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1.
Pediatr Dermatol ; 39(4): 535-540, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35584791

ABSTRACT

BACKGROUND: Acne vulgaris varies in clinical severity, from minimal comedonal disease to severe hemorrhagic and ulcerative lesions with scarring. While a family history confers a higher risk for developing acne, the correlation between heritability and clinical severity remains unclear. OBJECTIVE: To examine the natural history and heritability of severe acne with scarring in patients undergoing isotretinoin therapy. METHODS: A total of 101 subjects with severe acne with scarring and its variants, including acne conglobata and acne fulminans, were enrolled. All subjects and adult family members underwent an interview regarding their acne, and a corresponding "historical" Investigator's Global Assessment (hIGA) score (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe) was assigned. Study assessors performed an "examination" Investigator's Global Assessment (eIGA) based on the clinical examination of each subject (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate, 4 = severe, 5 = very severe). A detailed family history and pedigree were documented. RESULTS: Most subjects were Caucasian (44.5%) and male (79.2%) who had previously used doxycycline and/or minocycline (86.1%). The mean eIGA and hIGA scores were 2.7 and 4.4, respectively. 37.2% of subjects had one first-degree relative with a history of moderate or severe acne with scarring; of note, of the patients with hemorrhagic disease, 30% had at least one parent with moderate or severe acne. CONCLUSIONS: Severe forms of acne often "cluster" in families, underscoring the heritable nature of acne and the prognostic value of a family history of moderate or severe disease.


Subject(s)
Acne Vulgaris , Cicatrix , Acne Vulgaris/diagnosis , Acne Vulgaris/drug therapy , Acne Vulgaris/genetics , Adult , Cicatrix/pathology , Doxycycline/therapeutic use , Female , Humans , Isotretinoin/therapeutic use , Male , Minocycline/adverse effects , Treatment Outcome
2.
Pediatr Dermatol ; 39(2): 167-172, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35075666

ABSTRACT

Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.


Subject(s)
Tinea Capitis , Antifungal Agents/therapeutic use , Child , Family , Heterozygote , Humans , Immunotherapy , Tinea Capitis/diagnosis , Tinea Capitis/drug therapy , Tinea Capitis/microbiology
3.
Pediatr Dermatol ; 35(4): e206-e209, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29766555

ABSTRACT

Hand-foot-skin reaction is a distinct clinical condition arising in association with the use of multikinase inhibitors, including sorafenib. Because multikinase inhibitors are increasingly being used in children with cancer, recognition of this previously unfamiliar condition is of importance to pediatric dermatologists. We describe the diagnosis and successful treatment of a case of hand-foot-skin reaction in a child taking sorafenib for an unresectable desmoid tumor.


Subject(s)
Hand-Foot Syndrome/diagnosis , Niacinamide/analogs & derivatives , Orthotic Devices/adverse effects , Phenylurea Compounds/adverse effects , Protein Kinase Inhibitors/adverse effects , Child , Diagnosis, Differential , Fluocinolone Acetonide/therapeutic use , Glucocorticoids/therapeutic use , Hand-Foot Syndrome/drug therapy , Humans , Male , Niacinamide/adverse effects , Sorafenib
4.
Pediatr Dermatol ; 35(2): 170-181, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29314219

ABSTRACT

BACKGROUND/OBJECTIVES: Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS: A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS: The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION: Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.


Subject(s)
Psoriasis/diagnosis , Administration, Topical , Biological Therapy/adverse effects , Biological Therapy/methods , Child , Consensus , Cost of Illness , Disease Management , Female , Humans , Male , Phototherapy/adverse effects , Phototherapy/methods , Psoriasis/therapy , Quality of Life , Risk Factors
5.
Pediatrics ; 140(4)2017 Oct.
Article in English | MEDLINE | ID: mdl-28864554

ABSTRACT

Isotretinoin is the most effective acne therapy available, but has the potential for a number of adverse side effects, including transaminitis. The iPLEDGE isotretinoin program recommends avoiding some herbals and supplements due to potential side effects. However, little is known about the effects of protein supplements on the liver, particularly in patients taking isotretinoin. We designed a retrospective chart review to evaluate the symptoms, diagnosis, treatment, and outcome of patients on or preparing to take isotretinoin therapy who were concurrently ingesting protein or herbal supplementation and who developed transaminitis. In 100% (8/8) of cases, dietary supplementation was determined to be at least a possible cause of elevated liver transaminases. In 75% (6/8) of cases, dietary supplement appears to be the most likely cause at some point in their evaluation. Most of our patients' elevations in aspartate aminotransferase and/or alanine aminotransferase were likely caused by supplementation with protein, creatine, or herbal extracts, rather than prescribed isotretinoin or tetracycline antibiotics for acne. Hence, dietary supplementation may cause liver function abnormalities. As supplement usage appears common in teenagers, clinicians should consider counseling their patients to avoid these products, particularly when prescribing known hepatotoxic drugs.


Subject(s)
Acne Vulgaris/drug therapy , Chemical and Drug Induced Liver Injury/etiology , Dermatologic Agents/adverse effects , Dietary Supplements/adverse effects , Isotretinoin/adverse effects , Adolescent , Biomarkers/metabolism , Camellia sinensis/adverse effects , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/enzymology , Creatine/adverse effects , Dermatologic Agents/therapeutic use , Dietary Proteins/adverse effects , Female , Follow-Up Studies , Humans , Isotretinoin/therapeutic use , Male , Plant Preparations/adverse effects , Retrospective Studies , Transaminases/metabolism , Treatment Outcome
6.
J Am Acad Dermatol ; 77(1): 109-117, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28619551

ABSTRACT

BACKGROUND: Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence-based information and no clear guidelines concerning the classification and treatment of AF. OBJECTIVE: To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research. METHODS: A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5-hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations. RESULTS: Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus. LIMITATIONS: Limited evidenced-based data and prospective studies in the literature concerning the treatment of AF is available. CONCLUSION: These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants.


Subject(s)
Acne Vulgaris/drug therapy , Acne Vulgaris/classification , Evidence-Based Medicine , Humans , Practice Guidelines as Topic
7.
Birth Defects Res ; 109(11): 809-815, 2017 Jul 03.
Article in English | MEDLINE | ID: mdl-28402073

ABSTRACT

Infantile hemangiomas (IHs) are the most common vascular tumors in infants, appearing in early infancy and ultimately regressing with time. Clinical presentation may vary, with a minority of lesions causing impairment of vital function (e.g., respiratory or visual obstruction), permanent scarring, and/or disfigurement. The pathogenesis of IH is complex and poorly understood. Risk factors implicated in their development include preterm birth and placental anomalies. IH presents a myriad of clinical challenges, including correct diagnosis and whether or not to pursue treatment. This article is a review of the current literature regarding pathogenesis, clinical presentation, treatment, and prognosis of IH. Birth Defects Research 109:809-815, 2017. © 2017 Wiley Periodicals, Inc.


Subject(s)
Hemangioma/diagnosis , Hemangioma/epidemiology , Hemangioma/physiopathology , Female , Hemangioma, Capillary/complications , Humans , Infant , Infant, Newborn , Male , Placenta Diseases , Pregnancy , Prognosis , Risk Factors , Treatment Outcome , Vascular Neoplasms/complications
8.
J Drugs Dermatol ; 16(2): 105-109, 2017 02 01.
Article in English | MEDLINE | ID: mdl-28300851

ABSTRACT

Fungal infection of the nails is an increasingly recognized disease in infants and children. However, it can be difficult to distinguish clinically from other nail dystrophies. In addition, many mistakenly believe that onychomycosis does not occur in childhood. Under-recognition of this infectious disorder therefore occurs. Although many consider "nail fungus" a trivial cosmetic concern, it can lead to discomfort, risk of secondary infection, and a more significant health threat in immunocompromised or diabetic individuals. It should always be considered in the differential diagnosis of nail plate disorders in children as it is one of the more common causes.

Here we review the latest data on prevalence of the disease, reasons for its relatively low incidence compared with adults, and important predisposing factors. It is important to confirm the clinical diagnosis of onychomycosis in children, and affected individuals should be examined for concomitant tinea pedis. As familial disease often occurs, it is important to check parents and siblings as well for onychomycosis and tinea pedis.

Treatment of onychomycosis is challenging, and recurrence appears to be more common in children than in adults. Prolonged systemic antifungal therapy is commonly required. However, pediatric practitioners and parents alike hesitate when asked to treat young children with a systemic drug that requires laboratory monitoring and can have systemic toxicities. Due to their thinner, faster-growing nails, children are theoretically more likely to respond to topical monotherapy than adults, and therefore good candidates for topical antifungal therapy.

The clinical data on the use of topical antifungals in pediatric onychomycosis is scarce. We review data that exist from case reports and small clinical trials. New topical antifungals are now available that afford better nail penetration and additional delivery routes to the site of infection. Pediatric trials are now on-going, and should clarify the usefulness of these agents in children.


Subject(s)
Antifungal Agents/administration & dosage , Onychomycosis/diagnosis , Onychomycosis/drug therapy , Tinea Pedis/diagnosis , Administration, Topical , Adult , Age Factors , Antifungal Agents/adverse effects , Child , Ciclopirox , Family , Humans , Imidazoles/administration & dosage , Imidazoles/adverse effects , Incidence , Ketoconazole/administration & dosage , Ketoconazole/adverse effects , Lacquer , Morpholines/administration & dosage , Morpholines/adverse effects , Naphthalenes/administration & dosage , Naphthalenes/adverse effects , Onychomycosis/complications , Onychomycosis/epidemiology , Prevalence , Pyridones/administration & dosage , Pyridones/adverse effects , Recurrence , Terbinafine , Tinea Pedis/complications , Treatment Outcome
10.
Semin Cutan Med Surg ; 35(3): 108-16, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27607318

ABSTRACT

Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. While the majority regress without the need for intervention, approximately 10%, often site dependent, can cause serious complications and require treatment. IH complications can be categorized as life threatening, obstructive, ulcerative or disfiguring. Life threatening complications include airway and hepatic IHs. Functional complications obstructing vital structures or impairing function include periocular, nasal, labial, parotid, auricular, and breast IHs. Local complications arise from ulceration or those in cosmetically sensitive areas. Therapeutic options for complicated IHs include pharmacologic (topical or systemic), surgical, or laser interventions. Topical agents are best employed for small, superficial, and localized IHs; while systemic therapy is reserved for larger IHs and those with more aggressive growth characteristics with propranolol as first-line therapy.


Subject(s)
Hemangioma/complications , Hemangioma/therapy , Skin Neoplasms/complications , Skin Neoplasms/therapy , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Airway Obstruction/etiology , Airway Obstruction/therapy , Drug Therapy, Combination , Esthetics , Facial Neoplasms/complications , Facial Neoplasms/therapy , Humans , Infant , Laser Therapy , Propranolol/therapeutic use , Skin Ulcer/etiology , Skin Ulcer/therapy , Timolol/therapeutic use
12.
J Clin Aesthet Dermatol ; 8(12): 27-41, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26705446

ABSTRACT

Vascular anomalies are commonly encountered in pediatric and dermatology practices. Most of these lesions are benign and easy to diagnose based on history and clinical exam alone. However, in some cases the diagnosis may not be clear. This may be of particular concern given that vascular anomalies may occasionally be associated with an underlying syndrome, congenital disease, or serious, life-threatening condition. Defining the type of vascular lesion early and correctly is particularly important to determine the optimal approach to management and treatment of each patient. The care of pediatric patients often requires collaboration from a multitude of specialties including pediatrics, dermatology, plastic surgery, radiology, ophthalmology, and neurology. Although early characterization of vascular lesions is important, consensus guidelines regarding the evaluation and imaging of vascular anomalies does not exist to date. Here, the authors provide an overview of pediatric vascular lesions, current classification systems for characterizing these lesions, the various imaging modalities available, and recommendations for appropriate imaging evaluation.

13.
Clin Dermatol ; 33(6): 657-71, 2015.
Article in English | MEDLINE | ID: mdl-26686017

ABSTRACT

The changes in immune response that occur with age play a significant role in disease presentation and patient management. Evolution of the innate and adaptive immune systems throughout life, influenced partly by hormonal changes associated with puberty, plays a role in the differences between pediatric and adult response to disease. We review a series of manifestations of dermatologic infectious diseases spanning bacterial, viral, and fungal origins that can be seen in both pediatric and adult age groups and highlight similarities and differences in presentation and disease course. Therapeutic options are also discussed for these infectious diseases, with particular attention to variations in management between these population subgroups, given differences in pharmacokinetics and side effect profiles.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Erythema Infectiosum/diagnosis , Lyme Disease/diagnosis , Methicillin-Resistant Staphylococcus aureus , Skin Diseases, Infectious/diagnosis , Skin Diseases, Infectious/drug therapy , Acrodermatitis/epidemiology , Acrodermatitis/virology , Adolescent , Adult , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , Community-Acquired Infections/drug therapy , Humans , Infant , Lyme Disease/complications , Lyme Disease/drug therapy , Molluscum Contagiosum/complications , Molluscum Contagiosum/drug therapy , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Skin Diseases, Infectious/complications , Skin Diseases, Infectious/epidemiology , Skin Diseases, Infectious/microbiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/microbiology , Tinea Capitis/diagnosis , Tinea Capitis/drug therapy , Tinea Capitis/epidemiology
14.
Pediatr Dermatol ; 32(6): e305-6, 2015.
Article in English | MEDLINE | ID: mdl-26584701

ABSTRACT

Onychoheterotopia is a rare condition characterized by ectopic nail tissue growth. It is a digital mass that is commonly misdiagnosed. We describe a 6-year-old girl who presented with onychoheterotopia after trauma to the digit. Her onychoheterotopia was incorrectly diagnosed as a common wart. It is important to include onychoheterotopia in the differential diagnosis of digital masses, especially in the setting of previous traumatic injury.


Subject(s)
Choristoma/diagnosis , Finger Injuries/complications , Nail Diseases/diagnosis , Nails, Malformed/diagnosis , Warts/diagnosis , Child , Choristoma/etiology , Choristoma/surgery , Diagnosis, Differential , Female , Finger Injuries/diagnosis , Follow-Up Studies , Humans , Nail Diseases/etiology , Nail Diseases/surgery , Nails, Malformed/etiology , Nails, Malformed/surgery , Rare Diseases , Treatment Outcome , Warts/etiology
16.
Clin Dermatol ; 33(3): 333-9, 2015.
Article in English | MEDLINE | ID: mdl-25889135

ABSTRACT

Onychomycosis is a chronic infection of the nail unit, and its prevalence increases with age. Treatment options for children are similar to those for adults and include both oral and topical therapies. Oral agents, such as terbinafine, itraconazole, and fluconazole have been reported to have good efficacy and a low rate of side effects in children. Topical therapies, such as amorolfine and ciclopirox, can also be used as monotherapy or combined with oral agents to treat onychomycosis. Due to their thinner, faster-growing nails, children are more likely to respond to topical monotherapy than adults. There is currently insufficient data comparing emerging medical devices, such as laser therapy, with standard therapeutic options to recommend their use in children.


Subject(s)
Antifungal Agents/therapeutic use , Onychomycosis/drug therapy , Administration, Oral , Administration, Topical , Child , Humans
17.
J Drugs Dermatol ; 14(3): 223-33, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25738843

ABSTRACT

Onychomycosis is an often overlooked and/or undertreated disease. This may be in part due to an under appreciation among both physicians and patients of its impact on quality of life and the potential for significant complications, from tinea corporis and cruris, to bacterial superinfection. Some health care providers are unaware of the effective low-risk treatments currently available. Changing demographic characteristics such as the relative aging of the population; the increasing prevalence of diabetes and peripheral vascular disease, and widespread iatrogenic immunosuppression; and changes in lifestyle practices such as earlier and greater participation in sports, are likely to lead to an increased prevalence of onychomycosis in both adults and children. Two topical onychomycosis treatments, efinaconazole 10% solution, and tavaborole 5% solution were recently approved by the FDA. This article reviews the state of knowledge and describes, briefly, these new treatment options.


Subject(s)
Antifungal Agents/administration & dosage , Onychomycosis/diagnosis , Onychomycosis/epidemiology , Anti-Infective Agents, Local/administration & dosage , Boron Compounds/administration & dosage , Bridged Bicyclo Compounds, Heterocyclic/administration & dosage , Humans , Onychomycosis/drug therapy , Pharmaceutical Solutions/administration & dosage , Treatment Outcome , Triazoles/administration & dosage
18.
N Engl J Med ; 372(8): 735-46, 2015 Feb 19.
Article in English | MEDLINE | ID: mdl-25693013

ABSTRACT

BACKGROUND: Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited. METHODS: We performed a multicenter, randomized, double-blind, adaptive, phase 2-3 trial assessing the efficacy and safety of a pediatric-specific oral propranolol solution in infants 1 to 5 months of age with proliferating infantile hemangioma requiring systemic therapy. Infants were randomly assigned to receive placebo or one of four propranolol regimens (1 or 3 mg of propranolol base per kilogram of body weight per day for 3 or 6 months). A preplanned interim analysis was conducted to identify the regimen to study for the final efficacy analysis. The primary end point was success (complete or nearly complete resolution of the target hemangioma) or failure of trial treatment at week 24, as assessed by independent, centralized, blinded evaluations of standardized photographs. RESULTS: Of 460 infants who underwent randomization, 456 received treatment. On the basis of an interim analysis of the first 188 patients who completed 24 weeks of trial treatment, the regimen of 3 mg of propranolol per kilogram per day for 6 months was selected for the final efficacy analysis. The frequency of successful treatment was higher with this regimen than with placebo (60% vs. 4%, P<0.001). A total of 88% of patients who received the selected propranolol regimen showed improvement by week 5, versus 5% of patients who received placebo. A total of 10% of patients in whom treatment with propranolol was successful required systemic retreatment during follow-up. Known adverse events associated with propranolol (hypoglycemia, hypotension, bradycardia, and bronchospasm) occurred infrequently, with no significant difference in frequency between the placebo group and the groups receiving propranolol. CONCLUSIONS: This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma. (Funded by Pierre Fabre Dermatologie; ClinicalTrials.gov number, NCT01056341.).


Subject(s)
Adrenergic beta-Antagonists/administration & dosage , Hemangioma/drug therapy , Propranolol/administration & dosage , Administration, Oral , Adrenergic beta-Antagonists/adverse effects , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Humans , Hypotension/chemically induced , Infant , Male , Propranolol/adverse effects , Treatment Outcome
19.
J Clin Aesthet Dermatol ; 7(7): 37-45, 2014 Jul.
Article in English | MEDLINE | ID: mdl-25053982

ABSTRACT

Infantile hemangiomas are benign vascular tumors seen in 4.5 percent of neonates and infants. While most infantile hemangiomas can be managed with active nonintervention, a subset of patients will require more aggressive management. Here the authors review the use of beta-blockers in the treatment of infantile hemangiomas, including oral, topical, and multimodal treatment options. They discuss the latest data on propranolol, including criteria for patient selection, dosing recommendations, and appropriate monitoring for side effects and efficacy. Lastly, they review indications for topical timolol treatment and the potential benefits of concomitant laser therapy.

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