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McMullan P, Gochnauer H, Brown-Joel Z, O'Donnell P, Belazarian L. Superficial erosions in a pediatric patient. Pediatr Dermatol 2024. [PMID: 38712655 DOI: 10.1111/pde.15636] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/13/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Patrick McMullan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Heather Gochnauer
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Zoe Brown-Joel
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Patrick O'Donnell
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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2
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Neale H, Plumptre I, Belazarian L, Wiss K, Hawryluk EB. Cost and access considerations for magnetic resonance imaging screening of infants with congenital melanocytic nevi: Author's response to correspondence. J Am Acad Dermatol 2024:S0190-9622(24)00496-1. [PMID: 38499179 DOI: 10.1016/j.jaad.2024.02.056] [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: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Holly Neale
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Program, Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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3
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Karch JL, Grand D, Diaz AG, Belazarian L, Mann JA. Neonatal nasal necrosis: Case series and brief review. Pediatr Dermatol 2024. [PMID: 38459633 DOI: 10.1111/pde.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
There is limited information available on pressure-related neonatal nasal injuries. We present three neonates born with erythema and purpura of the nasal tip that subsequently ulcerated, then evolved into a thick eschar. Each healed well with conservative management but left behind significant scarring. The sharp demarcation and location of the lesions were suggestive of hypoxic tissue damage akin to halo scalp ring alopecia. Further investigation is necessary to elucidate the etiology and optimal management of this condition.
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Affiliation(s)
- Jamie L Karch
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - David Grand
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ariana G Diaz
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Leah Belazarian
- Department of Dermatology and Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Julianne A Mann
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Dermatology and Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Neale H, Plumptre I, Belazarian L, Wiss K, Hawryluk EB. Guidance on screening magnetic resonance imaging decisions for congenital melanocytic nevi. J Am Acad Dermatol 2024; 90:e107-e108. [PMID: 37972653 DOI: 10.1016/j.jaad.2023.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Holly Neale
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Program, Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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5
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Tan AJ, Su KA, Deng A, Belazarian L. A solitary polypoid papulonodule on the knee of a 13-year-old girl. Pediatr Dermatol 2024; 41:334-335. [PMID: 38044548 DOI: 10.1111/pde.15476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Alice J Tan
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine A Su
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - April Deng
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
- Department of Pathology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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6
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Neale H, Plumptre I, Belazarian L, Wiss K, Hawryluk EB. Seeking better resolution to magnetic resonance imaging recommendations for infants with congenital melanocytic nevi. J Am Acad Dermatol 2023; 89:e155-e156. [PMID: 37301289 DOI: 10.1016/j.jaad.2023.05.039] [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: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Holly Neale
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Program, Department of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts.
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7
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Pagani K, Plumptre I, Amin S, Lal K, Wiss K, Belazarian L. Low rates of neurological abnormalities in patients with pigmentary mosaicism: A retrospective cohort study from a tertiary dermatology center. Pediatr Dermatol 2023; 40:446-451. [PMID: 36813567 DOI: 10.1111/pde.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Pigmentary mosaicism (PM) is a descriptive term encompassing a range of hyper- and hypo-pigmented phenotypes in various patterns. Information from the neurology literature initially noted neurological abnormalities (NA) in up to 90% of children with PM. The dermatology literature suggests lower associated rates (15%-30%) of NA. Variations in terminology, inclusion criteria, and small population sizes makes interpreting existing PM literature complicated. We aimed to assess rates of NA in children presenting to dermatology with PM. METHODS We included patients <19 years, diagnosed with PM, nevus depigmentosus and/or segmental café au lait macules (CALM) seen in our dermatology department between 1 January 2006 and 31 December 2020. Patients with neurofibromatosis, McCune-Albright syndrome, and non-segmental CALM were excluded. Data collected included pigmentation, pattern, site(s) affected, presence of seizures, developmental delay, and microcephaly. RESULTS One hundred fifty patients were included (49.3% female), with a mean age at diagnosis of 4.27 years. Patterns of mosaicism were ascertained for 149 patients and included blaschkolinear (60/149, 40.3%), blocklike (79/149, 53.0%), or a combination of both patterns (10/149, 6.7%). Patients with a combination of patterns were more likely to have NA (p < .01). Overall, 22/149 (14.8%) had NA. Nine out of twenty-two patients with NA had hypopigmented blaschkolinear lesions (40.9%). Patients with ≥4 body sites affected were more likely to have NA (p < .01). DISCUSSION Overall, our population had low rates of NA in PM patients. A combination of blaschkolinear and blocklike patterns, or ≥4 body sites involved were associated with higher rates of NA.
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Affiliation(s)
- Kyla Pagani
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shray Amin
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Karan Lal
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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8
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Neale H, Plumptre I, Belazarian L, Wiss K, Hawryluk EB. Central nervous system magnetic resonance imaging abnormalities and neurologic outcomes in pediatric patients with congenital nevi: A 10-year multi-institutional retrospective study. J Am Acad Dermatol 2022; 87:1060-1068. [PMID: 35716834 DOI: 10.1016/j.jaad.2022.05.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/21/2021] [Revised: 04/28/2022] [Accepted: 05/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND High-risk congenital melanocytic nevi (CMN) are associated with abnormalities of the central nervous system (CNS), prompting magnetic resonance imaging (MRI) screening guidelines. OBJECTIVE Describe MRI brain and spine abnormalities in children with CMN and report trends between nevus features, MRI findings, and neurologic outcomes. METHODS Retrospective review of individuals aged ≤18 years with an MRI of the brain and/or spine and at least 1 dermatologist-diagnosed CMN. RESULTS Three hundred fifty-two patients were identified. Forty-six children had CMN that prompted an MRI of the brain and/or spine (50% male, average age at first image, 354.8 days). In these children, 8 (17%) had melanin detected in the CNS, of whom all had >4 CMN. One developed brain melanoma (fatal). In patients without CNS melanin, 4 had concerning imaging. Concerning MRI patients had more neurodevelopmental problems, seizures, neurosurgery, and death than individuals with unremarkable imaging. Three hundred six patients received MRIs for other reasons; none detected melanin. No children with only multiple small CMN (n = 15) had concerning imaging. LIMITATIONS Lack of a control group, cohort size, and retrospective methods. CONCLUSION MRI of the brain and spine is useful for detecting intervenable abnormalities in high-risk children. Healthy infants with few small CMN may not require screening MRI.
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Affiliation(s)
- Holly Neale
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isabella Plumptre
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Allergy and Immunology, Dermatology Program, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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9
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Leonard N, Droms R, Lal K, Wiss K, Aidlen JT, Silvestri D, Belazarian L. Utility of routine patch testing prior to surgical repair of pectus excavatum: A multidisciplinary experience via retrospective review at a single tertiary care center. Pediatr Dermatol 2021; 38:1510-1514. [PMID: 34647642 DOI: 10.1111/pde.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The Nuss procedure is the only implant procedure in which routine, rather than selective, preoperative patch testing is recommended. This practice has recently been called into question. OBJECTIVE To evaluate an updated experience of pre-implant patch testing in patients undergoing the Nuss procedure. METHODS A retrospective chart review of Nuss procedures from 2012 through 2020. RESULTS Forty-five patients were identified for data collection. From 2012 to 2014, none of the 14 patients were patch tested. From 2015 to 2020, 26 of 31 (83.9%) were patch tested. Of those tested, only 2 had a positive patch test. A hypoallergenic titanium bar was inserted in each case. In total, there were zero bar reactions. CONCLUSION The risks of patch testing are extremely small and should be weighed against the serious implications of even one bar allergy when deciding on future guidelines.
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Affiliation(s)
- Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Rebecca Droms
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jeremy T Aidlen
- Department of Pediatric Surgery, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Dianne Silvestri
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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10
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Abstract
Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.
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Affiliation(s)
- Chenin Ryan
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Kishore Vellody
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leah Belazarian
- Departments of Pediatrics and Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,Department of Dermatology, Dartmouth-Hitchcock Medical Center, Manchester, New Hampshire, USA
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11
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Abstract
Primary cutaneous marginal zone lymphoma (PCMZL) is a low-grade B-cell lymphoma that arises in the skin. An adolescent male presented with dermal nodules on the arms, legs, and back with a positive Darier sign, ultimately diagnosed as PCMZL. The nodules demonstrated a partial response to doxycycline in the setting of prior Lyme disease followed by a complete response to rituximab.
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Affiliation(s)
- Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christina Luffman
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Patrick O'Donnell
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lindsey Jolley
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
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12
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Brown R, Blankenship K, Amano SU, O'Donnell P, Belazarian L. Solitary blue-black nodule on the back of a teenage boy. Pediatr Dermatol 2021; 38:492-493. [PMID: 33870569 DOI: 10.1111/pde.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Regina Brown
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Kaitlin Blankenship
- Department of Dermatology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Shinya U Amano
- Department of Pathology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Patrick O'Donnell
- Department of Pathology, UMass Memorial Medical Center, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, UMass Memorial Medical Center, Worcester, MA, USA.,Department of Pediatrics, UMass Memorial Medical Center, Worcester, MA, USA
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13
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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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14
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Leonard N, Lal K, Belazarian L, Hermos C, Wiss K. Skin rash, strawberry tongue, and conjunctivitis in a teenage male. Pediatr Dermatol 2020; 37:e91-e92. [PMID: 33283930 DOI: 10.1111/pde.14394] [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: 11/27/2022]
Affiliation(s)
- Nicholas Leonard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christina Hermos
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Infectious Diseases, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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15
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Rork JF, McCormack L, Lal K, Wiss K, Belazarian L. Dermatologic conditions in Down syndrome: A single-center retrospective chart review. Pediatr Dermatol 2020; 37:811-816. [PMID: 32519435 DOI: 10.1111/pde.14214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/30/2019] [Revised: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Current literature addressing dermatologic conditions associated with Down syndrome is limited, with emphasis on rare skin conditions and lack of consensus on the incidence of more common disorders. OBJECTIVE We sought to evaluate dermatologic conditions in patients with Down syndrome diagnosed and managed by dermatologists. METHODS This was a retrospective analysis of 101 pediatric and adult patients with Down syndrome seen by the University of Massachusetts Dermatology Department between 2008 and 2018. RESULTS Folliculitis was the most common diagnosis overall (30.7%), followed by seborrheic dermatitis (26.7%) and hidradenitis suppurativa (22.8%). Eczematous dermatitis, alopecia areata, and xerosis were the most common diagnoses observed in children aged 0-12 years; hidradenitis suppurativa, folliculitis, and seborrheic dermatitis in adolescents aged 13-17 years; and folliculitis, seborrheic dermatitis, and xerosis in adults 18 years and older. Other notable diagnoses present overall included onychomycosis (9.9%) and psoriasis (8.9%). Malignant cutaneous tumors were present in two patients, specifically basal cell carcinoma and malignant melanoma in situ. LIMITATIONS This was a retrospective, single-institution study. CONCLUSION Dermatologic conditions in patients with Down syndrome vary by age but are most often adnexal and eczematous disorders. Trisomy of chromosome 21 and the resulting downstream effects, specifically on the immune system, may account for these findings.
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Affiliation(s)
- Jillian F Rork
- Department of Dermatology, Dartmouth Medical School, Lebanon, NH, USA
| | | | - Karan Lal
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
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16
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Krueger S, McLean R, Amano S, Belazarian L. Primary livedoid vasculopathy associated with mononeuritis multiplex. Dermatol Online J 2020; 26:13030/qt4c80g04v. [PMID: 32898400] [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: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023] Open
Abstract
A 40-year-old woman presented with painful ulcerations on the bilateral lower extremities. A biopsy confirmed the diagnosis of livedoid vasculopathy (LV). She was treated initially with aspirin and pentoxifylline, and with the addition of dipyridamole she has had no recurrence of her ulcerations to date. Despite this positive response to treatment she reported numbness and paresthesias in her legs. Nerve conduction studies confirmed a diagnosis of mononeuritis multiplex. This case highlights mononeuritis multiplex as a rarely described complication of LV, and suggests that early recognition of symptoms and a multidisciplinary approach are necessary for optimal management of this condition.
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Affiliation(s)
| | | | | | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA.
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17
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18
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Prindaville B, Belazarian L, Levin NA, Wiss K. Pityrosporum folliculitis: A retrospective review of 110 cases. J Am Acad Dermatol 2018; 78:511-514. [PMID: 29138059 DOI: 10.1016/j.jaad.2017.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 07/03/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pityrosporum folliculitis is an under-recognized eruption of the face and upper portion of the trunk that may be confused with, or occur simultaneously with, acne vulgaris. OBJECTIVE We sought to characterize risk factors for Pityrosporum folliculitis, its clinical presentation, and its response to treatment. METHODS A retrospective chart review was performed on all patients age 0 to 21 years seen at our facility from 2010 to 2015 with Pityrosporum folliculitis confirmed by a potassium hydroxide preparation. RESULTS Of 110 qualifying patients, more than 75% had acne that had recently been treated with antibiotics, and when recorded, 65% reported pruritus. Clinical examination demonstrated numerous 1- to 2-mm monomorphic papules and pustules that were typically on the forehead extending into the hairline and on the upper portion of the back. The most common treatment was ketoconazole shampoo, which led to improvement or resolution in most cases. Some patients required oral azole antifungals. LIMITATIONS This study was retrospective and relied on providers describing and interpreting the clinical findings and potassium hydroxide preparations. No standard grading system was used. CONCLUSION Unlike classic acne vulgaris, Pityrosporum folliculitis was more common after antibiotic use. It presented as fine monomorphic, pruritic papules and pustules along the hairline and on the upper portion of the back, and it improved with topical or oral azole antifungal therapy.
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Affiliation(s)
- Brea Prindaville
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nikki A Levin
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
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19
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Bronckers IMGJ, Seyger MMB, West DP, Lara-Corrales I, Tollefson M, Tom WL, Hogeling M, Belazarian L, Zachariae C, Mahé E, Siegfried E, Philipp S, Szalai Z, Vleugels RA, Holland K, Murphy R, Baselga E, Cordoro K, Lambert J, Alexopoulos A, Mrowietz U, Kievit W, Paller AS. Safety of Systemic Agents for the Treatment of Pediatric Psoriasis. JAMA Dermatol 2017; 153:1147-1157. [PMID: 28903160 DOI: 10.1001/jamadermatol.2017.3029] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Use of systemic therapies for moderate to severe psoriasis in children is increasing, but comparative data on their use and toxicities are limited. Objective To assess patterns of use and relative risks of systemic agents for moderate to severe psoriasis in children. Design, Setting, and Participants A retrospective review was conducted at 20 centers in North America and Europe, and included all consecutive children with moderate to severe psoriasis who used systemic medications or phototherapy for at least 3 months from December 1, 1990, to September 16, 2014. Main Outcomes and Measures The minimal core data set included age, sex, severity of psoriasis, systemic interventions, monitoring, adverse events (AEs), and reason for discontinuation. Results For 390 children (203 girls and 187 boys; mean [SD] age at diagnosis, 8.4 [3.7] years) with psoriasis who used 1 or more systemic medications, the mean interval between diagnosis and starting systemic therapy was 3.0 years. Methotrexate was used by 270 patients (69.2%), biologic agents (primarily etanercept) by 106 (27.2%), acitretin by 57 (14.6%), cyclosporine by 30 (7.7%), fumaric acid esters by 19 (4.9%), and more than 1 medication was used by 73 (18.7%). Of 270 children taking methotrexate, 130 (48.1%) reported 1 or more AEs associated with methotrexate, primarily gastrointestinal (67 [24.8%]). Folic acid 6 days per week (odds ratio, 0.16; 95% CI, 0.06-0.41; P < .001) or 7 days per week (OR, 0.21; 95% CI, 0.08-0.58; P = .003) protected against gastrointestinal AEs more than once-weekly folic acid, regardless of the total weekly dosage. Methotrexate-associated hepatic transaminase elevations were associated with obesity (35 of 270 patients [13.0%]), but a folic acid regimen was not. Injection site reactions occurred in 20 of 106 patients (18.9%) treated with tumor necrosis factor inhibitors, but did not lead to discontinuation of treatment. Having 1 or more AEs related to medication, gastrointestinal AE, laboratory abnormality, or AE leading to discontinuation of the drug was more likely with methotrexate than tumor necrosis factor inhibitors, but having 1 or more infections related to medication (predominantly upper airway) was less likely. Six patients developed a serious treatment-related AE (methotrexate, 3; fumaric acid esters, 2; and adalimumab, 1), but methotrexate and biologic agents were taken for a mean duration that was 2-fold greater than the mean duration for cyclosporine or fumaric acid esters. No patient developed tuberculosis or a malignant neoplasm. Conclusions and Relevance Medication-related AEs occur less often with tumor necrosis factor inhibitors than with methotrexate. Folic acid administration 6 or 7 times per week protected more against methotrexate-induced gastrointestinal AEs than did weekly administration. A prospective registry is needed to track the long-term risks of systemic agents for pediatric psoriasis.
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Affiliation(s)
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, the Netherlands
| | - 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
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - 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, 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
| | - Sandra Philipp
- Psoriasis Research and Treatment Center, Charité-Universitäts-Medizin, 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
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sanat Creu i Sant Pau, Barcelona, Spain
| | - Kelly 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
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
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20
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Abstract
Althouygh Menkes disease has well-recognized neurologic, developmental, and cutaneous features, the initial presentation may resemble child abuse. We describe a 5-month-old boy with multiple fractures indicative of nonaccidental trauma who was ultimately diagnosed with Menkes disease. Copper deficiency leads to connective tissue abnormalities and may result in subdural hematomas, wormian bones, cervical spine defects, rib fractures, and spurring of the long bone metaphyses. Several of these findings, including fractures and subdural hematomas, may be misinterpreted as child abuse.
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Affiliation(s)
- Rebecca J Droms
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jillian F Rork
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Riley McLean
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Madelena Martin
- Division of Genomic Medicine, Department of Pediatrics, University of California Davis Medical Center, Sacramento, California
| | - Leah Belazarian
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
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21
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St John J, Summe H, Csikesz C, Wiss K, Hay B, Belazarian L. Multiple Café au Lait Spots in a Group of Fair-Skinned Children without Signs or Symptoms of Neurofibromatosis Type 1. Pediatr Dermatol 2016; 33:526-9. [PMID: 27469520 DOI: 10.1111/pde.12936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/28/2022]
Abstract
BACKGROUND The presence of six or more café au lait (CAL) spots is a criterion for the diagnosis of neurofibromatosis type 1 (NF-1). Children with multiple CAL spots are often referred to dermatologists for NF-1 screening. The objective of this case series is to characterize a subset of fair-complected children with red or blond hair and multiple feathery CAL spots who did not meet the criteria for NF-1 at the time of their last evaluation. METHODS We conducted a chart review of eight patients seen in our pediatric dermatology clinic who were previously identified as having multiple CAL spots and no other signs or symptoms of NF-1. RESULTS We describe eight patients ages 2 to 9 years old with multiple, irregular CAL spots with feathery borders and no other signs or symptoms of NF-1. Most of these patients had red or blond hair and were fair complected. All patients were evaluated in our pediatric dermatology clinic, some with a geneticist. The number of CAL spots per patient ranged from 5 to 15 (mean 9.4, median 9). CONCLUSION A subset of children, many with fair complexions and red or blond hair, has an increased number of feathery CAL spots and appears unlikely to develop NF-1, although genetic testing was not conducted. It is important to recognize the benign nature of CAL spots in these patients so that appropriate screening and follow-up recommendations may be made.
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Affiliation(s)
- Jessica St John
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Heather Summe
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts
| | - Courtney Csikesz
- Dermatology Professionals, North Attleboro, Massachusetts.,Department of Dermatology, Roger Williams Medical Center, Providence, Rhode Island
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts.,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts
| | - Beverly Hay
- Division of Genetics, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Leah Belazarian
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts. .,Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, Massachusetts.
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22
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Tocci EM, Robinson A, Belazarian L, Foley E, Wiss K, Silvestri DL. Excipients in Oral Antihistamines Can Perpetuate Allergic Contact Dermatitis. Pediatr Dermatol 2015; 32:e242-4. [PMID: 26381657 DOI: 10.1111/pde.12668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Propylene glycol is a well-documented causative agent of allergic contact dermatitis (ACD). It is also reported to cause systemic dermatitis after ingestion of foods or medicines containing it and after intravenous injection of a medicine with propylene glycol in its base. We describe two adolescents with sensitivity to propylene glycol confirmed by patch testing whose dermatitis improved dramatically after cessation of oral antihistamines containing propylene glycol. We report these cases to alert providers to the potential for worsening of ACD due to systemic exposure to propylene glycol in patients with a cutaneous sensitivity to the allergen.
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Affiliation(s)
- Elizabeth M Tocci
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Amanda Robinson
- Division of Dermatology, Department of Medicine, UMass Memorial, Worcester, Massachusetts
| | - Leah Belazarian
- Division of Dermatology, Department of Medicine, UMass Memorial, Worcester, Massachusetts.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Elizabeth Foley
- Division of Dermatology, Department of Medicine, UMass Memorial, Worcester, Massachusetts
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, UMass Memorial, Worcester, Massachusetts.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Dianne L Silvestri
- Division of Dermatology, Department of Medicine, UMass Memorial, Worcester, Massachusetts.,Contact Dermatitis Referral Clinic, Worcester, Massachusetts
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23
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Garg A, Biello K, Hoot JW, Reddy SB, Wilson L, George P, Robinson-Bostom L, Belazarian L, Domingues E, Powers J, Jacob R, Powers M, Besen J, Geller AC. The Skin Cancer Objective Structured Clinical Examination (SCOSCE): A multi-institutional collaboration to develop and validate a clinical skills assessment for melanoma. J Am Acad Dermatol 2015; 73:959-65. [PMID: 26410358 DOI: 10.1016/j.jaad.2015.08.014] [Citation(s) in RCA: 6] [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: 03/17/2015] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Assessing medical students on core skills related to melanoma detection is challenging in the absence of a well-developed instrument. OBJECTIVE We sought to develop an objective structured clinical examination for the detection and evaluation of melanoma among medical students. METHODS This was a prospective cohort analysis of student and objective rater agreement on performance of clinical skills and assessment of differences in performance across 3 schools. RESULTS Kappa coefficients indicated excellent agreement for 3 of 5 core skills including commenting on the presence of the moulage (k = 0.87, 95% confidence interval 0.77-0.96), obtaining a history for the moulage (k = 0.84, 95% confidence interval 0.74-0.94), and making a clinical impression (k = 0.80, 95% confidence interval 0.68-0.92). There were no differences in performance across schools with respect to 3 of 5 core skills: commenting on the presence of the moulage (P = .15), initiating a history (P = .53), and managing the suspicious lesion (P value range .07-.17). Overall, 54.2% and 44.7% of students commented on the presence of the moulage and achieved maximum performance of core skills, respectively, with no difference in performance across schools. LIMITATIONS Limitations include overall sample size of students and schools. CONCLUSION The Skin Cancer Objective Structured Clinical Examination represents a potentially important instrument to measure students' performance on the optimal step-by-step evaluation of a melanoma.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York.
| | - Katie Biello
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Joyce W Hoot
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Shalini B Reddy
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Lindsay Wilson
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul George
- Department of Family Medicine, Brown Alpert Medical School, Providence, Rhode Island
| | | | - Leah Belazarian
- Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Erik Domingues
- Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer Powers
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Reza Jacob
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael Powers
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Justin Besen
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
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24
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Abstract
Pediatric fasciitides are rare benign lesions that may clinically mimic a malignant sarcoma. Nodular fasciitis, the most common of these fasciitides, rarely occurs in children younger than 5 years of age. Often there is a history of preceding trauma. Herein, we report the case of a 5-month-old boy diagnosed with nodular fasciitis in the setting of nonaccidental trauma.
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Affiliation(s)
- Lauren Strazzula
- UMass Memorial Healthcare, University of Massachusetts Medical School, Worcester, Massachusetts
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25
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Strazzula L, Senna MM, Yasuda M, Belazarian L. The deep penetrating nevus. J Am Acad Dermatol 2014; 71:1234-40. [PMID: 25175710 DOI: 10.1016/j.jaad.2014.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/16/2014] [Accepted: 07/19/2014] [Indexed: 01/13/2023]
Abstract
The deep penetrating nevus (DPN), also known as the plexiform spindle cell nevus, is a pigmented lesion that commonly arises on the head and neck in the first few decades of life. Histopathologically, the DPN is wedge-shaped and contains melanocytes that exhibit deep infiltration into the dermis. Given these features, DPN may clinically and histopathologically mimic malignant melanoma, sparking confusion about the appropriate evaluation and management of these lesions. The goal of this review is to summarize the clinical and histopathological features of DPN and to discuss diagnostic and treatment strategies for dermatologists.
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Affiliation(s)
- Lauren Strazzula
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Maryanne Makredes Senna
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Healthcare, Worcester, Massachusetts
| | - Mariko Yasuda
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Healthcare, Worcester, Massachusetts
| | - Leah Belazarian
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, UMass Memorial Healthcare, Worcester, Massachusetts; Division of Dermatology, Department of Pediatrics, University of Massachusetts Medical School, UMass Memorial Healthcare, Worcester, Massachusetts.
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26
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Garg A, Wang J, Reddy SB, Powers J, Jacob R, Powers M, Biello K, Cayce R, Savory S, Belazarian L, Domingues E, Korzenko A, Wilson L, Grant-Kels JM, George P, Robinson-Bostom L, Trotter SC, Geller AC. Curricular factors associated with medical students' practice of the skin cancer examination: an educational enhancement initiative by the integrated skin exam consortium. JAMA Dermatol 2014; 150:850-5. [PMID: 24898482 DOI: 10.1001/jamadermatol.2013.8723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts. OBJECTIVES To identify curricular factors associated with medical students' confidence, intent, and performance regarding the SCE. DESIGN, SETTING, AND PARTICIPANTS Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method. MAIN OUTCOMES AND MEASURES Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE. RESULTS Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04). CONCLUSIONS AND RELEVANCE To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Hofstra North Shore Long Island Jewish School of Medicine, Hempstead, New York
| | - Joyce Wang
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Shalini B Reddy
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer Powers
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Reza Jacob
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Michael Powers
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts
| | - Katie Biello
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Rachael Cayce
- Department of Dermatology, University of Texas Southwestern Medical School at Dallas
| | - Stephanie Savory
- Department of Dermatology, University of Texas Southwestern Medical School at Dallas
| | - Leah Belazarian
- Division of Dermatology, University of Massachusetts Medical School, Worcester
| | - Erik Domingues
- Division of Dermatology, University of Massachusetts Medical School, Worcester
| | - Adam Korzenko
- Department of Dermatology, Stony Brook University School of Medicine, Stony Brook, New York
| | - Lindsay Wilson
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut School of Medicine, Farmington
| | - Paul George
- Department of Dermatology, Brown Alpert Medical School, Providence, Rhode Island
| | | | - Shannon C Trotter
- Department of Dermatology, Ohio State University College of Medicine, Columbus
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
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27
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Cheraghi N, Robinson A, O'Donnell P, Belazarian L. Scalp sarcoidosis: a sign of systemic sarcoidosis. Dermatol Online J 2014; 20:doj_21767. [PMID: 24656280] [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: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 06/03/2023] Open
Abstract
Sarcoidosis is a systemic disease often with cutaneous manifestations. Scarring alopecia of the scalp is a rare form of cutaneous sarcoidosis. Herein, we describe a case of sarcoidosis of the scalp mimicking discoid lupus.
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Abstract
A 7-month-old girl was evaluated for V-shaped ridging of the fingernails consistent with chevron nails. Chevron nails are a normal variant in the pediatric population that is frequently outgrown. This case nicely demonstrates this normal finding that has so rarely been reported in the literature.
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Affiliation(s)
- Sofia Delano
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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Garg A, Wang J, Reddy SB, Powers J, Jacob R, Powers M, Biello K, Cayce R, Savory S, Belazarian L, Domingues E, Korzenko A, Wilson L, Grant-Kels JM, George P, Robinson-Bostom L, Trotter SC, Geller AC. The Integrated Skin Exam film: an educational intervention to promote early detection of melanoma by medical students. J Am Acad Dermatol 2013; 70:115-9. [PMID: 24220723 DOI: 10.1016/j.jaad.2013.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 08/07/2013] [Revised: 08/28/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge of the skin cancer examination (SCE) and its practice remain relevant competency gaps among medical students. OBJECTIVE We elaborate on a method of SCE known as the Integrated Skin Exam and discuss the development of an instructional film that illustrates its principles. We assess the tool's effect on knowledge, attitudes, and perceptions related to the SCE. METHODS Second-year students among 8 randomized schools viewed the film and completed pre-post questionnaires. RESULTS After viewing The Integrated Skin Exam film, students demonstrated improved melanoma knowledge, including identification of high-risk demographic groups (61% vs 42.9%, P < .001), high-risk anatomic sites in women (88.6% vs 46.5%, P < .001) and men (92.1% vs 34.8%, P < .001), and the ABCDEs of melanoma (98.4% vs 91.2%, P < .001). Students demonstrated increased confidence in the SCE (66.93% vs 16.40%, P < .001) and augmented intentions to practice it (99.05% vs 13.9%, P < .001). A greater proportion (70.4% vs 41.9%, P < .001) of students thought less than 3 minutes were required to integrate SCE into the routine examination. LIMITATIONS Longitudinal impact of the film was not assessed. CONCLUSION The Integrated Skin Exam film introduces an integrated approach to the SCE that addresses knowledge gaps, mitigates perceived barriers, and augments intention related to practice of the SCE.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
| | - Joyce Wang
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Reza Jacob
- Boston University School of Medicine, Boston, Massachusetts
| | - Michael Powers
- Boston University School of Medicine, Boston, Massachusetts
| | - Katie Biello
- Harvard School of Public Health, Boston, Massachusetts
| | - Rachael Cayce
- University of Texas Southwestern Medical School at Dallas, Dallas, Texas
| | - Stephanie Savory
- University of Texas Southwestern Medical School at Dallas, Dallas, Texas
| | - Leah Belazarian
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Erik Domingues
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Adam Korzenko
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Lindsay Wilson
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Jane M Grant-Kels
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Paul George
- Brown Alpert Medical School, Providence, Rhode Island
| | | | | | - Alan C Geller
- Harvard School of Public Health, Boston, Massachusetts
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Mercy K, Kwasny M, Cordoro KM, Menter A, Tom WL, Korman N, Belazarian L, Armstrong AW, Levy ML, Paller AS. Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States. Pediatr Dermatol 2013; 30:424-8. [PMID: 23360462 PMCID: PMC3641153 DOI: 10.1111/pde.12072] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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
The clinical features of pediatric psoriasis warrant further attention. A national study was conducted to determine the prevalence of scalp and nail involvement and a history of guttate psoriasis at onset according to age, sex, and disease severity. One hundred eighty-one children ages 5 to 17 years with plaque psoriasis were enrolled in a multicenter, cross-sectional study. Subjects and guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to the Physician's Global Assessment and body surface area measures. One hundred forty-three (79.0%) subjects reported a history of scalp involvement, and 71 (39.2%) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.19-0.84) but more likely to have had nail involvement (OR = 3.01, 95% CI = 1.62-5.60). Scalp and nail involvement was not related to psoriasis severity. In contrast, subjects with SP (35.9%) more often reported a history of guttate lesions than did those with MP (21.8%) (p = .02). Antecedent streptococcal infection was more common in children with guttate than those with plaque psoriasis at onset (p = .02) but did not correlate with severity. Sex-related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease. More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.
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Affiliation(s)
- Katherine Mercy
- Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA
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Alberta-Wszolek L, Belazarian L, Capaldi L, Clifford K, Goldberg D, Lorenzo M. My skin's on fire: Living with psoriasis (DVD). J Am Acad Dermatol 2007. [DOI: 10.1016/j.jaad.2007.01.043] [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: 10/23/2022]
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Belazarian L. April iotaderma (#147). J Am Acad Dermatol 2006. [DOI: 10.1016/j.jaad.2005.11.1087] [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: 10/24/2022]
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