1
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Paller AS, Rangel SM, Chamlin SL, Hajek A, Phan S, Hogeling M, Castelo-Soccio L, Lara-Corrales I, Arkin L, Lawley LP, Funk T, Castro Porto Silva Lopes F, Antaya RJ, Ramien ML, Vivar KL, Teng J, Coughlin CC, Rehmus W, Gupta D, Bercovitch L, Stein SL, Boull C, Tom WL, Liang MG, Hunt R, Luu M, Holland KE, Schoch JJ, Cella D, Lai JS, Griffith JW. Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders. JAMA Dermatol 2024:2817886. [PMID: 38656377 PMCID: PMC11044010 DOI: 10.1001/jamadermatol.2024.0594] [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: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024]
Abstract
Importance Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. Objective To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. Design, Setting, and Participants A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. Main Outcomes and Measures Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). Results The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = -0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = -0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. Conclusions and Relevance The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.
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Affiliation(s)
- Amy S. Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Stephanie M. Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah L. Chamlin
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Aleena Hajek
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheshanna Phan
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Marcia Hogeling
- Department of Medicine/Dermatology, University of California, Los Angeles
| | - Leslie Castelo-Soccio
- Department of Pediatric Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Irene Lara-Corrales
- Department of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa Arkin
- Department of Pediatric Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Tracy Funk
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | | | | | - Michele L. Ramien
- Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Karina L. Vivar
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Joyce Teng
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Carrie C. Coughlin
- Department of Medicine/Dermatology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Wingfield Rehmus
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deepti Gupta
- Department of Pediatric Dermatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle
| | - Lionel Bercovitch
- Department of Pediatric Dermatology, Hasbro Children’s Hospital, Brown University, Providence, Rhode Island
| | - Sarah L. Stein
- Departments of Medicine/Dermatology and Pediatrics, University of Chicago, Chicago, Illinois
| | - Christina Boull
- Department of Dermatology, University of Minnesota, Minneapolis
| | - Wynnis L. Tom
- Department of Pediatric Dermatology, Rady’s Children’s Hospital, University of California, San Diego
| | - Marilyn G. Liang
- Department of Pediatric Dermatology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raegan Hunt
- Department of Dermatology, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Minnelly Luu
- Department of Pediatric Dermatology, Children’s Hospital Los Angeles, Los Angeles
| | - Kristen E. Holland
- Department of Pediatric Dermatology, Children’s Wisconsin, Medical College of Wisconsin, Milwaukee
| | | | - David Cella
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jin-Shei Lai
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James W. Griffith
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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2
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Martinez-Cabriales S, Coulombe J, Aaron M, Hussain SH, Linggonegoro D, Lara-Corrales I, Barootes H, Brandling-Bennett H, Covelli I, Kirkorian AY, Shah N, Castelo-Soccio L, McKenzie P, Arkin LM, Heinze A, Liy-Wong C, Travis N, Rieder M, Del Pozzo-Magana BR, Schoch JJ, Monir R, Glick SA, Uwakwe L, Skillman S, Hekman DP, Lethebe BC, Ramien ML. Preliminary summary and reclassification of cases from the Pediatric Research of Management in Stevens-Johnson syndrome and Epidermonecrolysis (PROMISE) study: A North American, multisite retrospective cohort. J Am Acad Dermatol 2024; 90:635-637. [PMID: 37926378 DOI: 10.1016/j.jaad.2023.08.112] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/18/2023] [Accepted: 08/27/2023] [Indexed: 11/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Isabela Covelli
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | | | - Nidhi Shah
- Children's National Hospital, Washington, DC
| | | | - Paige McKenzie
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lisa M Arkin
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Adam Heinze
- University of Wisconsin-Madison, Madison, Wisconsin
| | - Carmen Liy-Wong
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nicole Travis
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | | | | | - Sharon A Glick
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Laura Uwakwe
- SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Sarah Skillman
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Dan P Hekman
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Michele L Ramien
- Alberta Children's Hospital, Calgary, Alberta, Canada; University of Calgary, Calgary Alberta, Canada.
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3
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Ramien ML, Jain V, Bergman J, Marcoux D, Lara-Corrales I. Prescribing patterns and preferences for moderate-to-severe pediatric (<12 years of age) atopic dermatitis: A survey of Canadian practitioners. JAAD Int 2024; 14:87-89. [PMID: 38318108 PMCID: PMC10838938 DOI: 10.1016/j.jdin.2023.10.003] [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] [Indexed: 02/07/2024] Open
Affiliation(s)
- Michele L. Ramien
- Department of Pediatrics, University of Calgary, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vipul Jain
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Probity Medical Research, Niagara Falls, Ontario, Canada
- Allergy Research Canada Inc, Niagara Falls, Ontario, Canada
| | - James Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Irene Lara-Corrales
- The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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4
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Kryshtalskyj MT, Agi J, Ramien ML, Kurek KC, Kherani F. Lichen sclerosus of the upper eyelid in a paediatric patient: a novel presentation. Can J Ophthalmol 2023; 58:e267-e268. [PMID: 37549886 DOI: 10.1016/j.jcjo.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
| | - Jorge Agi
- Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Kyle C Kurek
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Femida Kherani
- Cumming School of Medicine, University of Calgary, Calgary, AB.; Faculty of Medicine, University of British Columbia, Vancouver, BC
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5
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Dykman M, Coughlin C, Cotton C, Hawryluk E, Kirkorian AY, Silverman R, Castelo-Soccio L, Yu J, Faith EF, Siegel M, Arkin L, Ramien ML. Proceedings of the 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference. Pediatr Dermatol 2023; 40 Suppl 1:4-7. [PMID: 37088541 PMCID: PMC10775834 DOI: 10.1111/pde.15310] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 04/25/2023]
Abstract
The 10th Pediatric Dermatology Research Alliance (PeDRA) Annual Conference occurred November 3-5, 2022 in Bethesda, Maryland. This conference was the first in-person PeDRA conference after 2 years of a virtual format due to COVID-19. Fittingly, given the effects of the pandemic, the conference theme was "Reimagining Community." The conference included presentations and panel sessions on finding individual and collective purpose, leveraging community in pursuit of a shared goal, and creating a community of resources in collaboration with NIH. The goal of this meeting was to connect clinicians, basic scientists, patients, patient advocates, and industry partners. The reimagined community of pediatric dermatology research is a synergistic space for all members to better understand, prevent, treat, and cure dermatologic diseases and conditions in children. This two-and-a-half-day conference with over 300 attendees featured educational seminars including a keynote address, didactic lecture and panel sessions, skill-building workshops, 13 topic-specific breakout sessions, and an interactive poster session where 108 active and finished research projects could be discussed.
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Affiliation(s)
- Morgan Dykman
- Department of Dermatology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Carrie Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Colleen Cotton
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Elena Hawryluk
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A. Yasmine Kirkorian
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Robert Silverman
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jiade Yu
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Portland, Oregon, USA
| | - Lisa Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Michele L. Ramien
- Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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6
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Aaron M, Ramien ML, Powell J, McCuaig CC, Marcoux D, Piram M, Hatami A, Coulombe J. A retrospective single-centre case series of paediatric blistering severe cutaneous adverse reactions (SCARs): evaluation using new diagnostic classification confirms value of British Association of Dermatologists' guidelines. Clin Exp Dermatol 2023; 48:550-552. [PMID: 36733210 DOI: 10.1093/ced/llad014] [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: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 02/04/2023]
Abstract
Stevens-Johnson syndrome and toxic epidermonecrolysis are especially challenging to diagnose and manage in paediatric population given their rarity, more frequent infectious triggers and lack of randomized controlled trials to guide management. This retrospective case series of 59 paediatric blistering severe cutaneous adverse reactions using new diagnostic classification and British Association of Dermatologists' guidelines confirms their value in a real-life clinical setting.
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Affiliation(s)
- Michelle Aaron
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Michele L Ramien
- Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Julie Powell
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Catherine C McCuaig
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Danielle Marcoux
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Maryam Piram
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Afshin Hatami
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jérôme Coulombe
- Faculty of Medicine, University of Montreal, Montreal, Canada.,CHU Sainte-Justine, University of Montreal, Montreal, Canada
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7
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Ginter DC, Ramien ML, Brundler MA, Swaney LC, Miettunen PM, Luca NJ. A rare case of suspected lupus erythematous panniculitis as the presenting skin feature of juvenile dermatomyositis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221086317. [PMID: 35355853 PMCID: PMC8958673 DOI: 10.1177/2050313x221086317] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Juvenile dermatomyositis is a rare autoimmune myopathy of childhood, associated with systemic vasculopathy, primarily affecting the capillaries. Panniculitis is seen histologically in about 10% of patients with dermatomyositis; however, its clinical presentation is rare, with only 30 cases presented in the literature to date. The histopathology overlaps with other inflammatory disease states, and is almost identical to the panniculitis seen in lupus erythematous panniculitis. In the cases with both panniculitis and dermatomyositis, skin and muscle inflammation is usually the first clinical manifestation. We present a case of a 16-year-old female with panniculitis as the initial presenting feature of juvenile dermatomyositis in the context of a prior diagnosis of indeterminate colitis.
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Affiliation(s)
- Dylan C Ginter
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Community Pediatrics, Department of Pediatrics, and Division of Dermatology, Department of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Marie-Anne Brundler
- Department of Pathology and Laboratory Medicine and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura C Swaney
- Division of General Pediatrics, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Paivi Mh Miettunen
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Nadia Jc Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
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8
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Castle AMR, Ramien ML, Kanigsberg N, El Demellawy D, McGowan-Jordan J, Beaulieu Bergeron M, Armour CM. Porokeratotic eccrine ostial and dermal duct nevus associated with an 11 megabase 3p deletion. Pediatr Dermatol 2022; 39:107-111. [PMID: 34929758 DOI: 10.1111/pde.14850] [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] [Received: 07/22/2021] [Revised: 10/04/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Porokeratotic eccrine ostial and dermal duct nevus (PEODDN) is a rare eccrine hamartoma; the etiology is incompletely understood. A patient presented with congenital, widespread PEODDN. Clinical assessment, histopathologic, cytogenetic, and molecular genetic investigations on affected cells were pursued. Histopathology confirmed PEODDN, and chromosomal microarray on affected tissues identified a mosaic 3p26.3p25.3 deletion in affected tissues. This 11Mb deletion encompasses 47 OMIM genes. We propose that this and other chromosomal deletions may be implicated in some cases of PEODDN, suggesting locus heterogeneity and underscoring the importance of incorporating cytogenetic and molecular investigations into the multidisciplinary care of individuals with suspected mosaic genetic skin disorders.
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Affiliation(s)
- Alison M R Castle
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michele L Ramien
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Nordau Kanigsberg
- Division of Dermatology and Rheumatology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Dina El Demellawy
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean McGowan-Jordan
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Melanie Beaulieu Bergeron
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine M Armour
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Prenatal Screening Ontario (PSO), Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
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9
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Parker JJ, Sugarman JL, Silverberg NB, Gonzalez ME, Ramien ML, Teng JMC, Paller AS. Psoriasiform dermatitis during dupilumab treatment for moderate-to-severe atopic dermatitis in children. Pediatr Dermatol 2021; 38:1500-1505. [PMID: 34647354 DOI: 10.1111/pde.14820] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 02/21/2021] [Revised: 08/25/2021] [Accepted: 09/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVES Psoriasiform eruptions after initiation of dupilumab have been previously described in adults. This report details the risk of developing or unmasking psoriasiform eruptions after initiation of dupilumab in children. METHODS Records of patients ≤18 years of age with atopic dermatitis who developed psoriasiform dermatitis during treatment with dupilumab were reviewed retrospectively. RESULTS Six children, 4-18 years of age, on dupilumab for severe atopic dermatitis developed new-onset psoriasiform dermatitis at a median duration of 8 months (range, 6-12 months) after dupilumab initiation. Typical locations of psoriasis were involved (face, scalp, trunk, and extensor extremities). The majority showed clearance or near clearance with the use of medium-strength to potent topical corticosteroid ointments and 83% continued use of the dupilumab. A 7th patient had psoriasis, in addition to severe atopic dermatitis, and the psoriasis was unmasked by its failure to respond to dupilumab. CONCLUSION Although unusual, psoriasiform lesions can appear during effective treatment with dupilumab for atopic dermatitis, potentially reflecting a shift toward cutaneous IL-23/TH 17 pathway activation with dupilumab-induced suppression of type 2 immunity.
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Affiliation(s)
- Jennifer J Parker
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey L Sugarman
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Nanette B Silverberg
- Departments of Pediatrics and Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Michele L Ramien
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joyce M C Teng
- Departments of Pediatrics and Medicine, University of Calgary, Calgary, AB, USA.,Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Martinez-Cabriales SA, Kirchhof MG, Constantinescu CM, Murguia-Favela L, Ramien ML. Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020. Am J Clin Dermatol 2021; 22:443-455. [PMID: 34076879 PMCID: PMC8169786 DOI: 10.1007/s40257-021-00607-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines.
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Affiliation(s)
- Sylvia A Martinez-Cabriales
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Mark G Kirchhof
- Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Cora M Constantinescu
- Section of Infectious Diseases, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Luis Murguia-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada
| | - Michele L Ramien
- Section of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, AB, Canada.
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.
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11
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Ramien ML, Bahubeshi A, Lara-Corrales I, Pope E, Levy ML, Nopper AJ, Shear NH, Eichenfield L. Blistering severe cutaneous adverse reactions in children: proposal for paediatric-focused clinical criteria. Br J Dermatol 2021; 185:447-449. [PMID: 33730370 DOI: 10.1111/bjd.20063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/29/2022]
Affiliation(s)
- M L Ramien
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.,Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada.,University of Ottawa, Ottawa, ON, Canada
| | | | - I Lara-Corrales
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - E Pope
- Section of Paediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - M L Levy
- Department of Pediatrics and Medicine (Dermatology), Dell Medical School, University of Texas, Austin, TX, USA.,Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, TX, USA
| | - A J Nopper
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - N H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA, USA.,Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, University of California, San Diego, CA, USA
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12
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Ladha MA, Luca N, Constantinescu C, Naert K, Ramien ML. Response to Reader Comment Regarding "Approach to Chilblains During the COVID-19 Pandemic". J Cutan Med Surg 2021; 25:344-345. [PMID: 33624518 DOI: 10.1177/1203475421997405] [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: 11/16/2022]
Affiliation(s)
- Malika A Ladha
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, Canada
| | - Nadia Luca
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, Canada
| | - Cora Constantinescu
- 2129 Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Calgary, Canada
| | - Karen Naert
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Calgary, Canada
| | - Michele L Ramien
- 70401 Division of Dermatology, Department of Medicine, University of Calgary, Canada.,9978 Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Canada
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13
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Ramien ML. Reactive infectious mucocutaneous eruption: Mycoplasma pneumoniae-induced rash and mucositis and other parainfectious eruptions. Clin Exp Dermatol 2020; 46:420-429. [PMID: 32918499 DOI: 10.1111/ced.14404] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
Mycoplasma pneumoniae-induced rash and mucositis is the most accurate diagnosis for patients with blistering mucocutaneous disease provoked by an infection. Recent literature suggests expansion of the name is required, as other infections have caused a clinically similar presentation. This review provides a concise update on current understanding of M. pneumoniae-induced rash and mucositis and other reactive infectious mucocutaneous eruptions.
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Affiliation(s)
- M L Ramien
- Division of Community Medicine, Department of Pediatrics, University of Calgary Cummings School of Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada.,Division of Dermatology, Department of Medicine, University of Calgary Cummings School of Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
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14
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Abstract
Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.
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Affiliation(s)
- Malika A Ladha
- 70401 Division of Dermatology, Department of Medicine, University of Calgary Cumming School of Medicine, AB, Canada
| | - Nadia Luca
- 2129 Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary Cumming School of Medicine, AB, Canada
| | - Cora Constantinescu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Calgary Cumming School of Medicine, AB, Canada
| | - Karen Naert
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, University of Calgary, AB, Canada
| | - Michele L Ramien
- 70401 Division of Dermatology, Department of Medicine, University of Calgary Cumming School of Medicine, AB, Canada.,9978 Division of Community Pediatrics, Department of Pediatrics, University of Calgary, Alberta Children's Hospital, AB, Canada
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15
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Lansang P, Lara-Corrales I, Bergman JN, Hong CH, Joseph M, Kim VHD, Lam JM, Landells I, Marcoux D, Prajapati VH, Ramien ML, Spring S. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis. J Cutan Med Surg 2020; 23:32S-39S. [PMID: 31692378 DOI: 10.1177/1203475419882654] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.
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Affiliation(s)
- Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada.,Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Chih-Ho Hong
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada.,Probity Medical Research, Waterloo, ON, Canada
| | - Marissa Joseph
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Vy H D Kim
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada.,Division of Immunology & Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joseph M Lam
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ian Landells
- Division of Dermatology, Departments of Medicine and Pediatrics, Memorial University, St. John's, NL, Canada.,Nexus Clinical Research, St. John's, NL, Canada
| | - Danielle Marcoux
- Division of Dermatology, Department of Pediatrics, University of Montreal and CHU Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Vimal H Prajapati
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada.,Division of Pediatric Rheumatology, Department of Pediatrics, University of Calgary, AB, Canada.,Dermatology Research Institute, Calgary, AB, Canada
| | - Michele L Ramien
- Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada.,Division of Community Pediatrics, Department of Pediatrics, University of Calgary, AB, Canada
| | - Shanna Spring
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Department of Pediatrics, University of Ottawa, ON, Canada.,Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
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16
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Affiliation(s)
- Christopher D Sibley
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Michele L Ramien
- Division of Dermatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.,Division of Community Pediatrics, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
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17
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Ramien ML, Bruckner AL. Mucocutaneous Eruptions in Acutely Ill Pediatric Patients—Think of Mycoplasma pneumoniae (and Other Infections) First. JAMA Dermatol 2020; 156:124-125. [DOI: 10.1001/jamadermatol.2019.3589] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michele L. Ramien
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Anna L. Bruckner
- University of Colorado School of Medicine, Aurora
- Deputy Editor, JAMA Dermatology
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18
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Lara-Corrales I, Bergman JN, Landells I, Ramien ML, Lansang P. Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:3S-11S. [DOI: 10.1177/1203475419882049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common dermatoses encountered by health-care providers treating children. Diagnosis of AD is clinical, with no universally accepted biomarkers or assessment tools. Patient-reported outcomes and subjective assessments of quality of life in both the patient and family are important considerations when treating pediatric AD. Here, we provide an overview of pediatric AD epidemiology, its clinical presentation, burden, diagnosis, and assessment, with a focus on implications for patient counseling in order to optimize care.
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Affiliation(s)
- Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, ON, Canada
| | - James N. Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Ian Landells
- Departments of Medicine and Pediatrics, Division of Dermatology, Memorial University, St. John’s, NL, Canada
- Nexus Clinical Research, St. John’s, NL, Canada
| | - Michele L. Ramien
- Department of Medicine, Division of Dermatology, University of Calgary, AB, Canada
- Division of Community Pediatrics, Department of Pediatrics, Alberta Children’s Hospital, Calgary, AB, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, ON, Canada
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19
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Li HOY, Colantonio S, Ramien ML. Treatment of Mycoplasma pneumoniae-Induced Rash and Mucositis With Cyclosporine [Formula: see text]. J Cutan Med Surg 2019; 23:608-612. [PMID: 31502864 DOI: 10.1177/1203475419874444] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a relatively newly recognized clinical entity that typically presents with predominant mucositis accompanied by variable cutaneous involvement 7-9 days after the onset of prodromal symptoms. There are no evidence-based guidelines for treatment, and current standards of care may include supportive therapy, antibiotics, corticosteroids, and intravenous immunoglobulin . OBJECTIVE This case series aims to describe the potential efficacy of cyclosporine A (CsA) in the treatment of MIRM. METHODS The present case series details our use of CsA early in the course of MIRM in 3 pediatric patients. RESULTS Rapid clinical resolution was observed following CsA therapy. CONCLUSIONS We suggest that early initiation of CsA may be an effective therapeutic option for MIRM.
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Affiliation(s)
| | | | - Michele L Ramien
- Division of Rheumatology and Dermatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Division of Community Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada
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20
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Zarins A, Huang JW, Ramien ML. Photoprotection in the Immunosuppressed Pediatric Population. J Cutan Med Surg 2018; 22:639-642. [PMID: 30322295 DOI: 10.1177/1203475418782151] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Zarins
- 1 Division of Rheumatology and Dermatology, Department of Pediatrics, Children's Hospital of Eastern Ontario Division of Dermatology, Ottawa, ON, Canada.,2 Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Johnny W Huang
- 3 University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
| | - Michele L Ramien
- 1 Division of Rheumatology and Dermatology, Department of Pediatrics, Children's Hospital of Eastern Ontario Division of Dermatology, Ottawa, ON, Canada.,2 Division of Dermatology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
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21
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Shelley AJ, McDonald KA, McEvoy A, Sauder M, Kanigsberg N, Zemek R, Vaillancourt R, Pouliot A, Ramien ML. Usability, Satisfaction, and Usefulness of an Illustrated Eczema Action Plan. J Cutan Med Surg 2018; 22:577-582. [DOI: 10.1177/1203475418789028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: An eczema action plan (EAP) is an individualized tool to help caregivers and patients self-manage eczema. While novel illustrated EAPs have been developed and validated, there is limited literature examining the value of EAPs from patient and caregiver perspectives. Objectives: The objective of this study was to test the usability, satisfaction, and usefulness of our validated EAP from the perspective of patients and caregivers. Methods: Consecutive patients from the pediatric dermatology clinic of a tertiary children’s hospital from July 2016 to July 2017 were offered enrolment in a prospective survey study; informed consent was obtained from participants. The illustrated EAP was explained to the participant by a trained research assistant. Participants were sent electronic postvisit surveys using Likert scale questions via REDCap on EAP usability and satisfaction (9 items) as well as on usefulness (3 items). Results: Of 233 consecutive clinic patients, 192 participants (82%) were enrolled, and 112 (58%; 85 caregivers and 22 patients) completed the postvisit surveys. Characteristics were similar between responders and nonresponders. Overall, participants rated the usability (96%), satisfaction (85%), and usefulness (78%) of the EAP positively. Education level, experience with eczema, previous dermatology consultation, and participant type (caregiver vs patient) did not significantly affect the usability or usefulness ratings. However, caregivers’ overall EAP ratings were significantly higher ( P = .02) than the patients’. Conclusion: The caregivers and participants demonstrate that the EAP is a useful and highly usable tool. Future research should examine the effectiveness of EAP use on objective atopic dermatitis outcomes using a pragmatic clinical trial design.
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Affiliation(s)
| | | | - Alana McEvoy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Nordau Kanigsberg
- Department of Medicine, Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Rheumatology and Dermatology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roger Zemek
- Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Regis Vaillancourt
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annie Pouliot
- Department of Pharmacy, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Michele L. Ramien
- Department of Medicine, Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Rheumatology and Dermatology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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22
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Abstract
We report a case of an 11-year-old female with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) overlap, most likely triggered by sulfamethoxazole-trimethoprim, who was treated with the combination of methylprednisolone, cyclosporine, and etanercept. Her condition stabilized and her skin involvement did not progress after the addition of etanercept. To our knowledge, this is the first report of etanercept for pediatric SJS/TEN.
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Affiliation(s)
- Geneviève M Gavigan
- 1 Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,2 University of Ottawa, Ottawa, ON, Canada
| | - Nordau D Kanigsberg
- 1 Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,2 University of Ottawa, Ottawa, ON, Canada
| | - Michele L Ramien
- 1 Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,2 University of Ottawa, Ottawa, ON, Canada
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23
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Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, Patten SB. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol 2017; 178:76-85. [PMID: 28542914 DOI: 10.1111/bjd.15668] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MEDLINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate-to-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.
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Affiliation(s)
- I A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M S Farris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - C D Sibley
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M L Ramien
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - A G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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24
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McEvoy A, Sauder MB, McDonald K, Suter P, Pouliot A, Zemek R, Kanigsberg N, Vaillancourt R, Ramien ML. Derivation, Evaluation, and Validation of Illustrations of Key Counselling Points for a Pediatric Eczema Action Plan. J Cutan Med Surg 2017; 22:147-153. [PMID: 29098866 DOI: 10.1177/1203475417741260] [Citation(s) in RCA: 2] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current eczema action plans (EAP) are based on written instructions without illustrations. Incorporating validated illustrations into EAPs can significantly improve comprehension and usability. OBJECTIVE To produce and validate a set of illustrations for key counselling points of a pediatric EAP. METHODS Illustrations were developed using key graphic elements and refined by subject experts. Illustrations were evaluated during one-on-one structured interviews with parents/caregivers of children ages 9 and younger, as well as with children ages 10 to 17 years between September 2015 and June 2016. The concepts of transparency, translucency, and short-term recall were assessed for validation. RESULTS Of 245 participants, 81.3% were parents and/or caregivers of children 0 to 9 years old, and 18.7% were children between 10 and 17 years old. A total of 15 illustrations and 2 storyboards were evaluated; 9 illustrations and 2 storyboards were redesigned to reach the preset validation targets. Overall, 13 illustrations and 2 storyboards were validated. CONCLUSION A set of illustrations for use in an EAP was prospectively designed and validated, achieving acceptable transparency, translucency, and recall, with input from patients and a multidisciplinary medical team. The incorporation of validated illustrations into eczema action plans benefits patients with limited health literacy. Future studies should evaluate if illustrations improve understanding of eczema management and translate into improved clinical outcomes.
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Affiliation(s)
- Alana McEvoy
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Maxwell B Sauder
- 2 Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Phillipe Suter
- 4 Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Annie Pouliot
- 4 Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Roger Zemek
- 5 Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nordau Kanigsberg
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Michele L Ramien
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,6 Division of Rheumatology (Dermatology), Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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25
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Sauder MB, McEvoy A, Sampson M, Kanigsberg N, Vaillancourt R, Ramien ML, Zemek R. The Effectiveness of Written Action Plans in Atopic Dermatitis. Pediatr Dermatol 2016; 33:e151-3. [PMID: 26776967 DOI: 10.1111/pde.12774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atopic dermatitis (AD) is a chronic dermatosis requiring a stepwise and dynamic approach to management. The use of written action plans has been shown to improve outcomes in other chronic diseases that require a similar incremental approach. A systematic review was performed to evaluate the effect of a written eczema action plan (EAP) in AD management and to identify characteristics of effective action plans in children with eczema. Only two trials were identified as eligible, which highlights the need for more research on EAPs.
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Affiliation(s)
- Maxwell B Sauder
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alana McEvoy
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Library and Media Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nordau Kanigsberg
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Regis Vaillancourt
- Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michele L Ramien
- Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Rheumatology (Dermatology), University of Ottawa, Ottawa, Ontario, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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26
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Ramien ML, Ondrejchak S, Gendron R, Hatami A, McCuaig CC, Powell J, Marcoux D. Quality of life in pediatric patients before and after cosmetic camouflage of visible skin conditions. J Am Acad Dermatol 2014; 71:935-40. [DOI: 10.1016/j.jaad.2014.07.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/11/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
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27
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Ramien ML, Prendiville JS, Brown KL, Cairns RA. Cystic bone lesions in a boy with Darier disease: A magnetic resonance imaging assessment. J Am Acad Dermatol 2009; 60:1062-6. [DOI: 10.1016/j.jaad.2008.10.049] [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] [Received: 09/09/2008] [Revised: 10/19/2008] [Accepted: 10/26/2008] [Indexed: 11/30/2022]
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