Pediatric Skin Diseases Research Articles

Impact of a Pediatric Dermatology Service on Emergency Department Utilization for Children with Dermatitis.

Atopic dermatitis (AD) is the most common chronic pediatric skin disease, and it can profoundly affect a family's quality of life. Children with flaring AD often seek treatment in emergency departments (EDs), which leads to expensive care and ineffective long-term disease control. The objective of the current study was to determine the effect of a pediatric dermatology service (PDS) on ED use and charges and of disease outcomes for patients diagnosed with AD before and after establishing an intramural PDS. This retrospective study reviewed electronic medical records of patients presenting to an urban children's hospital ED with diagnoses encompassing the terms AD, eczema, dermatitis and International Classification of Diseases, Ninth Revision (ICD-9) codes 691.8 and 692.9 during the year before (pre-PDS period) and 3 years after establishing a PDS. There were 205 ED visits for dermatitis in the pre-PDS period and 130 in the with-PDS period, a 36.6% decrease (p < 0.001). In the pre-PDS period, 53.7% (n = 110/205) of patients presenting to the ED had moderate dermatitis, compared with 26.2% (n = 34/130) in the with-PDS period, a 69.1% decrease (p < 0.001). Total ED charges were $142,885 for the pre-PDS period and $90,610 for the with-PDS period, a $52,275 decrease. This study provides a salient example of achieving the triple aim of health care reform: improving health outcomes (decreased ED visits) improving the patient experience (transitioning care from the ED to the more appropriate ambulatory clinical setting), and decreasing the cost of care (decreased ED charges).

Paraneoplastic Pemphigus: Autoimmune-Cancer Nexus in the Skin.

Paraneoplastic pemphigus (PNP) is a debilitating and lethal adult and pediatric autoimmune blistering skin disease that occurs in the setting of a known or occult neoplasm. It is characterized by painful mucosal erosions that are often resistant to therapy. These clinical characteristics, in addition to positive immunohistochemistry findings make the diagnosis of PNP. The ability to recognize and diagnose PNP has dramatically improved in the last two and half decades. However, the mortality remains 75-90% with a mean survival of less than 1 year. The disease typically progresses from localized skin manifestations to multiple organ failure despite treatment with high dose corticosteroids and immunosuppressives. Because PNP has a low incidence and prevalence, information on treatment and management strategies has depended on a limited number of case reports and case series. The rarity of the disease hampers the ability to conduct large-scale clinical trials as well as investigations into the pathophysiology of PNP. In this article, we review clinical presentation, diagnosis, management, treatment, and pathophysiology of PNP.

Nickel Allergy and Our Children's Health: A Review of Indexed Cases and a View of Future Prevention.

Nickel is the leading cause of allergic contact dermatitis (ACD) from early childhood through adolescence. Studies have shown that skin piercings and other nickel-laden exposures can trigger the onset of nickel ACD in those who are susceptible. Nickel ACD causes a vast amount of cutaneous disease in children. Cases of nickel ACD in children have been reported in peer-reviewed literature from 28 states. Common items that contain inciting nickel include jewelry, coins, zippers, belts, tools, toys, chair studs, cases for cell phones and tablets, and dental appliances. The diagnosis of nickel ACD has been routinely confirmed by patch testing in children older than 6 months suspected of ACD from nickel. Unlike in Europe, there are no mandatory restrictions legislated for nickel exposure in the United States. Denmark has demonstrated that regulation of the nickel content in metals can lower the risk of ACD and the associated health care-related costs that arise from excess nickel exposure. To further awareness, this article reviews the prominent role of nickel in pediatric skin disease in the United States. It discusses the need for a campaign by caretakers to reduce nickel-related morbidity. Lastly, it promotes the model of European legislation as a successful intervention in the prevention of nickel ACD.

Epidemiology of Frequently Occurring Skin Diseases in Italian Children from 2006 to 2012: A Retrospective, Population-Based Study.

Recent estimates indicate an increase in the prevalence of skin diseases in children. Few large epidemiologic studies have examined prevalence trends in Europe. This study evaluated the incidence and prevalence of frequently occurring pediatric skin diseases (PSDs) in Italy as seen by family pediatricians (FPs). Data were retrospectively extracted from the Pedianet database (2006-2012) in children ages 0 to 14 years presenting with a skin disease at their FP. The incidence and prevalence estimates were calculated per year and stratified according to sex, age, and geographic area. A mean of 145,233 children (52.1% male) across five Italian regions were registered with their participating FP for a total of 913,253 person-years of follow-up. The majority of patients were from the northeast (44.6%) and 37.7% were ages 5-9 years. Incidence estimates (new cases/1,000 person-years) for most PSDs increased from 2006 to 2012, the highest being for atopic dermatitis (AD) (14.1 vs 16.5), acute urticaria (10.1 vs 11.6), and contact dermatitis (9.3 vs 10.8), whereas psoriasis remained unchanged over the 7 years (0.61 vs 0.57). In contrast, prevalence estimates (cases/100 patients) increased two to three times for several PSDs, including AD (2.7% vs 8.5%), seborrheic dermatitis (0.5% vs 1.6%), chronic urticaria (0.4% vs 0.8%), and psoriasis (0.09% vs 0.22%). Differences in prevalence according to age range and geographic area were observed for psoriasis, AD, and urticaria. This study provides comprehensive evidence of the increasing prevalence and incidence of PSDs across Italy. Additional causality studies to address this important clinical and psychosocial problem are recommended.

Epidemiología de dermatosis pediátricas en la región centro-occidental de Anatolia en Turquía

The field of pediatric dermatology has gained importance with the increment of pediatric patients and the discrepancy of their skin diseases with the adult versions. We aimed to describe frequency and distribution of pediatric skin diseases, and the diagnostic procedures and treatments prescribed. Cross-sectional epidemiological study. We collected data about diagnostic patterns, diagnostic methods and treatment modalities in pediatric dermatology outpatient clinic visits over 18 months. Infectious diseases (27.9%) and among them viral warts (17.5%) were the most prevalent diagnoses, followed by acne-acneiform diseases (19.9%) and allergic diseases (14.5%). Among the diagnostic tests histopathology was required in 5.2%, usually to diagnose inflammatory and tumoral lesions. Topical treatments (49.3%) were followed by systemic treatments (32.4%) in majority of cases. Viral warts were among the most common dermatoses, and preventive measures for HPV transmission should become important part of public health efforts in children.

Epidemiology of pediatric skin diseases in the mid-western Anatolian region of Turkey.

The field of pediatric dermatology has gained importance with the increment of pediatric patients and the discrepancy of their skin diseases with the adult versions. We aimed to describe frequency and distribution of pediatric skin diseases, and the diagnostic procedures and treatments prescribed. Cross-sectional epidemiological study. We collected data about diagnostic patterns, diagnostic methods and treatment modalities in pediatric dermatology outpatient clinic visits over 18 months. Infectious diseases (27.9%) and among them viral warts (17.5%) were the most prevalent diagnoses, followed by acne-acneiform diseases (19.9%) and allergic diseases (14.5%). Among the diagnostic tests histopathology was required in 5.2%, usually to diagnose inflammatory and tumoral lesions. Topical treatments (49.3%) were followed by systemic treatments (32.4%) in majority of cases. Viral warts were among the most common dermatoses, and preventive measures for HPV transmission should become important part of public health efforts in children.

The prevalence of pediatric skin diseases in Eastern Turkey

The prevalence of pediatric skin diseases in Eastern Turkey

A Comparison of Mental Health Problems among Children with Alopecia Areata or Atopic Dermatitis and Their Parents

Aims: There is an increased interest in the psychosocial impact of pediatric skin diseases on children and their families. The present study tried to examine possible differences regarding mental health problems among children with alopecia areata (AA) or atopic dermatitis (AD), and their parents. Study Design: Cross-sectional study. Place and Duration of Study: Department of Dermatology, “Penteli” Children’s Hospital and Department of Dermatology, Athens University Medical School, “Andreas Syggros” Hospital, Athens, Greece, between February 2004 and February 2009. Methodology: Parents of 51 pediatric outpatients (54.9% boys) with a diagnosis of either AD or AA (mean age = 8.0 ± 1.8 years) and a control group of 12 children and their parents completed the Symptom Checklist-90-R (SCL-90-R) and the Child Behavior Research Article British Journal of Medicine & Medical Research, 3(1): 162-172, 2013 163 Checklist (CBCL). Differences among AA, AD, and the control group were examined. Results: Both AA and AD groups had significantly (P < .001) higher mean values across several CBCL scales compared to healthy controls. However, the controls seemed to exhibit less mental health symptoms than the normative Greek samples, a finding reducing the value of the control group. Children’s Anxious/Depressed, Withdrawn, Somatic complaints and Social problems had significantly higher mean values in the AA group compared to the AD group. Parental mental health symptoms did not differ significantly between the two disease groups, but they were significantly higher in patient groups compared to control group. Conclusion: Children’s and parents’ mental health symptoms may be important targets of thorough assessment and treatment among pediatric AD and AA populations.

Psoriasiform Eruption and Oral Ulcerations as Adverse Effects of Topical 5% Imiquimod Treatment in Children: A Report of Four Cases

Imiquimod 5% cream is a topical immune-response modifier indicated in the treatment of multiple cutaneous conditions including actinic keratoses, superficial basal cell carcinoma, and condylomata acuminata. In children, it has been approved only for ages 12 and older in the treatment of external genital and perianal warts. It has also been used off label for a variety of pediatric skin disorders, including molluscum contagiosum (MC), trichoepitheliomas, verrucae plana, and verrucae vulgaris. Local and systemic adverse reactions have been reported, with the most frequently reported events being application site reactions including itching, burning, erythema, and erosion. Although these local reactions are well known, other rare local and systemic reactions can occur. There have been multiple case reports in adults of rare adverse cutaneous reactions occurring with imiquimod, but few have been reported in children. We present four cases of rare adverse cutaneous reactions. In all cases, the children were being treated with imiquimod 5% cream for verrucae or MC. Two of these patients developed a localized psoriasiform eruption, and two developed mucosal ulcerations.

Comorbid Infections of Pediatric Inflammatory Skin Diseases

Comorbid Infections of Pediatric Inflammatory Skin Diseases

Predictors of clinical success in a multidisciplinary model of atopic dermatitis treatment

Atopic dermatitis (AD) is one of the most common pediatric skin disorders. Because treatment involves allergen avoidance, dietary changes, and behavior modification, multidisciplinary treatment models have been used to complement conventional medication therapy. However, predictors of clinical response in these multidisciplinary models have not been studied. This study examined factors associated with a reduction in AD severity in a multidisciplinary outpatient pediatric AD treatment program providing medical, nutritional, and behavioral support. Data were collected from 170 patients between 2001 and 2006. The Eczema Area and Severity Index (EASI) score was determined at the time of each visit. Using a logistic regression model, we investigated the association of baseline demographic and clinical characteristics with clinical outcome. We also analyzed the association between improvement in the EASI score and behavioral changes. One hundred thirty-eight patients had significantly improved EASI scores, and 32 patients were nonresponders. Responders had a median improvement of 79% in their EASI score, whereas nonresponders had a 53% worsening of their EASI score (p < 0.0001) and a significantly worse absolute EASI score (p < 0.001). Predictors of clinical success included baseline EASI score, baseline age, and improved parental adherence to treatment recommendations. Improvement in the EASI score significantly correlated with quality-of-life measures: decreased itching and scratching, difficulty sleeping, and parental concerns about side effects. A multidisciplinary model of AD treatment has the best clinical outcomes in younger patients with severe AD. Ensuring parental compliance with treatment recommendations is important for clinical response.

Serum levels of heavy metals in childhood eczema and skin diseases: Friends or foes

The incidence of eczema has been increasing in developed countries. Environmental and hygiene factors have been incriminated. Although air and food pollution with heavy metals have been considered as possible culprits, these factors have never been investigated in Hong Kong. To evaluate if quality of life and eczema severity are associated with abnormal serum levels of six common heavy metals, namely, cadmium, lead, mercury, selenium, copper and zinc. Serum or whole blood was taken for measurement of six heavy metals from patients referred to the pediatric dermatology clinic. Eczema severity (SCORAD and NESS) and quality of life (CDLQI) were recorded. A total of 110 patients with eczema and 41 patients with miscellaneous skin conditions were recruited. Serum levels of the six heavy metals were generally within the upper limits of local reference ranges. Zinc levels were below the lower reference limit of 9.4 mum in 66 patients with eczema (60%) and 22 non-eczema patients (53%). Forty-four patients with eczema (40%) and 24 (58%) in non-eczema group had low copper levels. In eczema patients, lead levels were generally within normal limits but their levels were positively correlated with poor quality of life (CDLQI: r = 0.22 and p < 0.05), disease severity (objective SCORAD: r = 0.33 and p < 0.005; NESS: 0.20, p < 0.05), eosinophil count and log-transformed IgE. Copper/zinc ratio also correlated with NESS and CDLQI and was generally higher than non-eczema skin diseases. Our findings help reassure parents that levels of heavy metals generally do not exceed the local reference ranges for toxicity. However, lead levels have significant correlations with disease severity, quality of life and atopy. Low zinc and copper levels are commonly found in pediatric skin diseases and their significance needs to be determined.

Medizinische Informationssysteme im Internet

www.dermis.net was established in 1994 as a dermatological information system with now more than 4,000 pages and over 7,500 dermatological images in an atlas. 1,200 dermatological diagnoses and medical information with 1,100 synonyms can be searched by body location and in alphabetical order. Additionally, there are seven information modules about skin cancer, atopic dermatitis, rosacea, skin care, eczema, fungal diseases and hemorrhoids with links to other medical pages like Cochrane Library. Pediatric skin diseases are covered in PeDOIA. www.dermis.net is meanwhile available in German, English, Spanish, Portuguese, French and Turkish language. Current contents of this information system and user behavior are presented in this paper.

5% 5‐Fluorouracil Cream for Treatment of Verruca Vulgaris in Children

Warts are a common pediatric skin disease. Most treatments show only modest benefit, and some are poorly tolerated because of pain. 5-fluorouracil interferes with deoxyribonucleic acid and ribonucleic acid synthesis, and is used to treat genital warts in adults. Efficacy, safety, and tolerability of topical 5% 5-fluorouracil for treatment of common warts were examined in an open-label pilot study with pediatric patients. Thirty-nine children who have at least two hand warts applied 5% 5-fluorouracil cream (Efudex, Valeant Pharmaceuticals International) once or twice daily, under occlusion for 6 weeks. Assessment of treatment response and side effects was performed at baseline, treatment completion, and 3- and 6-month follow-ups. Hematology measures, liver function tests, and medication blood levels were reassessed at treatment completion. Eighty-eight percent of treated warts improved after 6 weeks of treatment, and 41% of subjects had complete resolution of at least one wart. Treatment response did not differ between once or twice daily applications. Tolerability and patient satisfaction were excellent. No subject had clinically significant blood levels of 5-fluorouracil. At 6 month follow-up, 87% of complete responders had no wart recurrence. Topical 5% 5-fluorouracil is a safe, effective, and well-tolerated treatment for warts in children.

Pediatric Skin Disorders Encountered in a Dermatology Outpatient Clinic in Turkey

This study documents the spectrum and frequency of skin disorders in a total of 2370 children encountered in a dermatology outpatient clinic in Turkey. Infectious skin diseases were most frequently observed (27.6%) followed by, eczemas (17.9%), acne (14,5%), papulosquamous diseases (6.9%), hair diseases (4.1%), pigmentation disorders (3.8%), generalized pruritus (2.8%), urticaria (2.7%), and insect bite (2.3%). Epidemiologic data are useful in planning of the health care and taking preventive measures to decrease the prevalence of skin disorders in children.

Pediatric Skin Diseases Have High Quality of Life Impact

Pediatric Skin Diseases Have High Quality of Life Impact

Pediatric Skin Diseases Strongly Affect Life Quality

Pediatric Skin Diseases Strongly Affect Life Quality

Pulsed Dye Laser Therapy for Pediatric Warts

Viral wart infections constitute one of the most common pediatric skin diseases, and various modalities have been used to manage them. Although pulsed dye laser therapy is known to be a safe and efficacious modality, the reported cure rates for this method have varied, and no studies have reported treatment of pediatric patients alone. This prospective, nonblinded, nonrandomized study was performed to evaluate the efficacy and safety of pulsed dye laser therapy for pediatric warts. We found that this method is safe, relatively effective, and worth considering as an additional therapeutic option for viral warts in children, although not as a first-line therapy.

The outside job: pediatric skin disease resulting from external factors

Correspondence to Albert C. Yan, MD, FAAP, FAAD Institution, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, USA Tel: +001 215 590 2169; e-mail: [email protected]

Phototherapy and Photochemotherapy in Pediatric Patients With Skin Diseases

临床实践证实,光疗及光化学疗法可以治疗儿童银屑病、白癜风、特应性皮炎及副银屑病等疾病,并且疗效肯定.另外,在一些少见皮肤病中也有应用.但是出于对光疗和光化学疗法长期应用的潜在不确切的致癌性的考虑,以及用于儿童治疗时所采用方法的不统一,和儿童依从性差等问题,限制了其在儿童中的应用.为此,介绍光疗及光化学疗法在儿童皮肤病的应用情况及其安全性和治疗特点等。