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Scollan ME, Levin LE, Lucky AW, Hook KP, Peoples K, Bruckner AL, Feinstein JA, Pope E, McCuaig CC, Powell J, Eichenfield LF, Levy ML, Diaz L, Glick SA, Paller AS, Browning JC, Morel KD. Characterization of wound microbes in epidermolysis bullosa: A focus on Pseudomonas aeruginosa. Pediatr Dermatol 2023; 40:863-865. [PMID: 37364926 PMCID: PMC10543531 DOI: 10.1111/pde.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
The most common bacteria isolated from wound cultures in patients recorded in the Epidermolysis Bullosa Clinical Characterization and Outcomes Database (EBCCOD) are Staphylococcus aureus and Pseudomonas aeruginosa. Given the prevalence of P. aeruginosa in this patient population and prior research implicating P. aeruginosa's potential role in carcinogenesis, we sought to further analyze patients with recorded wound cultures positive for Pseudomonas aeruginosa in the EBCCOD. We provide a descriptive analysis of this subset of patients and highlight potential avenues for future longitudinal studies that may have significant implications in our wound care management for patients with epidermolysis bullosa.
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Affiliation(s)
- Margaret E Scollan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Laura E Levin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne W Lucky
- Departments of Pediatrics and Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kristen P Hook
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine C McCuaig
- Departments of Pediatrics and Dermatology, CHU Sainte-Justine, University of Montreal, Montreal, Qubec, Canada
| | - Julie Powell
- Department of Dermatology, CHU Sainte- Justine, University of Montreal, Montreal, Qubec, Canada
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, University of California San Diego, San Diego, California, USA
| | - Moise L Levy
- Departments of Pediatrics and Dermatology, Dell Children's Medical Center, Austin, Texas, USA
| | - Lucia Diaz
- Department of Dermatology, Dell Children's Medical Center, Austin, Texas, USA
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Amy S Paller
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois, USA
| | - John C Browning
- Department of Dermatology, The Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Kimberly D Morel
- Departments of Pediatrics and Dermatology, Columbia University Irving Medical Center, New York, New York, USA
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Eichenfield LF, Stein Gold L, Kircik LH, Werschler WP, Beer K, Draelos ZD, Tanghetti EA, Papp KA, Baldwin H, Lain E, Sadick N, Gooderham MJ, Konda A. Triple-combination clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel for moderate-to-severe acne in children and adolescents: Randomized phase 2 study. Pediatr Dermatol 2023; 40:452-459. [PMID: 36949579 DOI: 10.1111/pde.15283] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/05/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND/OBJECTIVES Topical clindamycin phosphate 1.2%/benzoyl peroxide 3.1%/adapalene 0.15% gel (IDP-126) is the first fixed-dose triple-combination formulation in development for acne. This post hoc analysis investigated efficacy and safety of IDP-126 in children and adolescents with moderate-to-severe acne. METHODS In a randomized, double-blind phase 2 study (NCT03170388), participants ≥9 years of age with moderate-to-severe acne were eligible for randomization (1:1:1:1:1) to once-daily IDP-126, one of three dyad combination gels, or vehicle gel for 12 weeks. This post hoc analysis of pediatric participants (n = 394) included children and adolescents up to 17 years of age. Assessments included treatment success, inflammatory/noninflammatory lesion counts, Acne-Specific Quality of Life (Acne-QoL) questionnaire, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability. RESULTS At Week 12, treatment success rates were significantly greater with IDP-126 (55.8%) than with vehicle (5.7%; p < .001) or any of the dyad combinations (range: 30.8%-33.9%; p < .01, all). Lesion reductions with IDP-126 were also significantly greater than with vehicle (inflammatory: 78.3% vs. 45.1%; noninflammatory: 70.0% vs. 37.6%; p < .001, both) and 9.2%-16.6% greater than with any of the dyad combinations. Increases (improvements) from baseline in Acne-QoL domain scores were generally greater with IDP-126 than in any other treatment group. The most common treatment-related TEAEs across treatment groups were application site pain and dryness. Most treatment-related TEAEs were of mild-to-moderate severity. CONCLUSION IDP-126 gel-a novel fixed-dose, triple-combination topical formulation for acne-demonstrated superior efficacy to vehicle and three dyad component gels and was well tolerated in children and adolescents with moderate-to-severe acne.
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Affiliation(s)
- Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, La Jolla, California, USA
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California, USA
| | - Linda Stein Gold
- Division of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Leon H Kircik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Dermatology, Indiana University Medical Center, Indianapolis, Indiana, USA
- Physicians Skin Care, PLLC, DermResearch, PLLC, and Skin Sciences, PLLC, Louisville, Kentucky, USA
| | - William P Werschler
- Department of Dermatology, Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Kenneth Beer
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Zoe D Draelos
- Dermatology Consulting Services, PLLC, High Point, North Carolina, USA
| | - Emil A Tanghetti
- Center for Dermatology and Laser Surgery, Sacramento, California, USA
| | - Kim A Papp
- Alliance Clinical Trials and Probity Medical Research, Waterloo, Ontario, Canada
- Division of Dermatology, University of Toronto School of Medicine, Toronto, Ontario, Canada
| | - Hilary Baldwin
- The Acne Treatment and Research Center, Brooklyn, New York, USA
- Department of Dermatology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Edward Lain
- Austin Institute for Clinical Research, Austin, Texas, USA
| | - Neil Sadick
- Department of Dermatology, Weill Cornell Medical College, New York, New York, USA
- Sadick Dermatology, New York, New York, USA
| | - Melinda J Gooderham
- Department of Dermatology, Queens University, Peterborough, Ontario, Canada
- SKiN Centre for Dermatology and Probity Medical Research, Peterborough, Ontario, Canada
| | - Adarsh Konda
- Ortho Dermatologics (Ortho Dermatologics is a Division of Bausch Health US, LLC), Bridgewater, New Jersey, USA
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Ertugrul G, Aktas H. Comparison of sulfur ointment and permethrin treatments in scabies. Dermatol Ther 2022; 35:e15897. [PMID: 36193643 DOI: 10.1111/dth.15897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/15/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
Scabies is a contagious, parasitic skin disease that adversely affects the quality of life and, can cause systemic complications if it is not properly treated. Sulfur ointment and permethrin cream are among the most used topical agents in the treatment of scabies. In this study, we aimed to compare the efficacy of sulfur ointment and permethrin cream in the treatment of scabies. In this single-center study, patients who were diagnosed with scabies in the dermatology outpatient clinics of Karabuk University Training and Research Hospital between April, 2021 and September, 2021 were investigated retrospectively. Age, gender, date of diagnosis, topical agent used for scabies treatment, and response to the treatment at the control examination in the second week were recorded. The patients were divided into two groups those receiving 5% permethrin cream or 10% sulfur ointment, and the treatment efficacy of both agents was compared. This study showed that 10% sulfur ointment was significantly more effective in treating scabies than 5% permethrin cream (p < 0.001). Moreover, younger patients with scabies responded better to both treatments. 10% Sulfur ointment can be considered a safe and effective topical option in the treatment of scabies. The resistance to 5% permethrin cream, which is the most commonly used agent for scabies, can be a concern as an unexpected low success rate was obtained in this study.
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Affiliation(s)
- Goksen Ertugrul
- Department of Dermatology, Karabuk University, Faculty of Medicine, Karabuk, Turkey
| | - Habibullah Aktas
- Department of Dermatology, Karabuk University, Faculty of Medicine, Karabuk, Turkey
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Díaz-Guimaraens B, Saceda-Corralo D, Hermosa-Gelbard Á, Moreno-Arrones ÓM, Dominguez-Santas M, Suarez-Valle A, Vañó-Galván S. Imiquimod-enhanced immunotherapy with diphencyprone for patients with alopecia areata. Dermatol Ther 2022; 35:e15516. [PMID: 35421278 DOI: 10.1111/dth.15516] [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] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Topical immunotherapy with dyphencyprone (DPCP) is widely used in patients with alopecia areata (AA). It can produce a contact dermatitis that is believed to decrease Th1 response, predominant in AA. It has been shown that imiquimod (IMQ), a topical immunomodulator drug, can produce sensitization to DPCP in patients that do not show signs of contact dermatitis when exposed to DPCP. Nevertheless, there is no evidence as to whether it can improve DPCP efficacy in already sensitized patients. We present a series of 9 patients, (7 females [77%] and 2 males [22%]) with a mean age of 38.4 years (range, 19-60 years), successfully sensitized to DPCP, that were treated with a combination of DPCP and IMQ. The mean SALT (Severity of Alopecia Tool) score before adding IMQ was 43.3 (range, 10-60), and the mean number of months of DPCP use prior to the addition of IMQ was 6,8 (range 0-10). After adding IMQ to their DPCP treatment, 77% of the patients had further improvement, with a mean SALT reduction of 13.3 (range, [-50] - 40), and a mean duration of response of 5.2 months. No adverse effects were reported. According to this data, we believe that the combination of DPCP and IMQ can be a promising way of improving the efficacy of contact immunotherapy in AA, and requires further study. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Borja Díaz-Guimaraens
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - David Saceda-Corralo
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - Ángela Hermosa-Gelbard
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - Óscar M Moreno-Arrones
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - Miguel Dominguez-Santas
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - Ana Suarez-Valle
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
| | - Sergio Vañó-Galván
- Dermatology Department, Trichology Unit, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, University of Alcalá, Madrid
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Torre-Castro J, Estrach T, Peñate Y, Acebo E, Fernández de Misa R, Blanes M, Suh-Oh HJ, Botella-Estrada R, Torrelo A, García-Doval I, Machan S. Primary cutaneous lymphomas in children: A prospective study from the Spanish Academy of Dermatology and Venereology (AEDV) Primary Cutaneous Lymphoma Registry. Pediatr Dermatol 2021; 38:1506-1509. [PMID: 34632613 DOI: 10.1111/pde.14811] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Primary cutaneous lymphomas are rare in pediatric patients. The clinical and histopathological manifestations may differ from those in adults. Due to their low frequency and the insidious clinical picture, the diagnosis is usually delayed. The Spanish Primary Cutaneous Lymphoma Registry was initiated in 2016 as a multicenter registry that would allow better insight into the epidemiological, clinical, histopathological, and treatment response characteristics of patients with primary cutaneous lymphomas. METHODS We conducted a prospective observational cohort study of primary cutaneous lymphomas in pediatric patients participating in the Spanish Academy of Dermatology and Venereology (AEDV) Primary Cutaneous Lymphoma Registry. RESULTS At the time of the analysis, 10 patients under 18 years of age out of 799 all-age cases (1.25%) had been included in the registry (7 males, 3 females). The mean age at diagnosis was 9.7 years (SD: 4.8). Seven (70%) had mycosis fungoides, 2 of them had the folliculotropic variant; and 3 (30%) had primary cutaneous marginal zone B-cell lymphoma. CONCLUSIONS Primary cutaneous lymphomas are extremely rare in pediatric patients and usually have a good prognosis. Therefore, a high level of suspicion is necessary for the diagnosis. We suggest management by experienced physicians and follow-up into adulthood.
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Affiliation(s)
- Juan Torre-Castro
- Department of Dermatology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Teresa Estrach
- Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Yeray Peñate
- Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas, Spain
| | - Elvira Acebo
- Department of Dermatology, Hospital Universitario de Cruces, Bizkaia, Spain
| | - Ricardo Fernández de Misa
- Department of Dermatology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Mar Blanes
- Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Hae Jin Suh-Oh
- DIPO Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Pontevedra, Spain
| | - Rafael Botella-Estrada
- Department of Dermatology, Hospital Universitario la Fé, Valencia, Spain.,Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Salma Machan
- Department of Dermatology, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Campanati A, Atzori L, Potenza C, Damiani G, Bianchi L, Corazza M, Tiberio R, Prignano F, Argenziano G, Fargnoli MC, Stingeni L, Mazzotta A, De Pità O, Mazzatenta C, Feliciani C, Donini M, Offidani A, Peris K. Patient satisfaction with calcipotriol/betamethasone dipropionate cutaneous foam for the treatment of plaque psoriasis: The LION real-life multicenter prospective observational cohort study. Dermatol Ther 2021; 34:e15077. [PMID: 34333823 PMCID: PMC9285427 DOI: 10.1111/dth.15077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022]
Abstract
Topical treatment is the mainstay for mild or moderate psoriasis, but patients are generally little satisfied. Calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam has shown to improve signs and symptoms in plaque psoriasis patients. This study assessed patient's satisfaction with Cal/BD foam in a real‐life Italian dermatological clinical practice. A multicenter, 4‐week observational prospective cohort study enrolled, in 17 Italian dermatology clinics, adult patients with plaque psoriasis on the body and/or scalp. Treatment satisfaction was assessed by 9‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9), preference over previous treatments by Patient Preference Questionnaire (PPQ), and change in disease state by Psoriasis Area Severity Index (PASI). Overall 256 patients were eligible, with a mean (SD) age of 55.6 (15.4) years, 59.4% were males. Psoriasis severity was mild in 52.0% of patients, moderate in 43.3%, and severe in 4.7%. Scalp involvement was present in 36.7% of patients. Previous antipsoriatic treatments had been received by 80.5% of patients. TSQM‐9 median (25th–75th percentile) scores were 83.3 (66.7–88.9) for effectiveness, 77.8 (66.7–88.9) for convenience, and 78.6 (64.3–92.9) for global satisfaction. Mean (SD) PASI value decreased from 7.3 (4.8) to 2.1 (2.7) after 4 weeks. More than 90% of patients previously treated for psoriasis evaluated the Cal/BD foam more effective, easier to use and better tolerated compared to previous topical treatments at PPQ. This observational study provides real‐life evidence of a high level of satisfaction with effectiveness and convenience of the Cal/BD foam in a cohort of plaque psoriasis patients, with an objective improvement in PASI.
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Affiliation(s)
- Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Laura Atzori
- Department of Medical Sciences and Public Health, Dermatology Clinic, University of Cagliari, Cagliari, Italy
| | - Concetta Potenza
- Dermatology Unit Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy
| | - Giovanni Damiani
- Clinical Dermatology, Istituto Ortopedico Galeazzi IRCCS, Milan, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rossana Tiberio
- Dermatologic Clinic, Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Francesca Prignano
- Unit of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | | | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Ornella De Pità
- Clinical Pathology and Immune Inflammatory Disease of the Skin, Cristo Re Hospital, Rome, Italy
| | - Carlo Mazzatenta
- Dermatology Unit, Lucca Azienda USL Toscana Nord Ovest, Pisa, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Massimo Donini
- Department of Dermatology, SS Giovanni E Paolo Civil Hospital, Venice, Italy
| | - Annamaria Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Ketty Peris
- UOC di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Filoni A, Ambrogio F, De Marco A, Pacifico A, Bonamonte D. Topical beta-blockers in dermatologic therapy. Dermatol Ther 2021; 34:e15016. [PMID: 34075667 PMCID: PMC8459235 DOI: 10.1111/dth.15016] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/24/2021] [Indexed: 12/25/2022]
Abstract
An increasing use of beta-blockers in dermatology has been described over the last 10 years, despite the fact that their use in diseases other than infantile hemangiomas is off-label. This review discusses the emerging role of topical beta-blockers in the treatment of infantile hemangioma, but also pyogenic granuloma, Kaposi sarcoma, wounds and nail paronychia. Data in literature demonstrate that topical beta-blockers are a safe and valid therapeutic option in numerous cutaneous diseases. Side effects are mainly restricted to the application site. Further studies and randomized trials may contribute to reinforce the role of topical beta-blockers in the dermatological armamentarium.
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Affiliation(s)
- Angela Filoni
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy.,Section of Dermatology, Perrino Hospital, Brindisi, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Aurora De Marco
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Alessia Pacifico
- Phototherapy Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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8
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Dall'Oglio F, Lacarrubba F, Micali G. Erythema-directed digital photography and colorimeter scores correlate with rosacea erythema evaluation in patients under treatment with topical ivermectin. Dermatol Ther 2021; 34:e14920. [PMID: 33641260 DOI: 10.1111/dth.14920] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
Inflammatory rosacea is clinically characterized by persistent erythema and inflammatory lesions. Its severity is generally based on clinical observation that may be cumbersome. The aim of this study was to assess if erythema-directed digital photography (EEDP) and colorimeter (COL) correlate and are concordant with clinical evaluation of erythema degree of rosacea under topical treatment. Thirty naïve patients with mild/moderate inflammatory rosacea were instructed to apply ivermectin cream for 8 weeks. Erythema degree was performed at baseline, and at 2, 4, 6, and 8 weeks by clinician erythema assessment based on 5-point severity scale (from 0 = no erythema to 4 = fiery redness), and by instrumental evaluation by EDDP using the same 5-point scale of clinical assessment and by COL using a 5-point scale (from 0 = <1 units = no erythema to 4 > 12 units = fiery redness). Concordance and correlation analysis were performed using Cohen's Kappa coefficient and Correlation Coefficient test respectively. At baseline a statistically significant concordance/correlation value between EDDP and COL was observed. At 2 weeks, the statistical concordance/correlation value between instrumentals were both increased, along with a slight significant concordance between clinical assessment and erythema-directed digital photography. At 4, 6 and 8 weeks, a statistically significant increase of concordance/correlation value among all the considered parameters from baseline was found. The results of our study showed that at baseline and during the early treatment stage both EDDP and COL were able to appreciate more accurately the erythema grade compared to clinical observation supporting the use of non-invasive techniques for a more objective evaluation of erythema in rosacea.
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9
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Bradley F, Bayer ML, Co DO, Chiu Y, Huber AM, Ahmad RC, Baris HE, Oberle EJ, Kim S. Clinical characteristics and management of clinically amyopathic juvenile dermatomyositis across four academic centers. Pediatr Dermatol 2021; 38:413-419. [PMID: 33438772 DOI: 10.1111/pde.14510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/15/2023]
Abstract
BACKGROUND/OBJECTIVES Clinically amyopathic juvenile dermatomyositis (CAJDM) is an uncommon but important subset of patients with juvenile dermatomyositis, characterized by pathognomonic cutaneous findings without clinically evident muscle weakness. With limited data available and lack of standardized management guidelines for CAJDM, we sought to describe common features, including early indicators that may be associated with progression of muscle disease, and review the course and treatment of these patients. METHODS A retrospective chart review of patients with CAJDM was conducted at four North American academic centers between the years 2000 and 2015. RESULTS Twenty-nine patients were included, of whom 21 (72%) were female. After a median follow-up of 4 years (IQR 1.8-5.8 years), 5 of the 29 (17%) patients with CAJDM evolved into classic juvenile dermatomyositis. Median time to develop weakness was 12 months (IQR 8-19 months) after diagnosis. The skin disease of CAJDM patients who did not develop weakness was often found to be recalcitrant with 58% of them requiring multiple systemic therapies to control their cutaneous disease. CONCLUSION These results highlight the need for long-term monitoring for the development of myositis in CAJDM and for prospective studies on treatment of recalcitrant skin disease.
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Affiliation(s)
- Flora Bradley
- Department of Pediatrics, University of California, Fresno, CA, USA
| | - Michelle L Bayer
- Department of Dermatology, Aurora Health Care, Milwaukee, WI, USA
| | - Dominic O Co
- Department of Pediatrics, Section of Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yvonne Chiu
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Adam M Huber
- Department of Pediatrics, Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, NS, Canada
| | - Regina-Celeste Ahmad
- Department of Dermatology, Section of Pediatric Dermatology, UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | - Hatice E Baris
- Department of Pediatrics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Edward J Oberle
- Department of Pediatrics, Section of Pediatric Rheumatology, Nationwide Children's Hospital, Ohio State University, Columbus, Oh, USA
| | - Susan Kim
- Department of Pediatrics, Pediatric Rheumatology Division, UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA.,Department of Pediatrics, Pediatric Rheumatology, Boston Children's Hospital, Boston, MA, USA
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10
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Collier EK, Seivright JR, Shi VY, Hsiao JL. Pregnancy and breastfeeding in hidradenitis suppurativa: A review of medication safety. Dermatol Ther 2020; 34:e14674. [PMID: 33320387 DOI: 10.1111/dth.14674] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that disproportionately affects women of childbearing age. Pregnancy influences HS severity for many women, thus diligent continued management throughout pregnancy and postpartum may be required. Herein, we provide an updated review of pregnancy and lactation safety data for HS medications, including topical antiseptic washes, topical and systemic antibiotics, biologic and nonbiologic immunomodulators, immunosuppressants, adjunct medical therapies, and pain medications, to help guide risk-benefit discussions between providers and HS patients.
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Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Justine R Seivright
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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11
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Barua DP, Chowdhury MIH, Mowla MR, Reich A, Murrell D, Ruzicka T. Comparison of effectiveness of topical tacrolimus 0.1% vs topical halobetasol propionate 0.05% as an add-on to oral hydroxychloroquine in discoid lupus erythematosus. Dermatol Ther 2020; 34:e14675. [PMID: 33320408 DOI: 10.1111/dth.14675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/03/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
In recent years, calcineurin inhibitors have been used as the first line alternative to topical corticosteroids in the treatment of discoid lupus erythematosus (DLE). We aim to evaluate the efficacy and safety of topical tacrolimus 0.1% vs topical halobetasol propionate 0.05% in patients with DLE. This comparative study was carried out in the Department of Dermatology and Venereology, Chittagong Medical College Hospital (CMCH), Bangladesh between the period of July 2018 and June 2019. The change of DLE activity assessed with the cutaneous lupus erythematosus disease area and severity index was used as a primary outcome measure. The effective sample was 40 patients in each group. Both groups were similar in terms of baseline demographic and clinical characteristics. After 8 weeks of treatment, the mean total erythema score decreased significantly in both groups (in tacrolimus treated group [TTG] from 12.53 ± 8.05 to 8.03 ± 5.69, [P < .001] and in halobetasol propionate treated group [HTG] from 11.83 ± 7.17 to 7.30 ± 4.56 [P < .001]), as well as the mean total scale/hypertrophy score (in TTG from 8.08 ± 5.30 to 4.33 ± 3.21; [P < .001] and in HTG from 7.40 ± 4.73 to 3.68 ± 2.01, [P < .001]. The magnitude of reduction was significantly better in HTG [P = .032]). The mean total activity score decreased significantly in both groups (in TTG from 22.95 ± 13.40 to 14.33 ± 8.89, [P < .001] and in HTG from 22.15 ± 11.95 to 13.7 ± 7.22, [P < .001]). The present study demonstrated that tacrolimus 0.1% ointment and halobetasol propionate 0.05% ointment had a comparable efficacy in DLE patients; however, halobetasol showed significantly better improvement regarding scaly, hypertrophic lesions.
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Affiliation(s)
- Deva Pratim Barua
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | | | - Mohammad Rafiqul Mowla
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Dedee Murrell
- Dermatology, St George Hospital, University of NSW, Sydney, New South Wales, Australia
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Munich, Germany
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12
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Mirza HN, Mirza FN, Khatri KA. Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients. Dermatol Ther 2020; 34:e14432. [PMID: 33084193 DOI: 10.1111/dth.14432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/26/2020] [Revised: 09/20/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA-compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms "ablative laser" and "skin resurfacing" from March 2002 until July 2020. Studies included meta-analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self-resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.
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Affiliation(s)
- Humza N Mirza
- University of Michigan Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Fatima N Mirza
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Khalil A Khatri
- Skin & Laser Surgery Center of New England, Nashua, New Hampshire, USA
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13
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Eichenfield LF, Yosipovitch G, Stein Gold LF, Kalabis M, Zang C, Vlahos B, Sanders P, Myers DE, Bushmakin AG, Cappelleri JC, Olivadoti M, Paller AS. Improvement in disease severity and pruritus outcomes with crisaborole ointment, 2%, by baseline atopic dermatitis severity in children and adolescents with mild-to-moderate atopic dermatitis. Pediatr Dermatol 2020; 37:1030-1037. [PMID: 32981097 PMCID: PMC7756882 DOI: 10.1111/pde.14328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/26/2020] [Revised: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild-to-moderate atopic dermatitis (AD). This pooled post hoc analysis of two phase 3 trials (NCT02118766, NCT02118792) assessed improvement and time to improvement in Investigator's Static Global Assessment (ISGA) and Severity of Pruritus Scale (SPS) outcomes in pediatric patients with mild-to-moderate AD. METHODS Patients aged ≥2 years were randomly assigned 2:1 to receive twice-daily crisaborole or vehicle for 28 days. Patients aged 2-17 years were pooled for this analysis. Proportions of patients and time to achieving ISGA success (clear [0] or almost clear [1] with ≥2-grade improvement from baseline), ISGA clear/almost clear, ≥1-grade improvement in ISGA, SPS success (SPS score ≤1 with ≥1-grade improvement), or ≥1-grade improvement in SPS score were analyzed and stratified by baseline ISGA. RESULTS At first postbaseline assessment (day 8), significantly higher proportions of crisaborole- than vehicle-treated patients achieved ISGA success, ISGA clear/almost clear, ≥1-grade ISGA improvement, SPS success, or ≥1-grade improvement in SPS regardless of baseline ISGA. Differences were significantly greater over time for all outcomes for patients with moderate baseline ISGA and numerically greater for those with mild baseline ISGA. Median times to ISGA and SPS outcomes were shorter for crisaborole versus vehicle. CONCLUSION Improvement in ISGA and SPS outcomes were observed with crisaborole in pediatric patients with mild-to-moderate baseline AD.
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Affiliation(s)
| | - Gil Yosipovitch
- Miami Itch Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | | | | | | | | | | | | | | | | | | | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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14
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Alsaleemi A, O'Connor C, Irvine AD, Leahy TR. Topical cidofovir for the treatment of recalcitrant viral warts and molluscum contagiosum in Jacobsen syndrome. Pediatr Dermatol 2020; 37:1191-1192. [PMID: 32897593 DOI: 10.1111/pde.14355] [Citation(s) in RCA: 3] [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] [Received: 05/09/2020] [Revised: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Abstract
Jacobsen syndrome is caused by a terminal deletion on the long arm of chromosome 11 and can be associated with immunodeficiency. Patients with Jacobsen syndrome can be predisposed to cutaneous viral infections that are difficult to treat. We report successful use of topical 1% cidofovir as treatment of recalcitrant verruca vulgaris in one patient and molluscum contagiosum in another patient with Jacobsen syndrome. Topical cidofovir appears to be a good treatment option in this cohort and should be considered early for treatment-resistant cutaneous viral infections.
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Affiliation(s)
- Ali Alsaleemi
- Department of Paediatric Immunology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Cathal O'Connor
- Department of Paediatric Dermatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Alan D Irvine
- Department of Paediatric Dermatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland.,Department of Clinical Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Timothy Ronan Leahy
- Department of Paediatric Immunology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland.,Department of Paediatrics, Trinity College, University of Dublin, Dublin, Ireland
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15
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Bertoli MJ, Sadoughifar R, Schwartz RA, Lotti TM, Janniger CK. Female pattern hair loss: A comprehensive review. Dermatol Ther 2020; 33:e14055. [PMID: 32700775 DOI: 10.1111/dth.14055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 12/28/2022]
Abstract
Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low-level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.
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Affiliation(s)
- Mia J Bertoli
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
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16
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Almutairi N, Schwartz RA. COVID-19 with dermatologic manifestations and implications: An unfolding conundrum. Dermatol Ther 2020; 33:e13544. [PMID: 32385869 PMCID: PMC7261983 DOI: 10.1111/dth.13544] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus SARS‐CoV‐2 has caused Coronavirus Disease 2019, widely known as COVID‐19, now a pandemic with extraordinary infectivity, mortality, and fomite adhesiveness. We delineate cutaneous manifestations of COVID‐19, some of which may represent adverse cutaneous drug reactions, and skin changes associated with COVID‐19 lifestyle alterations in patients and health care workers. We review COVID‐19 from both a dermatologic and public health perspective.
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Affiliation(s)
- Nawaf Almutairi
- Kuwait University, Faculty of Medicine and Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Kuwait University, Faculty of Medicine and Rutgers New Jersey Medical School, Newark, New Jersey, USA
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17
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Camacho I, Scott J, DeKlotz C. Topical sirolimus for treatment of a solitary angiokeratoma. Dermatol Ther 2020; 33:e13907. [PMID: 32594609 DOI: 10.1111/dth.13907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/06/2020] [Revised: 06/13/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
Angiokeratomas are benign vascular neoplasms that arise as solitary or multiple lesions, most commonly treated with excision, electrodessication, cryotherapy, or laser therapies. This case presents a young female whose solitary angiokeratoma was treated with topical 1% sirolimus cream, improving the appearance, symptoms, and size of the lesion. Topical sirolimus cream may be a noninvasive treatment option for angiokeratomas with fewer risks than standard therapy that may be feasible and preferable for some patients.
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Affiliation(s)
- Isabella Camacho
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jennifer Scott
- Derpartment of Dermatology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia, USA
| | - Cynthia DeKlotz
- Derpartment of Dermatology, Medstar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia, USA
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18
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Friedman PC, Fridman G, Fridman A. Using cold plasma to treat warts in children: A case series. Pediatr Dermatol 2020; 37:706-709. [PMID: 32323887 DOI: 10.1111/pde.14180] [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] [Received: 09/16/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023]
Abstract
Treatment of warts is especially challenging in the pediatric patient population because of the pain associated with many of available treatments. Cold atmospheric pressure plasma is a novel treatment with expanding clinical uses for a variety of skin conditions. In this case series, we present five pediatric patients who achieved full clearance of warts with cold plasma treatment. While further studies are needed, these results are promising because of the efficacy and entirely painless nature of this treatment modality.
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Affiliation(s)
| | - Gregory Fridman
- C&J Nyheim Plasma Institute, Drexel University, Camden, NJ, USA
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19
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Fisher J, Moustafa D, Su KA, Bartenstein DW, Lilly E, Kroshinsky D, Hawryluk EB. A pediatric approach to management of skin growths in basal cell nevus syndrome. Pediatr Dermatol 2020; 37:527-530. [PMID: 32065689 DOI: 10.1111/pde.14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/29/2022]
Abstract
Little guidance on management of basal cell nevus syndrome in children exists. We report a case series of four patients diagnosed with BCNS in early childhood, in whom several highly suspicious lesions were biopsied, but several smaller and questionably concerning lesions were treated with therapies that are more tolerable for children, including topical imiquimod, 5-fluorouracil, cryotherapy, or touch electrodessication following topical anesthetic cream. These therapies were well tolerated, and all residual or persistent lesions were subsequently biopsied and found to be benign. This approach is often preferable for pediatric BCNS patients, in whom concerning lesions can be identified clinically and managed compassionately. However, any lesion that exhibits growth, bleeding, or symptoms should be biopsied for definitive diagnosis.
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Affiliation(s)
- Jonathan Fisher
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Danna Moustafa
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine A Su
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Diana W Bartenstein
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Evelyn Lilly
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Elena B Hawryluk
- Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
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20
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Shayegan LH, Levin LE, Galligan ER, Lucky AW, Bruckner AL, Pope E, Lara-Corrales I, Wiss K, McCuaig CC, Garzon MC, Eichenfield LF, Hook KP, Browning JC, Schachner LA, Perman MJ, Castelo-Soccio L, Levy ML, Glick SA, Morel KD. Skin cleansing and topical product use in patients with epidermolysis bullosa: Results from a multicenter database. Pediatr Dermatol 2020; 37:326-332. [PMID: 31944391 DOI: 10.1111/pde.14102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND/OBJECTIVES Epidermolysis bullosa (EB) comprises a group of inherited skin blistering diseases. There is currently no cure, and management includes skin protection and prevention of infection. To date, there has been no systematic investigation of home skin care practices among EB patients on a multicenter scale. METHODS This cross-sectional, observational study included data collected from patients with EB enrolled in the Epidermolysis Bullosa Characterization and Clinical Outcomes Database (EBCCOD) who provided answers to a patient-directed questionnaire between January 1, 2017, and December 31, 2017. RESULTS Of 202 respondents, 130 (64.4%) had dystrophic EB, 51 (25.2%) had EB simplex, 21 (7.4%) had junctional EB, 3 (1.5%) had Kindler syndrome, and 3 (1.5%) had an unspecified subtype. Seventy-eight patients reported cleansing in plain water only (39%). Of those who used an additive in their cleansing water, 75 (57%) added salt, 71 (54%) added bleach, 36 (27%) added vinegar, and 34 (26%) endorsed the use of an "other" additive (multiple additives possible). Reported concentrations of additives ranged widely from 0.002% sodium hypochlorite and 0.002% acetic acid solutions, which are thought to have negligible effects on microbes, to 0.09% sodium hypochlorite and 0.156% acetic acid, concentrations shown to be cytotoxic. One hundred eighty-eight patients answered questions regarding topical product use (93%). Of those, 131 reported topical antimicrobial use (70%). Mupirocin and bacitracin were the most commonly reported topical antibiotics (59, 58 [31.4%, 30.9%], respectively). CONCLUSIONS These findings highlight the variety of skin care routines and frequent use of topical antimicrobials among EB patients and have potential implications for antibiotic resistance. The reported range of bleach and vinegar additives to cleansing water, including cytotoxic concentrations, emphasizes the need for clear and optimized skin cleansing recommendations.
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Affiliation(s)
- Leila H Shayegan
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Laura E Levin
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Eloise R Galligan
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Anne W Lucky
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Dermatology, University of California San Diego, San Diego, California
| | - Kristen P Hook
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - John C Browning
- Department of Pediatric Dermatology, Children's Hospital San Antonio, San Antonio, Texas
| | - Lawrence A Schachner
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - Marissa J Perman
- Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Moise L Levy
- Departments of Pediatrics and Medicine (Dermatology), Dell Medical School, University of Texas, Austin, Texas
- Department of Pediatric Dermatology, Dell Children's Medical Center, Austin, Texas
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Kimberly D Morel
- Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York
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21
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Bresesti I, Ciolfi C, Rotatore G, Borisov AN, Zuccotti GV, Brazzelli V. Acute ulceronecrotic adverse reaction to potassium hydroxide 5% solution in the treatment of molluscum contagiosum. Pediatr Dermatol 2020; 37:224-225. [PMID: 31625620 DOI: 10.1111/pde.14015] [Citation(s) in RCA: 3] [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: 11/29/2022]
Abstract
Molluscum contagiosum is a common childhood condition, and although it is self-limited, treatments are often prescribed. Several medications are available, but there is no consensus regarding the optimal choice in the pediatric population. We report a child who underwent potassium hydroxide 5% treatment resulting in superficial diffuse erosions caused by the inappropriate application. This underlines the importance of parent education before use of this medication with well-known caustic properties.
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Affiliation(s)
- Ilia Bresesti
- Department of Pediatrics, "L. Sacco" Hospital, University of Milan, Milan, Italy
| | - Christian Ciolfi
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Giuseppe Rotatore
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | - Angel N Borisov
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
| | | | - Valeria Brazzelli
- Department of Clinical, Surgical, Diagnostics and Pediatric Sciences, Institute of Dermatology, IRCCS Policlinico San Matteo Foundation and University of Pavia, Pavia, Italy
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22
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Sernicola A, Gattazzo I, Di Staso F, Giordano D, Capalbo A, Persechino F, Scuderi G, Persechino S. Treatment of refractory conjunctivitis associated to dupilumab with topical pimecrolimus applied to the eyelid skin. Dermatol Ther 2019; 32:e13134. [PMID: 31639238 DOI: 10.1111/dth.13134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 09/06/2019] [Revised: 10/07/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
Patients with atopic dermatitis commonly experience ophthalmic complications, and a higher incidence of conjunctivitis has been observed during treatment with dupilumab. We present the case of a 49-year-old woman with persistent severe atopic dermatitis who complained of refractory conjunctivitis associated with dupilumab. Ocular examination showed features of atopic conjunctivitis for which an external topical application to the eyelids of pimecrolimus 10 mg/g cream was prescribed. The patient showed substantial clinical remission after only 12 days. This case was remarkable as the medication applied externally to the eyelid skin was effective in treating the conjunctival involvement possibly due to penetration of pimecrolimus through the eyelid layers. Further studies are needed to support the use of this drug for dupilumab-related conjunctivitis.
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Affiliation(s)
- Alvise Sernicola
- Dermatology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Irene Gattazzo
- Ophthalmology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Federico Di Staso
- Ophthalmology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Domenico Giordano
- Dermatology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Alessandro Capalbo
- Dermatology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Flavia Persechino
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
| | - Severino Persechino
- Dermatology Unit, NESMOS Department, "Sapienza" University of Rome, Rome, Italy
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23
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Kurt MH, Kolsuz ME, Eren H. Corticosteroid injection in treatment of persistent oral lichen planus: Three cases. Dermatol Ther 2019; 32:e13015. [PMID: 31268212 DOI: 10.1111/dth.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/03/2019] [Revised: 05/27/2019] [Accepted: 06/23/2019] [Indexed: 01/15/2023]
Abstract
Oral lichen planus (OLP) is a chronic inflammatory disease with unknown etiology. There are many clinical types of OLP. OLP cases are often asymptomatic; however, atrophic or erosive forms may cause sensitivity, burning, and discomfort. The best model of the OLP treatment modality is to evaluate the restorations that may lead to oral mucosa hypersensitivity as the first step. Local corticosteroid injection therapy may be preferred to eliminate the possible systemic side effects of systemic corticosteroid medication in patients with OLP. The aim of this case series is to evaluate treatment alternatives in OLP.
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Affiliation(s)
- Mehmet H Kurt
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
| | - Mehmet E Kolsuz
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
| | - Hakan Eren
- Faculty of Dentistry, Dentomaxillofacial Radiology Department, Ankara University, Ankara, Turkey
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24
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Abstract
BACKGROUND Umbilical granuloma is an overgrowth of granulation tissue following the separation of umbilical cord. Treatment options for this common entity are limited and have side effects such as chemical burns. In this study, we present a novel modification of the salt application method to treat infants with umbilical granuloma. METHODS Seventeen infants were recruited in our study after institutional ethics committee approval and consent from the parents. The area of application was cleaned, and common table salt was carefully applied over the lesion. The granuloma was then occluded with surgical adhesive tape for 24 hours. Cases were followed up the next day to remove the occlusive tape and for assessment of improvement. RESULTS All seventeen cases responded well to this approach with complete resolution of lesions at 24 hours. Small clotlike shrunken tissue was found at the site of granuloma, which was easily scraped off during gentle cleansing. No major complication or recurrence was noted in 3 months of follow-up. CONCLUSION Complete resolution of umbilical granuloma can be achieved with a single, clinic-based application of salt under occlusion for 24 hours. Salt causes shrinkage of granuloma inside occluded hyperosmolar chamber by desiccant effect. The salient features of this method include ease of application, low cost of treatment, accurate one-time physician-controlled application, and complete and rapid resolution without complication.
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Affiliation(s)
- Jimish Bagadia
- Department of Dermatology and Venereology, K. J. Somaiya Medical College and Research Centre, Mumbai, India
| | - Saurabh Jaiswal
- Department of Dermatology and Venereology, K. J. Somaiya Medical College and Research Centre, Mumbai, India
| | - Krishna B Bhalala
- Department of Dermatology and Venereology, K. J. Somaiya Medical College and Research Centre, Mumbai, India
| | - Shital Poojary
- Department of Dermatology and Venereology, K. J. Somaiya Medical College and Research Centre, Mumbai, India
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25
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Patel VM, Schwartz RA, Lambert WC. Topical antibiotics in pregnancy: A review of safety profiles. Dermatol Ther 2019; 32:e12951. [PMID: 31025480 DOI: 10.1111/dth.12951] [Citation(s) in RCA: 5] [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: 03/11/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022]
Abstract
Medications should be used with caution in women of childbearing age who are pregnant, or are contemplating pregnancy. Although topical medications are considered safer than oral or parenteral agents, their safety data in pregnancy must be assessed carefully. The available information on medication use in pregnancy is limited, and not always aided by the FDA pregnancy letter category system. Thus, in this article, we aggregate human studies, animal studies, and pharmacokinetics data to provide recommendations on utilizing topical antibiotics in pregnancy.
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Affiliation(s)
- Viral M Patel
- Department of Dermatology, Stony Brook University Medical Center, Stony Brook, New York
| | - Robert A Schwartz
- Departments of Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - W Clark Lambert
- Departments of Dermatology and Pathology, Rutgers New Jersey Medical School, Newark, New Jersey
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26
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Abstract
We report a pediatric case of extensive, progressive benign cephalic histiocytosis (BCH) involving the face, trunk, and extremities with response of facial lesions to treatment with topical 1% rapamycin. A split-face model was used to demonstrate improvement on the treated side versus the untreated side. After physician and parental perception of effectiveness, based in part on photodocumentation, subsequently both cheeks were treated with continued improvement.
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Affiliation(s)
- Kaiane Habeshian
- Division of Pediatric Dermatology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert A Silverman
- Department of Pediatrics, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Cynthia M C DeKlotz
- Division of Dermatology, MedStar Georgetown University Hospital-Washington Hospital Center, Washington, District of Columbia
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27
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Kim EJ, Aria AB, Wilmas K, Lewis DJ, Torres-Cabala CA, Nunez C, Dabaja BS, Duvic M. Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder in a pediatric patient successfully treated with low-dose radiation. Pediatr Dermatol 2019; 36:e23-e26. [PMID: 30548331 DOI: 10.1111/pde.13728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Primary cutaneous CD4+ small- to medium-sized pleomorphic T-cell lymphoproliferative disorder (PCSM-LPD) is a rare and low-grade form of cutaneous T-cell proliferation with the average age of diagnosis of 54 years. Because of its rarity, the etiology or exact clinicopathology of PCSM-LPD remains unclear, with < 10 pediatric cases reported. A 13-year-old boy presented to our clinic with a raised tumor with PCSM-LPD histology and was successfully treated with ultra-low-dose radiation therapy. While no standard of care has been established for pediatric PCSM-LPD, this report represents an example of achieving remission in a pediatric tumor with minimal potential for therapy-related long-term toxicity.
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Affiliation(s)
- Esther J Kim
- School of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexander B Aria
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Kelly Wilmas
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Daniel J Lewis
- School of Medicine, Baylor College of Medicine, Houston, Texas.,Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cesar Nunez
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract
BACKGROUND Sinecatechins ointment, a green tea derivative, is a novel agent approved for the treatment of anogenital warts in immunocompetent adults and has been reported to be effective in treating extragenital warts as well. Data are lacking in children. We sought to determine the efficacy and tolerability of sinecatechins ointment for treating warts in children. METHODS A retrospective cohort study was conducted of children with anogenital and/or extragenital warts treated with sinecatechins ointment for at least 1 month. The primary outcome was frequency of complete response (total resolution of warts at follow-up). Secondary outcomes included frequency of partial response (reduction in number and/or size of warts) and adverse events. There was no control group for comparison. RESULTS Of 24 patients who met the inclusion criteria, 14 (58.3%) had anogenital warts, 7 (29.2%) had extragenital warts, and 3 (12.5%) had both anogenital and extragenital warts. Mean age at treatment initiation was 8.0 years (SD = 3.9). Median duration of warts at treatment initiation was 1.2 years (range 0.09-12.62). Sixteen patients (66.7%) experienced a reduction in the number and/or size of the warts. Four patients (16.7%) had complete resolution. Median treatment duration was 4.5 months (range 0.6-21.8) overall. Median time to complete resolution was 2.9 months (range 1.3-7.7). Fifty-four percent of patients used sinecatechins ointment as prescribed. Adverse events were limited to mild local irritation (7 patients; 29.2%). CONCLUSION Sinecatechins ointment is a promising therapy for warts in children, and its use should be evaluated in prospective controlled clinical trials.
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Affiliation(s)
- Maya Deeb
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Rebecca Levy
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
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29
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Abstract
Sirolimus has emerged as a promising treatment for complex congenital vascular malformations but is limited because of systemic side effects. Topically compounded formulations, which have been found to be successful in the treatment of several other conditions, are a preferred drug delivery system to provide local therapy. We report a case of a venolymphatic malformation in an adolescent girl treated with topical 1% sirolimus cream leading to improvement in appearance and associated symptoms.
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Affiliation(s)
- Michael A Cardis
- MedStar Washington Hospital Center/MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Cynthia M C DeKlotz
- MedStar Washington Hospital Center/MedStar Georgetown University Hospital, Washington, District of Columbia
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30
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Abstract
BACKGROUND/OBJECTIVES Data on treatment options in pediatric alopecia areata are limited. Topical anthralin has been demonstrated to be an effective treatment option in adults and has minimal systemic toxicity. Prior results on its efficacy in children with alopecia areata have been mixed. METHODS Medical records of 37 patients with alopecia areata who were started on topical anthralin before age 17 were reviewed for efficacy and safety data. Scalp regrowth was quantified by serial photography if available or by medical record documentation if photographs were unavailable. Mean duration of clinical follow-up was 2.5 years. RESULTS Most patients were started on anthralin while continued on prior therapies, including topical corticosteroids, minoxidil, and/or intralesional corticosteroids. Twelve patients (32%) experienced complete scalp regrowth, while 25 patients (68%) experienced at least 50% maximal scalp regrowth with using anthralin. Of the patients with at least 50% scalp regrowth, mean time to first clinically observed response was 3.4 months. Mean time to maximal response was 15 months. Four patients stopped anthralin due to skin irritation. Relapses affected 64% of those with at least 50% maximal scalp regrowth. CONCLUSIONS Topical anthralin provides children with alopecia areata an additional option that offers potential for significant scalp regrowth with minimal systemic effects. Treatment course may need to be continued for at least 1 year in order to achieve maximal efficacy. The efficacy of anthralin may be limited by high rate of recurrence and local adverse effects.
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Affiliation(s)
- Sean Z Wu
- Department of Dermatology, University of Cincinnati, Cincinnati, Ohio
| | - Sophie Wang
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Wilma F Bergfeld
- Department of Dermatology, Cleveland Clinic Foundation, Cleveland, Ohio
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31
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Abstract
Several treatment modalities are available for the management of alopecia areata (AA); however, no therapy is universally effective and treatment can be frustrating in severe cases, with low response and high recurrence rates. Recent studies show that the JAK/STAT pathway plays a central role in the pathogenesis of this disease by determining the crosstalk between the infiltrating CD8+ T cells and the hair follicles, suggesting a role of JAK inhibitors in the treatment of AA. However, reports on the off-label use of these more expensive targeted agents have shown variable results. We present a case of a child with recalcitrant ophiasis-pattern AA who had failed steroid therapy and was treated successfully with leflunomide and anthralin, possibly by the synergistic effect on the JAK/STAT pathway inhibition, and we propose this combination could be a cost-effective therapeutic option for recalcitrant AA.
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32
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Bowles VM, VanLuvanee LJ, Alsop H, Hazan L, Shepherd K, Sidgiddi S, Allenby K, Ahveninen T, Hanegraaf S. Clinical studies evaluating abametapir lotion, 0.74%, for the treatment of head louse infestation. Pediatr Dermatol 2018; 35:616-621. [PMID: 29999197 PMCID: PMC6175393 DOI: 10.1111/pde.13612] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is a need for better control of head louse infestations. Abametapir is an inhibitor of metalloproteinases critical for louse survival and egg development. The efficacy of abametapir lotion, 0.74%, was assessed for its ability to clear head louse infestations after a single application. METHODS Two randomized, double-blind, multicenter, vehicle-controlled studies were conducted in subjects aged 6 months and older to compare the effectiveness of abametapir lotion versus vehicle control for eliminating head louse infestations without nit combing. Abametapir lotion was applied to dry hair for 10 minutes on day 0 and then rinsed with water. The primary endpoint was the proportion of index subjects (youngest household member with ≥ 3 live lice at screening) in the intent-to-treat population who were louse free at all follow-up visits through day 14. Older household members with one or more live lice at screening were designated as nonindex subjects and treated as per the index subject within their household. RESULTS In the intent-to-treat population (index subjects, N = 216), 81.5% of subjects treated with abametapir lotion were louse free through day 14 after a single treatment, versus 49.1% with vehicle (P < 0.001). For the combined index and nonindex population (N = 704), 85.9% were louse free through day 14 in the abametapir group, versus 61.3% in the vehicle group (P < 0.001). The most frequently reported adverse events were erythema (4.0%), rash (3.2%), and skin burning sensation (2.6%). CONCLUSION Abametapir lotion, 0.74%, was effective at clearing active head louse infestations through day 14 in subjects aged 6 months and older. All adverse events (including one serious but unrelated to study drug) resolved uneventfully.
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Affiliation(s)
- Vernon M Bowles
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Vic., Australia.,Hatchtech Pty Ltd, Melbourne, Vic., Australia
| | | | - Hugh Alsop
- Hatchtech Pty Ltd, Melbourne, Vic., Australia
| | - Lydie Hazan
- Axis Clinical Trials, Los Angeles, California
| | - Katie Shepherd
- LSRN Research/The Shepherd Institute for Lice Solutions, West Palm Beach, Florida
| | - Srinivas Sidgiddi
- Promius Pharma, a subsidiary of Dr. Reddy's Laboratories, Princeton, New Jersey
| | - Kent Allenby
- Promius Pharma, a subsidiary of Dr. Reddy's Laboratories, Princeton, New Jersey
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Abstract
The treatment options for ichthyosis are limited. Successful treatment with topical N-acetylcysteine has been reported in a small number of patients, with generally good results. We report the finding of a retrospective chart review of 18 patients treated with N-acetylcysteine. Although topical N-acetylcysteine is an effective therapy for some patients with ichthyosis, problems with irritation, objectionable odor, and compounding costs limit its use.
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Affiliation(s)
- Laura Kaplan
- Downstate Medical School, State University of New York, Brooklyn, NY, USA
| | - Leslie Castelo-Soccio
- Division of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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34
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Hilerowicz Y, Koren A, Mashiah J, Katz O, Sprecher E, Artzi O. Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application: A treatment option for pediatric cutaneous leishmaniasis. Pediatr Dermatol 2018; 35:366-369. [PMID: 29574997 DOI: 10.1111/pde.13457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/18/2023]
Abstract
BACKGROUND Leishmaniasis is a protozoan zoonotic parasitic infection with cutaneous, mucocutaneous, and visceral manifestations. Israel is endemic for cutaneous leishmaniasis, which is a self-limited disease but is associated with scarring, which is often a source of psychological and social burden for patients. Scars can be especially devastating for children and teenagers. A wide range of physical and medical approaches is used to treat cutaneous leishmaniasis, among which intralesional injections of sodium stibogluconate rank among the most frequently used. Unfortunately, despite being effective, this therapeutic modality can be very painful. Fractional ablative laser creates a controlled mesh-like pattern of tissue ablation in the skin that promotes dermal remodeling and collagen production while at the same time facilitating enhanced delivery of topically applied medications. METHODS Patients were treated with fractional ablative carbon dioxide laser followed by immediate topical application of sodium stibogluconate. All children were diagnosed with cutaneous leishmaniasis prior to treatment initiation.. RESULTS Ten children were treated. One leishmania tropica-positive girl failed to respond. The other nine patients achieved clinical cure and demonstrated good to excellent final cosmesis. Self-rated patient satisfaction and tolerance were high No adverse effects were observed or reported during treatment. CONCLUSION Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application appears to be a safe and promising treatment for cutaneous leishmaniasis infection in children. Future controlled studies are required to validate these findings and compare this technique with traditional approaches.
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Affiliation(s)
- Yuval Hilerowicz
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Koren
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jacob Mashiah
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Pediatric Dermatology Clinic, Tel Aviv Sourasky Medical Center, Dana Children's Hospital, Tel Aviv, Israel
| | - Oren Katz
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Pediatric Dermatology Clinic, Tel Aviv Sourasky Medical Center, Dana Children's Hospital, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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35
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Siegfried EC, Jaworski JC, Eichenfield LF, Paller A, Hebert AA, Simpson EL, Altman E, Arena C, Blauvelt A, Block J, Boguniewicz M, Chen S, Cordoro K, Hanna D, Horii K, Hultsch T, Lee J, Leung DY, Lio P, Milner J, Omachi T, Schneider C, Schneider L, Sidbury R, Smith T, Sugarman J, Taha S, Tofte S, Tollefson M, Tom WL, West DP, Whitney L, Zane L. Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry. Pediatr Dermatol 2018; 35:303-322. [PMID: 29600515 DOI: 10.1111/pde.13452] [Citation(s) in RCA: 12] [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] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option. Several clinical trials with level 1 evidence have supported the use of topical treatments for mild to moderate atopic dermatitis in adults and children, but these trials have had little consistency in protocol design. Consensus recommendations will help standardize clinical development and trial design for children. The Food and Drug Administration issues guidance documents for industry as a source for "the Agency's current thinking on a particular subject." Although they are nonbinding, industry considers these documents to be the standard for clinical development and trial design. Our consensus group is the first to specifically address clinical trial design in this population. We developed a draft guidance document for industry, Developing Drugs for Treatment of Atopic Dermatitis in Children (≥3 months to <18 years of age). This draft guidance has been submitted to the Food and Drug Administration based on a provision in the Federal Register (Good Guidance Practices).
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Affiliation(s)
- Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Lawrence F Eichenfield
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Amy Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, TX, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Charles Arena
- Clinical Development & Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Suephy Chen
- Department of Dermatology, Emory University, and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Diane Hanna
- Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy and University of Missouri, Kansas City, MO, USA
| | - Thomas Hultsch
- Translational Medicine, Sanofi-Genzyme, Cambridge, MA, USA
| | - James Lee
- Dermavant Sciences, Raleigh-Durham, NC, USA
| | - Donald Y Leung
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Theodore Omachi
- Immunology/Respiratory, Genentech, Inc., San Francisco, CA, USA
| | | | - Lynda Schneider
- Department of Pediatrics, Harvard Medical School and Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sharif Taha
- National Eczema Association, San Rafael, CA, USA
| | - Susan Tofte
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Wynnis L Tom
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucinda Whitney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lee Zane
- Anacor Pharmaceuticals, Palo Alto, CA, USA
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36
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Li AW, Lalor LE, Bellodi Schmidt F, Luu M. A pediatric case of squamous cell cancer in situ in the setting of sclerodermatous graft-versus-host disease and voriconazole treatment. Pediatr Dermatol 2018; 35:e165-e169. [PMID: 29570823 DOI: 10.1111/pde.13473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/23/2022]
Abstract
Sclerodermatous graft-versus-host disease is a subtype of cutaneous chronic graft-versus-host disease that is characterized by sclerosis of the skin and subcutaneous tissue, resulting in debilitating contractures, among other life-threatening complications. Children with sclerodermatous graft-versus-host disease are at high risk of developing nonmelanoma skin cancer because of several risk factors, including young age at transplantation, prolonged immunosuppression, and exposure to photosensitizing antimicrobial prophylaxis such as voriconazole. The immunosuppression required to treat sclerodermatous graft-versus-host disease makes effectively treating nonmelanoma skin cancer and sclerodermatous graft-versus-host disease in the same patient challenging. We describe a challenging case of a 6-year-old boy with a history of sclerodermatous graft-versus-host disease and voriconazole exposure presenting with squamous cell carcinoma in situ on the left temple and actinic keratoses on the scalp treated with topical chemotherapy agents.
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Affiliation(s)
- Alvin W Li
- School of Medicine, Yale University, New Haven, CT, USA
| | - Leah E Lalor
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Minnelly Luu
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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37
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Abstract
BACKGROUND/OBJECTIVES There are no reliably effective, well-tolerated topical agents for the treatment of hyperhidrosis. We sought to evaluate the efficacy and tolerability of oxybutynin 3% gel in adolescents and young adults with primary focal hyperhidrosis. METHODS Patients with severe axillary hyperhidrosis were treated with topical oxybutynin 3% gel for 4 weeks. Response to treatment was assessed by calculating change in Hyperhidrosis Disease Severity Score from baseline to weeks 1 and 4. Change in health-related quality of life was assessed using the Children's Dermatology Life Quality Index or the Dermatology Life Quality Index. Adverse effects were evaluated using patient diaries, investigator global review, and physical examination. RESULTS Of 10 patients aged 13-24 enrolled, seven completed the study. Of those who completed the study, four (57.1%) reported reduction in axillary Hyperhidrosis Disease Severity Score at week 1 and all seven (100%) at week 4. Six patients (85.7%) reported reduction in Children's Dermatology Life Quality Index or Dermatology Life Quality Index score. Anticholinergic adverse effects were infrequent. The majority of treatment-related adverse events were mild to moderate in severity. One patient experienced a severe adverse event. CONCLUSION Oxybutynin 3% gel reduced hyperhidrosis severity and improved health-related quality of life in this small pilot study. Safety and efficacy should be further evaluated in a large, prospective, placebo-controlled study.
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Affiliation(s)
- Nicholas V. Nguyen
- Division of Dermatology, Akron Children’s Hospital, Akron, Ohio, Departments of Internal Medicine and Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio
| | - Jane Gralla
- Departments of Pediatrics, Biostatistics & Informatics, School of Medicine, University of Colorado, Aurora, Colorado
| | - James Abbott
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Anna L. Bruckner
- Departments of Dermatology and Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
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38
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Abstract
This retrospective study aimed to identify factors that predict treatment response in a cohort of Asian children with vitiligo. Shorter duration of vitiligo was associated with better repigmentation. Patients with focal vitiligo of short duration have a good chance of achieving repigmentation with topical agents alone.
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Affiliation(s)
- Evelyn Yuxin Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
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Gordon SC, Bartenstein DW, Tajmir SH, Song JS, Hawryluk EB. Delayed-type hypersensitivity to vaccine aluminum adjuvant causing subcutaneous leg mass and urticaria in a child. Pediatr Dermatol 2018; 35:234-236. [PMID: 29314223 DOI: 10.1111/pde.13390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/10/2023]
Abstract
A 3-year-old girl presented with a 7-month history of a waxing and waning left thigh mass associated with pruritus and erythema at the site of two previous DTaP-HepB-IPV vaccinations. Patch testing was positive to aluminum chloride, supporting a diagnosis of vaccine granuloma secondary to aluminum allergy; her symptoms had been well controlled with antihistamines and topical steroids. Injection site granulomas are a benign but potentially bothersome reaction to aluminum-containing immunizations that can be supportively managed, and we encourage strict adherence to the recommended vaccine schedule in this setting. Patch testing is a sensitive, noninvasive diagnostic tool for patients presenting with this clinical finding, and dermatologist awareness can prevent unnecessary medical examination and provide reassurance.
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Affiliation(s)
- Samantha C Gordon
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Diana W Bartenstein
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,School of Medicine, Tufts University, Boston, MA, USA
| | - Shahein H Tajmir
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Johanna S Song
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Rossi A, Anzalone A, Fortuna MC, Caro G, Garelli V, Pranteda G, Carlesimo M. Multi-therapies in androgenetic alopecia: review and clinical experiences. Dermatol Ther 2016; 29:424-432. [PMID: 27424565 DOI: 10.1111/dth.12390] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Androgenetic alopecia (AGA) is a genetically determined progressive hair-loss condition which represents the most common cause of hair loss in men. The use of the medical term androgenetic alopecia reflects current knowledge about the important role of androgens and genetic factors in its etiology. In addition to androgen-dependent changes in the hair cycle, sustained microscopic follicular inflammation contributes to its onset. Furthermore, Prostaglandins have been demonstrated to have the ability in modulating hair follicle cycle; in particular, PGD2 inhibits hair growth while PGE2/F2a promote growth. Due to the progressive nature of AGA, the treatment should be started early and continued indefinitely, since the benefit will not be maintained upon ceasing therapy. To date, only two therapeutic agents have been approved by the Food and Drug Administration and European Medicines Agency for the treatment of AGA: topical minoxidil and oral finasteride. Considering the many pathogenetic mechanisms involved in AGA, various treatment options are available: topical and systemic drugs may be used and the choice depends on various factors including grading of AGA, patients' pathological conditions, practicability, costs and risks. So, the treatment for AGA should be based on personalized therapy and targeted at the different pathophysiological aspects of AGA.
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Affiliation(s)
- Alfredo Rossi
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - Alessia Anzalone
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - Maria Caterina Fortuna
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - Gemma Caro
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - Valentina Garelli
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
| | - Giulia Pranteda
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy
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Angelo T, Barbalho GN, Gelfuso GM, Gratieri T. Minoxidil topical treatment may be more efficient if applied on damp scalp in comparison with dry scalp. Dermatol Ther 2016; 29:330-333. [PMID: 27356887 DOI: 10.1111/dth.12369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
There is yet no consensus among prescribers whether minoxidil (MXD) formulations should be applied on wet/damp or dry scalp and no clear FDA guidelines on the matter. We hypothesized that the use of MXD on damp scalp may lead to higher drug penetration. First, because the drug diffusion and consequent deposition into the hair follicle may be favored when follicle cast is humid. Second, because humidity may also prevent drug crystallization and, therefore, maintain a higher thermodynamic activity for longer periods, which leads to increased penetration. Following in vitro experiments on rat and porcine skin we confirmed the hypothesis, which could markedly improve treatment effectiveness.
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Affiliation(s)
- T Angelo
- Laboratory of Food Drugs and Cosmetics (LTMAC), University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - G N Barbalho
- Laboratory of Food Drugs and Cosmetics (LTMAC), University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - G M Gelfuso
- Laboratory of Food Drugs and Cosmetics (LTMAC), University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - T Gratieri
- Laboratory of Food Drugs and Cosmetics (LTMAC), University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil.
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Goren A, Shapiro J, Sinclair R, Kovacevic M, McCoy J. α1 -AR agonist induced piloerection protects against the development of traction alopecia. Dermatol Ther 2015; 29:160-3. [PMID: 26678522 DOI: 10.1111/dth.12324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Traction alopecia is hair loss that occurs after persistent pulling (e.g., during cosmetic procedures) on the roots of hair over time. Unlike plucking, which is painful, persistent pulling may go unnoticed until a patient presents with either bald spots or diffuse telogen shedding. Each hair follicle in the scalp contains an arrector pili muscle that, when contracted, erects the hair. The smooth muscle in the arrector pili expresses α1 adrenergic receptors (α1 -AR). As such, we hypothesized that contraction of the arrector pili muscle via an α1 -AR agonist would increase the threshold of force required to pluck hair during cosmetic procedures. Female subjects, ages 18-40, were recruited to study the effect of topically applied phenylephrine, a selective α1 -AR agonist, on epilation force and hair shedding during cosmetic procedures. In our blinded study, 80% of subjects demonstrated reduced shedding on days using phenylephrine compared to days using a placebo solution. The average reduction in hair loss was approximately 42%. In addition, the force threshold required for epilation increased by approximately 172% following topical phenylephrine application. To our knowledge this is the first study demonstrating the utility of α1 -AR agonists in the treatment of traction alopecia and hair shedding during cosmetic procedures.
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Affiliation(s)
- Andy Goren
- Applied Biology, Irvine, California.,Department of Dermatology and Venereology, University of Rome "G.Marconi", Italy
| | - Jerry Shapiro
- Department of Dermatology, New York University Langone Medical Center, New York City, New York
| | - Rodney Sinclair
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Maja Kovacevic
- Department of Dermatology and Venereology, University of Rome "G.Marconi", Italy
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Li L, Wu Y, Li L, Sun Y, Qiu L, Gao XH, Chen HD. Triple combination treatment with fractional CO2 laser plus topical betamethasone solution and narrowband ultraviolet B for refractory vitiligo: a prospective, randomized half-body, comparative study. Dermatol Ther 2015; 28:131-4. [PMID: 25753514 DOI: 10.1111/dth.12202] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Vitiligo on extremities and/or bony prominences is very resistant to treatment. Twenty-five patients with symmetrical and stable vitiligo on extremities and/or bony prominences were enrolled. The treatment side received fractional carbon dioxide laser followed by topical compound betamethasone solution and narrowband ultraviolet B phototherapy. The control side received laser treatment plus phototherapy. The result of treatment side showed that 44% patients achieved over 50% re-pigmentation and patient satisfaction score was 5.12 ± 3.23, higher than those of control (p < 0.05). Adverse events were slight and tolerable. The triple combination treatment could be used as an alternative modality for refractory vitiligo.
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Affiliation(s)
- Lu Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Wu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Li Li
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Yan Sun
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Li Qiu
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Xing-Hua Gao
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
| | - Hong-Duo Chen
- Department of Dermatology, The First Hospital of China Medical University, Shenyang, China
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Abstract
Our aim was to study the effects and safety of cantharidin in the treatment of molluscum contagiosum (MC), we conducted a prospective, double-blinded, placebo-controlled, randomized clinical trial to evaluate the safety and efficacy of topical cantharidin for treatment of pediatric MC in an academic ambulatory care center. Twenty-nine children aged 5-10 with a diagnosis of MC were enrolled to receive treatment with cantharidin or placebo. The main outcome measure was complete clearance of all molluscum lesions. In contrast to previous retrospective observational studies, the performance of cantharidin treatment over 2 months was not substantially better than the performance of placebo. The scope of follow-up was limited to five visits over 2 months of treatment. A longer follow-up period might have captured a greater effect of cantharidin. Over a 2 month period, the magnitude of the cantharidin treatment effects in the target population are, at best, not large. This study provided objective unbiased estimates of the magnitude of cantharidin treatment effects and provided important prospective safety data. Our subjects experienced minimal side effects when treated with cantharidin.
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Affiliation(s)
- Jacquelyn Coloe Dosal
- Department of Dermatology & Cutaneous Surgery, University of Miami, Miami, FL
- Department of Dermatology, University of North Carolina, Chapel Hill, NC
| | - Paul W. Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Ja-An Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | | | - Dean S Morrell
- Department of Dermatology, University of North Carolina, Chapel Hill, NC
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Turner MJ, Dasilva-Arnold SC, Yi Q, Mehrotra P, Kaplan MH, Travers JB. Topical application of a vitamin D analogue exacerbates atopic dermatitis and induces the atopic dermatitis-like phenotype in Stat6VT mice. Pediatr Dermatol 2013; 30:574-8. [PMID: 23889122 PMCID: PMC3770906 DOI: 10.1111/pde.12187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 11/28/2022]
Abstract
Calcipotriene is a topical vitamin D3 analogue approved for the treatment of plaque and scalp psoriasis. We report the case of a 2-year-old boy whose atopic dermatitis (AD) flared in response to application of calcipotriene 0.005% cream and solution for a mistaken diagnosis of plaque and scalp psoriasis. We investigated whether the patient's eruption was secondary to an allergic contact dermatitis. In the Stat6VT mouse model of AD we tested whether calcipotriene could induce the otherwise-spontaneous AD-like phenotype. Closed patch testing was done on the patient with calcipotriene solution and cream, moisturizing cream, and 51% isopropanol. Stat6VT and wild-type (WT) mice were treated for 7 days with calcipotriene solution or vehicle (isopropanol) applied to the right and left upper back skin, respectively, after which mice were followed longitudinally for 10 weeks. Biopsy specimens from prior treatment sites were then collected for histology and RNA isolation. RNA was analyzed for interleukin (IL-4) expression using quantitative polymerase chain reaction. Patch testing was negative. Stat6VT mice, in contrast to WT mice, developed a persistent eczematous dermatitis at sites of calcipotriene application. Clinical and histologic features and high IL-4 transcript levels were consistent with the spontaneous AD-like phenotype seen in Stat6VT mice. At sites of active disease, calcipotriene can worsen a flare of AD. In Stat6VT mice, calcipotriene can induce the AD-like phenotype.
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Affiliation(s)
- Matthew J Turner
- Department of Dermatology, Indiana University, Indianapolis, Indiana
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