good-quality smears in older women. Use of the Cytobrush plus spatula and the control method produced smear results the quality of which varied considerably with each clinician.