Pediatric Dermatology Research Articles

Global research trends of infantile hemangioma: A bibliometric and visualization analysis from 2000 to 2022

BackgroundInfantile hemangioma (IH) has received global attention, resulting in a significant volume of literature. However, there is a lack of bibliometric analyses specifically focusing on IH publications. This study aims to fill this gap by conducting a comprehensive analysis of IH publications, investigating their characteristics, contribution distribution, and developmental trends. By enhancing our understanding of IH and identifying potential research topics and collaborators, this study will contribute to the advancement of the field. MethodsA total of 4333 articles and reviews on IH were collected from the Web of Science (WoS) database, spanning the years 2000–2022. The study encompassed a comprehensive analysis of IH publications, evaluating their quantity and quality. Additionally, we profiled publishing groups based on country, institution, author publication records, and collaboration networks. Lastly, we identified and summarized the prominent research topics. ResultsAnnual publications on IH have increased over the past 20 years. The United States has the highest number of publications and the highest total number of citations. Pediatric Dermatology was the most influential journal in the IH field. The citation analysis indicated that the articles published by Léauté-Labrèze in 2008 had the highest number of citations. The articles published by North PE in 2000 and Boye E in 2001 laid a certain research foundation for this field. Concerning institutions, most of the cooperative relationships were established in the same country/region. The United States has the largest number of scientific research institutions and IH researchers, leading most of the cross-country collaboration. The University of California, San Francisco, Medical College of Wisconsin, Harvard University, and Shanghai Jiaotong University were the research centers that published the most IH-related research. Frieden IJ, Mulliken JB, and Drolet BA were the top three most influential authors. Frieden IJ, Garzon MC, and Mulliken JB were the top three authors with the most cited frequency. In addition, keywords and keyword co-occurrence networks prompted that the pathological mechanism of IH, clinical analysis, and other vascular anomalies are research hotspots. Analysis of trending topics suggests that research on IH has evolved from treatment-focused studies towards investigations of other vascular diseases and a series of clinical case studies. Currently, clinical case studies receive the most attention in the field. ConclusionsThis comprehensive bibliometric study provides a thorough analysis of post-2000 publications in the field of IH, offering insights into current research trends for the first time. The findings suggest that future investigations will continue to prioritize understanding IH mechanisms, treatment approaches, and treatment evaluation. Furthermore, the exploration of other vascular diseases and the inclusion of clinical case studies are expected to contribute to advancements in IH clinical practice. By identifying potential collaborators, partner institutions, and new research avenues, this study offers valuable guidance for future in-depth research on IH.

A Heim Pál Gyermekkórház Bőrgyógyászati Osztályának története

The ancestor of today’s Heim Pál Children’ Hospital was the Royal Hungarian Children’s Home. Here began the hospitalisation of children with skin diseases. After a brief history of the Children's Home and the later Hospital, the author presents the history of the Department of Paediatric Dermatology from 1934 to the present day.

Pediatric Dermatology in Canada: A Broad Review of Population Needs, Workforce and Training With Proposed Solutions.

The need for pediatric dermatology services is increasing across Canada. In parallel, the complexity of treatment with novel targeted therapeutics has increased. Currently, there is no accredited and limited non-accredited fellowship training access to pediatric dermatology in Canada. Understanding the current state of pediatric dermatology training in Canada will provide insight into opportunities for strategic improvement. A survey was distributed to 44 pediatric dermatology providers. In addition, a review of the burden of pediatric skin disease and education/training in Canada was performed. Thirty-four specialists responded to the survey (77% response rate). One third of current pediatric dermatology providers are over 50 years old and half of these (15%) plan to retire within the next 5 years. Half of respondents were dermatologists, 35% were pediatricians, and 11% were double boarded. Almost all respondents practiced in an academic setting (94%). Most had further fellowship training in pediatric dermatology (82.4%) but only 57% achieved this training in Canada, due to lack of accredited or non-accredited funded fellowship positions. There is a high and growing need for pediatric dermatology specialty care in a diverse range of settings. The current provider population and training programs are insufficient to meet current and future demands. We highlighted solutions to close this gap between supply and demand including increased double board certification in Pediatrics and Dermatology, a protected pediatric stream within existing Dermatology residency training programs and accredited fellowships in Pediatric Dermatology for both dermatologists and pediatricians.

Virtual reality and noise canceling headphone distraction during pediatric dermatologic procedures.

Pain and anxiety related to medical procedures have long been recognized as a significant healthcare concern. If a patient's procedural pain and anxiety are not addressed, long-term physical and psychological sequelae including increased perceived pain, anxiety, disruptive behavior, trauma reactions, or refusal of future procedures can occur. The objective of our study was to assess the utility of a virtual reality (VR) headset or noise-canceling headphones (HP) compared to treatment as usual (TAU) in reducing pain and anxiety during pediatric dermatology procedures. Results indicated a significant difference between pre- versus post-procedure anxiety in the VR and HP groups but not the TAU group suggesting non-pharmacologic technology-based interventions such as VR and headphones may reduce patients' anxiety during pediatric dermatology procedures.

Temporal Changes in the Skin Microbiome of Epidermolysis Bullosa Patients following the Application of Wound Dressings.

Epidermolysis bullosa (EB) is a group of rare hereditary skin disorders characterized by the formation of painful blisters, erosions, and ulcers. In addition, the wounds can easily become infected with different pathogens. Therefore, the dynamics in the microbial populations across the various stages of EB can shed light on pathophysiology, the effect of treatment, and the factors involved in its recovery, but they are understudied. We thus sought to characterize the skin microbiome among patients with EB over time. A prospective study conducted in the pediatric dermatology clinic at Soroka Medical Center, Beer-Sheva, Israel. Children (0-18) with simplex and recessive dystrophic EB were sampled at two different time points: before a therapeutic regimen and 90 days (±14 days) later. Samples were obtained from lesional skin (wound), healthy, non-lesional skin, and seborrheic skin (forehead). Samples were subject to 16S rRNA amplicon sequencing. Analyses performed included comparisons of relative abundance at the phyla and genera taxonomic levels, alpha and beta diversity comparisons, and differential abundance. 32 children with EB were enrolled, for whom 192 skin microbiome samples were obtained. Lesional skin samples harbored significantly less Bacteroidota and Fusobacteriota before the initiation of treatment. Following topical dressing, we observed more Firmicutes and less Proteobacteria in lesional skin samples than healthy and seborrheic skin samples. In addition, Staphylococcus was significantly more abundant in lesional samples than in non-lesional and seborrheic samples following treatment. Our study recaptured the reduced bacterial diversity and increased staphylococcal carriage in EB patients, showing a potential effect of topical dressing either directly on the wound microbiome or indirectly through the contribution towards skin healing. The detection of Firmicutes in general, and S. aureus specifically, commensurate with the application of a wound dressing may warrant the use of additional treatment methods to facilitate wound healing. Future studies in these patients should prospectively correlate the temporal changes in the microbiome associated with various treatment modalities in order to optimize the care of EB patients.

Mask-related Facial Dermatoses in an Asian Pediatric Population in the Era of COVID-19 Pandemic: A Cross-sectional Study

Abstract Introduction: Mask-related dermatoses have been widely reported in adults since the global COVID-19 pandemic. Compulsory mask wearing has been mandated in many countries. As pediatric dermatologists, we aim to characterize different types of mask-related dermatoses in the pediatric population, evaluate the prevalence, and potential exacerbating and mitigating factors to improve compliance in children in this era of regular mask wearing. Methods: We conducted a cross-sectional study from November 1, 2020, to January 31, 2021, at a tertiary hospital in the form of an anonymous online questionnaire. This included all children aged (2–20 years old) in our pediatric dermatology clinics, tertiary education students (16–20 years old), and children of hospital/health-care cluster staff (2–20 years old). Results: Of the 577 participants who reported regular mask wearing, 140 (24.3%) reported symptoms. The most common symptoms were itching (74.5%), dryness (49.6%), dyspnea (32.1%), and oily skin (29.9%). The most common rashes were acne (48.9%), eczema (27%), dryness/peeling (23.4%), urticaria (18.2%), and cheilitis (16.8%). The most statistically significant risk factors for developing mask-related symptoms and/or rashes were (a) prolonged duration of mask wearing/day and (b) preexisting dermatoses and/or atopic history (especially atopic dermatitis). Conclusions: As the pediatric population remains vulnerable to emerging COVID-19 variants and other respiratory viruses, masks remain an important form of protection in daily life. Like in adults, regular mask wearing can lead to various facial symptoms/dermatoses in pediatric wearers, adding to dermatological burden during a pandemic. Those with preexisting risk factors should be made aware of this. We recommend all pediatric mask wearers should not exceed continuous mask wearing for 4 h and to take scheduled “mask breaks” in safe, well-ventilated areas.

Diaper dermatitis and associated factors among 1–24 months children visiting public health facilities of Arba Minch town, Gamo zone, southern Ethiopia

BackgroundDiaper dermatitis is one of infants and toddlers' most common skin diseases; it accounts for 10–20 % of all skin diseases and 25 % of pediatric dermatology visits. Diaper dermatitis also increases parents' mental health problems and compromises the quality of life. Despite its ill outcome, diaper dermatitis's burden and risk factors are poorly studied in Ethiopia. Therefore, this study aimed to assess the magnitude of diaper dermatitis and associated factors among 1–24 months children visiting public health facilities in Arba Minch town, southern Ethiopia. MethodsA facility-based cross-sectional study was conducted among 671 mother-child pairs from May 15 to June 15, 2022. A structured and pretested interviewer-administered questionnaire and observational checklist were used to collect the information. The data was collected using an open data kit tools and analyzed using Stata version 17.0. Bivariable and multivariable analyses were carried out to identify factors associated with diaper dermatitis. P-value <0.05 was considered to declare statistical significance. ResultsIn this study, 664 mother-child pairs, yielded a response rate of 98.96 %, were involved. Overall, 35.69 % [95 % CI: 32.04, 39.47] of children encountered diaper dermatitis. Being government-employed (AOR: 2.49, 95 % CI: 1.42, 4.35), primiparity (AOR: 1.52, 95 % CI: 1.03, 2.23), unplanned pregnancy (AOR: 1.93, 95 % CI: 1.22, 3.04), having poor knowledge about diaper dermatitis (AOR: 1.74, 95 % CI: 1.19, 2.56), using both disposable and non-disposable diapers alternatively (AOR: 3.35, 95 % CI: 1.55, 7.22), and applying ointments on diaper area (AOR: 1.93, 95 % CI: 1.26, 2.97) all increase the likelihood of diaper dermatitis. ConclusionDiaper dermatitis was high in the study hospitals; over one-third experienced it. Maternal occupation, parity, pregnancy status, maternal knowledge of diaper dermatitis, diaper type, and ointment application were significantly associated with diaper dermatitis. Improving maternal/guardian knowledge about diapering and diaper dermatitis is critical to reducing the burden and severity of the problem.

Israeli pediatricians' confidence level in diagnosing and treating children with skin disorders: a cross-sectional questionnaire pilot study.

Pediatricians daily see large numbers of patients with skin disorders. However, they encounter limited guidance as a result of a marked deficiency in pediatric dermatologists. Hence, reevaluation of training opportunities during pediatric residency has become essential. Our aim was to evaluate the confidence level of pediatric residents and specialists in diagnosing and treating skin disorders in children and to determine career and training-related characteristics that influence it. Conducted as a cross-sectional study, we administered a questionnaire to 171 pediatricians across Israel. We assessed respondents' self-efficacy about their ability to diagnose and treat skin disorders and collected data regarding their previous dermatology training and preferred training methods. 77.8% of respondents reported below or average self-efficacy scores in diagnosing and managing children with skin disorders. Older age (>40 years old; OR = 5.51, p = 0.019), treating a higher number of patients with skin disorders (OR = 2.96, p = 0.032), and having any training in dermatology, either during medical school or residency (OR = 7.16, p = 0.031, OR = 11.14, p = 0.003 respectively), were all significant parameters involved in pediatricians reporting high self-efficacy in skin disorder management. Most pediatric residents and pediatricians have average or below-average confidence in managing pediatric skin disorders. We suggest incorporating dermatology rotations during pediatric residency to improve young pediatricians' self-efficacy in managing skin disorders and ultimately help pediatricians provide better care for patients presenting with dermatological conditions. These findings can ultimately help refine a pilot program in dermatology that might be implemented during pediatric residency.

Pediatrik Kutanöz Leishmania Olgularının Değerlendirilmesi

Cutaneous Leishmaniasis (CL) is a disease caused by leishmania-type protozoans, which is transmitted by the bite of infected female phlebotomine sandflies and is characterized by ulcerated nodular lesions. Twenty-one pediatric cutaneous leishmania cases followed by pediatric infectious diseases and dermatology were included in the study. The demographic and clinical characteristics of the patients, the local or systemic treatments, and side effects were analyzed retrospectively. 14 (66%) of the patients were female and 7 (34%) were male. The mean age of the cases was 6.4 years. Fifteen of the patients were refugees (seven of the patients were from Iraq, and eight of them were from Syria). Ten of the patients ( 47%) had lesions only on the face, 6 (28%) were both on the face and hand, 4 (20%) were on the lower extremities. Seven patients (34%) had a single lesion, fourteen had multiple lesions and seven had more than four lesions. Amastigote was observed in the microbiological examination of skin scraping samples of 13 patients. Intralesional therapy was given to 15 patients, systemic treatment was given to 6 patients, and 2 patients refused systemic treatment. Five patient was given meglumine antimoniate, one patient was given amphotericin B. In one patient, side effects such as facial swelling, rash, and edema developed after amphotericin b, and the treatment was changed to meglumine antimoniate. Leishmaniasis is a chronic disease caused by flagellate protozoa of the genus Leishmania. especially in endemic countries. CL has become a relatively common condition all over the world due to international travel, migration, and refugees. Cutaneous Leishmania should be considered when there are chronic, painless skin lesions outside of endemic areas.

Quiz questions from pediatric dermatology

Quiz questions from pediatric dermatology

Proposed Response Parameters for Twelve-Month Drug Trial in Juvenile Systemic Sclerosis: Results of the Hamburg International Consensus Meetings.

Juvenile systemic sclerosis (SSc) is an orphan disease, associated with high morbidity and mortality. New treatment strategies are much needed, but clearly defining appropriate outcomes is necessary if successful therapies are to be developed. Our objective here was to propose such outcomes. This proposal is the result of 4 face-to-face consensus meetings with a 27-member multidisciplinary team of pediatric rheumatologists, adult rheumatologists, dermatologists, pediatric cardiologists, pulmonologists, gastroenterologists, a statistician, and patients. Throughout the process, we reviewed the existing adult data in this field, the more limited pediatric literature for juvenile SSc outcomes, and data from 2 juvenile SSc patient cohorts to assist in making informed, data-driven decisions. The use of items for each domain as an outcome measure in an open label 12-month clinical trial of juvenile SSc was voted and agreed upon using a nominal group technique. After voting, the domains agreed on were global disease activity, skin, Raynaud's phenomenon, digital ulcers, musculoskeletal, cardiac, pulmonary, renal, and gastrointestinal involvement, and quality of life. Fourteen outcome measures had 100% agreement, 1 item had 91% agreement, and 1 item had 86% agreement. The domains of biomarkers and growth/development were moved to the research agenda. We reached consensus on multiple domains and items that should be assessed in an open label, 12-month clinical juvenile SSc trial as well as a research agenda for future development.

The distribution of industry payments among pediatric dermatologists from 2015 to 2021.

To understand the landscape of industry payments to pediatric dermatologists to foster transparency and identify potential disparities in funding. Using the Centers for Medicare and Medicaid Services (CMS) Open Payments database, a national cross-sectional study was performed examining payments to pediatric dermatologists from 2015 to 2021. Of the 147 pediatric dermatologists who received industry funding, 35 were male and 112 were female. $9 million in payments was amassed, with 10% of pediatric dermatologists accounting for 94% of total industry payments. Consulting was the most common service, with Pfizer Inc., Amgen Inc., and Regeneron Healthcare Solutions Inc. representing the top three companies. Mean payment was $143,836 for males and $35,943 for females (p < .001). Eight female and seven male pediatric dermatologists received payments in the top 10th percentile, with different average payment in this subgroup (females $447,588 vs. males $698,746, p = .03). 11 states did not have a pediatric dermatologist receiving industry payments, while California (19) and Texas (12) had the most. There are approximately 400 board-certified pediatric dermatologists in the United States and fewer than 40% are receiving monetary compensation from private industry. A fraction of physicians accounted for a majority of total industry payments and industry payments to male pediatric dermatologists were higher despite nearly triple the number of female pediatric dermatologists. With the rise of valuable partnerships between healthcare and industry in modern medicine, the implications of geographic, gender, and financial disparity of industry payments in pediatric dermatology are worthy of further study.

Perceptions of skincare ingredients and product labels in pediatric eczema care.

Educating pediatric eczema patients and caregivers on appropriate product selection and avoidance of common irritants or allergens is a crucial aspect of eczema management. This study surveyed 80 pediatric caregivers in an academic pediatric dermatology clinic to assess influential factors in caregivers' selection of pediatric eczema-care products and identify ways to improve patient counseling on appropriate product selection and avoidance of common irritants or allergens. Caregivers frequently reported positive perceptions of commonly recommended ingredients for eczema but had inconsistent perceptions of fragrant plant oils and extracts, regardless of previous counseling on fragrance avoidance. These findings demonstrate uncertainty and misperceptions perpetuated by product labeling and a need for improved counseling strategies for avoiding fragrance and excessive product costs.

43418 Accuracy of Referral Diagnoses in Pediatric Dermatology

43418 Accuracy of Referral Diagnoses in Pediatric Dermatology

Society for Pediatric Dermatology 48th Annual Meeting Poster Abstracts Presented in Asheville, North Carolina, 13 to 16 July 2023

Society for Pediatric Dermatology 48th Annual Meeting Poster Abstracts Presented in Asheville, North Carolina, 13 to 16 July 2023

Outpatient surgery at the Pediatric Dermatology Unit.

Outpatient surgery at the Pediatric Dermatology Unit.

'Guidelines are not the issue, access to support and advice is the problem': a cross-sectional survey of general practitioners referring to paediatric dermatology.

This study describes the findings from a cross-sectional survey of 206 general practitioners (GPs), investigates the factors affecting the referral process to secondary care and highlights challenges faced. The results showed that most GPs are interested in caring for children with skin diseases locally, given sufficient support and training. However, GPs reported challenges because of limited access to resources and advice, high demand on dermatology services, and the need for better collaboration between generalists and specialists. We suggest sharing knowledge and lessons learned from quality improvement exercises to create a more effective and connected care system.

P04 Biologics combined with conventional systemic agents for the treatment of children with severe psoriasis: practice survey among French and Italian paediatric dermatologists

Abstract Combined therapies involve the use of multiple drugs to increase efficacy and reduce the toxicity of individual treatments. We performed a survey carried out among French and Italian paediatric dermatologists (SFPD, GrPso, SIDerP) to better understand the reasons for using or avoiding these combinations. The survey was completed by 61 paediatric dermatologists (France, 57.4%; Italy, 42.6%; hospital practice, 98.4%; members of societies of paediatric societies and/or psoriasis working groups, 73.8%). Thirty-nine (63.9%) had previously used or planned to use the combined therapies, most commonly TNF-α inhibitors with acitretin or methotrexate. The most common reasons for dermatologists not using combined therapies were a lack of information about the safety (27.3%) or effectiveness (22.7%) of the combinations and the absence of recommendations on how to use combined therapies (22.7%). The main reason for using these treatments was to improve the outcome of biologic therapies in cases of partial efficacy or loss of efficacy. The most frequent clinical situations in which the dermatologists indicated that they combined therapies were to control a loss of efficacy (82.1%) and to treat psoriasis flare-ups (51.3%). Combined therapies have been used by the majority of paediatric dermatologists in the treatment of childhood psoriasis. Absence of information about these combined therapies, and no guidelines about their use are major limits for their use. However, these combined therapies should be considered for the treatment of children with severe psoriasis, psoriatic arthritis and recalcitrant disease. Their use needs to be clarified in future management guidelines.

P12 #corticophobia: a review of misinformation related to topical steroids

Abstract Misinformation in healthcare is now at crisis level worldwide, with the internet as the primary source of prevarication. Topical corticosteroids (TCS) are a safe and effective treatment used in multiple conditions in paediatric dermatology. Nonadherence to prescribed TCS can be due to phobia secondary to misinformation, and poor compliance is a common obstacle to disease control. TCS phobia is a complex, multifaceted phenomenon that exploits children with skin disease and obstructs their path to successful treatment. This study aims to examine the content of TCS-related misinformation available online. A formal review of PubMed was performed in June 2022, using the terms ‘topical corticosteroids’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, along with an informal Google search using combinations of these terms, and further targeted searches on social media applications including Facebook, Twitter, Instagram and TikTok. The main fears expressed by children and parents regarding TCS included potential adverse effects (skin thinning, stunted growth/development). ‘Topical steroid withdrawal’, ‘red skin syndrome’ or ‘TCS addiction’ is a particularly prevalent myth currently being propagated on social media, with most content suggesting that eczema is due to a ‘leaky gut’ and not skin inflammation. Numerous websites promoting misinformation were frequently endorsed by companies advertising ‘natural’ products as treatment alternatives, including ‘herbal’ remedies which can contain significant quantities of corticosteroids or other potent ingredients. The paediatric dermatology community should be vigilant of the type of TCS-related misinformation online, and actively attempt to counteract it with evidence-based advice.

O03 Langerhans cell histiocytosis: case series of presentations to dermatology in the BRAF era

Abstract Langerhans cell histiocytosis (LCH) is a rare disease driven by MAPK pathway mutations. This condition is on a spectrum, from single-system to life-threatening multisystem disease. Identification of the BRAF mutation is leading to improved understanding and targeted therapies. However, there is limited information on genetic status, phenotype and dermatological features. Fourteen patients were seen in the Paediatric Dermatology department in period 2015–2022: 11 males and 3 females; 9 patients had multisystem LCH; 8 patients had cutaneous manifestations of LCH; and 4 had limited cutaneous LCH. Six patients were diagnosed in the department and typically had multiple incorrect diagnoses and treatments prior to review. Clinical features varied from widespread skin involvement, scalp/groin intertrigo, flexural ulcerations and telangiectatic papules. Eight had LCH diagnosed in other tissues by oncology and referral advice on cutaneous symptoms were sought. Most patients have required input from dermatology throughout treatment. Biopsies were taken when unclear diagnosis and/or pathology would influence treatment. Several consultations revealed benign pathologies including keratosis pilaris and dermatitis requiring topical treatment advice only. All five patients with BRAF v600 mutation had multisystem disease including diabetes insipidus, adrenal insufficiency, gut and bone lesions. Two patients with severe LCH and BRAF mutations are being treated successfully with dabrafenib. Our series demonstrates the important role of dermatology in the diagnosis and management of LCH. This series confirms clinical heterogeneity and an association of BRAF V600E mutation with multiorgan disease. Ongoing work should expand our knowledge of the relationship of genetic alterations with clinical phenotypes and comorbidities.