Pediatric Dermatology最新文献

Pyoderma gangrenosum (PG) is a rare skin disorder with poorly understood pathophysiology. PG infrequently occurs in children, and approximately 4% of patients with PG are infants and children. First line therapy is topical and systemic corticosteroids, which typically yields rapid response. We report a case of rapidly progressive pediatric PG of unknown inciting cause that ultimately required multi-modal therapy with systemic and topical corticosteroids, high-dose infliximab, and colchicine.

Background: Moisturizers are a crucial baseline therapy for atopic dermatitis (AD).

Objective: To evaluate the real-life experience of using moisturizers in AD patients and to assess parents' opinions and challenges regarding moisturizer use.

Methods: This cross-sectional study used a questionnaire completed by the parents of pediatric AD patients. The assessment questionnaire evaluated demographic factors as well as practices, opinions, and challenges regarding the use of moisturizers in AD treatment. Applying moisturizers twice daily, considered sufficient use, was evaluated across demographic levels using bivariate analysis.

Results: A total of 425 patients with AD participated in the study. The median age was 4 years, 51% of patients were female, 61% had moderate to severe AD, 34% had a family history of AD, and 41% of cases reported sufficient moisturizer use. Factors associated with increased frequency of application of moisturizers included younger age at diagnosis, higher parents' educational level, and increased family income. The twice-daily application versus less frequent application was associated with fewer monthly flare-ups (33% vs. 17%, p < 0.001). Overall, 54% of patient guardians believed that moisturizers were necessary for treating AD, 69% considered fragrance-free formulas to be better, and 86% thought there to be a need for counseling from their physician on using moisturizers in AD treatment. Factors undermining the application of moisturizers included the time needed for application, cost, and lack of patient cooperation.

Conclusion: In real-world practice, parents tend to underutilize moisturizers. To address this issue, treating physicians must provide additional education, and health insurance companies should consider covering moisturizers to ensure their accessibility.

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, usually fatal complication of blood transfusion.

Objective: To describe the characteristics of TA-GVHD in children.

Methods: The clinical records of pediatric patients diagnosed with TA-GVHD between January 2007 and December 2021 were reviewed.

Results: We analyzed 94 clinical records of pediatric patients (0-18 years) with a diagnosis of GVHD, of whom 6 (6.38%) were associated with TA-GVHD; both genders being equally affected. The median age at diagnosis of the underlying disorder was 9 years, 1 month (range 2 months-15 years, 3 months); the median age at diagnosis of TA-GVHD was 9 years, 5.5 months (range 1 year, 7 months-15 years, 7 months). There were 27 grafts; 8 were irradiated and 12 were filtered. All patients presented with Stage 3 cutaneous TA-GVHD and histopathological Grade 2. All cases corresponded to classic acute TA-GVHD with global clinical Grade I-II. Mortality rate was 67%. The median follow-up of our patients was 2 years and 2 months (range 4 months-3 years, 4 months).

Conclusions: TA-GVHD, although less frequently encountered than in previous years, is still a concern. Early suspicion of TA-GVHD is mandatory due to its high mortality rates and rapid progression. Prevention by using irradiated blood products is the sole effective measure against this condition. Failing to identify and preempt TA-GVHD not only jeopardizes patient survival but also underscores the critical importance of vigilant monitoring and proactive intervention in at-risk patients.

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder presenting in childhood. Dupilumab is the first approved biologic agent for the treatment of moderate-to-severe AD in pediatric populations. While generally well-tolerated, dupilumab-associated ocular surface disease (DAOSD) is a known complication. In severe cases, this may necessitate discontinuation of treatment.

Objective: We aim to describe DAOSD in our cohort of Asian pediatric patients with moderate-to-severe AD on dupilumab.

Methods: We performed a single-center retrospective review of children and adolescents on dupilumab for moderate-to-severe AD who developed ophthalmological complications from 2019 to 2024. Most patients had prophylactic lubricant eyedrops. Data collected and analyzed included demographics, ophthalmologic findings, treatment, and outcomes of eye condition.

Results: Of 216 patients treated with dupilumab, 16 (7.4%) developed ophthalmologist-diagnosed DAOSD. All patients had co-existing eyelid or head and neck eczema while 31.3% of these patients had pre-existing eye conditions. Eye redness (87.5%) was the most common presenting symptom, followed by pruritus (43.8%) and eye discharge (25%). The most common eye finding was conjunctivitis (87.5%), followed by limbitis (62.5%) and papillary reaction (62.5%). Two patients required temporary interruption of dupilumab. No patients required discontinuation of dupilumab treatment. The median time to resolution of eye complications was 14 weeks.

Conclusion: In a real-world setting, the incidence and severity of DAOSD in pediatric patients appears to be lower than that of adults. Prophylactic use of lubricant eye drops, close monitoring and early referral to pediatric ophthalmologists can help reduce the incidence of severe eye disease requiring discontinuation of dupilumab.

Shwachman-Diamond syndrome (SDS) is a rare inherited bone marrow failure syndrome characterized by the triad of exocrine pancreatic dysfunction, cytopenia, and skeletal abnormalities. We report a 5-month-old boy with SDS who presented with generalized ichthyosis in the neonatal period that evolved into more eczematous skin eruptions, accompanied by severe failure to thrive. This report highlights the importance of including SDS as a differential diagnosis in patients who present with early ichthyosis, failure-to-thrive, gastrointestinal symptoms and cytopenia.

An odontogenic cutaneous sinus tract is considered an uncommon skin lesion resulting from a dental infection. In most cases of periapical abscesses, the sinus tract emerges intraorally, but rarely may appear on the cutaneous surface. The nonspecific clinical symptoms and diverse appearance of such lesions can lead to misdiagnosis and mistreatment of patients. In cases of non-healing facial lesions, it is recommended to consider referring the patient for a comprehensive dental examination to prevent inappropriate treatment.

Linear psoriasis is a rare clinical presentation of psoriasis characterized by erythematous scaly plaques distributed along Blaschko's lines. We describe an 8-year-old male with a linear Blaschkoid plaque in which biopsy findings and clinical history were consistent with linear psoriasis. The lesion showed only mild improvement with topical steroid therapy but exhibited significant clearance with the biologic agent ixekizumab, an IL-17A inhibitor. With limited supporting literature regarding management, this case report illustrates the clinical manifestation, diagnosis, and an effective management strategy for linear psoriasis in a pediatric patient.

Patient education materials (PEMs) are crucial for improving patient adherence and outcomes; however, they may not be accessible due to high reading levels. Our study used seven readability measures to compare the readability of Spanish PEMs from the Society of Pediatric Dermatology (SPD) with those generated by Open-AI's ChatGPT 4.0 and Google Gemini. Our results showed that when prompted to produce material at a 6th grade level, both AI ChatBots generated significantly improved readability scores when compared to the SPD handouts. These findings suggest that AI-generated PEMs could better meet readability standards and potentially improve patient outcomes, although further studies are needed to confirm this.

Kaposiform hemangioendothelioma (KHE) is a vascular neoplasm characterized by abnormal angiogenesis and lymphangiogenesis. Here, we present a case of a 19-month-old male with KHE of the right leg with bony involvement who was initially misdiagnosed with infantile hemangioma. Due to its heterogeneous presentation and frequent occurrence of comorbidities such as Kasabach-Merritt phenomenon, clinical and pathological correlation is essential for diagnosis of KHE.

Extended essays or commentaries providing an opportunity to express personal views and opinions that are meant to enlighten, entertain, and educate readers, and can include articles about medical history, ethics, literature or the arts related to pediatric dermatology. Patient perspectives are also encouraged. Questions on whether a potential submission is appropriate for this section can be addressed to the Editors-in-Chief, or the Section Editors, Lucinda Kohn, MD, MHS (lucinda.kohn@cuanschutz.edu) or Neil Prose, MD (prose001@mc.duke.edu).