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Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF. Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10. J Pediatr 2024; 267:113907. [PMID: 38218370 DOI: 10.1016/j.jpeds.2024.113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco, School of Medicine, San Francisco, CA; Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christine K Fox
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Sarah L Chamlin
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, Madison, WI
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kelly K Barry
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tina Ho
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Chantal Cotter
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | - David Bosquez
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | | | - Jordan K Bui
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tracy Funk
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Alison Small
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Wenelia Baghoomian
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert C Yan
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James R Treat
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Griffin Stockton Hogrogian
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Huang
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Catherine C McCuaig
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victoria Barrio
- Department of Dermatology, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Anthony J Mancini
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret E Scollan
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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Abstract
One in ten infants are born with a vascular birthmark each year. Some vascular birthmarks, such as infantile hemangiomas, are common, while vascular malformations, such as capillary, lymphatic, venous, and arteriovenous malformations, are less so. Diagnosing uncommon vascular birthmarks can be challenging, given the phenotypic heterogeneity and overlap amongst these lesions. Both sporadic and germline variants have been detected in various genes associated with vascular birthmarks. Identification of these genetic variants offers insight into both diagnosis and underlying molecular pathways and can be fundamental in the discovery of novel therapeutic approaches. The PIK3/AKT/mTOR and RAS/MEK/ERK signaling pathways, which mediate cell growth and angiogenesis, are activated secondary to genetic variations in vascular malformations. Somatic variants in TEK (TIE2) and PIK3CA cause venous malformations. Variants in PIK3CA also cause lymphatic malformations as well as a number of overgrowth syndromes associated with vascular anomalies. Variants in GNAQ and GNA11 have been identified in both so-called "congenital" hemangiomas and capillary malformations. RASA1 and EPHB4 variants are associated with capillary malformation-arteriovenous malformation syndrome. This review discusses the genetics of vascular birthmarks including the various phenotypes, genetic variants, pathogenesis, associated syndromes, and new diagnostic techniques.
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Affiliation(s)
- Priya Mahajan
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas
| | - Katie L Bergstrom
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas
| | - Thuy L Phung
- Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Denise W Metry
- Department of Dermatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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Sanaphay V, Sengchanh S, Phengsavanh A, Sanaphay A, Techasatian L. Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR. Glob Pediatr Health 2021; 8:2333794X21990908. [PMID: 33614846 PMCID: PMC7868484 DOI: 10.1177/2333794x21990908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022] Open
Abstract
Newborn skin disorders are quite common and happen to occur during the neonatal period. Most of the birthmarks are transient; however, worried parents often seek medical advice from their child’s physician regarding skin lesions. Thus, it is important to differentiate the skin lesions from pathologic ones to avoid unnecessary diagnostic or therapeutic procedures. This is the first published study in Lao neonates that carried out the data from 4 central hospitals in Vientiane Capital, Lao PDR from September 2019 to February 2020. Among 500 neonates, Sebaceous gland hyperplasia (53%), Mongolian patches (46.6%), and Erythema toxicum neonatorum (30%) were the 3 most common cutaneous conditions found in the Lao newborns. From a clinical point of view, these findings are often a source of parental anxiety and medical concern for inexperienced clinicians.
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Affiliation(s)
- Vilounna Sanaphay
- University of Health Sciences, Vientiane, Lao People's Democratic Republic
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