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Sticherling M, McPherson T, de Lucas Laguna R, Costanzo A, Reed C, Artime E, Robert C, Lucas J, Schuster C, Mahé E. Patient Characteristics and Treatment Patterns in European Pediatric Patients with Psoriasis: A Real-World, Cross-Sectional Study. Dermatol Ther (Heidelb) 2022; 12:1793-1808. [PMID: 35797001 PMCID: PMC9357581 DOI: 10.1007/s13555-022-00761-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction This study evaluated patient characteristics and treatment patterns according to weight in pediatric patients with psoriasis in a real-world setting. Methods Primary care and specialist physicians treating pediatric patients with psoriasis aged 6–17 years in five European countries were surveyed in the 2019–2020 Adelphi Real World Pediatric Psoriasis Disease Specific Programme. At least two patients with current or previous biologic use were included per physician. Patient characteristics and treatment patterns were analyzed overall and for patients weighing 25–50 kg or more than 50 kg. Results Data from 772 patients weighing 25–50 kg and 1147 weighing more than 50 kg were analyzed. Median age at diagnosis was significantly less in lighter than heavier patients (10.0 vs. 14.0 years; p < 0.001), as was median disease duration (2.2 vs. 3.0 years; p < 0.001). Topical treatments were prescribed in 59.0% of patients overall (70.3% of lighter and 51.4% of heavier patients; p < 0.001), and were used to treat mild rather than moderate-to-severe psoriasis. Conventional systemic use was low (10.8% of patients overall) and predominantly for moderate-to-severe psoriasis. In this biologic-enriched sample, most biologics (78.2%) were prescribed in older (> 13 years) patients. Biologic use increased with line of therapy (6.6% of first-line, 18.0% of second-line, 33.7% of third-line, 44.7% of fourth-line treatments). Conclusion Biologics are predominantly prescribed in older (> 13 years) and heavier (> 50 kg) patients, with little first- or second-line use. The low use of biologics in European pediatric patients with psoriasis may represent an unmet treatment need, as topical or conventional systemic agents remain the main treatment option for moderate or severe psoriasis in these patients through the treatment pathway. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00761-7. This study looked into types of treatments according to body weight in children with psoriasis, since approved dosing regimens for some treatments are based on body weight. Primary care and specialist physicians treating children with psoriasis aged 6–17 years in five European countries completed a survey. Patient information for those receiving specific types of psoriasis treatments were collected. Of the children included, 772 weighed 25–50 kg and 1147 weighed more than 50 kg. Most children received treatments applied to the skin, such as creams and ointments; this occurred in 70% of lighter patients and in 51% of heavier patients. Conventional treatments taken via the mouth were prescribed in a few patients (11% [overall]), while newer biologic drugs were taken to a greater extent in heavier (30%) than lighter (16%) patients. Most biologics (78%) were prescribed in older (> 13 years) patients. Biologic use increased with the number of failed previous treatments, comprising 7%, 18%, 34%, and 45% of first, second, third, and fourth treatments, respectively. We conclude that children with psoriasis who are treated with biologic drugs are predominantly older and heavier, and have more severe psoriasis. Prescriptions for biologics are given after many other treatments have been tried.
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Affiliation(s)
- Michael Sticherling
- Department of Dermatology, Psoriasic-Center, Deutsches Zentrum Immuntherapie (DZI), University of Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Tess McPherson
- Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE UK
| | - Raúl de Lucas Laguna
- Servicio de Dermatología Infantil, Hospital Universitario La Paz, P.º de la Castellana, 261, 28046 Madrid, Spain
| | - Antonio Costanzo
- Dermatology, Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milan, Italy
- Dermatology, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Catherine Reed
- Eli Lilly and Company, 8 Arlington Square West, Downshire Way, Bracknell, Berkshire, RG12 1PU UK
| | - Esther Artime
- Eli Lilly and Company, Av. de la Industria, 30, 28108 Alcobendas, Madrid, Spain
| | - Camille Robert
- Lilly France SAS, 24 Bd Vital Bouhot, 92521 Neuilly Sur Seine, France
| | - James Lucas
- Adelphi Real-World, Adelphi Mil, Grimshaw Lane, Macclesfield, SK10 5JB UK
| | | | - Emmanuel Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, 69, Rue du Lieutenant-Colonel Prud’hon, 95107 Argenteuil, France
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Chiloeches Fernández C, Feito Rodríguez M, Rodríguez Bandera A, Quintana Castanedo L, Ruiz Bravo E, de Lucas Laguna R. Metastatic neuroblastoma mimicking an infantile hemangioma. Pediatr Dermatol 2021; 38:316-317. [PMID: 33099811 DOI: 10.1111/pde.14421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/24/2020] [Revised: 09/06/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023]
Abstract
Neuroblastoma is the most common solid tumor malignancy in the first year of life. We present a rare case of a 5-month-old girl with an infraorbital tumor that simulated an infantile hemangioma clinically but was ultimately diagnosed as metastatic neuroblastoma.
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Affiliation(s)
| | | | | | | | - Elena Ruiz Bravo
- Anatomy Pathology Department, Hospital Universitario La Paz, Madrid, Spain
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Quintana-Castanedo L, Feito-Rodríguez M, Pérez-Conde I, Maseda-Pedrero R, Chiloeches-Fernández C, de Lucas Laguna R. Chronic sole ulcer in a child with dyskeratosis congenita: An atypical wound successfully treated with punch grafting. Pediatr Dermatol 2020; 37:1131-1134. [PMID: 32777110 DOI: 10.1111/pde.14316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
Dyskeratosis congenita (DC) is an unusual inherited disease characterized by the triad of mucosal leukoplakia, nail dystrophy, and skin pigmentation. Hyperkeratosis of the palms and soles is another reported skin finding. This hyperkeratosis can lead to fissures, chronic erosion, and deep ulcerations. These atypical wounds are not only a diagnostic but a therapeutic challenge for clinicians, and there are no standardized treatments for these types of chronic wounds. Punch grafting is a traditional and minimally invasive technique to enhance wound healing, and it has been associated with significant and quick pain reduction in ulcers with various underlying causes. Herein, we describe a patient with DC with a chronic and refractory plantar ulcer successfully treated with punch grafting.
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Quintana Castanedo L, Feito Rodríguez M, Maseda Pedrero R, Chiloeches Fernández C, de Lucas Laguna R. Ischemic ulcers of the toes secondary to Raynaud's phenomenon in a child successfully treated with botulinum toxin. Pediatr Dermatol 2020; 37:681-683. [PMID: 32212180 DOI: 10.1111/pde.14160] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Raynaud's phenomenon (RP) is an episodic vasospastic response to cold or emotional stress causing color changes and pain. These attacks can lead to digital ischemia, ulcers, and gangrene. Severe and refractory RP in children is a therapeutic challenge for clinicians because there are no standardized treatment protocols for these patients. We present a case of RP involving the toes of a child successfully treated with botulinum toxin A.
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Quintana Castanedo L, Sánchez Orta A, Maseda Pedrero R, Santos Simarro F, Palomares Bralo M, Feito Rodríguez M, de Lucas Laguna R. Skin and nails abnormalities in a patient with ZTTK syndrome and a de novo mutation in SON. Pediatr Dermatol 2020; 37:517-519. [PMID: 32045494 DOI: 10.1111/pde.14113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/28/2023]
Abstract
Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome is a rare, severe, and recently described multisystem developmental disorder characterized by delayed psychomotor development and intellectual disability, characteristic facial features, hypotonia, poor overall growth, and visual abnormalities. Mucocutaneous manifestations have not been reported so far among individuals with ZTTK syndrome. Herein, we present a patient with ZTTK syndrome due to a de novo mutation in SON gene, who has dental abnormalities and retronychia of the toenails. We suggest that mucocutaneous features may be a part of the phenotype.
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Affiliation(s)
| | - Alba Sánchez Orta
- Department of Dermatology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Fernando Santos Simarro
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPaz, CIBERER, Madrid, Spain
| | - María Palomares Bralo
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, IdiPaz, CIBERER, Madrid, Spain
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in Pediatric Dermatology: Part II-Developmental anomalies and vascular lesions. Pediatr Dermatol 2020; 37:40-51. [PMID: 31742750 DOI: 10.1111/pde.13897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/13/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a noninvasive and harmless diagnostic technique that is especially appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and aids our understanding of cutaneous pathology. In this second part, we describe the ultrasonographic findings of developmental anomalies and vascular lesions.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Rodríguez Bandera AI, Sebaratnam DF, Feito Rodríguez M, de Lucas Laguna R. Cutaneous ultrasound and its utility in pediatric dermatology. Part I: Lumps, bumps, and inflammatory conditions. Pediatr Dermatol 2020; 37:29-39. [PMID: 31743485 DOI: 10.1111/pde.14033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/20/2022]
Abstract
High-frequency ultrasonography represents a promising tool for pediatric dermatologists. It is a non-invasive diagnostic technique that is particularly appealing when working with children. It can be easily performed at the patient's bedside, avoiding diagnostic delays, sedation, or multiple visits. It represents a useful adjunct to clinical examination and can enhance our understanding of cutaneous diseases. Patient cooperation and limited training and experience are the main challenges for cutaneous ultrasonography in pediatric dermatology. This review describes cutaneous ultrasonography and the nuances of its use in the pediatric setting, followed by the ultrasonographic findings of cutaneous lumps, bumps, and inflammatory dermatoses commonly encountered in pediatric patients.
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Affiliation(s)
| | - Deshan Frank Sebaratnam
- Sydney Children's Hospitals' Network, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
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Rodríguez Bandera AI, Stewart N, de la Cruz Troca JJ, Andrés Esteban EM, Feito Rodríguez M, de Lucas Laguna R. Movement artifacts in pediatric cutaneous ultrasonography. Dermatol Online J 2019. [DOI: 10.5070/d3251042609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Rodríguez Bandera AI, Stewart N, Beato MJ, de Lucas Laguna R. Comment on "Usefulness of ultrasonography in the diagnosis of subcutaneous granuloma annulare". Pediatr Dermatol 2018; 35:875-876. [PMID: 30397952 DOI: 10.1111/pde.13615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Nicholas Stewart
- The Skin Hospitals, Darlinghurst and Westmead Hospital, Sydney, New South Wales, Australia
| | - María Jose Beato
- Department of Pathology, University Hospital La Paz, Madrid, Spain
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Rodríguez Bandera AI, Moreno Bonilla G, Feito Rodríguez M, Beato Merino MJ, de Lucas Laguna R. Usefulness of high-frequency ultrasonography in the assessment of cutaneous lesions in children with hematologic malignancies. Pediatr Dermatol 2018; 35:e276-e280. [PMID: 29943873 DOI: 10.1111/pde.13563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/21/2022]
Abstract
High-frequency ultrasonography is a bedside tool increasingly used for the assessment of skin lesions, but there have been few reports about its importance in children with skin signs of hematologic disease. We present three cases to highlight the usefulness of high-frequency ultrasonography in assisting with the diagnosis of these skin lesions.
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Baselga Torres E, Bernabéu Wittel J, van Esso Arbolave DL, Febrer Bosch MI, Carrasco Sanz Á, de Lucas Laguna R, del Pozo Losada J, Hernández Martín Á, Jiménez Montañés L, López Gutiérrez JC, Martín-Santiago A, Redondo Bellón P, Ruíz-Canela Cáceres J, Torrelo Fernández A, Vera Casaño Á, Vicente Villa MA. Consenso español sobre el hemangioma infantil. An Pediatr (Barc) 2016; 85:256-265. [DOI: 10.1016/j.anpedi.2015.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022] Open
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Baselga Torres E, Bernabéu Wittel J, van Esso Arbolave DL, Febrer Bosch MI, Carrasco Sanz Á, de Lucas Laguna R, del Pozo Losada J, Hernández Martín Á, Jiménez Montañés L, López Gutiérrez JC, Martín-Santiago A, Redondo Bellón P, Ruíz-Canela Cáceres J, Torrelo Fernández A, Vera Casaño Á, Vicente Villa MA. Spanish consensus on infantile haemangioma. Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.10.017] [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: 10/22/2022] Open
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Floristan U, Feltes R, González-Beato M, Feito M, Laguna RDL. Targetoid lesions and neutrophilic dermatosis within neonatal lupus erythematosus: unusual clinical and histologic presentations. J Cutan Med Surg 2010; 14:46-7. [PMID: 20128992 DOI: 10.2310/7750.2009.09026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
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