1
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Berry W, D'Arcy C, Welsh B, Orchard D, Bekhor PS, Robertson SJ. Naevoid miliaria profunda, successfully treated with botulinum toxin. Australas J Dermatol 2024. [PMID: 38530143 DOI: 10.1111/ajd.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Affiliation(s)
- William Berry
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Colleen D'Arcy
- Department of Pathology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Belinda Welsh
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Philip S Bekhor
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Susan J Robertson
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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2
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Mahar PD, Robertson SJ, Orchard D, Baker C, Foley P. Paediatric indications and dosing guidance for advanced targeted treatments in Australia. Australas J Dermatol 2024. [PMID: 38445760 DOI: 10.1111/ajd.14230] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
As with adults, paediatric patients may benefit from a number of advanced targeted therapies for inflammatory skin disease. This brief report aims to be an accessible reference tool with respect to regulatory approval and reimbursement of these treatments within Australia.
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Affiliation(s)
- Patrick D Mahar
- Skin Health Institute, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan J Robertson
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Dermatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Baker
- Skin Health Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter Foley
- Skin Health Institute, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia
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3
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Punchihewa N, Orchard D. Combination oral antifungal therapy for paediatric fungal infection: An option to improve efficacy and overcome clinical resistance. Australas J Dermatol 2024; 65:59-62. [PMID: 37927148 DOI: 10.1111/ajd.14186] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
There is increasing evidence of clinically resistant cutaneous fungal infections. The use of combination oral antifungals is described in adults but not in paediatric patients. We present seven paediatric cases of clinically resistant fungal infections treated successfully with combination oral antifungal therapy after inadequate response to a single agent.
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Affiliation(s)
- Nisal Punchihewa
- Department of Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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4
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Tasani M, Gopinatham L, Orchard D. Letter to the Editor. J Paediatr Child Health 2023. [PMID: 37144960 DOI: 10.1111/jpc.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Monika Tasani
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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5
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McWhirter S, Foster R, Halbert A, Miller R, Morgan VA, Rademaker M, Robertson S, Scardamaglia L, Warren L, Wong LC, Zappala T, Orchard D. Discoid (nummular) eczema in the paediatric setting - An Australian/New Zealand narrative. Australas J Dermatol 2022; 63:e289-e296. [PMID: 36057946 DOI: 10.1111/ajd.13915] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
Discoid (nummular) eczema is a common and distinctive eczema variant, which has not been studied in depth. Although the principles of management are similar to that of classic atopic dermatitis, distinctions are made due to its unique presentation and persistent clinical course in children. Australian and New Zealand dermatologists with an interest in paediatric eczema developed a consensus narrative to assist clinicians in diagnosing and treating this subtype of eczema. Identifying triggers, potent topical corticosteroids under occlusion, skin barrier support and management of pruritus are first-line therapies, however, many eventually require systemic immunomodulatory agents.
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Affiliation(s)
| | - Rachael Foster
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Anne Halbert
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Robert Miller
- Townsville University Hospital, Townsville, Queensland, Australia
| | | | | | | | | | - Lachlan Warren
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Li-Chuen Wong
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Tania Zappala
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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6
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Orchard D. Preventing atopic eczema: vitamin D supplementation another piece of the puzzle? Br J Dermatol 2022; 187:630-631. [DOI: 10.1111/bjd.21806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Orchard
- Department of Dermatology The Royal Children’s Hospital Melbourne Parkville Victoria Australia
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7
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Gan C, King E, Orchard D. Secukinumab use in the treatment of Netherton's syndrome. Australas J Dermatol 2022; 63:365-367. [PMID: 35622930 DOI: 10.1111/ajd.13880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
Netherton syndrome is a rare, severe genetic disorder of cornification without specific treatment. We describe two cases who demonstrated marked cutaneous improvement with secukinumab and suggest a role for IL-17 therapy in treating this condition.
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Affiliation(s)
- Christian Gan
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma King
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Orchard
- Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Mactaggart E, Orchard D, Mui Tam M. Baby wipes and nappy rash - what is the relationship? A review. Australas J Dermatol 2021; 62:470-477. [PMID: 34523734 DOI: 10.1111/ajd.13715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
Baby wipes are a commonly used cleansing method for infants. A literature review has been performed to assess if using baby wipes is beneficial or harmful compared to water and cloth in terms of nappy rash. This includes a detailed analysis of baby wipe ingredients, as many skin irritants as well as allergens are identified. MedLine, Embase and PubMed were searched and after 420 titles and abstracts were screened, 21 studies remained for inclusion. Baby wipes are deemed as superior to water and cloth in the majority of the literature. However, no definitive conclusion can be drawn as many studies are also industry funded. The most notable allergens identified are fragrances, such as linalool, cocamidopropyl betaine (surfactant), formaldehyde-releasing preservatives and other preservatives, including methylisothiazolinone and methylchloroisothiazolinone. As not all allergens are listed on the label accurately, this can be misleading for the consumer.
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Affiliation(s)
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Mei Mui Tam
- Dermatologist, Skin Health Institute, Melbourne, VIC, Australia
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9
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McWhirter S, Robinson P, Orchard D. Asthma improvement in children with eczema treated with azathioprine: A case series. Australas J Dermatol 2020; 62:e306-e308. [PMID: 33247837 DOI: 10.1111/ajd.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Seamus McWhirter
- Box Hill Hospital, Eastern Health, Box Hill, Victoria, Australia
| | - Phil Robinson
- Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Flemington, Parkville, Victoria, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital Flemington, Parkville, Victoria, Australia
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10
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Russo C, Doolan BJ, Orchard D. An indigenous 2‐month‐old with a papular eruption of the scapula. Int J Dermatol 2020; 59:801-803. [DOI: 10.1111/ijd.14774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Carlo Russo
- Department of Dermatology The Royal Children's Hospital Parkville Vic. Australia
- Melbourne Medical School The University of Melbourne Parkville Vic. Australia
| | - Brent J. Doolan
- Department of Dermatology The Royal Children's Hospital Parkville Vic. Australia
| | - David Orchard
- Department of Dermatology The Royal Children's Hospital Parkville Vic. Australia
- Department of Paediatrics The University of Melbourne Parkville Vic. Australia
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11
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Lowe AJ, Lee B, Orchard D, King E, Abramson MJ, Allen KJ, Hui J, Southey MC, Lodge CJ, Dharmage SC. Palm reading and water divining: A cross-sectional study of the accuracy of palmar hyperlinearity and transepidermal water loss to identify individuals with a filaggrin gene null mutation. J Am Acad Dermatol 2020; 83:1186-1188. [PMID: 32068048 DOI: 10.1016/j.jaad.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/05/2019] [Accepted: 01/22/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Adrian John Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Bambie Lee
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - David Orchard
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Australia
| | - Emma King
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Dermatology, The Royal Children's Hospital, Melbourne, Australia; Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Melissa C Southey
- Department of Clinical Pathology, The Melbourne Medical School, The University of Melbourne, Melbourne, Australia; Melbourne Australia and Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
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12
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Amalia N, Orchard D, Francis KL, King E. Systematic review and meta‐analysis on the use of probiotic supplementation in pregnant mother, breastfeeding mother and infant for the prevention of atopic dermatitis in children. Australas J Dermatol 2019; 61:e158-e173. [DOI: 10.1111/ajd.13186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Nasya Amalia
- Faculty of Medicine Universitas Indonesia Jakarta Indonesia
- Faculty of Medical Science University of Melbourne Melbourne Australia
| | - David Orchard
- Faculty of Medical Science University of Melbourne Melbourne Australia
- Dermatology DepartmentThe Royal Children's Hospital Melbourne Australia
| | - Kate Louise Francis
- Clinical Epidemiology and Biostatistics Unit Murdoch Children's Research Institute The Royal Children's Hospital Melbourne Australia
| | - Emma King
- Faculty of Medical Science University of Melbourne Melbourne Australia
- Dermatology DepartmentThe Royal Children's Hospital Melbourne Australia
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13
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Smithson SL, Orchard D, Scardamaglia L. Mycophenolate mofetil to treat mid-dermal elastolysis. Pediatr Dermatol 2018; 35:e221-e223. [PMID: 29683223 DOI: 10.1111/pde.13511] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mid-dermal elastolysis is an acquired skin condition affecting the elastin fibers of the dermis, resulting in laxity of the skin. We report a case of mid-dermal elastolysis for which novel treatment with mycophenolate mofetil was successful.
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Affiliation(s)
- Sarah L Smithson
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Laura Scardamaglia
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
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14
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Gin A, King E, Scardamaglia E, Orchard D. Eczema exacerbation caused by Coxsackie virus A6. Australas J Dermatol 2018; 59:64-65. [DOI: 10.1111/ajd.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Gin
- Royal Children's Hospital; Melbourne Victoria Australia
| | - Emma King
- Royal Children's Hospital; Melbourne Victoria Australia
| | | | - David Orchard
- Royal Children's Hospital; Melbourne Victoria Australia
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15
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Leins L, Orchard D. Eczema management in school-aged children. Aust Fam Physician 2017; 46:896-899. [PMID: 29464225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Atopic eczema is a relapsing inflammatory skin condition that can be lifelong. Management of eczema is often focused on infants, with many school-aged children undertreated. Uncontrolled eczema has a significant impact on the quality of life of the child and their family. OBJECTIVE The objective of this article is to discuss the practical management of eczema in school-aged children. DISCUSSION This article will describe how eczema manifests in school-aged children, focusing on when to suspect triggers and how to manage these from a general practice perspective, and when to refer the child on to specialist services.
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16
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Nguyen T, Orchard D, Zacharin M. Liver haemangiomas and consumptive hypothyroidism in association with three cutaneous haemangiomas. J Paediatr Child Health 2017; 53:1226-1228. [PMID: 28752673 DOI: 10.1111/jpc.13671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/24/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Trung Nguyen
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Margaret Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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17
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Wong CC, Allen KJ, Orchard D. Changes to infant feeding guidelines: Relevance to dermatologists. Australas J Dermatol 2017; 58:e171-e175. [PMID: 28266703 DOI: 10.1111/ajd.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/17/2016] [Indexed: 11/26/2022]
Abstract
The newly revised Australian Infant Feeding Guidelines recommends that all infants, including those at high risk of allergy, be introduced foods traditionally considered allergenic (such as peanut butter, dairy, wheat and egg) within the first year of life. High-risk infants are those with early onset eczema (<3-months old) or with moderate to severe eczema not responding to treatment (<6-months old). Eczema can also represent a symptom of allergy presentation and the recommended introduction of some foods in this group may lead to allergic reactions at home. Although there have been no reported deaths from gradual food introduction to infants at home and cohort studies have only reported mild to moderate reactions, there is anecdotal evidence that more severe reactions can occur rarely. Allergic reactions, even if they are not life-threatening, can be a terrifying experience for parents. Dermatologists play an important role when dealing with high-risk infants in promoting the message of early allergenic food introduction yet also instigating appropriate allergy testing when necessary. This short review aims to provide an update to Australasian dermatologists on the newly revised Australian Infant Feeding Guidelines and provide a food allergy screening pathway for high-risk infants prior to commencement of allergenic foods.
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Affiliation(s)
- Celestine C Wong
- Department of Dermatology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katrina J Allen
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Centre for Food and Allergy Research, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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18
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Smithson SL, Rademaker M, Adams S, Bade S, Bekhor P, Davidson S, Dore A, Drummond C, Fischer G, Gin A, Grills C, Halbert A, Lokmic Z, McCahon E, Morgan VA, Murrell DF, Orchard D, Penington A, Purvis D, Relic J, Robertson S, Robinson AJ, Scardamaglia L, Su J, Tan S, Wargon O, Warren L, Wong LC, Zappala T, Phillips R. Consensus statement for the treatment of infantile haemangiomas with propranolol. Australas J Dermatol 2017; 58:155-159. [DOI: 10.1111/ajd.12600] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Susan Adams
- University of New South Wales School of Women's and Children's Health; Randwick New South Wales Australia
| | - Stuart Bade
- The Lady Cilentro Children's Hospital; Brisbane Queensland Australia
| | - Philip Bekhor
- Royal Children's Hospital; Melbourne Victoria Australia
| | - Samantha Davidson
- The Lady Cilentro Children's Hospital; Brisbane Queensland Australia
| | - Amanda Dore
- The Lady Cilentro Children's Hospital; Brisbane Queensland Australia
| | | | - Gayle Fischer
- University of Sydney; Sydney New South Wales Australia
| | - Alexander Gin
- Royal Children's Hospital; Melbourne Victoria Australia
| | - Claire Grills
- Royal Children's Hospital; Melbourne Victoria Australia
| | - Anne Halbert
- Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Zerina Lokmic
- Murdoch Childrens Research Institute; Melbourne Victoria Australia
| | - Emma McCahon
- Children's Hospital at Westmead; Sydney Australia
| | | | | | - David Orchard
- Royal Children's Hospital; Melbourne Victoria Australia
| | | | - Diana Purvis
- Starship Children's Hospital; Auckland New Zealand
| | - John Relic
- John Hunter Children's Hospital; Newcastle New South Wales Australia
| | | | | | | | - John Su
- Royal Children's Hospital; Melbourne Victoria Australia
| | - Swee Tan
- Gillies McIndoe Research Institute; Wellington New Zealand
| | - Orli Wargon
- Sydney Children's Hospital; Sydney New South Wales Australia
| | - Lachlan Warren
- Women's and Children's Hospital; Adelaide South Australia Australia
| | | | - Tania Zappala
- The Lady Cilentro Children's Hospital; Brisbane Queensland Australia
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19
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Jain SV, Harris AG, Su JC, Orchard D, Warren LJ, McManus H, Murrell DF. The Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI): grading disease severity and assessing responsiveness to clinical change in epidermolysis bullosa. J Eur Acad Dermatol Venereol 2016; 31:692-698. [PMID: 27580431 PMCID: PMC5412907 DOI: 10.1111/jdv.13953] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The lack of validated outcome measures for epidermolysis bullosa (EB) presents major barriers to evaluating disease severity and comparing the efficacy of therapies. The Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) was recently introduced as a valid and reliable instrument for EB; however, its interpretation for use in clinical practice and clinical trials is yet to be defined. OBJECTIVE To assess the interpretability of the EBDASI in classifying patients according to disease severity and clinical response. METHODS A total of 53 outpatients with EB at two interstate institutions were prospectively evaluated. At each visit, the principal dermatologist completed the EBDASI and global assessments of disease severity and change. Classifications for mild, moderate and severe disease using the EBDASI were determined using receiver operating characteristic curves. Minimal clinically important differences for the EBDASI activity subscale were calculated and compared with the standard error of measurement. RESULTS Total EBDASI score ranges of 0-42, 43-106 and 107-506 corresponded to mild, moderate and severe disease respectively. Reduction in EBDASI activity scores of greater than 9 indicated clinically significant improvement. An increase of 3 in the activity score indicated deterioration. CONCLUSION The EBDASI is a responsive tool and may be useful in characterizing disease severity and response. The cut-offs proposed in this study provide the first practical guide for interpreting the EBDASI, further supporting its use for longitudinal patient assessment and in clinical trials.
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Affiliation(s)
- S V Jain
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A G Harris
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J C Su
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - D Orchard
- Department of Dermatology, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - L J Warren
- Department of Dermatology, Women's and Children's Hospital, Adelaide, SA, Australia
| | - H McManus
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - D F Murrell
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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20
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Robinson AJ, Foster RS, Halbert AR, King E, Orchard D. Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids. Australas J Dermatol 2016; 58:e138-e140. [DOI: 10.1111/ajd.12551] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron J Robinson
- Department of Dermatology; Royal Children's Hospital; Melbourne Victoria Australia
| | - Rachael S Foster
- Halbert Dermatology; Hollywood Medical Centre; Perth Western Australia Australia
| | - Anne R Halbert
- Halbert Dermatology; Hollywood Medical Centre; Perth Western Australia Australia
- Department of Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Emma King
- Department of Dermatology; Royal Children's Hospital; Melbourne Victoria Australia
| | - David Orchard
- Department of Dermatology; Royal Children's Hospital; Melbourne Victoria Australia
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21
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Yee J, Orchard D. Monitoring recommendations for oral azathioprine, methotrexate and cyclosporin in a paediatric dermatology clinic and literature review. Australas J Dermatol 2016; 59:31-40. [PMID: 27435804 DOI: 10.1111/ajd.12526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Systemic oral immunomodulators azathioprine, methotrexate and cyclosporin are widely used in paediatric dermatology. Routine blood tests are performed to minimise drug-related adverse events. However, the frequency of monitoring tests may lead to significant fearful experiences for patients. We reviewed haematological abnormalities and clinical side-effects in a paediatric clinic population commencing immunomodulators for dermatological conditions, where haematological profiles are monitored less frequently than in current recommendations. METHODS A retrospective chart review of children started on azathioprine, methotrexate or cyclosporin for a dermatological condition between 2001-2015 from a primarily paediatric, private dermatology practice was performed. Blood tests were done at baseline, 1 month, 2 months and then 3-monthly for children on azathioprine. Children on methotrexate and cyclosporin had tests done at baseline, after 1 month and then 3-monthly. RESULTS In total, 242 children were included in this study. Azathioprine, methotrexate and cyclosporin cohorts had 95, 97 and 50 patients treated for a mean duration of 656, 758 and 313 days, respectively. Isolated abnormal blood tests indicated the cessation of azathioprine in 3/95 (3%), methotrexate in 5/97 (5%) and cyclosporin in 2/50 (4%) of patients. Abnormal blood test results were not associated with any reported clinical side-effects in the azathioprine (P = 0.726), methotrexate (P = 0.06) or cyclosporin groups (P = 0.250). CONCLUSION In our experience, less frequent monitoring did not result in any significant adverse events over a 15-year period. We suggest that haematological monitoring during immunosuppressants use can be safely reduced from current recommendations.
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Affiliation(s)
- Joy Yee
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Orchard
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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22
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Bhabha FK, Walsh M, Orchard D, Savarirayan R. Terminal osseous dysplasia with pigmentary defects; Case and brief review of filamin A-related disorders. Australas J Dermatol 2015; 57:312-315. [DOI: 10.1111/ajd.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Maie Walsh
- Victorian Clinical Genetics Services; Clinical Genetics
| | - David Orchard
- Royal Children's Hospital; Melbourne Victoria Australia
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23
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Mooney E, Rademaker M, Dailey R, Daniel BS, Drummond C, Fischer G, Foster R, Grills C, Halbert A, Hill S, King E, Leins E, Morgan V, Phillips RJ, Relic J, Rodrigues M, Scardamaglia L, Smith S, Su J, Wargon O, Orchard D. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australas J Dermatol 2015; 56:241-51. [DOI: 10.1111/ajd.12313] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Emma Mooney
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Marius Rademaker
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | | | - Ben S Daniel
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Catherine Drummond
- Department of Dermatology; Canberra Hospital; Canberra Australian Capital Territory
- Australian National University; Canberra Australian Capital Territory
| | - Gayle Fischer
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - Rachael Foster
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Claire Grills
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Anne Halbert
- Department Paediatric Dermatology; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Sarah Hill
- Department of Dermatology; Waikato Hospital; Hamilton New Zealand
| | - Emma King
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Elizabeth Leins
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
| | - Vanessa Morgan
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
| | - Roderic J Phillips
- Department of Paediatrics; Monash University; Melbourne Victoria
- Department of Vascular Biology; Royal Children's Hospital; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - John Relic
- Department of Dermatology; Royal Newcastle Centre; Newcastle New South Wales
| | - Michelle Rodrigues
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- Department of Dermatology; St Vincent's Hospital; Melbourne Victoria
| | - Laura Scardamaglia
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology; Royal Melbourne Hospital; Melbourne Victoria
- Department of Dermatology; Western Hospital; Melbourne Victoria
| | - Saxon Smith
- Department of Dermatology; Royal North Shore Hospital; Sydney New South Wales
- Sydney Medical School; University of Sydney; Sydney New South Wales
| | - John Su
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
- University of Melbourne; Melbourne Victoria
- Department of Dermatology, Eastern Health; Murdoch Children's Research Institute; Melbourne Victoria
- Monash University; Melbourne Victoria
- Murdoch Children's Research Institute; Melbourne Victoria
| | - Orli Wargon
- Department Paediatric Dermatology; Sydney Children's Hospital; Sydney New South Wales
| | - David Orchard
- Department of Paediatric Dermatology; Royal Children's Hospital; Melbourne Victoria
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24
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Daniel BS, Orchard D. Ocular side-effects of topical corticosteroids: what a dermatologist needs to know. Australas J Dermatol 2015; 56:164-9. [PMID: 25754554 DOI: 10.1111/ajd.12292] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 11/04/2014] [Indexed: 01/08/2023]
Abstract
Topical corticosteroids are used frequently in dermatology and atopic dermatitis without significant adverse effects. Though ocular diseases such as glaucoma and cataracts are known complications of systemic corticosteroids, the role of topical corticosteroids is limited to case reports. This review assesses the literature regarding topical steroids and their role in ocular diseases. There is evidence of harm to vision when potent topical corticosteroids are inappropriately used for prolonged periods to periorbital sites. There is no evidence to date that weak TCS to the face or potent TCS to areas other than the eyes results in ocular complications. Further research trials are required in this area.
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Affiliation(s)
- Benjamin S Daniel
- Dermatology Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Orchard
- Dermatology Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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25
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Bhabha FK, Magee J, Ng SY, Grills CE, Su J, Orchard D. Multiple clustered dermatofibroma presenting in a segmental distribution. Australas J Dermatol 2015; 57:e20-2. [PMID: 25557526 DOI: 10.1111/ajd.12257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Multiple dermatofibromas is a rare entity consisting of more than fifteen lesions. Multiple clustered dermatofibroma is a distinct variant of multiple dermatofibromas and is defined as a well-demarcated plaque composed of individual dermatofibromas. We report a 16-year-old boy with multiple clustered dermatofibroma in a segmental distribution, which has previously not been reported in the literature.
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Affiliation(s)
| | - Jill Magee
- Dorevitch Pathology, Melbourne, Victoria, Australia
| | - Su Yuen Ng
- Paediatrics, Institute Pediatrik, Kuala Lumpur, Malaysia
| | | | - John Su
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David Orchard
- Royal Children's Hospital, Melbourne, Victoria, Australia
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26
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Ng SY, D'Arcy C, Orchard D. Acquired idiopathic lipoatrophic panniculitis in a 12-month-old infant. Australas J Dermatol 2014; 56:e102-4. [DOI: 10.1111/ajd.12159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Su Yuen Ng
- Dermatology Department; Royal Children's Hospital; Melbourne Victoria Australia
- Paediatrics Department; Institute Pediatrik; Kuala Lumpur General Hospital; Kuala Lumpur Wilayah Persekutuan Malaysia
| | - Colleen D'Arcy
- Anatomical Pathology Department; Royal Children's Hospital; Melbourne Victoria Australia
| | - David Orchard
- Dermatology Department; Royal Children's Hospital; Melbourne Victoria Australia
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27
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Abstract
We present an instructive case of a 13-year old male who presented with bilateral scrotal redness, swelling and tenderness, but with a normal testicular exam. His scrotal swelling persisted despite treatment with intravenous antibiotics, and on further history he reported 2 years of intermittent upper lip swelling. After a referral to a dermatologist, a lip biopsy showed granulomatous changes and he was referred to the gastroenterology department. A gastroscopy and colonoscopy was performed and histology confirmed non-caseating granulomas consistent with Crohn's disease (CD). Eighteen months after the diagnosis of CD he developed perianal disease with a fistula and distal anal stricture. He was successfully treated with insertion of a seton and escalation of therapy to azathioprine and infliximab. CD is a phenotypically diverse chronic inflammatory condition with an increasing incidence in Australia and other Western countries. Non-typical presentations, such as perianal manifestations or orofacial granulomatosis, can be the only presenting symptom in CD, and this highlights the importance for a high degree of clinical suspicion. Genital involvement is rare, but reported.
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Affiliation(s)
- Karthik Rajah
- Department of Gastroenterology, Royal Children's Hospital, Australia; Department of Paediatrics, Royal Children's Hospital, Australia
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28
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Cheung Y, Gayden T, Campeau P, LeDuc C, Russo D, Nguyen VH, Guo J, Qi M, Guan Y, Albrecht S, Moroz B, Eldin K, Lu J, Schwartzentruber J, Malkin D, Berghuis A, Emil S, Gibbs R, Burk D, Vanstone M, Lee B, Orchard D, Boycott K, Chung W, Jabado N. A recurrent PDGFRB mutation causes familial infantile myofibromatosis. Am J Hum Genet 2013; 92:996-1000. [PMID: 23731537 DOI: 10.1016/j.ajhg.2013.04.026] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 04/18/2013] [Accepted: 04/30/2013] [Indexed: 10/26/2022] Open
Abstract
Infantile myofibromatosis (IM) is the most common benign fibrous tumor of soft tissues affecting young children. By using whole-exome sequencing, RNA sequencing, and targeted sequencing, we investigated germline and tumor DNA in individuals from four distinct families with the familial form of IM and in five simplex IM cases with no previous family history of this disease. We identified a germline mutation c.1681C>T (p.Arg561Cys) in platelet-derived growth factor receptor β (PDGFRB) in all 11 affected individuals with familial IM, although none of the five individuals with nonfamilial IM had mutations in this gene. We further identified a second heterozygous mutation in PDGFRB in two myofibromas from one of the affected familial cases, indicative of a potential second hit in this gene in the tumor. PDGFR-β promotes growth of mesenchymal cells, including blood vessels and smooth muscles, which are affected in IM. Our findings indicate p.Arg561Cys substitution in PDGFR-β as a cause of the dominant form of this disease. They provide a rationale for further investigations of this specific mutation and gene to assess the benefits of targeted therapies against PDGFR-β in aggressive life-threatening familial forms of the disease.
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29
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Sharma N, Clark J, Pham H, Efron D, MacGregor D, O'Keefe R, Orchard D. TEN-like eruption in setting of EBV positive T-cell lymphoproliferative disease with HLH, in a child. Australas J Dermatol 2013; 55:e44-7. [PMID: 23573996 DOI: 10.1111/ajd.12037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/13/2013] [Indexed: 11/28/2022]
Abstract
Haemophagocytic lymphohistiocytosis complicating Epstein-Barr virus positive T-cell lymphoproliferative disease of childhood is a rare and life-threatening entity. We report a child with this condition presenting with a toxic epidermal necrolysis-like eruption.
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Affiliation(s)
- Niyati Sharma
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
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30
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Affiliation(s)
- Charmaine Gray
- Department of General Medicine; Infectious Diseases Unit; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - Lauren Young
- Department of Dermatology; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - David Orchard
- Department of Dermatology; Royal Children's Hospital Melbourne; Parkville Victoria Australia
| | - Tom G Connell
- Department of General Medicine; Infectious Diseases Unit; Royal Children's Hospital Melbourne; Parkville Victoria Australia
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31
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Abstract
We present the case of a boy with a clinical diagnosis of Goltz (focal dermal hypoplasia) syndrome. This is a rare genodermatosis characterized by widespread dysplasia of mesodermal and ectodermal tissues. It is inherited in an X-linked dominant fashion and is normally lethal in male patients. Mutations in the PORCN gene (Xp11.23), the proteins of which are key regulators in embryonic development, have been found to be responsible for the syndrome. Sequencing of the PORCN gene was negative in our patient. This case highlights some of the challenges of obtaining a molecular diagnosis in male patients with suspected Goltz syndrome in the clinical setting.
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Affiliation(s)
- Anita L Lasocki
- Department of Dermatology, The Royal Children's Hospital, Victoria, Australia.
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32
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Dinh H, O'Brien T, Mason G, Orchard D. Targetoid spongiotic reaction pattern: A case series of seven paediatric patients. Australas J Dermatol 2011; 52:117-22. [PMID: 21605095 DOI: 10.1111/j.1440-0960.2011.00766.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present seven cases of a targetoid eruption, clinically mimicking erythema multiforme, occurring in paediatric patients aged 12 months to 14 years. All patients presented with a pruritic targetoid eruption on body and acral sites which spared mucosal areas. All patients demonstrated a spongiotic reaction pattern on histology without lichenoid change and demonstrated excellent responses to either oral prednisolone or topical corticosteroids. We propose the term 'targetoid spongiotic reaction pattern (TSRP)' for our subset of paediatric patients. We review the literature regarding targetoid eruptions in the paediatric population.
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Affiliation(s)
- Hope Dinh
- Department of Dermatology, Royal Children's Hospital, Victoria, Australia.
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33
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Abstract
We present two families in whom infantile myofibromatosis affects two generations. The disease expression in these families suggests an autosomal dominant mode of inheritance. Clinical diagnosis and establishment of the inheritance pattern have important prognostic implications for the affected individual and family members and serves to guide subsequent genetic counselling.
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Affiliation(s)
- Annika Smith
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia
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34
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Abstract
We present a case series of childhood lymphomatoid papulosis (LyP), an entity which is commonly misdiagnosed and poorly described in the paediatric dermatology literature. Clinically and histologically, the features of LyP in children can mimic insect bite reactions, with prominent dermal neutrophils and eosinophils. However, CD30 immunohistochemical staining of atypical lymphocytes within a mixed inflammatory infiltrate should point to the diagnosis of LyP. There is no consensus to guide management of childhood LyP due to its rarity and largely unknown natural course. We discuss our experience with LyP in five children and the use of methotrexate to induce rapid resolution of persistent lesions and to reduce recurrences in two children. Although none of our cases have experienced malignant transformation to date, life-long monitoring is advocated.
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Affiliation(s)
- Leona Yip
- Department of Dermatology, The Royal Children's Hospital, Victoria, Australia.
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35
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36
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Tuxen AJ, Orchard D. Childhood and adolescent orofacial granulomatosis is strongly associated with Crohn's disease and responds to intralesional corticosteroids. Australas J Dermatol 2011; 51:124-7. [PMID: 20546219 DOI: 10.1111/j.1440-0960.2010.00627.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We present seven cases of orofacial granulomatosis occurring in paediatric patients aged 6-16 years. All patients were investigated for Crohn's disease and a strong association was found. All patients were treated with intralesional corticosteroid injections with excellent clinical responses. We review the literature and discuss the epidemiological association between childhood orofacial granulomatosis and Crohn's disease, as well as various treatment options, and propose a treatment protocol that was efficacious and well tolerated in all our patients.
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Affiliation(s)
- Alana J Tuxen
- The Royal Children's Hospital, Parkville, Victoria, Australia.
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37
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Roberts H, Orchard D. Methotrexate is a safe and effective treatment for paediatric discoid (nummular) eczema: a case series of 25 children. Australas J Dermatol 2011; 51:128-30. [PMID: 20546220 DOI: 10.1111/j.1440-0960.2010.00634.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We present a case series of 25 paediatric patients with refractory discoid eczema treated with methotrexate. Patients were commenced on either 5 mg or 10 mg of methotrexate per week. Sixteen patients (64%) completely cleared their eczema after an average of 10.5 months of methotrexate therapy. A further three patients (12%) have responded well and are almost clear at the time of writing. Methotrexate was well tolerated by the majority of patients and no serious adverse events were observed. Methotrexate should be considered in moderate to severe paediatric discoid eczema that has failed to respond to conventional therapies.
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Affiliation(s)
- Hugh Roberts
- Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia.
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38
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Frew J, Lim SW, Klausseger A, Chow CW, Tran K, Su J, Orchard D, Varigos G, Sawamura D, Nishie W, Shimizu H, Murrell DF. Autosomal dominant bullous dermolysis of the newborn associated with a heterozygous missense mutation p.G1673R in type VII collagen. Australas J Dermatol 2010; 52:e1-4. [DOI: 10.1111/j.1440-0960.2010.00684.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tebruegge M, Connell T, Ritz N, Orchard D, Curtis N. Mycobacterium marinum infection following kayaking injury. Int J Infect Dis 2010; 14 Suppl 3:e305-6. [PMID: 20541959 DOI: 10.1016/j.ijid.2010.02.2246] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 02/19/2010] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marc Tebruegge
- Department of Paediatrics, The University of Melbourne, Royal Children's Hospital Melbourne, Parkville, Victoria 3052, Australia.
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40
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Kho YC, Rhodes LM, Robertson SJ, Su J, Varigos G, Robertson I, Hogan P, Orchard D, Murrell DF. Epidemiology of Epidermolysis Bullosa in the Antipodes. ACTA ACUST UNITED AC 2010; 146:635-40. [DOI: 10.1001/archdermatol.2010.109] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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41
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Abstract
A severe cutaneous eruption in an unwell patient can be a major cause of physician anxiety. With numerous differential diagnoses, an early accurate diagnosis can be challenging. infectious causes are the most important to exclude in a timely manner and drug rash and eosinophilia with systemic symptoms (DRESS) is another differential diagnosis that should be considered in children. This hypersensitivity reaction is associated with multisystem involvement. Children with underlying chronic diseases may have impairment of normal metabolic pathways and are also often on multiple medications. Therefore, drugs should always be considered in the aetiopathology of any new symptoms and signs. This case report informs readers of the association of sulfasalazine and DRESS in an 11-year-old with inflammatory bowel disease and discusses its pathogenesis and treatment. Increased awareness of this disorder will hopefully lead to increased reporting and consequently illuminate the syndrome more clearly and help guide its prevention and treatment.
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Affiliation(s)
- Jeremy Rosenbaum
- Department of Gastroenterology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
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43
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Yiasemides E, Trisnowati N, Su J, Dang N, Klingberg S, Marr P, Melbourne W, Tran K, Chow CW, Orchard D, Varigos G, Murrell DF. Clinical heterogeneity in recessive epidermolysis bullosa due to mutations in the keratin 14 gene,KRT14. Clin Exp Dermatol 2008; 33:689-97. [DOI: 10.1111/j.1365-2230.2008.02858.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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44
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45
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Sakata S, Orchard D, Mason G. Skin rash with the histological absence of metachromatic granules as the presenting feature of Hunter syndrome in a 6-year-old boy. Br J Dermatol 2008; 159:249-50. [PMID: 18489604 DOI: 10.1111/j.1365-2133.2008.08595.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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46
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Orchard D. An Illustrated Dictionary of Dermatologic Syndromes, 2nd edition. Australas J Dermatol 2006. [DOI: 10.1111/j.1440-0960.2006.00281.x] [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: 11/27/2022]
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47
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Chen DL, Chong AH, Green J, Orchard D, Williams R, Clemens L. A novel case of polyfibromatosis and interstitial granulomatous dermatitis with arthritis. J Am Acad Dermatol 2006; 55:S32-7. [PMID: 16843121 DOI: 10.1016/j.jaad.2006.02.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 02/03/2006] [Accepted: 02/19/2006] [Indexed: 11/26/2022]
Abstract
Polyfibromatosis is a rare condition in which several cutaneous fibrotic conditions, such as Dupuytren's contracture, keloid formation, Peyronie's disease and plantar fibromatosis, may coexist. Interstitial granulomatous dermatitis with arthritis is also a rare condition characterized by arthritis and infiltrated rope-like lesions with granulomatous histologic features. We report a case of the simultaneous occurrence of both conditions in the same individual. To our knowledge, this has not been previously described. The clinical course has been slow, progressive, and recalcitrant to treatment.
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Affiliation(s)
- Daniel Litu Chen
- Department of Dermatology, St Vincent's Hospital, Melbourne, Australia
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48
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Abstract
We report on 50 consecutive suitable patients with one or more palmoplantar warts who were treated with a patient-applied ointment comprising 0.1% diphencyprone and 15% salicylic acid in white soft paraffin. All patients sensitized to diphencyprone were followed up clinically and assessed by patient questionnaire. The intention to treat success rate in this series was 88%. The time to wart clearance ranged from less than 4 weeks to 4 months. In our patient group, 90% rated their treatment as 'excellent' or 'good', whereas 10% stated that the reaction induced by diphencyprone was 'too severe'. Our results are compared with those previously published using diphencyprone in the treatment of palmoplantar warts.
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Affiliation(s)
- Katherine Armour
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
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49
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Orchard D. Rashes in infants. Pitfalls and masquerades. Aust Fam Physician 2001; 30:1047-51. [PMID: 11759454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Physiological and pathological skin eruptions are extremely common in neonates and are often presented to the general practitioner as either a primary or incidental problem at consultation. OBJECTIVE To discuss the presentation and treatment of common dermatological conditions presenting in the first six months of life. DISCUSSION Common conditions such as pityrosporum folliculitis, neonatal acne, cradle cap, eczema and food allergy are discussed. The rarer conditions of zinc deficiency and neonatal lupus are described because they may pose significant potential medical consequences.
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Affiliation(s)
- D Orchard
- Department of Dermatology, Royal Children's Hospital, Victoria.
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50
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Affiliation(s)
- D Orchard
- Departments of Dermatology and Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado, USA
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