ABSTRACT
Advances in laser therapy have led to novel therapeutic approaches to common pediatric skin conditions. As a non-invasive alternative to surgical options, laser therapy is efficacious in treating a broad range of conditions, from vascular and pigmented lesions to tattoo and hair removal. This paper reviews the basic mechanics of laser therapy, its role in common pigmented pediatric dermatoses, and special considerations for this unique age group.
Subject(s)
Low-Level Light Therapy/methods , Nevus, Pigmented/therapy , Pain/drug therapy , Pigmentation Disorders/therapy , Skin Neoplasms/therapy , Age Factors , Anesthetics, Local/administration & dosage , Child , Humans , Infant , Infant, Newborn , Low-Level Light Therapy/adverse effects , Low-Level Light Therapy/instrumentation , Pain/etiology , Pain Management/methods , Pigmentation Disorders/etiology , Skin/radiation effects , Skin Pigmentation/radiation effects , Tattooing/adverse effects , Treatment OutcomeABSTRACT
OBJECTIVES: A cleansing body wash containing diluted sodium hypochlorite (0.006% NaOCl) was evaluated for management of moderate-to-severe Staphylococcus aureus-colonized, atopic dermatitis in children. METHODS: A 6-week, prospective, open-label study was conducted with 50 evaluable participants (ages 6 months to 17 years) who had moderate-to-severe atopic dermatitis with S aureus skin colonization documented by culture. Participants were instructed to continue using their current medications while using the study product, 0.006% NaOCl body wash, once daily to affected areas for 6 weeks. Primary outcome measures were Investigator's Global Assessment, Eczema Area and Severity Index, and Body Surface Area scores. Secondary outcome measures were the Visual Analog Scale for pruritus, Family Dermatology Life Quality Index, and Patient Satisfaction Questionnaire for Problem Areas. A subject daily diary and a six-item subject questionnaire that provided information on preferences for bleach bath vs body wash were secondary outcome measures. RESULTS: Daily use of the 0.006% NaOCl body wash led to improvement for all outcome measures comparing baseline to 2-week and to 6-week evaluations. Of the 50 skin S aureus-positive subjects, 32/50 (64%) were still positive at 2 weeks. A 36.5% decrease in subject's daily record of topical corticosteroid application at end of study compared to baseline was found. Participant surveys indicated preferences for the body wash over bleach baths. CONCLUSIONS: Sodium hypochlorite (NaOCl) body wash improved all outcome measures for moderate-to-severe S aureus-colonized AD in infants, children, and adolescents. The limited reduction in S aureus further suggests that sodium hypochlorite has ameliorative effects other than antimicrobial actions.
Subject(s)
Baths , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/microbiology , Patient Safety , Sodium Hypochlorite/pharmacology , Staphylococcal Skin Infections/drug therapy , Administration, Cutaneous , Adolescent , Age Factors , Child , Child, Preschool , Cohort Studies , Disinfectants/pharmacology , Female , Follow-Up Studies , Humans , Infant , Male , Prospective Studies , Risk Assessment , Severity of Illness Index , Sex Factors , Staphylococcal Skin Infections/diagnosis , Time Factors , Treatment OutcomeABSTRACT
A 49-year-old man presented with progressive, painful, ulcerative, retiform purpuric patches on the torso and extremities. Multiple skin biopsies revealed a prominent pan-dermal vascular proliferation but no occlusive vasculopathy or cutaneous vasculitis. Diffuse dermal angiomatosis should be considered in the differential diagnosis of retiform purpura, especially in patients with atherosclerotic disease or underlying hypercoagulable states.
Subject(s)
Angiomatosis/diagnosis , Purpura/diagnosis , Skin Diseases, Vascular/diagnosis , Angiomatosis/complications , Angiomatosis/pathology , Diagnosis, Differential , Humans , Male , Middle Aged , Purpura/etiology , Purpura/pathology , Skin Diseases, Vascular/complications , Skin Diseases, Vascular/pathologyABSTRACT
BACKGROUND: Current information indicates that psoriasis is a metabolic disorder with systemic manifestations. Reports have revealed an association between psoriasis and several chronic autoimmune disorders. For one of these disorders, Hashimoto's thyroiditis (HT), there are scarce, and relatively unconfirmed, reports of an association with psoriasis. We sought to determine if such an association is detectable in a large medical record data repository. METHODS: We searched one institution's electronic medical record data repository from January 2010 to December 2013. Patients were identified by ICD-9 codes (psoriasis: 696.0; 696.1, HT: 245.2). Only data from patients with laboratory-confirmed HT (anti-thyroid peroxidase [anti-TPO] antibodies; thyroglobulin antibodies; serum thyroid-stimulating hormone; and free T3) were eligible for inclusion. Logistic regression analysis was used to obtain an odds ratio (OR) to establish an association between psoriasis and HT. Stratified analyses were performed to test for confounding variable and effect modification. RESULTS: Medical records for 856,615 individuals with documented encounters between January 1, 2010, and December 31, 2013, were detected. A total of 9654 had a diagnosis of psoriasis, and 1745 had a diagnosis of HT. Of these, 41 subjects were diagnosed with both conditions. A significant association existed for psoriasis and HT, even after adjusting for confounding variables that included gender, age, psoriatic arthropathy, and the use of systemic anti-psoriatic agents (OR = 2.49; 95% CI 1.79-3.48; P < 0.0001). CONCLUSIONS: This association has broad clinical impact and deserves further attention with regard to patient care, clinical research, and developmental therapeutics.
Subject(s)
Hashimoto Disease/blood , Hashimoto Disease/epidemiology , Psoriasis/blood , Psoriasis/epidemiology , Adult , Aged , Autoantibodies/blood , Comorbidity , Cross-Sectional Studies , Female , Humans , Iodide Peroxidase/immunology , Male , Middle Aged , Retrospective Studies , Thyrotropin/blood , Triiodothyronine/bloodSubject(s)
Arthritis, Rheumatoid/drug therapy , Certolizumab Pegol/adverse effects , Nephrotic Syndrome/chemically induced , Nephrotic Syndrome/pathology , Arthritis, Rheumatoid/diagnosis , Biopsy, Needle , Certolizumab Pegol/therapeutic use , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Immunohistochemistry , Middle Aged , Recovery of Function , Severity of Illness Index , Withholding TreatmentABSTRACT
Throughout history, individuals have had a myriad of dermatologic conditions characterized as chronic pruritic dermatoses. The term atopic dermatitis was not coined until the early 20th century. Many diseases typical of this condition were reported using a variety of eponyms and descriptive terms. Even as the incidence of atopic dermatitis rises, it remains poorly understood in the modern era, and viewing the disease from a historical perspective provides useful insight into its nature. This article highlights the evolution of concepts related to the pathogenesis of and recommended treatments for atopic dermatitis.
