ABSTRACT
Infantile hemangioma (IH) is the most common benign tumor of childhood, with a prevalence of 4 % to 10 %. It is characterized by a proliferative rapid growth phase, which starts after a few weeks of life, followed by a slow regression phase. In IH cases that are potentially disfiguring or life-threatening (10 % to 15 % of all cases), systemic therapy should be promptly initiated. Data source The present study reviews published scientific articles available in reliable electronic databases. Selected were all studies that evaluated the pathogenesis of IH and the mechanisms of action of propranolol. Conclusions The pathogenesis of IH has not been fully elucidated. Studies show that, in the proliferative phase of IH, there is an imbalance of angiogenic factors and an increase in the levels of vascular endothelial growth factor and matrix metalloproteinases 2 and 9. In the regression phase, the levels of these factors decrease, whereas those of antiangiogenic factors, including tissue inhibitors of matrix metalloproteinases, increase. Since 2008, propranolol has become the drug of choice in the treatment of IH, targeting vascular tone, angiogenesis, and apoptosis. Current insights into the pathogenesis of IH allow for the development of new therapeutic strategies.
Subject(s)
Hemangioma/drug therapy , Propranolol/therapeutic use , Skin Neoplasms/drug therapy , Angiogenesis Inducing Agents/metabolism , Cell Proliferation/drug effects , Cell Proliferation/physiology , Female , Hemangioma/embryology , Hemangioma/physiopathology , Humans , Infant, Newborn , Matrix Metalloproteinase 2/physiology , Matrix Metalloproteinase 9/physiology , Neoplasm Regression, Spontaneous/physiopathology , Pregnancy , Skin Neoplasms/embryology , Skin Neoplasms/physiopathology , Vascular Endothelial Growth Factor A/physiologyABSTRACT
BACKGROUND: Infantile hemangiomas (IHs) are the most common benign vascular tumors of childhood. Propranolol is an effective drug in treating IH. A reliable and complementary instrument is necessary to evaluate IH response to propranolol in addition to clinical and photographic assessments. Ultrasonography is a simple and non-invasive technique that enables precise measurements of tumor size and contributes to objective follow-up. OBJECTIVE: To demonstrate the use of serial ultrasonography as an adjunctive tool for assessment of IH treatment with propranolol. PATIENTS AND METHODS: A retrospective study of 19 patients with IH treated with propranolol was conducted from January 2009 to March 2014. Data of individual IH volume at the beginning and at least 6 months after the onset of treatment and overall volume reduction by ultrasonographic measurement were obtained. RESULTS: We observed a statistically significant IH volume reduction of approximately 0.51 cm3 . This volume corresponds to an average reduction of 47% in the final volume compared with the initial volume. CONCLUSION: Ultrasonographic measurements contribute to demonstrate tumor regression and IH response to propranolol. Thus, ultrasonography is an important instrument to guide therapeutic strategies.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Hemangioma, Capillary/diagnostic imaging , Hemangioma, Capillary/drug therapy , Neoplastic Syndromes, Hereditary/diagnostic imaging , Neoplastic Syndromes, Hereditary/drug therapy , Propranolol/therapeutic use , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/drug therapy , Child, Preschool , Female , Humans , Infant , Male , Photography , Retrospective Studies , Treatment Outcome , UltrasonographyABSTRACT
BACKGROUND: Cutaneous tuberculosis has re-emerged in the last 15 years together with the higher incidence of pulmonary tuberculosis and multidrug resistance. The choice for a single diagnostic tool among the many available today is a challenge. Our objective was to compare polymerase chain reaction (PCR) with other exams in the diagnosis of cutaneous tuberculosis and atypical mycobacteria skin infection. METHODS: PCR and a set of five different exams were performed in 32 patients (34 samples of paraffin-embedded tissue) evaluated for 3 years in a university hospital, considering the response to mycobacterial infection treatment as a positive case. RESULTS: PCR was the most sensitive (88%) and specific (83%) exam. Culture, immunohistochemistry and acid-fast bacilli were not in agreement with clinical response to treatment. Conclusions Although PCR is a useful tool, careful clinical exam is still the gold standard for the evaluation and treatment of cutaneous tuberculosis and mycobacteria skin infection.
Subject(s)
Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium tuberculosis/isolation & purification , Polymerase Chain Reaction/methods , Skin Diseases, Bacterial/diagnosis , Tuberculosis, Cutaneous/diagnosis , Adolescent , Adult , Age Distribution , Aged , Biopsy, Needle , Brazil/epidemiology , Cohort Studies , DNA, Bacterial/analysis , Female , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Mycobacterium Infections, Nontuberculous/epidemiology , Risk Factors , Sensitivity and Specificity , Severity of Illness Index , Sex Distribution , Skin Diseases, Bacterial/epidemiology , Tuberculin Test , Tuberculosis, Cutaneous/epidemiology , Young AdultABSTRACT
Discoid lupus erythematosus is much less frequent and studied in children. We undertook a retrospective study of 34 children less than 16 years of age with this disease, seen over a period of 9 years. A female predominance of 2:1 was found. An association between discoid lupus erythematosus and systemic lupus erythematosus was observed in 23.5% of patients, a higher proportion compared to adult discoid lupus erythematosus. Disseminated lesions were much more frequent in patients with criteria for systemic lupus erythematosus (87.5% vs 34%), suggesting that it could be associated with a worse prognosis. Histologic findings were similar to those observed in adult discoid lupus erythematosus.
