1
|
Hebert AA, Browning J, Kwong PC, Duarte AM, Price HN, Siegfried E. Managing Pediatric Psoriasis: Update on Treatments and Challenges-A Review. J DERMATOL TREAT 2022; 33:2433-2442. [PMID: 35736804 DOI: 10.1080/09546634.2022.2059051] [Citation(s) in RCA: 1] [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] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated inflammatory disease with prominent cutaneous features, although the limited number of medications approved for pediatric psoriasis makes treating this population difficult. This review provides an overview of the challenges associated with diagnosing and treating pediatric psoriasis as well as the approved and off-label treatments for children and infants with psoriasis. METHODS Articles relevant to pediatric psoriasis were identified using series of PubMed searches. Topics relevant to pediatric psoriasis were explored, including disease characteristics, epidemiology, treatment efficacy and safety, and access to care. Publications previously known to the authors were also included. RESULTS Clinical features of psoriasis can be challenging to identify clinically, and patients face challenges gaining access to treatment. Most medications that have been approved for adult psoriasis lack data and labelling to support safe and effective use in pediatric patients, and therefore access is limited. A growing number of clinical trials using biologic agents for pediatric psoriasis aim to broaden available treatment options but may also raise unique concerns associated with the use of these medications in children. CONCLUSION Pediatric psoriasis is underrecognized and often undertreated. Clinicians must balance relative risks and potential benefits when developing a treatment strategy for these patients.
Collapse
Affiliation(s)
- A A Hebert
- UTHealth McGovern Medical School, Houston, TX, USA
| | - J Browning
- UT Health San Antonio, San Antonio, TX, USA
| | - P C Kwong
- Wolfson Children's Hospital, Jacksonville, FL, USA
| | - A M Duarte
- The Children's Skin Center, Nicklaus Children's Hospital, Miami, FL, USA
| | - H N Price
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - E Siegfried
- Saint Louis University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
2
|
Neves A, Gordo I, Sequeira V, Vieira AR, Silva E, Silva F, Duarte AM, Mendes S, Ganhão R, Peleteiro MC, Assis C, Rebelo R, Magalhães MF, Gil MM, Gordo LS. Negative impact on the reproductive potential of blue jack mackerel Trachurus picturatus by Kudoa infection of the ovary. Dis Aquat Organ 2020; 141:47-52. [PMID: 32940250 DOI: 10.3354/dao03515] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Reproduction of Trachurus picturatus off the western Portuguese coast was studied over 1 yr. During histological analyses, the presence of Kudoa sp. was detected in advanced vitellogenic oocytes. Kudoa infections are known to cause economic loss through the induction of post-mortem liquefaction of fish muscles, but ovarian infection as reported in this study will seriously affect the reproductive potential of the species and thus impact fisheries productivity. Only females showed gonad infection which led to total degradation of advanced vitellogenic oocytes. No macroscopic, somatic or condition indices revealed differences between infected and uninfected females, rendering this infection event a concealed suppression of reproduction.
Collapse
Affiliation(s)
- A Neves
- Faculdade de Ciências, Universidade de Lisboa, Bloco C2, Campo Grande, 1749-016 Lisboa, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Abstract
An intra-conical histologically malignant solitary fibrous tumor of the orbit presented in a 28 year-old female with intact vision and exophthalmos. Total resection was achieved by means of a frontal craniotomy and orbital roof osteotomy. Evidence of a beneficial role for adjuvant treatments in this particular tumor is controversial and vision impairment is a possible side effect. Therefore they were not employed. The patient is well after two years of follow-up.
Collapse
Affiliation(s)
- L Mascarenhas
- Neurosurgery Service, Anatomic Pathology Service, Pedro Hispano Hospital, Matosinhos, Portugal.
| | | | | | | | | | | | | |
Collapse
|
4
|
|
5
|
Abstract
EMLA (eutectic mixture of local anesthetics) cream is used topically to provide local anesthesia for a variety of painful superficial procedures. Although the side effects of EMLA are usually mild and transient local skin reactions, potential life threatening complications can be encountered. We report a case of central nervous toxicity after EMLA application for curettage of molluscum contagiosum lesions in a pediatric patient. This complication was the result of a therapeutic misadventure that led to an excessive application of EMLA cream over an extensive area causing an overdose of lidocaine and prilocaine with their subsequent systemic toxicities.
Collapse
Affiliation(s)
- E Rincon
- Division of Emergency Medicine, Miami Children's Hospital, Florida 33155, USA
| | | | | | | |
Collapse
|
6
|
Abstract
Young children with atopic dermatitis were treated with standard topical care and massaged by their parents for 20 minutes daily for a 1 month period. A control group received standard topical care only. The children's affect and activity level significantly improved, and their parent's anxiety decreased immediately after the massage therapy sessions. Over the 1 month period, parents of massaged children reported lower anxiety levels in their children, and the children improved significantly on all clinical measures including redness, scaling, lichenification, excoriation, and pruritus. The control group only improved significantly on the scaling measure. These data suggest that massage therapy may be a cost-effective adjunct treatment for atopic dermatitis, since there is a one-time expense of $30 for the child to receive the massage and the parent to learn the technique.
Collapse
Affiliation(s)
- L Schachner
- Department of Pediatrics, University of Miami School of Medicine, Florida, USA
| | | | | | | | | |
Collapse
|
7
|
Curado I, Duarte AM, Lal AA, Oliveira SG, Kloetzel JK. Antibodies anti bloodstream and circumsporozoite antigens (Plasmodium vivax and Plasmodium malariae/P. brasilianum) in areas of very low malaria endemicity in Brazil. Mem Inst Oswaldo Cruz 1997; 92:235-43. [PMID: 9332584 DOI: 10.1590/s0074-02761997000200017] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
During 1992-1994, 33 malaria cases were reported in two regions in Brazil where few sporadic atypical cases occur, most of them in home owners, who are weekenders, while home caretakers live there permanently. Indirect Fluorescent Antibody Test (IFAT), with Plasmodium vivax, and Enzime Linked Immunosorbent Assay (ELISA) with repeat peptides of the circumsporozoite (CS) proteins of the 3 known P. vivax variants and P. malarie/P. brasilianum, were performed on 277 sera, obtained within a 5 to 10 km range of malaria cases. Very rarely did any of these donors recall typical malaria episodes. Blood smears of all but 5 were negative. One of the 5 malaria cases included in our serology was of a home owner, I of a permanent resident, 3 from Superintendência de Controle de Endemias employees who went there to capture mosquitoes. In Region 1 the prevalence of IFAT positive sera was 73% and 28% among caretakers, 18% and 9.6% among home owners. In Region 2 (3 localities) no distinction was possible between caretakers and home owners, IFAT positivity being 38%, 28% and 7%. The relative percentage of positive anti-CS repeats ELISA, differed for each of the peptides among localities. Dwellings are in the vicinity of woods, where monkeys are frequently seen. The origin of these malaria cases, geographical differences and high seropositivity is discussed.
Collapse
Affiliation(s)
- I Curado
- Laboratório de Imunopatologia, Instituto Butantan, São Paulo, Brasil
| | | | | | | | | |
Collapse
|
8
|
Abstract
Recently, interest in the potential impact of the environment on our general health has heightened. Particular focus has been directed toward environmental skin injuries because the integument, the only organ of the body that is constantly exposed to the surrounding environment, directly demonstrates the damaging effects of the environment and thereby allows for direct visual recognition by both physicians and laypersons. The characteristic cutaneous features, physiologic responses, therapeutic approaches to promote healing, and preventive measures that may be taken to avoid future environmental injury are discussed. The scope of environmental injuries to the skin is extremely vast; therefore, the focus of this review is limited to cutaneous injuries that may result as a consequence of ultraviolet irradiation, marine life, and electrical forces.
Collapse
Affiliation(s)
- A M Duarte
- University of Miami School of Medicine, Florida, USA
| |
Collapse
|
9
|
Abstract
Three normal preschool children were presented with a sorting task ordinarily insoluble by 4-year-olds, based on the visual discrimination of what features two sample stimuli had in common. Failing to sort correctly according to that criterion, they were then presented with task-analytic conditions in which they learned to name correctly the common features of pairs of such stimuli and to sort correctly according to experimenter-named common attributes. This proved insufficient in producing correct sorting, even when the children were asked to name what the stimuli had in common and did so correctly just before they were asked to sort. The children were then asked to self-instruct: The experimenter said, "So, what are you looking for?" just before the children began to sort in response to the experimenter's presentation of two sample stimuli. This condition typically yielded correct answers to the question and correct sorting, which proved reversible if the experimenter discontinued the question or asked the child to not ask or answer what the two stimuli had in common, just before sorting. The self-instructional effect was found to generalize to new sets of visual stimuli and to a novel experimenter.
Collapse
Affiliation(s)
- A M Duarte
- Department of Human Development, University of Kansas, Lawrence 66045-2133
| | | |
Collapse
|
10
|
Abstract
We describe nine patients with eosinophilic pustular folliculitis occurring in infancy. All patients had recurrent crops of pruritic papules primarily affecting the scalp and brow region of the face. Biopsy specimens revealed folliculitis with a predominant eosinophilic infiltrate. Bacterial and fungal cultures of pustules were negative. Most patients had leukocytosis and eosinophilia. Clinical response to topical corticosteroid and/or systemic antibiotic therapy was noted. Eosinophilic pustular folliculitis of infancy must be considered in the differential diagnosis of pustular disorders in infancy.
Collapse
Affiliation(s)
- A M Duarte
- Department of Pediatrics, University of Miami, Fla
| | | | | | | | | |
Collapse
|
11
|
Abstract
All forms of cutaneous T-cell lymphoma are rare in children. We describe an 11-year-old girl who had generalized exfoliative erythroderma, intense pruritus, peripheral lymphadenopathy, mycosis cells in the skin and lymph nodes, and Sézary cells in the peripheral blood. Results of a biopsy specimen of involved skin showed changes consistent with mycosis fungoides. A classic case of Sézary syndrome has not previously been reported in childhood or preadolescence.
Collapse
Affiliation(s)
- L Meister
- Department of Pediatrics, University of Miami School of Medicine, FL 33101
| | | | | | | | | |
Collapse
|
12
|
Blauvelt A, Duarte AM, Pruksachatkunakorn C, Leonardi CL, Schachner LA. Human papillomavirus type 6 infection involving cutaneous nongenital sites. J Am Acad Dermatol 1992; 27:876-9. [PMID: 1334983 DOI: 10.1016/0190-9622(92)70271-g] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Human papillomavirus (HPV) type 6 is classically considered a mucosatropic virus. Interestingly, clinical manifestations of HPV 6 infection that involve nonmucosal or nongenital sites have rarely been described. The reasons for this site specific infectivity of HPV 6 are unknown. We describe a patient who had condylomata acuminata-like lesions that involved cutaneous nongenital sites; HPV 6 DNA was detected in skin biopsy specimens with use of the polymerase chain reaction, followed by hybridization with use of type-specific DNA probes.
Collapse
Affiliation(s)
- A Blauvelt
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33101
| | | | | | | | | |
Collapse
|
13
|
Affiliation(s)
- A Blauvelt
- Department of Dermatology, University of Miami School of Medicine, FL 33101
| | | | | |
Collapse
|
14
|
Abstract
Scabies is a pruritic skin infestation caused by the itch mite Sarcoptes scabiei. Physical proximity allows the mite to move from one host to another. The diagnosis is made by identifying the mite or its eggs or excrement microscopically from a sample of skin scrapings. Treatment is achieved with topical application of a scabicide and elimination of the mite from the patient's surroundings.
Collapse
Affiliation(s)
- C Pruksachatkunakorn
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33101
| | | | | |
Collapse
|
15
|
Duarte AM, Psillakis JM. Creation of a free muscle flap by neo-vascularization. Plast Reconstr Surg 1988. [DOI: 10.1097/00006534-198812000-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|