Effectiveness of topical propranolol 4% gel in the treatment of pyogenic granuloma in children.

Pyogenic granuloma is a benign acquired vascular tumor that affects the skin and mucous membranes, occurring more often in children and young adults. Treatment is often required due to the associated risk of ulceration and bleeding. There are several publications reporting the use of beta-blockers for the treatment of pyogenic granuloma. The aim of the present study was to evaluate the clinical effectiveness and safety profile of topical propranolol 4% gel for the treatment of pyogenic granuloma. A retrospective study of all cases of pyogenic granuloma treated with topical propranolol 4% gel between 2014 and 2015 was performed. Epidemiological, clinical and treatment data, including effectiveness score and safety, were reviewed. Of a total of 18 patients with pyogenic granuloma, 11 (61.1%) showed complete resolution of the lesion while two (11.1%) had an almost complete response. In three cases (16.6%), the treatment was discontinued due to bleeding, and the lesions were removed by curettage. Local irritation and lack of compliance led to treatment discontinuation in two cases. Altogether, 13 out of 18 patients (72%) had complete or almost complete response to treatment. There was a correlation between treatment duration and response to treatment. One patient only reported local side-effects including irritation, redness and scaling of the treated area leading to discontinuation of the treatment and curettage of the pyogenic granuloma. No systemic adverse effects were reported. This is an uncontrolled retrospective study. Propranolol 4% gel may be considered as a safe and efficient topical therapy for pyogenic granuloma.

Assessment of the effectiveness of topical propranolol 4% gel for infantile hemangiomas.

BACKGROUND: Infantile hemangiomas (IHs) are the most common vascular tumors in children. Because of their benign character and natural involution, the vast majority of IHs do not require any treatment. In the past few years, topical beta blockers have been reported to be an effective treatment of superficial IHs. OBJECTIVE: We sought to evaluate the clinical effectiveness and safety profile of topical propranolol 4% gel for the treatment of IHs. METHODS: A retrospective study of all cases of IHs treated with topical propranolol 4% gel between 2013 and 2015 was performed. All patients were evaluated in a pediatric dermatology unit of a tertiary medical center. Epidemiologic, clinical, and treatment data, including effectiveness score and safety, were reviewed. RESULTS: The study included 63 patients with a total of 75 IHs. Of the total number of IHs, 43 (57.3%) showed a good response to treatment, 19 (25.3%) a partial response, and 13 (17.33%) poor or no response, thus 62 (82.6%) had good or partial response to treatment. Age at treatment initiation, treatment time, thickness of the superficial component, and size of the lesions were shown to predict response to therapy. Out of the entire examined group, only two patients reported minor local side effects manifested by irritation, redness, and scaling of the treated area. No systemic adverse effects were reported. LIMITATIONS: This is an uncontrolled retrospective study. CONCLUSION: Propranolol 4% gel is a safe and efficient topical therapy for IH.

To Treat Molluscum Contagiosum or Not-Curettage: An Effective, Well-Accepted Treatment Modality.

BACKGROUND/OBJECTIVES: Molluscum contagiosum (MC) is a common viral disease primarily affecting children. The objective was to compare the effectiveness of curettage as a treatment modality for MC with no treatment. METHODS: We performed a retrospective study of 2,022 children with MC between 2008 and 2012. Epidemiologic, clinical, and treatment data, including effectiveness, safety, and satisfaction, were reviewed. RESULTS: Fifty-six percent of the children were 2 to 5 years of age. The duration of the infection was 1 to 2 years for 51%, less than 1 year for 32%, and more than 2 years for 17% of the children. Seventy percent of the children were self-referrals; 86% had had a previous examination and 76% of those had been advised not to treat the infection. The disease was mild (22%), moderate (64%), or severe (14%). A total of 1,879 patients underwent curettage; 70% were cured after one treatment and 26% after two treatments. Satisfaction was high: 97% of children and parents. CONCLUSION: Active treatment should be offered despite the fact that MC is self-limiting. Curettage in an appropriate setting is very effective, with high patient satisfaction and fast cure rates.

Tinea capitis outbreak among paediatric refugee population, an evolving healthcare challenge.

Outbreaks of tinea capitis (TC) represent a major medical and economic burden. Population migrations have become a phenomenon of increasing relevance for medical conditions management. Given the recent massive arrival of immigrants, we sought to determine epidemiologic trends for TC among paediatric populations at the Tel Aviv Medical Center. We conducted a retrospective study of all TC cases diagnosed between 2010 and 2014 in a paediatric dermatology unit of a tertiary medical centre, serving as a referral centre for the paediatric refugee population from the great Tel Aviv area. Epidemiologic, clinical and treatment data including effectiveness and safety were reviewed. In all, 145 children met the inclusion criteria. Trend analyses showed increases in TC rates over the study period. Incidence rates were higher in boys than in girls. Children of African origin had the highest TC incidence rates as compared with other ethnic groups. Trichophyton violaceum and Microsporum audouinii were the predominant causative organisms. Treatment with griseofulvin was satisfactory in all cases. There was a significant increase in TC incidence rates in the Tel Aviv area over the study period. TV and MA were the predominant organisms. These trends may be a result of poor living conditions and crowded school premises.

Pemphigus and depression comorbidity: a case control study.

BACKGROUND: While quality of life can be significantly affected in pemphigus patients, few studies have systematically investigated the co-morbidity of psychiatric disorders in these patients. OBJECTIVE: To assess the association between pemphigus and depression comorbidity, using the computerized medical database of Israel's largest health maintenance organization. METHODS: In a case-control study, co-morbidities of adult pemphigus patients retrieved from the database of a large healthcare organization from 1998 to 2010 were compared with age- and gender-matched controls from the same database. The main outcome measure was the prevalence of co-morbid psychiatric disorders (anxiety, psychosis, schizophrenia and depression) in pemphigus patients and controls. The study included 255 pemphigus patients (157 women (62%) and 98 (38%) men) and 509 controls (313 women (62%) and 196 (38%) men) aged 20 years and older (a ratio of 3:2 in both groups). Mean age was 63.5 ± 15.7 years in the pemphigus group and 63.2 ± 15.7 years in the control group. RESULTS: Depression was the only psychiatric disorder significantly increased among pemphigus patients compared with controls. Alcohol abuse and smoking did not differ between groups. Depression was over-represented in a large population of pemphigus patients, indicating the disorder as a possible significant co-morbidity. After controlling for confounders including age, gender, and duration of corticosteroid therapy, the association with depression persisted (OR = 1.19, 95% CI: 1.12-1.27), p<0.001). CONCLUSION: The increased prevalence of depressive morbidity, especially in the presence of commonly prescribed corticosteroid treatment, emphasizes the need for psychiatric assessment and intervention in these patients.

Color Doppler Ultrasound Follow-Up of Infantile Hemangiomas and Peripheral Vascularity in Patients Treated with Propranolol.

BACKGROUND: Infantile hemangiomas (IHs) are the most common vascular tumors in childhood. Diagnosis of IHs is usually clinical, however, to determine the actual dimensions of the lesion or the anatomic changes that occur during its evolution and treatment, a color Doppler ultrasound (CDU) examination can be performed. To date, there are few publications that assess the sonographic response to propranolol in IHs, and to our knowledge, none that consider simultaneous evaluation of both intralesional and normal peripheral blood vessels in these cases. OBJECTIVE: Evaluation of the anatomic effect of propranolol in IHs and peripheral blood vessels using CDU. METHODS: A cohort study was performed in 10 pediatric patients with a diagnosis of IH in whom systemic therapy with propranolol was indicated. The patients underwent a baseline and 3-month follow-up CDUs of the tumor and the main peripheral vessels of the right upper extremity. RESULTS: The group was composed of 7 (70%) girls and 3 (30%) boys. The average CDU decrease in size of the longitudinal axis was 11%; of the transverse axis, 24%; tumor thickness, 30%; and intralesional vessel thickness, 46%. Hemangioma volume measured by CDU decreased an average of 51%. The thickness of the peripheral vessels did not change significantly between the baseline and 3-month follow-up CDUs. CONCLUSION: CDU permits noninvasive quantification of the changes in IHs and peripheral vessels in patients receiving propranolol therapy. In our cohort of cases there was a significant reduction in tumor volume; however, peripheral vascularity was not significantly affected.