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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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Brandling-Bennett HA, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies O, Siegfried EC. Executive summary: Consensus treatment guidelines for the use of methotrexate for inflammatory skin disease in pediatric patients. J Am Acad Dermatol 2024:S0190-9622(24)00310-4. [PMID: 38342248 DOI: 10.1016/j.jaad.2023.12.074] [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: 09/12/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Heather A Brandling-Bennett
- Seattle Children's Hospital, Seattle, Washington; Division of Dermatology, Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Lisa M Arkin
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yvonne E Chiu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Leslie Castelo-Soccio
- Dermatology Branch, National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dominic O Co
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Megan L Curran
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Austin M Dalrymple
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Alan D Irvine
- Department of Paediatric Dermatology, Trinity College Dublin, Dublin, Ireland
| | - Susan Kim
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - A Yasmine Kirkorian
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia; Children's National Hospital, Washington, District of Columbia
| | - Irene Lara-Corrales
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Melissa Reyes
- Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California, San Diego School of Medicine, San Diego, California; Rady Children's Hospital-San Diego, San Diego, California
| | - Abby S Van Voorhees
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Ruth Ann Vleugels
- Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Lara Wine Lee
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
| | - Olivia Davies
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elaine C Siegfried
- Division of Rheumatology, Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri; SSM Health Cardinal Glennon Children's Hospital, St. Louis, Missouri
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Stein Gold LF, Tom WL, Shi V, Sanders P, Zang C, Vlahos B, Cha A. Impact of Crisaborole in Treatment-Experienced Patients With Mild-to-Moderate Atopic Dermatitis. Dermatitis 2024; 35:84-91. [PMID: 38206678 DOI: 10.1089/derm.2023.0112] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background: Crisaborole ointment, 2%, is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of patients with mild-to-moderate atopic dermatitis (AD). Objective: To assess the efficacy and safety of crisaborole in patients with AD who had received prior treatment with (a) corticosteroids (systemic or topical) or topical calcineurin inhibitors (TCIs) or (b) topical corticosteroids (TCSs) or TCIs or (c) who were treatment-naive (TN). Methods: This post hoc analysis comprised patients aged ≥2 years with mild-to-moderate AD. Patients were assigned (2:1) to receive crisaborole or vehicle twice daily for 28 days. Patient response was assessed with the Investigator's Static Global Assessment (ISGA), Dermatology Life Quality Index (DLQI), Children's Dermatology Life Quality Index (CDLQI), and Dermatitis Family Impact (DFI) tools. Safety was also assessed. Results: A significantly higher percentage of patients treated with crisaborole versus vehicle achieved ISGA success regardless of treatment history. Patients treated with crisaborole had significant reductions in DLQI, CDLQI, and DFI scores versus those who received vehicle regardless of treatment history, with the exception of DLQI and DFI scores in the TN group. Crisaborole was well tolerated in all subgroups. Conclusion: Crisaborole demonstrated a favorable efficacy and safety profile in both treatment-experienced and TN patients. ClinicalTrials.gov, NCT02118766 and NCT02118792.
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Affiliation(s)
| | - Wynnis L Tom
- University of California San Diego and Rady Children's Hospital-San Diego, San Diego, California, USA
| | - Vivian Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | | | - Amy Cha
- Pfizer, Inc., New York, New York, USA
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4
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Siegfried EC, Arkin LM, Chiu YE, Hebert AA, Callen JP, Castelo-Soccio L, Co DO, Cordoro KM, Curran ML, Dalrymple AM, Flohr C, Gordon KB, Hanna D, Irvine AD, Kim S, Kirkorian AY, Lara-Corrales I, Lindstrom J, Paller AS, Reyes M, Begolka WS, Tom WL, Van Voorhees AS, Vleugels RA, Lee LW, Davies OMT, Brandling-Bennett HA. Methotrexate for inflammatory skin disease in pediatric patients: Consensus treatment guidelines. Pediatr Dermatol 2023; 40:789-808. [PMID: 37316462 DOI: 10.1111/pde.15327] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/19/2022] [Accepted: 03/26/2023] [Indexed: 06/16/2023]
Abstract
Methotrexate (MTX) is a readily accessible drug, first used in 1948 and employed for a wide variety of indications since then. However, despite widespread off-label use, FDA labeling does not include approved indications for the use of MTX for many inflammatory skin diseases in pediatric patients, including morphea, psoriasis, atopic dermatitis, and alopecia areata, among others. Without published treatment guidelines, some clinicians may be hesitant to use MTX off-label, or uncomfortable prescribing MTX in this population. To address this unmet need, an expert consensus committee was convened to develop evidence- and consensus-based guidelines for use of MTX to treat pediatric inflammatory skin disease. Clinicians with experience and expertise in clinical research, drug development, and treating inflammatory skin disease in pediatric patients with MTX were recruited. Five committees were created based on major topic areas: (1) indications and contraindications, (2) dosing, (3) interactions with immunizations and medications, (4) adverse effects (potential for and management of), and (5) monitoring needs. Pertinent questions were generated and addressed by the relevant committee. The entire group participated in a modified Delphi process to establish agreement on recommendations for each question. The committee developed 46 evidence- and consensus-based recommendations, each with >70% agreement among members, across all five topics. These are presented in tables and text, along with a discussion of supporting literature, and level of evidence. These evidence- and consensus-based recommendations will support safe and effective use of MTX for the underserved population of pediatric patients who may benefit from this valuable, time-honored medication.
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Affiliation(s)
- Elaine C Siegfried
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Lisa M Arkin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yvonne E Chiu
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adelaide A Hebert
- UTHealth McGovern Medical School at Houston, Houston, Texas, United States
| | - Jeffrey P Callen
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Leslie Castelo-Soccio
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dominic O Co
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Megan L Curran
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Austin M Dalrymple
- SSM Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Carsten Flohr
- Department of Paediatric Dermatology, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Ken B Gordon
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Susan Kim
- University of California, San Francisco, California, USA
| | - A Yasmine Kirkorian
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Jill Lindstrom
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Reyes
- US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | | | - Wynnis L Tom
- University of California, San Diego School of Medicine, San Diego, California, USA
- Rady Children's Hospital-San Diego, San Diego, California, USA
| | | | - Ruth Ann Vleugels
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Wine Lee
- Medical University of South Carolina, Charleston, South Carolina, USA
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5
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Leung DYM, Paller AS, Zaenglein AL, Tom WL, Ong PY, Venturanza ME, Kuligowski ME, Li Q, Gong X, Lee MS. Safety, pharmacokinetics, and efficacy of ruxolitinib cream in children and adolescents with atopic dermatitis. Ann Allergy Asthma Immunol 2022; 130:500-507.e3. [PMID: 36586583 DOI: 10.1016/j.anai.2022.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Therapies for children with atopic dermatitis (AD) have safety and tolerability concerns that may limit long-term use. Ruxolitinib cream, a Janus kinase (JAK) inhibitor, is effective and well tolerated in adolescents and adults with AD. OBJECTIVE To analyze the safety and tolerability of ruxolitinib cream in pediatric patients. Pharmacokinetics and efficacy were also evaluated in this phase 1 study (NCT03257644). METHODS Patients aged 2 to 17 years with AD (affected body surface area 8%-20%; Investigator's Global Assessment score ≥2) were enrolled stepwise in 6 age-descending, strength-increasing cohorts to apply 0.5%, 0.75%, or 1.5% ruxolitinib cream twice daily for 28 days. Safety, pharmacokinetics, and efficacy were analyzed at baseline, week 2 (day 10), and week 4 (day 29). RESULTS Among 71 patients, 44 (62.0%) had a baseline Investigator's Global Assessment score of 3; median (range) body surface area affected at baseline was 12.2% (1.7%-20.4%). Ruxolitinib cream was well tolerated, with 4 patients (5.6%) experiencing treatment-related adverse events (all grades 1/2). No clinically meaningful changes in mean chemistry or hematology values were observed, and no consistent pattern of change in bone biomarkers was detected. Mean plasma ruxolitinib levels within each cohort (range, 23.1-97.9 nM) were well below the half-maximal inhibitory concentration for thrombopoietin phosphorylation of STAT3 (281 nM). All cohorts experienced improvements in exploratory efficacy end points. CONCLUSION Ruxolitinib cream was well tolerated in pediatric patients with AD, with no effect on blood counts or bone biomarkers. Mean plasma concentration was low. Efficacy was consistent with data from previous studies in adolescents and adults. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03257644.
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Affiliation(s)
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Wynnis L Tom
- University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Peck Y Ong
- Children's Hospital Los Angeles, Los Angeles, California
| | | | | | - Qian Li
- Incyte Corporation, Wilmington, Delaware
| | | | - Mark S Lee
- Progressive Clinical Research, San Antonio, Texas
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Natsis N, Soeprono F, Nelson A, Barrio VR, Tom WL. Diffuse Geometric Erosions on the Skin of a Premature Infant, Fraternal Twin Unaffected. Pediatr Rev 2021; 42:118-121. [PMID: 34470890 DOI: 10.1542/pir.2019-0017] [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] [Indexed: 11/24/2022]
Affiliation(s)
- Nicola Natsis
- School of Medicine, University of California, San Diego, San Diego, CA.,Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Fred Soeprono
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Aislyn Nelson
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Victoria R Barrio
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, CA.,Department of Dermatology, University of California, San Diego, San Diego, CA
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7
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Pithadia DJ, Kerns ML, Golden WC, Balagula Y, Glick SA, Huang A, Natsis NE, Tom WL, Cohen BA. Heterogeneous cutaneous findings associated with intrauterine HSV infection: A case series and literature review. Pediatr Dermatol 2021; 38:831-841. [PMID: 34227161 DOI: 10.1111/pde.14682] [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: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Herpes simplex virus (HSV) infection acquired in utero may present with non-vesicular dermatologic findings in affected newborns, which may pose a diagnostic dilemma. We aimed to describe and assess the range of non-vesiculobullous skin lesions that neonates with intrauterine HSV infection may manifest at birth. METHODS We collected a multicenter case series and conducted a literature review of neonates with intrauterine HSV infection presenting with non-vesiculobullous cutaneous lesions. RESULTS Twenty-two cases were reviewed, including six managed clinically by members of our team and 16 identified in the literature. Four (18%) were associated with twin pregnancies, and thirteen (59%) cases occurred in premature infants. Only four (18%) mothers had a documented history of HSV infection. Twelve (55%) cases resulted in poor outcomes, including long-term neurologic sequelae or death. Cutaneous manifestations included erosions, ulcerations, crusted papules or plaques, calcinosis cutis, excoriations, macules (erythematous, hypopigmented, or hyperpigmented), cutaneous atrophy, contractures, and bruising. About one-third of neonates developed new-onset vesicular lesions within a week of birth; in each of these cases, accurate diagnosis and therapy were delayed until appearance of vesicles. CONCLUSIONS The range of dermatologic findings associated with intrauterine HSV is extremely broad, and the various morphologies present at birth likely reflect different stages of the ongoing evolution of an HSV infection that began in utero. Clinicians should have a low threshold for HSV testing in premature neonates born with atypical cutaneous lesions, since early detection and treatment of HSV may reduce morbidity and mortality from systemic complications.
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Affiliation(s)
- Deeti J Pithadia
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle L Kerns
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William C Golden
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Nicola E Natsis
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mancuso JB, Haddock ES, Tucker S, Newbury R, Hinds B, Tom WL. Congenital cutaneous non-neural granular cell tumor mimicking herpetic infection: Case report and review of the literature. Pediatr Dermatol 2021; 38:647-651. [PMID: 33738854 DOI: 10.1111/pde.14569] [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: 11/30/2022]
Abstract
We present a case of a female neonate with a cluster of six skin colored to yellowish pseudovesicular papules on her right forearm present since birth, initially thought to be a herpes simplex virus infection. Punch biopsy with immunostaining revealed a diagnosis of S100-negative, CD163-positive congenital cutaneous non-neural granular cell tumor. Only four other reports are presented in the literature of this entity, three of which also presented on the arm with somewhat similar clinical findings. We briefly reviewed the subtypes of classic and S100-negative non-neural granular cell tumors.
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Affiliation(s)
| | - Ellen S Haddock
- Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | - Suzanne Tucker
- Department of Pathology, Rady Children's Hospital, San Diego, CA, USA
| | - Robert Newbury
- Department of Pathology, Rady Children's Hospital, San Diego, CA, USA
| | - Brian Hinds
- Department of Dermatology, University of California San Diego, San Diego, CA, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California San Diego, San Diego, CA, USA
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Simpson EL, Tom WL, Bushmakin AG, Cappelleri JC, Yosipovitch G, Ständer S, Luger T, Sanders P, Gerber RA, Myers DE. Relationship Among Treatment, Pruritus, Investigator's Static Global Assessment, and Quality of Life in Patients with Atopic Dermatitis. Dermatol Ther (Heidelb) 2021; 11:587-598. [PMID: 33751495 PMCID: PMC8018915 DOI: 10.1007/s13555-021-00506-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 11/13/2020] [Accepted: 02/17/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The Investigator’s Static Global Assessment (ISGA) is a 5-point rating scale that is recommended by the US Food and Drug Administration for assessing the severity of atopic dermatitis (AD), and ISGA success is a widely used endpoint in AD clinical studies. In this study, we seek to interpret the relationship of ISGA with treatment, pruritus, and quality of life (QoL) by conducting post hoc analyses of pooled data from two phase 3 crisaborole studies. Methods Patients aged ≥ 2 years with baseline ISGA of 2 (mild) or 3 (moderate) were randomly assigned 2:1 to receive crisaborole or vehicle for 28 days. Disease severity, pruritus severity, and QoL were assessed with the ISGA, Severity of Pruritus Scale (SPS), and Dermatology Life Quality Index (DLQI; patients aged ≥ 16 years), or Children’s Dermatology Life Quality Index (CDLQI; patients aged 2–15 years), respectively. The effect of treatment on ISGA and the relationship between ISGA and QoL were analyzed using a longitudinal repeated-measures model. The interrelationship between treatment, disease severity, pruritus, and QoL was analyzed with a mediation model. Results Overall, 1522 patients (crisaborole, n = 1016; vehicle, n = 506) were included. Estimated longitudinal profiles indicated changes in ISGA by day 8 were large for crisaborole (effect size [ES]: − 0.68) and small for vehicle (ES: − 0.34). There was a direct relationship between ISGA and DLQI and CDLQI severity bands in the longitudinal repeated-measures model. For both QoL mediation models, treatment effects on QoL were mediated indirectly by reduction in pruritus (DLQI, 42.4%; CDLQI, 58.1%) and disease severity (DLQI, 12.2%; CDLQI, 33.1%). Conclusions These post hoc analyses suggest that ISGA success is a clinically meaningful endpoint associated with reduction in the severity of pruritus and improvement in QoL. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00506-y.
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Affiliation(s)
- Eric L Simpson
- Oregon Health and Science University, Portland, OR, USA.
| | - Wynnis L Tom
- UC San Diego and Rady Children's Hospital-San Diego, San Diego, CA, USA
| | | | | | - Gil Yosipovitch
- Department of Dermatology, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sonja Ständer
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Thomas Luger
- Department of Dermatology, University Hospital Münster, Münster, Germany
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10
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Chiu YE, Shmuylovich L, Kiguradze T, Anderson K, Sibbald C, Tollefson M, Kunzler E, Tom WL, Bond K, Ahmad RC, Garcia-Romero MT, Irfan M, Kollman K, Hunt R, Stein SL, Arkin L, Wong V, Pope E, Jacobe H, Brandling-Bennett HA, Cordoro KM, Bercovitch L, Rangel SM, Liu X, Szabo A, Paller AS. Body site distribution of pediatric-onset morphea and association with extracutaneous manifestations. J Am Acad Dermatol 2021; 85:38-45. [PMID: 33689776 DOI: 10.1016/j.jaad.2021.03.017] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The distribution of pediatric-onset morphea and site-based likelihood for extracutaneous complications has not been well characterized. OBJECTIVE To characterize the lesional distribution of pediatric-onset morphea and to determine the sites with the highest association of extracutaneous manifestations. METHODS A retrospective cross-sectional study was performed. Using clinical photographs, morphea lesions were mapped onto body diagrams using customized software. RESULTS A total of 823 patients with 2522 lesions were included. Lesions were more frequent on the superior (vs inferior) anterior aspect of the head and extensor (vs flexor) extremities. Linear morphea lesions were more likely on the head and neck, whereas plaque and generalized morphea lesions were more likely on the trunk. Musculoskeletal complications were more likely with lesions on the extensor (vs flexor) extremity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.2-3.4), whereas neurologic manifestations were more likely with lesions on the anterior (vs posterior) (OR, 2.8; 95% CI, 1.7-4.6) and superior (vs inferior) aspect of the head (OR, 2.3; 95% CI, 1.6-3.4). LIMITATIONS Retrospective nature and the inclusion of only patients with clinical photographs. CONCLUSION The distribution of pediatric-onset morphea is not random and varies with body site and within individual body sites. The risk stratification of extracutaneous manifestations by body site may inform decisions about screening for extracutaneous manifestations, although prospective studies are needed.
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Affiliation(s)
- Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Section of Pediatric Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Leonid Shmuylovich
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Tina Kiguradze
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Cathryn Sibbald
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Elaine Kunzler
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Kelsie Bond
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Regina-Celeste Ahmad
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | | | - Mahwish Irfan
- Department of Dermatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kaitlyn Kollman
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Sarah L Stein
- Departments of Medicine and Pediatrics, Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Lisa Arkin
- Departments of Dermatology and Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Vivian Wong
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena Pope
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Heidi Jacobe
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas
| | - Heather A Brandling-Bennett
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital and University of Washington, San Francisco, California
| | - Kelly M Cordoro
- Department of Dermatology, Section of Pediatric Dermatology, University of California San Francisco, San Francisco, California
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephanie M Rangel
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xuerong Liu
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Bronckers IMGJ, Paller AS, West DP, Lara-Corrales I, Tollefson MM, Tom WL, Hogeling M, Belazarian L, Zachariae C, Mahé E, Siegfried E, Blume-Peytavi U, Szalai Z, Vleugels RA, Holland K, Murphy R, Puig L, Cordoro KM, Lambert J, Alexopoulos A, Mrowietz U, Kievit W, Seyger MMB. A Comparison of Psoriasis Severity in Pediatric Patients Treated With Methotrexate vs Biologic Agents. JAMA Dermatol 2020; 156:384-392. [PMID: 32022846 DOI: 10.1001/jamadermatol.2019.4835] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Few studies have compared the use of methotrexate and biologics, the most commonly used systemic medications for treatment of moderate to severe psoriasis in children. Objective To assess the real-world, 6-month reduction in psoriasis severity and long-term drug survival (rate and duration of adherence to a specific drug) of methotrexate vs biologics in plaque psoriasis in children. Design, Setting, and Participants A retrospective medical records review was conducted at 20 European and North American centers. Treatment response was based on site-reported Psoriasis Area and Severity Index (PASI) and/or Physician Global Assessment (PGA) scores at baseline and within the first 6 months of treatment. Participants included all 234 consecutively seen children with moderate to severe psoriasis who received at least 3 months of methotrexate or biologics from December 1, 1990, to September 16, 2014, with sufficient data for analysis. Data analysis was performed from December 14, 2015, to September 1, 2016. Main Outcomes and Measures PASI, with a range from 0 to 72 (highest score indicating severe psoriasis), and/or PGA, with a scale of 0 (clear), 1 (minimal), 2 (mild), 3 (moderate), 4 (severe), and 5 (very severe). Results Of 234 pediatric patients (103 boys [44.0%]; 131 girls [56.0%]) treated with methotrexate and/or biologics, 163 patients (69.7%) exclusively received methotrexate, 47 patients (20.1%) exclusively received biologics, and 24 children (10.2%) received methotrexate and biologics sequentially. Of the latter cohort, 23 children were treated initially with methotrexate. Mean (SD) age at initiation was 11.6 (3.7) years for methotrexate and 13.3 (2.9) years for biologics (73.2% for etanercept) (P = .002). Among patients evaluated by a scoring method at 6-month follow-up, 75% or greater improvement in PASI (PASI75) was achieved in 12 of 30 patients (40.0%) receiving methotrexate and 20 of 28 patients (71.4%) receiving biologics, and PGA was clear/almost clear (PGA 0/1) in 41 of 115 patients (35.6%) receiving methotrexate and 18 of 37 patients (48.6%) receiving biologics. Achieving PASI75 and/or PGA 0/1 between baseline and 6 months was more likely with biologics than methotrexate (PASI75: odds ratio [OR], 4.56; 95% CI, 2.02-10.27; P < .001; and PGA 0/1: OR, 2.00; 95% CI, 0.98-4.00; P = .06). Decreased mean PASI and PGA scores were associated with biologics more than with methotrexate (PASI effect, -3.13; 95% CI, -4.33 to -1.94; P < .001; and PGA effect, -0.31; 95% CI, -0.56 to -0.06; P = .02). After 1, 3, and 5 years of use, overall drug survival rates for methotrexate were 77.5%, 50.3%, and 35.9%, and for biologics, the rates were 83.4%, 64.3%, and 57.1%, respectively. Biologics were associated with a better confounder-corrected drug survival than methotrexate (hazard ratio [HR], 2.23; 95% CI, 1.21-4.10; P = .01). Discontinuation owing to lack of response was comparable (HR, 1.64; 95% CI, 0.80-3.36; P = .18). Conclusions and Relevance Methotrexate and biologics appear to be associated with improvement in pediatric psoriasis, although biologics seem to be associated with greater reduction in psoriasis severity scores and higher drug survival rates than methotrexate in the real-world setting. Additional studies directly comparing these medications should be performed for confirmation.
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Affiliation(s)
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Irene Lara-Corrales
- Department of Pediatric Medicine, Dermatology Section, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Wynnis L Tom
- Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego.,Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego
| | - Marcia Hogeling
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona.,now with the Department of Dermatology, UCLA (University of California, Los Angeles)
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Elaine Siegfried
- Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri.,Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Charité- Universitätsmedizin, Berlin, Germany
| | - Zsuzsanna Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Ruth Ann Vleugels
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Ruth Murphy
- Paediatric Dermatology Department, Nottingham University Hospitals, Nottingham, England
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco Medical Center, San Francisco.,Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Alex Alexopoulos
- First Department of Pediatrics, Agia Sofia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, the Netherlands
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12
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Reynolds SD, Mathur AN, Chiu YE, Brandling-Bennett HA, Pope E, Siegel MP, Holland KE, Paller AS, Siegfried EC, Tom WL, Lara-Corrales I, Tollefson MM, Maguiness S, Eichenfield LF, Sugarman J, Frieden IJ, Oza VS, Cipriano SD, Huang JT, Shah SD, Lauren CT, Castelo-Soccio L, McMahon P, Cordoro KM. Systemic immunosuppressive therapy for inflammatory skin diseases in children: Expert consensus-based guidance for clinical decision-making during the COVID-19 pandemic. Pediatr Dermatol 2020; 37:424-434. [PMID: 32320494 DOI: 10.1111/pde.14202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES The COVID-19 pandemic has raised questions about the approach to management of systemic immunosuppressive therapies for dermatologic indications in children. Change to: Given the absence of data to address concerns related to SARS-CoV-2 infection and systemic immunosuppressive therapies in an evidence-based manner, a Pediatric Dermatology COVID-19 Response Task Force (PDCRTF) was assembled to offer time-sensitive guidance for clinicians. METHODS A survey was distributed to an expert panel of 37 pediatric dermatologists on the PDCRTF to assess expert opinion and current practice related to three primary domains of systemic therapy: initiation, continuation, and laboratory monitoring. RESULTS Nearly all respondents (97%) reported that the COVID-19 pandemic had impacted their decision to initiate immunosuppressive medications. The majority of pediatric dermatologists (87%) reported that they were pausing or reducing the frequency of laboratory monitoring for certain immunosuppressive medications. In asymptomatic patients, continuing therapy was the most popular choice across all medications queried. The majority agreed that patients on immunosuppressive medications who have a household exposure to COVID-19 or test positive for new infection should temporarily discontinue systemic and biologic medications, with the exception of systemic steroids, which may require tapering. CONCLUSIONS The ultimate decision regarding initiation, continuation, and laboratory monitoring of immunosuppressive therapy during the pandemic requires careful deliberation, consideration of the little evidence available, and discussion with families. Consideration of an individual's adherence to COVID-19 preventive measures, risk of exposure, and the potential severity if infected must be weighed against the dermatological disease, medication, and risks to the patient of tapering or discontinuing therapies.
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Affiliation(s)
- Sean D Reynolds
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Anubhav N Mathur
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Yvonne E Chiu
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather A Brandling-Bennett
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Elena Pope
- Dermatology Section, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael P Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana, USA
| | - Kristen E Holland
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, Missouri, USA
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | | | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic and Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, University of California, San Diego, California, USA.,Rady Children's Hospital, San Diego, California, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Vikash S Oza
- Ronald O Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Sarah D Cipriano
- Department of Dermatology, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer T Huang
- Dermatology Program, Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sonal D Shah
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Christine T Lauren
- Departments of Dermatology and Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Patrick McMahon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco, California, USA
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13
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Simpson EL, Yosipovitch G, Bushmakin AG, Cappelleri JC, Luger T, Ständer S, Tom WL, Ports WC, Zielinski MA, Tallman AM, Tan H, Gerber RA. Direct and Indirect Effects of Crisaborole Ointment on Quality of Life in Patients with Atopic Dermatitis: A Mediation Analysis. Acta Derm Venereol 2019; 99:756-761. [PMID: 30896779 DOI: 10.2340/00015555-3181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022] Open
Abstract
Crisaborole ointment is a nonsteroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis. Using pooled data from two phase 3 studies (NCT02118766/NCT02118792), mediation modeling determined the interrelationship among pruritus, quality of life (QoL), and treatment. Patients aged ≥ 2 years received crisaborole ointment 2% or vehicle twice daily for 28 days. QoL measures were Dermatology Life Quality Index (DLQI) (≥ 16 years) and Children's Dermatology Life Quality Index (CDLQI) (2-15 years). Pruritus was assessed by the Severity of Pruritus Scale (4-point scale from 0 to 3). The indirect effect of crisaborole on QoL mediated through its effect on pruritus was 51% (DLQI model, p < 0.05) and 72% (CDLQI model, p < 0.05). Direct effect (other effects) on QoL was 49% (DLQI model, p < 0.05) and 28% (CDLQI model, p > 0.05). Mediation modeling shows that crisaborole affects QoL mostly indirectly through pruritus severity reduction.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, 97225 Portland, USA.
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14
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Siegfried EC, Jaworski JC, Eichenfield LF, Paller A, Hebert AA, Simpson EL, Altman E, Arena C, Blauvelt A, Block J, Boguniewicz M, Chen S, Cordoro K, Hanna D, Horii K, Hultsch T, Lee J, Leung DY, Lio P, Milner J, Omachi T, Schneider C, Schneider L, Sidbury R, Smith T, Sugarman J, Taha S, Tofte S, Tollefson M, Tom WL, West DP, Whitney L, Zane L. Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry. Pediatr Dermatol 2018; 35:303-322. [PMID: 29600515 DOI: 10.1111/pde.13452] [Citation(s) in RCA: 12] [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] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option. Several clinical trials with level 1 evidence have supported the use of topical treatments for mild to moderate atopic dermatitis in adults and children, but these trials have had little consistency in protocol design. Consensus recommendations will help standardize clinical development and trial design for children. The Food and Drug Administration issues guidance documents for industry as a source for "the Agency's current thinking on a particular subject." Although they are nonbinding, industry considers these documents to be the standard for clinical development and trial design. Our consensus group is the first to specifically address clinical trial design in this population. We developed a draft guidance document for industry, Developing Drugs for Treatment of Atopic Dermatitis in Children (≥3 months to <18 years of age). This draft guidance has been submitted to the Food and Drug Administration based on a provision in the Federal Register (Good Guidance Practices).
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Affiliation(s)
- Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Lawrence F Eichenfield
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Amy Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, TX, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Charles Arena
- Clinical Development & Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Suephy Chen
- Department of Dermatology, Emory University, and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Diane Hanna
- Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy and University of Missouri, Kansas City, MO, USA
| | - Thomas Hultsch
- Translational Medicine, Sanofi-Genzyme, Cambridge, MA, USA
| | - James Lee
- Dermavant Sciences, Raleigh-Durham, NC, USA
| | - Donald Y Leung
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Theodore Omachi
- Immunology/Respiratory, Genentech, Inc., San Francisco, CA, USA
| | | | - Lynda Schneider
- Department of Pediatrics, Harvard Medical School and Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sharif Taha
- National Eczema Association, San Rafael, CA, USA
| | - Susan Tofte
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Wynnis L Tom
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucinda Whitney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lee Zane
- Anacor Pharmaceuticals, Palo Alto, CA, USA
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15
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Eichenfield LF, Paller AS, Tom WL, Sugarman J, Hebert AA, Friedlander SF, Siegfried E, Silverberg N, Cordoro KM. Pediatric psoriasis: Evolving perspectives. Pediatr Dermatol 2018; 35:170-181. [PMID: 29314219 DOI: 10.1111/pde.13382] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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
BACKGROUND/OBJECTIVES Childhood-onset psoriasis is a common skin disorder that has recently received increasing attention, particularly because of its significant medical, social, financial, and psychological burdens and its associated comorbidities. With limited data available and lack of standardized management guidelines for pediatric psoriasis, an expert panel desired to provide an updated critical overview and practical guidance for management of the affected population. METHODS A panel of pediatric dermatologists with extensive experience in pediatric psoriasis defined and prioritized a core set of topics, performed an English-language literature review, prepared critical evaluations and presentations of topic areas, and carried out a consensus meeting and follow-up consensus manuscript. RESULTS The summation of evolving perspectives in pediatric psoriasis includes epidemiology and natural history of the disease, precipitating factors and comorbidities, quality of life and burden of disease, clinical features and disease presentation, differential diagnosis, pathogenesis and treatment, including topical, photo, and systemic therapies. CONCLUSION Pediatric psoriasis is an important immune-mediated inflammatory skin disease with potential for significant impact on affected individuals and their caregivers. Current state-of-the-art care is based primarily on experience and expert consensus, but pediatric data are accumulating and therapeutic options are rapidly evolving.
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Affiliation(s)
- Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Adelaide A Hebert
- Pediatric Dermatology, McGovern School of Medicine and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA.,Department of Pediatrics, University of California, San Diego School of Medicine and Rady Children's Hospital, San Diego, CA, USA
| | - Elaine Siegfried
- Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA.,Department of Dermatology, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Nanette Silverberg
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
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Tom WL. Food Allergy and Atopic Dermatitis: Fellow Travelers or Triggers? ACTA ACUST UNITED AC 2017; 36:S95-S97. [PMID: 29659643 DOI: 10.12788/j.sder.2017.049] [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: 12/01/2017] [Accepted: 12/31/2017] [Indexed: 11/20/2022]
Abstract
Many children with atopic dermatitis also have an allergy to one or more foods, but the presence of these two conditions in an individual does not necessarily indicate a causal link between them. Testing and interpretation, sometimes with specialist consultation, may be required to discern whether food allergy is present in a child with atopic dermatitis and-if it is present-whether the food is triggering or exacerbating signs and symptoms of atopic dermatitis. Recent milestone trials have demonstrated that early introduction of peanuts can reduce the development of peanut allergy in at-risk children. Parents may benefit from education about current revised guidelines that now recommend offering peanut-containing foods to most children at the time he or she is ready for solid food. Semin Cutan Med Surg 36(supp4):S95-S97.
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Affiliation(s)
- Wynnis L Tom
- Associate Clinical Professor of Dermatology and Pediatrics University of California San Diego School of Medicine Rady Children's Hospital San Diego, CA
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17
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Bronckers IMGJ, Seyger MMB, West DP, Lara-Corrales I, Tollefson M, Tom WL, Hogeling M, Belazarian L, Zachariae C, Mahé E, Siegfried E, Philipp S, Szalai Z, Vleugels RA, Holland K, Murphy R, Baselga E, Cordoro K, Lambert J, Alexopoulos A, Mrowietz U, Kievit W, Paller AS. Safety of Systemic Agents for the Treatment of Pediatric Psoriasis. JAMA Dermatol 2017; 153:1147-1157. [PMID: 28903160 DOI: 10.1001/jamadermatol.2017.3029] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Use of systemic therapies for moderate to severe psoriasis in children is increasing, but comparative data on their use and toxicities are limited. Objective To assess patterns of use and relative risks of systemic agents for moderate to severe psoriasis in children. Design, Setting, and Participants A retrospective review was conducted at 20 centers in North America and Europe, and included all consecutive children with moderate to severe psoriasis who used systemic medications or phototherapy for at least 3 months from December 1, 1990, to September 16, 2014. Main Outcomes and Measures The minimal core data set included age, sex, severity of psoriasis, systemic interventions, monitoring, adverse events (AEs), and reason for discontinuation. Results For 390 children (203 girls and 187 boys; mean [SD] age at diagnosis, 8.4 [3.7] years) with psoriasis who used 1 or more systemic medications, the mean interval between diagnosis and starting systemic therapy was 3.0 years. Methotrexate was used by 270 patients (69.2%), biologic agents (primarily etanercept) by 106 (27.2%), acitretin by 57 (14.6%), cyclosporine by 30 (7.7%), fumaric acid esters by 19 (4.9%), and more than 1 medication was used by 73 (18.7%). Of 270 children taking methotrexate, 130 (48.1%) reported 1 or more AEs associated with methotrexate, primarily gastrointestinal (67 [24.8%]). Folic acid 6 days per week (odds ratio, 0.16; 95% CI, 0.06-0.41; P < .001) or 7 days per week (OR, 0.21; 95% CI, 0.08-0.58; P = .003) protected against gastrointestinal AEs more than once-weekly folic acid, regardless of the total weekly dosage. Methotrexate-associated hepatic transaminase elevations were associated with obesity (35 of 270 patients [13.0%]), but a folic acid regimen was not. Injection site reactions occurred in 20 of 106 patients (18.9%) treated with tumor necrosis factor inhibitors, but did not lead to discontinuation of treatment. Having 1 or more AEs related to medication, gastrointestinal AE, laboratory abnormality, or AE leading to discontinuation of the drug was more likely with methotrexate than tumor necrosis factor inhibitors, but having 1 or more infections related to medication (predominantly upper airway) was less likely. Six patients developed a serious treatment-related AE (methotrexate, 3; fumaric acid esters, 2; and adalimumab, 1), but methotrexate and biologic agents were taken for a mean duration that was 2-fold greater than the mean duration for cyclosporine or fumaric acid esters. No patient developed tuberculosis or a malignant neoplasm. Conclusions and Relevance Medication-related AEs occur less often with tumor necrosis factor inhibitors than with methotrexate. Folic acid administration 6 or 7 times per week protected more against methotrexate-induced gastrointestinal AEs than did weekly administration. A prospective registry is needed to track the long-term risks of systemic agents for pediatric psoriasis.
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Affiliation(s)
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University, Nijmegen, the Netherlands
| | - Dennis P West
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Irene Lara-Corrales
- Department of Pediatric Medicine, Dermatology Section, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Wynnis L Tom
- Department of Dermatology, Rady Children's Hospital San Diego, University of California, San Diego.,Department of Pediatrics, Rady Children's Hospital San Diego, University of California, San Diego
| | - Marcia Hogeling
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona.,now with the Department of Dermatology, University of California, Los Angeles
| | - Leah Belazarian
- Department of Dermatology, University of Massachusetts Medical School, Worcester
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emmanuel Mahé
- Department of Dermatology, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Elaine Siegfried
- Department of Dermatology, St Louis University School of Medicine, St Louis, Missouri.,Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri
| | - Sandra Philipp
- Psoriasis Research and Treatment Center, Charité-Universitäts-Medizin, Berlin, Germany
| | - Zsuzsanna Szalai
- Department of Dermatology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Ruth Ann Vleugels
- Department of Dermatology, Boston Children's Hospital, Boston, Massachusetts
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee
| | - Ruth Murphy
- Paediatric Dermatology Department, Nottingham University Hospitals, Nottingham, England
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sanat Creu i Sant Pau, Barcelona, Spain
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco Medical Center, San Francisco.,Department of Pediatrics, University of California, San Francisco Medical Center, San Francisco
| | - Jo Lambert
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Alex Alexopoulos
- First Department of Pediatrics, Agia Sofia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Ulrich Mrowietz
- Psoriasis Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Nijmegen, the Netherlands
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois.,Department of Pediatrics, Northwestern University, Chicago, Illinois
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Osier E, Wang AS, Tollefson MM, Cordoro KM, Daniels SR, Eichenfield A, Gelfand JM, Gottlieb AB, Kimball AB, Lebwohl M, Mehta NN, Paller AS, Schwimmer JB, Styne DM, Van Voorhees AS, Tom WL, Eichenfield LF. Pediatric Psoriasis Comorbidity Screening Guidelines. JAMA Dermatol 2017; 153:698-704. [PMID: 28514463 DOI: 10.1001/jamadermatol.2017.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Psoriasis is a complex inflammatory skin condition associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health. Objective To develop the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. Evidence Review A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and removing reviews and editorials produced 153 relevant manuscripts. An expert panel in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence. Findings Because of the limited number of pediatric studies published on these topics, the strength of the panel's recommendations is classified as SORT level C expert consensus recommendations. The majority of recommendations coincide with those endorsed by the American Academy of Pediatrics for the general pediatric patient but with added attention to signs and symptoms of arthritis, depression, and anxiety. The panel also identified key areas for further investigation. Conclusions and Relevance Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities. These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children.
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Affiliation(s)
- Emily Osier
- Department of Dermatology, Eastern Virginia Medical School, Norfolk
| | - Audrey S Wang
- Division of Dermatology, Sharp Rees-Stealy Medical Group, San Diego, California
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Kelly M Cordoro
- Division of Pediatric Dermatology, Department of Dermatology, University of California San Francisco, San Francisco
| | - Stephen R Daniels
- Section of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Andrew Eichenfield
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons of Columbia University, New York, New York
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Mark Lebwohl
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Nehal N Mehta
- Division of Intramural Research, Section of Inflammation and Cardiometabolic Diseases, National Institutes of Health/National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego
| | - Dennis M Styne
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | | | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, Rady Children's Hospital San Diego and University of California, San Diego School of Medicine, San Diego
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Affiliation(s)
- Eric P Sorensen
- School of Medicine, University of California, San Diego, La Jolla, CA
| | - Wynnis L Tom
- Departments of Dermatology and Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, CA
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20
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Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, Eichenfield LF, Forsha DW, Rees WC, Simpson EL, Spellman MC, Stein Gold LF, Zaenglein AL, Hughes MH, Zane LT, Hebert AA. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol 2016; 75:494-503.e6. [PMID: 27417017 DOI: 10.1016/j.jaad.2016.05.046] [Citation(s) in RCA: 329] [Impact Index Per Article: 41.1] [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: 04/09/2016] [Revised: 05/20/2016] [Accepted: 05/31/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Additional topical treatments for atopic dermatitis (AD) are needed that provide relief while minimizing risks. OBJECTIVE We sought to assess the efficacy and safety of crisaborole ointment, a phosphodiesterase 4 inhibitor, in two phase III AD studies (AD-301: NCT02118766; AD-302: NCT02118792). METHODS Two identically designed, vehicle-controlled, double-blind studies enrolled and randomly assigned (2:1, crisaborole:vehicle) patients aged 2 years or older with an Investigator's Static Global Assessment (ISGA) score of mild or moderate for twice-daily application for 28 days. The primary end point was ISGA score at day 29 of clear (0)/almost clear (1) with 2-grade or greater improvement from baseline. Additional analyses included time to success in ISGA score, percentage of patients achieving clear/almost clear, reduction in severity of AD signs, and time to improvement in pruritus. RESULTS More crisaborole- than vehicle-treated patients achieved ISGA score success (clear/almost clear with ≥2-grade improvement; AD-301: 32.8% vs 25.4%, P = .038; AD-302: 31.4% vs 18.0%, P < .001), with a greater percentage with clear/almost clear (51.7% vs 40.6%, P = .005; 48.5% vs 29.7%, P < .001). Crisaborole-treated patients achieved success in ISGA score and improvement in pruritus earlier than those treated with vehicle (both P ≤ .001). Treatment-related adverse events were infrequent and mild to moderate in severity. LIMITATIONS Short study duration was a limitation. CONCLUSIONS Crisaborole demonstrated a favorable safety profile and improvement in all measures of efficacy, including overall disease severity, pruritus, and other signs of AD.
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Affiliation(s)
- Amy S Paller
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| | - Wynnis L Tom
- Rady Children's Hospital-San Diego, San Diego, California; University of California, San Diego, La Jolla, California
| | - Mark G Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Mark Boguniewicz
- National Jewish Health, Denver, Colorado; University of Colorado School of Medicine, Denver, Colorado
| | | | - Lawrence F Eichenfield
- Rady Children's Hospital-San Diego, San Diego, California; University of California, San Diego, La Jolla, California
| | | | | | | | | | | | | | | | - Lee T Zane
- Anacor Pharmaceuticals, Inc, Palo Alto, California
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21
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Haddock ES, Calame A, Shimizu C, Tremoulet AH, Burns JC, Tom WL. Psoriasiform eruptions during Kawasaki disease (KD): A distinct phenotype. J Am Acad Dermatol 2016; 75:69-76.e2. [PMID: 26946987 PMCID: PMC4912865 DOI: 10.1016/j.jaad.2016.02.1146] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A psoriasis-like eruption develops in a subset of patients with Kawasaki disease (KD). OBJECTIVE We sought to systematically compare KD-associated psoriasiform eruptions with classic psoriasis and the outcomes of KD in children with and without this rash. METHODS This was a retrospective study of 11 KD cases with a psoriasiform eruption matched 1:2 by age, gender, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of 2 late cornified envelope (LCE) genes, LCE3C_LCE3B-del, associated with increased risk for pediatric-onset psoriasis. RESULTS Similar to classic psoriasis, KD-associated eruptions were characterized clinically by well-demarcated, scaly pink plaques and histopathologically by intraepidermal neutrophils, suprabasilar keratin 16 expression, and increased Ki-67 expression. They showed less frequent diaper area involvement, more crust and serous exudate, and an enduring remission (91% vs 23% with confirmed resolution; P < .001). Frequency of LCE3C_LCE3B-del and major KD outcomes were similar between cases and controls. LIMITATIONS The study was limited by the small number of cases, treatment variation, and availability of skin biopsy specimens. CONCLUSIONS Although the overall clinical and histopathologic findings were similar to conventional psoriasis, this appears to be a distinct phenotype with significantly greater propensity for remission. No adverse effect on KD outcomes was noted.
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Affiliation(s)
- Ellen S Haddock
- School of Medicine, University of California, San Diego in La Jolla, California
| | - Antoanella Calame
- Department of Dermatology, University of California, San Diego, California; Compass Dermatopathology, La Jolla, California
| | - Chisato Shimizu
- Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Jane C Burns
- Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California
| | - Wynnis L Tom
- Department of Dermatology, University of California, San Diego, California; Department of Pediatrics, University of California, San Diego, California; Rady Children's Hospital, San Diego, California.
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22
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Tom WL, Playford MP, Admani S, Natarajan B, Joshi AA, Eichenfield LF, Mehta NN. Characterization of Lipoprotein Composition and Function in Pediatric Psoriasis Reveals a More Atherogenic Profile. J Invest Dermatol 2016; 136:67-73. [PMID: 26763425 PMCID: PMC4731044 DOI: 10.1038/jid.2015.385] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 05/17/2015] [Revised: 08/24/2015] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
Psoriasis is associated with increased cardiovascular disease in adults, but the risk profile of children with psoriasis remains to be fully characterized. We measured lipoprotein composition and function in 44 patients with pediatric psoriasis and 44 age- and sex-matched healthy controls, using nuclear magnetic resonance spectroscopy and a validated ex vivo assay of high-density lipoprotein cholesterol efflux capacity. The mean age of the patients was 13 years and the population was ethnically diverse. Children with psoriasis had higher waist-to-hip ratios (0.85 vs. 0.80; P < 0.002) and insulin resistance measures (log-transformed homeostasis model assessment of insulin resistance 0.65 vs. 0.41; P = 0.07). Despite comparable traditional lipid values, having psoriasis was associated with higher apolipoprotein B concentrations (72.4 vs. 64.6; P = 0.02), decreased large high-density lipoprotein particles (5.3 vs. 6.7; P < 0.01), and reduced cholesterol efflux capacity after adjusting for age, sex, fasting glucose, homeostasis model assessment of insulin resistance, systolic blood pressure, body mass index, apolipoprotein A-1, and high-density lipoprotein cholesterol concentration (β -0.22; P = 0.02). Patients with pediatric psoriasis have a more atherogenic cardiometabolic risk profile, with evidence of insulin resistance and lipoprotein dysfunction by particle size, number, and functional assessment. These findings may provide a basis for the observed link later in life between psoriasis and cardiovascular disease, and support the need to screen and educate young patients to minimize later complications.
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Affiliation(s)
- Wynnis L Tom
- Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego and Rady Children's Hospital, San Diego, California, USA.
| | - Martin P Playford
- Cardiology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Shehla Admani
- Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Balaji Natarajan
- Cardiology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Aditya A Joshi
- Cardiology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Nehal N Mehta
- Cardiology Branch, National Institutes of Health, Bethesda, Maryland, USA
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23
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Zane LT, Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, Eichenfield LF, Forsha DW, Rees WC, Simpson EL, Stein Gold LF, Zaenglein AL, Hebert AA. Two phase 3 study results of children and adults with mild-to-moderate atopic dermatitis treated with Crisaborole Topical Ointment, 2%, a novel, nonsteroidal, topical, anti-inflammatory, phosphodiesterase 4 inhibitor. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.191.26] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Up to 90% of children and adults with atopic dermatitis (AD), a chronic inflammatory skin disease, present with mild-to-moderate disease. Crisaborole Topical Ointment, 2%, is a novel, nonsteroidal, topical, anti-inflammatory, phosphodiesterase 4 inhibitor being studied for the treatment of AD. The efficacy and safety of crisaborole was assessed in 2 identically designed, multicenter, vehicle-controlled, double-blind Phase 3 studies (301 and 302) that enrolled patients ≥2 years old with mild-to-moderate AD affecting ≥5% of body surface area (BSA). Patients were randomized 2:1 to receive crisaborole or vehicle twice daily and evaluated on Days 8, 15, 22, and 29. The primary endpoint defined success in the Investigator’s Static Global Assessment (ISGA) as “almost clear/1” or “clear/0” with ≥2-grade improvement from baseline at Day 29. Secondary endpoints analyzed the time to success and the percentage of patients achieving “almost clear/1” or “clear/0” on ISGA. At Day 29, more crisaborole-treated patients achieved ISGA success than vehicle (301: 32.8% vs 25.4%, P = 0.038; 302: 31.4% vs 18.0%, P < 0.001), with a greater percentage of “almost clear/1” or “clear/0” ISGA scores (301: 51.7% vs 40.6%, P = 0.005; 302: 48.5% vs 29.7%, P < 0.001). Success in ISGA scores was achieved earlier with crisaborole than vehicle (P < 0.001). Treatment-related adverse events (AEs) were usually mild and included upper respiratory tract infection (pooled data, crisaborole vs vehicle: 3.0% vs 3.0%) and application site pain (4.4% vs 1.2%). AE-related discontinuation rates were low for both groups (1.2%). 2 large Phase 3 studies demonstrated crisaborole may represent a novel, safe, and efficacious treatment for patients with mild-to-moderate AD.
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Affiliation(s)
| | | | - Wynnis L. Tom
- 3Rady Children’s Hosp. San Diego
- 4Univ. of California, San Diego
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Zane LT, Hebert AA, Eichenfield LF, Lebwohl MG, Paller AS, Simpson EL, Tom WL, Hughes MH. Crisaborole Topical Ointment, 2%, a novel nonsteroidal, anti-inflammatory, topical, phosphodiesterase 4 inhibitor, reduced pruritus and signs of atopic dermatitis in 2 phase 3 studies in children and adults with mild-to-moderate atopic dermatitis. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.191.27] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Atopic dermatitis (AD) is an inflammatory skin disease with intense pruritus and eczematous lesions. Crisaborole Topical Ointment, 2% (Anacor Pharmaceuticals, Palo Alto, CA), is an investigational, nonsteroidal, anti-inflammatory, topical, phosphodiesterase 4 inhibitor for the treatment of AD. Here, we present the impact of crisaborole on pruritus and signs of AD evaluated as supportive efficacy endpoints for 2 Phase 3 studies (301, 302). Patients ≥2 years old with mild-to-moderate AD were enrolled in 2 double-blind, vehicle-controlled, multicenter Phase 3 studies of identical design. Patients were randomized 2:1 to receive crisaborole or vehicle twice daily for 28 days. Supportive efficacy endpoints examined severity of pruritus (measured twice daily) and signs of AD (measured weekly) on a 4-point scale (None [0] to Severe [3]). Success was defined for pruritus or each sign or symptom of AD as achievement of None (0) or Mild (1) with ≥1-grade improvement from baseline. Improvement in pruritus was achieved sooner in crisaborole-treated patients than vehicle-treated patients (pooled data: median, 1.37 vs 1.70 days; P = 0.001). A greater proportion of crisaborole-treated patients achieved success for all clinical signs of AD by Day 29 (301, 302; erythema: 62.8% vs 46.1%; 54.9% vs 33.9%; induration/papulation: 57.7% vs 54.8%; −51.9% vs 40.2%; exudation: 41.0% vs 33.3%; 38.1% vs 27.2%; excoriation: 63.0% vs 51.8%; 57.2% vs 44.2%; lichenification: 51.7% vs 46.5%; 51.4% vs 35.3%). In 2 large Phase 3 studies, crisaborole demonstrated early relief of pruritus and showed improvement in all measured signs of AD. Crisaborole Topical Ointment, 2%, may represent a safe and efficacious treatment for patients ≥2 years with mild-to-moderate AD.
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Affiliation(s)
| | | | | | | | | | | | - Wynnis L. Tom
- 3Rady Children’s Hosp. San Diego
- 4Univ. of California, San Diego
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Tom WL, Van Syoc M, Chanda S, Zane LT. Pharmacokinetic Profile, Safety, and Tolerability of Crisaborole Topical Ointment, 2% in Adolescents with Atopic Dermatitis: An Open-Label Phase 2a Study. Pediatr Dermatol 2016; 33:150-9. [PMID: 26777394 DOI: 10.1111/pde.12780] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 01/11/2023]
Abstract
BACKGROUND Phosphodiesterase-4 (PDE4) is an emerging target in treating inflammatory skin diseases. Crisaborole topical ointment, 2% is a novel, boron-based, topical PDE4 inhibitor under investigation for treatment of mild to moderate atopic dermatitis (AD). METHODS Adolescent patients aged 12 to 17 years with treatable AD lesions involving ≥ 10% to ≤ 35% body surface area (BSA) were enrolled into a phase 2a, open-label study comprising pharmacokinetic (PK), safety, tolerability, and efficacy assessments. Crisaborole topical ointment, 2% was applied twice daily to affected areas for 28 days, with dosage based on baseline treatable BSA. PK blood samples were collected on days 1, 2, 4, 6, 8, and 9. Safety assessments included adverse events (AEs), laboratory parameters, and vital signs. Efficacy assessments included the Investigator's Static Global Assessment (ISGA) score and severity of AD signs and symptoms. RESULTS Twenty-three patients were enrolled; 22 completed the study (1 patient discontinued due to an AE [application site dermatitis]). PK analysis demonstrated limited exposure to crisaborole topical ointment, 2% after 8 days of dosing. Ten patients reported a total of 19 AEs, most commonly application site pain and nasopharyngitis (3 patients each). There were no clinically meaningful changes in laboratory or vital sign parameters. Efficacy was demonstrated by reductions in mean ISGA and AD sign and symptom severity scores. At day 29, eight patients (35%) had achieved an ISGA score ≤ 1 with ≥ 2-grade improvement. Mean treatable BSA declined from 17.6% to 8.2%. CONCLUSION These results provide preliminary evidence for the limited systemic exposure, safety, and effectiveness of crisaborole topical ointment, 2% in adolescents with mild to moderate AD.
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Affiliation(s)
- Wynnis L Tom
- University of California, San Diego and Rady Children's Hospital, San Diego, California
| | | | | | - Lee T Zane
- Anacor Pharmaceuticals, Palo Alto, California
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Song SS, Matiz C, Tom WL, Calame A, Krakowski AC, Friedlander SF. Ecthyma Gangrenosum-Like Lesions Secondary to Methicillin-Sensitive Staphylococcus aureus in an Immunocompetent Child. Pediatr Dermatol 2015; 32:e259-62. [PMID: 26459977 DOI: 10.1111/pde.12699] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe a previously healthy 15-month-old girl who developed ecthyma gangrenosum (EG)-like lesions secondary to methicillin-sensitive Staphylococcus aureus (MSSA). Her systemic symptoms and negative blood cultures suggested MSSA toxin-mediated effects. When toxin-mediated systemic symptoms accompany such lesions, pathogens other than Pseudomonas aeruginosa should be considered.
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Affiliation(s)
- Silvia S Song
- Department of Dermatology, University of California at San Diego, San Diego, California.,Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catalina Matiz
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Wynnis L Tom
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Antoanella Calame
- Rady Children's Hospital, San Diego, California.,Compass Dermatopathology, La Jolla, California
| | - Andrew C Krakowski
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Sheila F Friedlander
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
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Munden A, Butschek R, Tom WL, Marshall JS, Poeltler DM, Krohne SE, Alió AB, Ritter M, Friedlander DF, Catanzarite V, Mendoza A, Smith L, Friedlander M, Friedlander SF. Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol 2015; 170:907-13. [PMID: 24641194 DOI: 10.1111/bjd.12804] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aetiology and exact incidence of infantile haemangiomas (IHs) are unknown. Prior studies have noted immunohistochemical and biological characteristics shared by IHs and placental tissue. OBJECTIVES We investigated the possible association between placental anomalies and the development of IHs, as well as the demographic characteristics and other risk factors for IHs. PATIENTS AND METHODS Pregnant women (n = 578) were prospectively enrolled and their offspring followed for 9 months. Placental evaluations were performed and demographic data collected on all mother-infant pairs. RESULTS We evaluated 594 infants: 34 haemangiomas [either IH or congenital (CH)] were identified in 29 infants, yielding an incidence of 4·5% for IH (27 infants) and 0·3% for CH (two infants). Placental anomalies were noted in almost 35% of haemangioma-related pregnancies, approximately twice the incidence noted in pregnancies with unaffected infants (P = 0·025). Other risk factors for IH included prematurity (P = 0·016) and low birth weight (P = 0·028). All IHs were present by 3 months of age, and cessation of growth had occurred in all by 9 months of age. Most occurred on the trunk. Of note, 20% of identified IHs were abortive or telangiectatic in nature, small focal lesions that did not proliferate beyond 3 months of age. Only one IH required intervention. CONCLUSIONS This is the first prospective American study to document the incidence of IHs in infants followed from birth to early infancy. The association with placental anomalies was statistically significant. The overall incidence mirrors prior estimates, but the need for treatment was lower than previously reported.
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Affiliation(s)
- A Munden
- University of California, San Diego School of Medicine, San Diego, CA, U.S.A
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Chalmers JR, Schmitt J, Apfelbacher C, Dohil M, Eichenfield LF, Simpson EL, Singh J, Spuls P, Thomas KS, Admani S, Aoki V, Ardeleanu M, Barbarot S, Berger T, Bergman JN, Block J, Borok N, Burton T, Chamlin SL, Deckert S, DeKlotz CC, Graff LB, Hanifin JM, Hebert AA, Humphreys R, Katoh N, Kisa RM, Margolis DJ, Merhand S, Minnillo R, Mizutani H, Nankervis H, Ohya Y, Rodgers P, Schram ME, Stalder JF, Svensson A, Takaoka R, Teper A, Tom WL, von Kobyletzki L, Weisshaar E, Zelt S, Williams HC. Report from the third international consensus meeting to harmonise core outcome measures for atopic eczema/dermatitis clinical trials (HOME). Br J Dermatol 2014; 171:1318-25. [PMID: 24980543 PMCID: PMC4298247 DOI: 10.1111/bjd.13237] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [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] [Accepted: 06/25/2014] [Indexed: 01/25/2023]
Abstract
This report provides a summary of the third meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in San Diego, CA, U.S.A., 6-7 April 2013 (HOME III). The meeting addressed the four domains that had previously been agreed should be measured in every eczema clinical trial: clinical signs, patient-reported symptoms, long-term control and quality of life. Formal presentations and nominal group techniques were used at this working meeting, attended by 56 voting participants (31 of whom were dermatologists). Significant progress was made on the domain of clinical signs. Without reference to any named scales, it was agreed that the intensity and extent of erythema, excoriation, oedema/papulation and lichenification should be included in the core outcome measure for the scale to have content validity. The group then discussed a systematic review of all scales measuring the clinical signs of eczema and their measurement properties, followed by a consensus vote on which scale to recommend for inclusion in the core outcome set. Research into the remaining three domains was presented, followed by discussions. The symptoms group and quality of life groups need to systematically identify all available tools and rate the quality of the tools. A definition of long-term control is needed before progress can be made towards recommending a core outcome measure.
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Affiliation(s)
- J R Chalmers
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, U.K
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Siegel DH, Choate KA, Drolet BA, Frieden IJ, Rittenberg S, Teng JM, Tom WL, Williams ML, Eichenfield LF, Paller AS. Proceedings of the Inaugural Pediatric Dermatology Research Alliance (PeDRA) conference. J Invest Dermatol 2014; 134:2671-2674. [PMID: 25318428 PMCID: PMC4350365 DOI: 10.1038/jid.2014.227] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Skin disease research involving children currently faces several major hurdles and as a result, many therapies are only available for off-label use in children and many of the most pressing clinical needs of our pediatric population remain unsolved. A strategic planning committee of the Society for Pediatric Dermatology (SPD) identified the need for an organized, inclusive research alliance to augment the resources of individual practitioners and pre-existing smaller collaborative groups and facilitate robust, multicenter basic, translational, and clinical research and therapeutic trials. A December 2011 National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Roundtable on Pediatric Dermatology further detailed the therapeutic gaps and barriers to translation of scientific advances to clinical practice. Building on these forums, in July 2012, a group of interested investigators met in Monterey, CA to develop the infrastructure for collaborative pediatric skin research, now called the Pediatric Dermatology Research Alliance (PeDRA). The vision of PeDRA is to create sustainable collaborative research networks to better understand, prevent, treat and cure dermatologic diseases in children. From that starting point, subcommittees and expert members were added, stakeholders identified, and seed funding garnered, with the first PeDRA stand-alone research meeting* realized in Chicago, IL in October 2013.
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Affiliation(s)
- Dawn H Siegel
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Keith A Choate
- Departments of Dermatology and Pathology, Yale University, New Haven, Connecticut, USA
| | - Beth A Drolet
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | | | - Joyce M Teng
- Departments of Dermatology and Pediatrics, Stanford University, Stanford, California, USA
| | - Wynnis L Tom
- Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego, San Diego, California, USA
| | - Mary L Williams
- Departments of Dermatology and Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Lawrence F Eichenfield
- Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego, San Diego, California, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois, USA
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Affiliation(s)
- Lauren Becker
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois
| | - Wynnis L Tom
- Department of Pediatrics and Medicine (Dermatology), University of California, San Diego
| | - Karin Eshagh
- Department of Pediatrics and Medicine (Dermatology), University of California, San Diego
| | - Latanya T Benjamin
- Departments of Dermatology and Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University, Chicago, Illinois
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Sidbury R, Davis DM, Cohen DE, Cordoro KM, Berger TG, Bergman JN, Chamlin SL, Cooper KD, Feldman SR, Hanifin JM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Simpson EL, Tom WL, Williams HC, Elmets CA, Block J, Harrod CG, Begolka WS, Eichenfield LF. Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327-49. [PMID: 24813298 DOI: 10.1016/j.jaad.2014.03.030] [Citation(s) in RCA: 525] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 11/16/2022]
Abstract
Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.
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Affiliation(s)
- Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - David E Cohen
- Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy G Berger
- Department of Dermatology, University of California, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L Chamlin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathryn Schwarzenberger
- Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Wynnis L Tom
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Hywel C Williams
- Center of Evidence-based Dermatology, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Lawrence F Eichenfield
- University of San Diego, San Diego, California; Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
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Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2013; 70:338-51. [PMID: 24290431 DOI: 10.1016/j.jaad.2013.10.010] [Citation(s) in RCA: 674] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/03/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in the management and care of AD, providing updated and expanded recommendations based on the available evidence. In this first of 4 sections, methods for the diagnosis and monitoring of disease, outcomes measures for assessment, and common clinical associations that affect patients with AD are discussed. Known risk factors for the development of disease are also reviewed.
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Affiliation(s)
- Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital San Diego, San Diego, California
| | - Sarah L Chamlin
- Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Steven R Feldman
- Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Timothy G Berger
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - James N Bergman
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - David E Cohen
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Kevin D Cooper
- Department of Dermatology, Case Western University, Cleveland, Ohio
| | - Kelly M Cordoro
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Alfons Krol
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - David J Margolis
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Hywel C Williams
- Centre of Evidence-Based Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Craig A Elmets
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie Block
- National Eczema Association, San Rafael, California
| | | | | | - Robert Sidbury
- Department of Dermatology, Seattle Children's Hospital, Seattle, Washington
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Mercy K, Kwasny M, Cordoro KM, Menter A, Tom WL, Korman N, Belazarian L, Armstrong AW, Levy ML, Paller AS. Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States. Pediatr Dermatol 2013; 30:424-8. [PMID: 23360462 PMCID: PMC3641153 DOI: 10.1111/pde.12072] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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
The clinical features of pediatric psoriasis warrant further attention. A national study was conducted to determine the prevalence of scalp and nail involvement and a history of guttate psoriasis at onset according to age, sex, and disease severity. One hundred eighty-one children ages 5 to 17 years with plaque psoriasis were enrolled in a multicenter, cross-sectional study. Subjects and guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to the Physician's Global Assessment and body surface area measures. One hundred forty-three (79.0%) subjects reported a history of scalp involvement, and 71 (39.2%) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.19-0.84) but more likely to have had nail involvement (OR = 3.01, 95% CI = 1.62-5.60). Scalp and nail involvement was not related to psoriasis severity. In contrast, subjects with SP (35.9%) more often reported a history of guttate lesions than did those with MP (21.8%) (p = .02). Antecedent streptococcal infection was more common in children with guttate than those with plaque psoriasis at onset (p = .02) but did not correlate with severity. Sex-related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease. More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.
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Affiliation(s)
- Katherine Mercy
- Department of Dermatology, Northwestern University, Chicago, Illinois 60611, USA
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Paller AS, Mercy K, Kwasny MJ, Choon SE, Cordoro KM, Girolomoni G, Menter A, Tom WL, Mahoney AM, Oostveen AM, Seyger MMB. Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study. JAMA Dermatol 2013; 149:166-76. [PMID: 23560297 DOI: 10.1001/jamadermatol.2013.1078] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the relationship of excess and central adiposity with pediatric psoriasis severity. DESIGN, SETTING, AND PARTICIPANTS Multicenter, cross-sectional study of 409 psoriatic children. Psoriasis was classified as mild (worst Physician's Global Assessment score ≤3 with body surface area ≤10%) or severe (worst Physician's Global Assessment score ≥3 with body surface area >10%). Children were enrolled from 9 countries between June 19, 2009, and December 2, 2011. MAIN OUTCOME MEASURES Excess adiposity (body mass index percentile) and central adiposity (waist circumference percentile and waist to height ratio). RESULTS Excess adiposity (body mass index ≥85th percentile) occurred in 37.9% of psoriatic children (n=155) vs 20.5% of controls (n=42) but did not differ significantly by severity. The odds ratio (95% CI) of obesity (body mass index ≥95th percentile) overall in psoriatic children vs controls was 4.29 (1.96-9.39) and was higher with severe (4.92; 2.20-10.99) than with mild (3.60; 1.56-8.30) psoriasis, particularly in the United States (7.60; 2.47-23.34, and 4.72; 1.43-15.56, respectively). Waist circumference above the 90th percentile occurred in 9.3% of the control (n=19), 14.0% of the mild psoriasis (n=27), and 21.2% of the of severe psoriasis (n=43) participants internationally; this incidence was highest in the United States (12.0% [n=13], 20.8% [16], and 31.1% [32], respectively). Waist to height ratio was significantly higher in psoriatic (0.48) vs control (0.46) children but was unaffected by psoriasis severity. Children with severe psoriasis at its worst, but mild at enrollment, showed no significant difference in excess or central adiposity from children whose psoriasis remained severe. CONCLUSIONS Globally, children with psoriasis have excess adiposity and increased central adiposity regardless of psoriasis severity. The increased metabolic risks associated with excess and central adiposity warrant early monitoring and lifestyle modification. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00879944
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Affiliation(s)
- Amy S Paller
- Department of Dermatology, Northwestern University, 676 N St Clair, Ste 1600, Chicago, IL 60611, USA.
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Chiu YE, Drolet BA, Blei F, Carcao M, Fangusaro J, Kelly ME, Krol A, Lofgren S, Mancini AJ, Metry DW, Recht M, Silverman RA, Tom WL, Pope E. Variable response to propranolol treatment of kaposiform hemangioendothelioma, tufted angioma, and Kasabach-Merritt phenomenon. Pediatr Blood Cancer 2012; 59:934-8. [PMID: 22648868 PMCID: PMC3528889 DOI: 10.1002/pbc.24103] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [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] [Received: 11/29/2011] [Accepted: 01/11/2012] [Indexed: 12/20/2022]
Abstract
Propranolol is a non-selective beta-adrenergic antagonist successfully used in a case of kaposiform hemangioendothelioma (KHE) associated with Kasabach-Merritt phenomenon (KMP). We report 11 patients treated with propranolol for KHE and the related variant tufted angioma (TA), six of whom also had KMP. The varied responses to treatment, with only 36% responding in our series, demonstrate the need for further study of this medication before routine use for these indications.
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Affiliation(s)
| | | | - Francine Blei
- Vascular Birthmark Institute of New York, New York, NY
| | | | - Jason Fangusaro
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Alfons Krol
- Oregon Health And Science University, Portland, OR
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Affiliation(s)
- Wynnis L Tom
- Dermatology, University of California, San Diego, and Rady Children's Hospital, San Diego, CA, USA.
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Melancon JM, Tom WL, Lee RA, Jackson M, Brian Jiang SI. Management of Pilomatrix Carcinoma: A Case Report of Successful Treatment with Mohs Micrographic Surgery and Review of the Literature. Dermatol Surg 2011; 37:1798-805. [DOI: 10.1111/j.1524-4725.2011.02170.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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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Tom WL, Hurley MY, Oliver DS, Shah MR, Bree AF. Features of basal cell carcinomas in basal cell nevus syndrome. Am J Med Genet A 2011; 155A:2098-104. [PMID: 21834051 DOI: 10.1002/ajmg.a.34127] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 05/01/2011] [Indexed: 11/10/2022]
Abstract
Basal cell nevus syndrome (BCNS) is an autosomal dominant genodermatosis that is characterized by early onset basal cell carcinomas (BCCs) that define the disease and often lead to diagnosis of the underlying syndrome. The objective of this study was to investigate the anatomic location, subtypes, and impact of BCCs on a group of 61 individuals affected with BCNS attending a research colloquium. Fifty individuals had at least one prior BCC with 22 participants having over 100 lesions. The median age of syndrome diagnosis was 11 years and median age of first BCC was 16 years. Males had more lesions on the upper back, upper extremities, and M-zone of the face, while females had more lesions on the scalp, back, and lower extremities. Pigmented BCCs were concentrated on the neck, upper trunk, and extremities. Subjects with >100 lesions showed wider anatomic distribution. The number of BCCs did not correlate with any of the other major features of the syndrome. Eighty percent of affected individuals reported great concern related to BCCs, citing the limitations and morbidity of available treatments. Vigilant surveillance, which was found to be inconsistent for participants in this study, is warranted. Future work should include development of a consensus guideline on skin examinations and strategies to optimize therapy of BCCs in this syndrome.
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Affiliation(s)
- Wynnis L Tom
- Division of Dermatology, Department of Pediatrics, University of California, San Diego, California, USA
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Abstract
The omphalomesenteric duct is an embryologic connection between the digestive tract and yolk sac, which typically involutes by the time of birth. Failure of the obliteration process can result in omphalomesenteric duct remnants. We present two cases of children with such remnants, one with an umbilical polyp requiring traditional excisional therapy and one more unusual case of an umbilical cord cyst resolving spontaneously without intervention. The differential diagnosis, which includes urachal remnants and umbilical pyogenic granulomas, is discussed, along with management and special considerations that practioners should be aware of when treating pediatric umbilical and umbilical cord lesions.
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Affiliation(s)
- Jessica W Hsu
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California 92123, USA
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Tom WL, Hsu JW, Eichenfield LF, Friedlander SF. Pediatric “STUMP” lesions: Evaluation and management of difficult atypical Spitzoid lesions in children. J Am Acad Dermatol 2011; 64:559-72. [DOI: 10.1016/j.jaad.2009.12.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/25/2009] [Accepted: 12/31/2009] [Indexed: 02/01/2023]
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Matiz C, Tom WL, Eichenfield LF, Pong A, Friedlander SF. Children with atopic dermatitis appear less likely to be infected with community acquired methicillin-resistant Staphylococcus aureus: the San Diego experience. Pediatr Dermatol 2011; 28:6-11. [PMID: 21070347 DOI: 10.1111/j.1525-1470.2010.01293.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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
Given the increasing rate of community-acquired methicillin resistant Staphylococcus aureus skin infections in the population, such infections might be concurrently increasing in patients with atopic dermatitis. This study assessed current and prior rates of community-acquired methicillin resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus skin and soft tissue infections in children with atopic dermatitis compared to the general pediatric population. Other antibiotic sensitivity and resistance patterns, including clindamycin-inducible resistance, were also identified. Retrospective study of all skin and soft tissue isolates were positive for Staphylococcus aureus during two distinct 1-year periods, obtained by the outpatient services and the emergency department at Rady Children's Hospital, the major regional pediatric health center in San Diego, California. Of the Staphylococcus aureus isolates obtained from January to December 2000, none from atopic dermatitis patients were methicillin resistant Staphylococcus aureus, while 4.2% of those obtained from the general outpatient pediatric population showed methicillin resistance. In the period from June 2007 to May 2008, 11 of 78 isolates (14.1%) from children with atopic dermatitis were methicillin resistant Staphylococcus aureus. This was significantly lower than the rate of increase noted in the general pediatric population (658 of 1482, or 44.4%, in 2007/2008, p < 0.05). Clindamycin-inducible resistance was noted in 1.9% of the isolates in the general population; all six tested isolates from atopic patients lacked clindamycin-inducible resistance. In this study, children with atopic dermatitis had a much lower rate of community-acquired methicillin resistant Staphylococcus aureus infection compared to the general outpatient pediatric population. Clindamycin-inducible resistance was very low in both groups.
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Affiliation(s)
- Catalina Matiz
- Division of Pediatric Dermatology, University of California, San Diego and Rady Children's Hospital, San Diego, California 92123, USA
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Clayton LA, Tom WL. Individualizing treatment for adolescent acne to achieve optimal outcomes. J Pediatr Health Care 2010; 24:127-32. [PMID: 20189066 DOI: 10.1016/j.pedhc.2009.06.003] [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: 02/12/2009] [Revised: 05/29/2009] [Accepted: 06/03/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Lara A Clayton
- Pediatric & Adolescent Dermatology, Rady Children's Hospital, San Diego, CA 92123, USA.
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Abstract
Acne vulgaris is a common disorder that affects more than 17 million individuals in the United States. Knowledge of the disease is an important part of clinical practice, particularly for the pediatric practitioner. Contrary to common belief, acne is not a disease limited to adolescents and young adults but can occur at any stage of life. This article is a case-based review of acne during childhood and adolescence. Workup is based on age and concurrent physical findings, whereas therapy depends on the type of skin lesions along with patient characteristics and preferences.
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Affiliation(s)
- Wynnis L Tom
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California 92123, USA
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Abstract
Efalizumab is a recombinant, humanized monoclonal anti-CD11a antibody used for the treatment of moderate to severe plaque psoriasis. Immune-mediated thrombocytopenia and anaemia have previously been reported with this therapy. We describe the first case of immune-mediated pancytopenia in a patient treated with efalizumab. Close monitoring of all blood cell counts is warranted in light of this case.
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Affiliation(s)
- W L Tom
- Department of Dermatology, Saint Louis University School of Medicine, 1402 South Grand Blvd, MO 63104, USA
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Abstract
OBJECTIVE To determine the efficacy and safety of short-contact administration of topical tretinoin on foot ulcers in patients with diabetes. DESIGN Randomized, double-blind, placebo-controlled trial. SETTING Outpatient clinic at a Veterans Affairs medical center. PATIENTS Twenty-four volunteers with diabetic foot ulcers but without evidence of peripheral arterial disease or infection. INTERVENTIONS Patients were randomized to 4 weeks of daily treatment with either topical 0.05% tretinoin solution (Retin-A) or placebo saline solution. Photographs and assessment of wound size and appearance were assessed every 2 weeks for a total of 16 weeks. MAIN OUTCOME MEASURES The proportion of ulcers that healed in each group and the degree of change in ulcer size. RESULTS Twenty-two patients, with a total of 24 foot ulcers, completed the study. At the end of 16 weeks, 2 (18%) of 11 ulcers in the control group and 6 (46%) of 13 ulcers in the tretinoin treatment group healed completely. Topical tretinoin therapy significantly decreased ulcer area and depth compared with placebo treatment over the 16 weeks of the study (P < .01 for surface area; P = .02 for depth). Adverse effects mainly consisted of mild pain at the ulcer site. CONCLUSIONS Short-contact application of topical tretinoin improved the healing of foot ulcers in patients with diabetes. The tretinoin therapy was generally well tolerated, without serious local or systemic adverse effects.
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Affiliation(s)
- Wynnis L Tom
- Division of Dermatology, Department of Medicine, University of California, San Diego, USA
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Abstract
Dyskeratosis congenita is a rare, progressive, degenerative disorder characterized by cutaneous and mucosal involvement in the first decade of life with malignant changes and bone marrow failure in the second and third decades. The primary inheritance pattern is X-linked recessive, with the majority of cases presenting in boys. We report dyskeratosis congenita in an adolescent girl with choanal atresia, a previously unreported association.
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Affiliation(s)
- Elizabeth V Lener
- Division of Pediatric and Adolescent Dermatology, Children's Hospital, San Diego, California, USA
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Abstract
Concern regarding the use of smallpox for bioterrorism has led to the reintroduction of smallpox vaccination. The historic background leading to protective methods against smallpox disease, the adverse reactions and contraindications associated with vaccination, and the ongoing development of potentially safer smallpox vaccines are reviewed here.
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Affiliation(s)
- Wynnis L Tom
- Department of Internal Medicine, San Diego School of Medicine, University of California, 200 West Arbor Drive, Mail Code 8422, San Diego, CA 92103, USA
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Abstract
UNLABELLED We tested the hypothesis that L-arginine (the substrate for nitric oxide production)-combined with amrinone, milrinone (Type III phosphodiesterase [PDE] inhibitors), zaprinast, or sildenafil (Type V PDE inhibitors)-would vasodilate synergistically. Internal mammary artery segments were excised from anesthetized swine, divided into rings, and suspended in a tissue bath at 37 degrees C. Force of contraction was measured during dose-response testing of combinations of L-arginine and amrinone, milrinone, zaprinast, or sildenafil. Amrinone and milrinone were additive to L-arginine. N(G)-methyl-L-arginine (L-NMA) inhibited the effects of milrinone but not amrinone. The effective concentration of amrinone eliciting 50% relaxation (EC(50)) was 3.8E-05M (n = 6) when given alone and 4. 4E-05M (n = 6) with L-NMA. Milrinone had EC(50) = 6.0E-06M alone (n = 6) and 2.8E-05M (n = 6) with L-NMA. Zaprinast (EC(50) = 6.5E-05M, n = 6) and sildenafil (EC(30) = 1.8E-05M, n = 6) were synergistic with L-arginine. L-NMA blocked their effects, increasing the EC(50) for zaprinast to 9.9E-03M and the EC(30) for sildenafil to 6.1E+02M. In conclusion, L-arginine is additive to the vasodilation of the type III PDE inhibitors, amrinone and milrinone, but synergistic with the type V PDE inhibitors, zaprinast and sildenafil. IMPLICATIONS Amrinone and milrinone, Type III cAMP-dependent phosphodiesterase inhibitors, are additive to L-arginine-dependent vasodilation. Zaprinast and sildenafil, Type V cGMP-dependent phosphodiesterase inhibitors, are synergistic with L-arginine.
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Affiliation(s)
- A W Wallace
- Department of Anesthesiology, San Francisco Veterans Administration Medical Center and Department of Anesthesiology, University of California-San Francisco, San Francisco, California, USA.
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Wong WS, Chinn DO, Chinn M, Chinn J, Tom WL, Tom WL. Cryosurgery as a treatment for prostate carcinoma: results and complications. Cancer 1997; 79:963-74. [PMID: 9041159] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been a resurgence of interest in cryosurgical ablation of the prostate for the treatment of carcinoma. This is due to recent advances in cryosurgical technology, which have resulted in relatively lower morbidity. The objective of this study was to evaluate the effectiveness of ultrasound-guided cryosurgical ablation of prostate carcinoma. METHODS Eighty-three patients who had biopsy-proven prostate carcinoma underwent cryosurgical ablation of their entire prostate gland. The initial group of 12 patients had their procedures performed under ultrasound guidance only. The other 71 patients had cryosurgery performed with temperature monitoring in combination with ultrasound guidance. Twelve patients who had positive biopsies underwent a second cryosurgical procedure. All patients had prostate specific antigen (PSA) levels measured at 3, 6, 12, 18, 24, and 30 months after cryosurgery. Ultrasound-guided sextant biopsies were performed at 3-6, 12-18, and 24 months. RESULTS The median PSA dropped by 95%, from a preoperative value of 4.3 ng/mL to 0.2 ng/mL 30 months after cryosurgery. The authors experienced a high failure rate (positive biopsies) of 83% for the initial group of 12 patients who did not have temperature monitoring during the cryosurgical procedure. This was in contrast to a success rate of 90% (negative biopsies) for the next 71 patients, who did have temperature monitoring (P < 0.05, chi-square test). Twelve patients underwent a second cryosurgery, and the success rate for this group was 91% (11 of 12 patients). The combined success rate for both the first cryosurgery and the second was 94% (62 of 77 patients). Complications included urethral sloughing, urinary incontinence, impotence, bladder neck contracture, and bladder contracture. The majority of patients recovered rapidly from their cryosurgical procedures and were able to resume normal activities 3-4 weeks afterward. CONCLUSIONS These preliminary results demonstrate that cryosurgical ablation of the prostate is a viable treatment option for prostate carcinoma. In the authors' experience, ultrasound alone may not be adequate for monitoring the entire cryosurgical procedure. The authors found that temperature monitoring shortened their learning curve, enabled them to freeze prostate tissue more aggressively, and may have contributed to their overall success.
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Affiliation(s)
- W S Wong
- Cryosurgical Center of Southern California, Alhambra Hospital, USA
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