Skin Diseases In Children Research Articles

Sistem Pakar Diagnosis Penyakit Kulit Pada Anak Menggunakan Metode Certainty Factor

Technological advances in the modern era have facilitated various aspects of life, including health. Puskesmas Tanjung Ria in Jayapura, Papua, Indonesia, serves about 100 patients daily from 07:30 to 14:30. One of its main services is the diagnosis of skin diseases in children, which can be caused by genetic factors, environment, stress and parasitic infections. Research shows that there are about 20 to 30 pediatric patients with skin diseases every week. Often the treatment of skin diseases is delayed due to public understanding at the Tanjung Ria Health Center, diagnosis is carried out by a team consisting of 1 doctor and 1 assistant with a symptom-based approach. However, the main obstacles are hectic work schedules and limited resources. Available pediatricians may not have enough experience in dermatology, which can lead to suboptimal treatment. To reduce uncertainty in medical diagnosis and improve the diagnosis of skin diseases in children, the Certainty Factor (CF) method is applied in the expert system. This study proposes the development of a web-based system that uses certainty factor methods for early symptoms of skin diseases in children, in order to prevent delays in treatment. System development uses the waterfall method, which includes needs analysis, design, coding and testing with the blackbox method.

Assessment of serum levels of ischemia modified albumin and interleukin-17 in children with atopic dermatitis.

Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin disease in childhood. Interleukin 17 (IL17) is one of the pro-inflammatory cytokines that has an important role in the pathogenesis of many skin diseases including AD. Ischemia modified albumin (IMA) is an indicator of oxidative stress, inflammation and ischemia. The aim of the study was to assess the IL-17 and IMA serum levels in the children patients with AD in comparison to a control group. Additionally, the study seeks to examine the correlation between these biomarkers and their association with disease severity, disease stages, and other clinical characteristics. The case-control study enrolled two groups: (patient group: 50 children with AD) and (control group: 50 healthy age and sex-matched children). Full history was taken from all cases along with full dermatologic examination. The assessment of AD severity was conducted by using Eczema Area and Severity Index (EASI). Evaluation of IL-17 and IMA was performed by using ELISA technique. There was a statistically significant elevation in the mean levels of IL-17 and IMA in patients with AD compared to the control group. A strong positive correlation was observed between IL-17 and IMA levels. Additionally, both IL-17 and IMA levels exhibited a statistically significant negative correlation with the duration of the disease and the age of the patients. The elevated serum levels of IL17 and IMA and their positive correlation confirm that AD is a systemic inflammatory disease influenced and associated with increased oxidative stress.

New Opportunities of Dupilumab in Achieving Disease Control in Preschool Age Patients with Atopic Dermatitis: Clinical Case

Background. Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases in children. It manifests during the first year of life in majority of cases. Early AD manifestation is a risk factor for the development of other atopic spectrum diseases in the future. Nowadays, the ability of the dupilumab, as a genetically engineered biologic drug (GEBD), to modify the disease course, to reduce the frequency of AD persistence and the possibility of multimorbid atopic phenotype development is widely discussed. Thus, dupilumab management in young children with early onset and severe course arouses specific interest. Clinical case description. This article demonstrates the experience of effective administration of GEBD dupilumab in 4-year old patient with severe AD and comorbid food allergies. Continuous therapy for 12 weeks allowed to recover disease’s skin manifestations. No adverse events were reported. Conclusion. Long-term continuous dupilumab administration in children aged from 6 months to 5 years has proven its efficacy and acceptable safety profile. The potential disease-modifying effect of dupilumab is especially significant for young and preschool children due to the high risk atopic multimorbidity developing during this period.

Qualitative study with mothers of children with atopic dermatitis: emotional and social impacts.

Atopic Dermatitis (AD) is the most common skin disease in childhood and its control requires the support of the family members. This disease significantly interferes with the Quality of Life (QoL) of children and families, however, literature on the social and emotional impact of the disease on the caregivers is lacking. To evaluate the emotional and social impact of AD on mothers of children with the disease. This is a qualitative study of semi-structured interviews with mothers of children diagnosed with AD. The following variables were evaluated: diagnosis and start of treatment, knowledge about the disease, and impact on the mothers' lives. The material was analyzed using Lawrence Bardin's content analysis technique. The AD severity was assessed by SCORAD. A total of 23 interviews were conducted with mothers of children diagnosed with AD. In 82.6% of the cases, the mothers presented conflicts in the face of the first contacts with the disease. In 43.5% of cases, mothers were solely responsible for their children's treatment. About 56.6% defined AD as a cause of suffering and difficulty and 21.7% pointed out the AD experience as a learning experience. The AD is a chronic disease that has a psychological and social impact on the lives of mothers. In the treatment of AD, mothers must be screened and offered psychological support to improve adherence to treatment in the long term.

Global, Regional and National Burden of Paediatric Atopic Dermatitis: A Trend and Geographic Inequalities Analysis.

Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors. Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age-standardised prevalence and age-standardised incidence. For potential associated factors, correlations of above trends and indexes of socio-economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population-level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change. Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age-standardised prevalence and incidence decreased by -0.17% (-0.19% to -0.16%) and -0.12% (-0.13% to -0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age-standardised prevalence and incidence was in high SDI regions (by -0.20% and -0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population-level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels. Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region-specific strategies targeting potential factors is essential to reduce paediatric AD burden.

Clinical and socioeconomic pattern of infective dermatoses in pediatric population at a tertiary care center of Northeast India

Background: Cutaneous disorders are one of the most important components of any health-care system, especially which including children. Infective dermatoses are the most common skin diseases in children. The pattern of dermatoses in children varies from one country to another and within the same country from one state to another due to various climatic, cultural, and socioeconomic factors. Aims and Objectives: The aims and objectives are to study the clinical and socioeconomic profile of cutaneous infections and infestations among children. Materials and Methods: All children up to 12 years presenting with cutaneous infections and infestations were taken as study participants. A detailed history of the disease, socioeconomic status, and housing condition was taken from the patients as well as from the parents. Local, general, and systemic examinations were carried out on all the children and their examination findings were recorded in a standard pro forma for analysis and interpretation of data. Results: A total number of 1932 were children aged 0–12 years patients attended the Dermatology Outpatient Department during the study period of which 665 (34%) presented with infective dermatoses. 61.20% of patients belonged to school-aged children (5–12 years) 76.7% had a family with 4–6 members. 67.67% were from the rural areas, and 77.4% belonged to the lower class. Scabies was the leading offender (29.92%) among infective dermatoses followed by Impetigo contagiosa (20.45%). Conclusion: There is an increased incidence of cutaneous infections and infestations with increasing age among children. The incidence is associated with housing conditions, family size, socioeconomic strata, and seasonal. Most of these conditions are common and controllable with easy preventive and curative measures.

Profile of Micronutrients in Patients Presenting with Pityriasis Alba in a Tertiary Care Center: A Case–control Study

Abstract Background: Pityriasis alba (PA) is a common, self-limiting skin disease of childhood. Several micronutrient deficiencies have been attributed to causing PA. Few studies have found a decreased level of serum zinc to be associated with PA, whereas other studies have found a deficiency of serum copper, magnesium, ferritin, and Vitamin D3 to be associated with PA. Aims and Objectives: The objective of the study was to estimate the serum levels of micronutrients (zinc, copper, magnesium, and ferritin), hemoglobin (Hb), serum albumin, and Vitamin D3 in patients of PA and compare the same with that of controls. Materials and Methods: A total of 36 patients with PA and 36 controls were enrolled in the study. Five milliliters of venous blood will be obtained from both cases and controls to conduct the investigations. The serum levels of zinc, ferritin, magnesium, copper, Vitamin D3, hemoglobin, and serum albumin levels were detected. The data were analyzed statistically. Results: In this study, we observed a low serum level of zinc associated with PA patients, when compared to healthy controls with P &lt; 0.042. The serum levels of magnesium in cases were significantly low compared to controls with P &lt; 0.002, which was statistically significant. Vitamin D and Hb levels were also significantly reduced in the PA patients. However, we did not find statistical significance between serum levels of copper, albumin, and ferritin in cases and controls with P = 0.408, P = 0.055, and P = 0.082, respectively. Conclusion: PA is a multifactorial etiological condition, in which micronutrient deficiency is an important cause and supplementation of micronutrients among these patients may be beneficial.

Triggered Skin Sensitivity: Understanding Contact Dermatitis.

Dermatitis, the incendiary reaction of the skin to various components, can manifest invarioustypes, including atopic dermatitis, contact dermatitis, nummular eczema, seborrhoea, and stasis dermatitis. Atopic dermatitis is the most common skin disease in children and has a growing prevalence in recent years.It is characterized by extreme tingling, eczemous skin injuries, dryness of the skin, and a family history of atopic illnesses.Contact dermatitis (CD) is a common, irritating skin disorder caused by allergens and aggravating elements in the environment. It is the most common cause of work-related dermatitis and plays a substantial role in hand and face dermatitis. A completerestorativehistory is essential for establishing CD and identifying the allergies that cause it. Fix testing, skin tests for fast contact reactions, serum allergen-specific IgE testing, subjective and quantitative evaluation of allergens inside probable items patientswere exposedto, and challenge testing are among the other diagnostic techniques. To avoid a breakdown and the continuation of the skin illness, early and suitable therapy is critical. Allergic dermatitis to contact (ACD) develops during thenormal, delayed incendiary reaction and has a perplexing etiology. Accurate identification of the allergenthat iscausing the reaction allows for adequate individual avoidance. Themajortreatment alternatives continue to be corticosteroids. Nickel-contact dermatitis is an allergic reaction that affects both children and adults. Adverse contact dermatitis (ACD) is a frequent skin reaction to a common allergen that can affectbothchildren and adults. Less than 10% of all diagnostic procedures in pediatric patients involve checking for ACD symptoms.To answer the clinical question,a thorough history is gathered based on appearance, age group, and dermatitis type.According to pediatricians in the US, metals, perfumes, topical antimicrobials, excessive chemicals, and fabric softeners are the most typical allergens.

Stigmatization and Mental Health Impact of Chronic Pediatric Skin Disorders

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. 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. 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. 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). 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. 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.

Pattern of Skin Diseases in Children Attending the Dermatology Clinic in Al-Gamhoria Teaching Hospital, Aden, Southern Yemen

Background: Skin diseases constitute a major health problem affecting a large proportion of the population including children causing distress and disability. This study aimed to determine the pattern and frequency of skin diseases. Methods: A retrospective hospital-based, cross-sectional study of all children up to 14 years old who attending dermatology clinic of Al-Gamhoria teaching hospital, Aden Yemen from January to December 2022. Results: Out of 3,184 patients, pediatric patients constituted 191 (6%),56.5% were boys and 43.5 were girls. Maximum number of patients were in the age group of &gt;1-5 years. Majority of dermatoses belonged to infections (45.1%), followed by eczema (20.9%) Bacterial infections (19.9 %) were the most common infections followed by fungal (17.3%), viral (7.9 %) and infestation constituted (13.1%). The majority of patients had one disease, (95.3%) while the rest had two diseases (4.7%). Conclusions: in the present study, infections and eczema were the most common dermatological conditions. This study provides insight about the pattern of various dermatoses among children in urban setting. Keywords: Pattern, skin disorders, children, hospital –based

Clinical Features of Paediatric Inflammatory Epidermolysis Bullosa Acquisita: A Case Series Study.

Epidermolysis bullosa acquisita (EBA) rarely develops in childhood. This study retrospectively recruited paediatric patients with EBA (age ≤ 16 years), diagnosed by clinical and histopathological features and results of immunofluorescence, immunoblotting and enzyme-linked immunosorbent assay (ELISA), and reviews their clinical manifestations, histopathology, immunological features, and responses to various treatments. All 7 included patients presented with inflammatory EBA. Among them, 3 had a bullous pemphigoid-like phenotype. Pathologically, in addition to dermal-epidermal blistering, in all patients, the distribution of neutrophils was superficial perivascular or interstitial, or in the dermal papilla. Mixed neutrophils and eosinophils were detected in 2 of the 3 patients with bullous pemphigoid-like phenotypes. In addition to treatment with glucocorticoids, dapsone was administered in 4 patients, while thalidomide and sulfasalazine were administered in 1 patient. All patients responded to the these therapies. Relapse was mainly due to reduction and cessation of glucocorticoids. In conclusion, EBA in childhood may be unique, and thus distinct from its adult counterpart. Specific treatment and follow-up protocols are required for therapy of this rare autoimmune skin disease in children.

Abrocitinib, tralokinumab and upadacitinib for treating moderate-to-severe atopic dermatitis.

Atopic dermatitis is a chronic relapsing inflammatory skin condition. One of the most common skin disorders in children, atopic dermatitis typically manifests before the age of 5 years, but it can develop at any age. Atopic dermatitis is characterised by dry, inflamed skin accompanied by intense itchiness (pruritus). To appraise the clinical and cost effectiveness of abrocitinib, tralokinumab and upadacitinib within their marketing authorisations as alternative therapies for treating moderate-to-severe atopic dermatitis compared to systemic immunosuppressants (first-line ciclosporin A or second-line dupilumab and baricitinib). Studies were identified from an existing systematic review (search date 2019) and update searches of electronic databases (MEDLINE, EMBASE, CENTRAL) to November 2021, from bibliographies of retrieved studies, clinical trial registers and evidence provided by the sponsoring companies of the treatments under review. A systematic review of the clinical effectiveness literature was carried out and a network meta-analysis undertaken for adults and adolescents at different steps of the treatment pathway. The primary outcome of interest was a combined response of Eczema Area and Severity Index 50 + Dermatology Life Quality Index ≥ 4; where this was consistently unavailable for a step in the pathway, an analysis of Eczema Area and Severity Index 75 was conducted. A de novo economic model was developed to assess cost effectiveness from the perspective of the National Health Service in England. The model structure was informed through systematic review of the economic literature and by consulting clinical experts. Effectiveness data were obtained from the network meta-analysis. Costs and utilities were obtained from the evidence provided by sponsoring companies and standard UK sources. Network meta-analyses indicate that abrocitinib 200 mg and upadacitinib 30 mg may be more effective, and tralokinumab may be less effective than dupilumab and baricitinib as second-line systemic therapies. Abrocitinib 100 mg and upadacitinib 15 mg have a more similar effectiveness to dupilumab. Upadacitinib 30 and 15 mg are likely to be more effective than ciclosporin A as a first-line therapy. Upadacitinib 15 mg, abrocitinib 200 and 100 mg may be more effective than dupilumab in adolescents. The cost effectiveness of abrocitinib and upadacitinib for both doses is dependent on the subgroup of interest. Tralokinumab can be considered cost-effective as a second-line systemic therapy owing to greater cost savings per quality-adjusted life-year lost. The primary strength of the analysis of the three new drugs compared with current practice for each of the subpopulations is the consistent approach to the assessment of clinical and cost effectiveness. However, the conclusions are limited by the high uncertainty around the clinical effectiveness and lack of data for the primary outcome for comparisons with baricitinib and for the adolescent and adult first-line populations. The most significant limitation that Eczema Area and Severity Index 50 + Dermatology Life Quality Index ≥ 4 could not be obtained for the adolescent and adult first-line systemic treatment populations is due to a paucity of data for dupilumab and ciclosporin A. A comparison of the new drugs against one another in addition to current practice would be beneficial to provide a robust view on which treatments are the most cost-effective. This study is registered as PROSPERO CRD42021266219. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: 135138) and is published in full in Health Technology Assessment; Vol. 28, No. 4. See the NIHR Funding and Awards website for further award information.

Risk factors of food sensitization in young children with atopic dermatitis.

Atopic dermatitis (AD) is a common chronic and relapsing skin disease in children and food allergies have been well documented in one-third of children. However, there are limit data about the risk factors of food sensitization in children with AD. The aim of this study was to evaluate the risk factors associated with food sensitization, among AD children. A cross-sectional study, from the electronic medical records of 119 AD patients, aged from 2 to 5 years were reviewed. The demographic data, onset and severity of AD, family history of atopy, age of first antibiotic usage, age of first applying and frequency of moisturizer used, age of introduction to allergenic foods and food specific IgE levels were recorded. The prevalence of food sensitization was; 60%. The most common food allergens were egg white (56.8%), cow's milk (40%) and wheat (34.7%). The significant factors associated with overall food sensitization were; history of parent-reported food allergies (OR = 4.4, P = 0.001), severe AD (OR = 4.5, P = 0.03) and breast feeding > 6 months (OR = 3.5, P = 0.002). Factors associated with egg white allergies were the history of parent-reported food allergies (OR = 3.8, P = 0.02), and severe AD (OR = 4.2, P = 0.04). There were also significant factors associated with cow's milk allergies this being; severe AD (OR = 6, P = 0.03) and a maternal history of asthma (OR = 10.9, P = 0.01). Severe AD was a factor associated with all food sensitization, egg allergy and cow's milk allergy. Maternal asthma was also significantly associated with cow's milk allergy.

Profil Penyakit Kulit pada Pasien Anak yang Berobat di Poliklinik Kulit dan Kelamin RSUD Provinsi Nusa Tenggara Barat Periode Januari 2020–Juni 2023

Skin diseases can affect all ages, children are no exception. Skin diseases in children can cause considerable discomfort, parental anxiety, and embarrassment in children and impact on absenteeism rates in school-age children. The purpose of this study was to determine the statistical epidemiology of pediatric skin diseases so that they could provide information regarding the prevalence of the disease so that it could be a way to evaluate the causes of skin diseases to help prevent and treat skin diseases. This study using descriptive retrospective method from secondary data from medical records of children aged 0 to 18 years undergoing treatment at the Dermatology and Venereology Polyclinic at Nusa Tengara Barat Province Hospital in the period January 2020 - June 2023. Then processed with software for presentation in tabular form. During this period, there were 475 pediatric patients with 448 new patients and 27 old patients. Generally men numbered 282 (59.4%). The most common categories of skin diseases in children were infectious diseases with 288 cases (60.6%), dermato-allergo-immunology with 89 cases (18.7%) and non-infectious diseases with 59 cases (12.5%). Most skin diseases are caused by infections, mainly parasitic infestations (mostly scabies), fungal infections (mostly pityriasis versicolor) and followed by bacterial infections (mostly impetigo crustosa).

Erythropoietic protoporphyria: case reports for clinical and therapeutic hints

BackgroundErythropoietic protoporphyria is a rare disorder which represents an important health problem in children, causing painful photosensitivity. Little is known on the correlation between genetic profile and clinical manifestations. The standard of care for Erythropoietic protoporphyria is based on avoiding sun and using sun protections, but recent literature has suggested that cimetidine may have a role in improving sun sensitivity. Herein we report our case series describing the successful use of cimetidine and analyzing potential phenotype-genotype correlations.Case presentationThis case series describes five patients presented to our Rheumatology Service complaining sun sensitivity. Blood exams and genetic analysis were consistent with the diagnosis of erythropoietic protoporphyria. Four of 5 patients received cimetidine in addition to standard therapies and the effect of treatment was evaluated by Erythropoietic Protoporphyria - Quality of Life questionnaire.ConclusionsErythropoietic protoporphyria usually manifests in early childhood after a short sun exposure. Skin manifestations are the main reason for investigations, although sometimes they can be more subtle, leading to a significant diagnostic delay. Skin diseases in children can have profound effects on their family and social relationships. A treatment with cimetidine appears to be an excellent therapeutic option in children with Erythropoietic protoporphyria.

Views about the nature of skin diseases in children and their treatment in Russian folk medicine

Views about the nature of skin diseases in children and their treatment in Russian folk medicine

Urticaria in childhood—what’s new?

AbstractUrticaria can manifest at any age, including infants and young children. Urticaria is one of the most prevalent skin diseases in childhood. As in adults, a distinction is made between acute and chronic urticaria, with chronic urticaria further classified into chronic spontaneous urticaria and inducible urticaria. According to the current German S3 guideline for classification, diagnosis, and treatment of urticaria, existing literature suggests that the prevalence, disease characteristics, causes, and also the response to treatment are very similar in children and adults. The clinical hallmark of urticaria is the subjective sensation of itch. In young children who may have difficulty expressing itching, it is crucial to observe their scratching behavior during clinical examinations. Particularly in children, mastocytosis and autoinflammatory syndromes (cryopyrin-associated periodic syndromes [CAPS], especially Muckle–Wells syndrome and childhood Still’s disease) are important differential diagnoses. Autoinflammatory syndromes are characterized by additional symptoms such as fever, bone pain, muscle pain, and joint complaints. Cryopyrin-associated periodic syndromes usually manifest in infancy, so that these diseases must be considered, especially if cold-associated urticarial skin lesions are present. Appropriate and early treatment can prevent serious sequelae. In maculopapular mastocytosis (urticaria pigmentosa), reddish macules are characteristic for the disease; especially after elicitation of the Darier’s sign, differentiation from urticaria can be difficult, but the macules are permanent. Clinically, wheals and/or angioedema are found similarly to adults, indicating that mast cell-induced angioedema is also associated with childhood urticaria. In the case of exclusive angioedema, hereditary angioedema must also be considered, which usually manifests for the first time during puberty, often linked to hormone preparation usage.

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.

Maternal nutritional factors and environmental exposure in early life and childhood atopic dermatitis

Atopic dermatitis(AD)is a chronic, recurrent, inflammatory skin disease in children. The disease is characterized by dryness, chronic eczema-like lesions and obvious itching, seriously affecting the quality of life of children and their families. The pathogenesis of AD is not yet to be clear, and it might be the interaction of genetic susceptibility and environmental exposure to induce skin barrier impairment and immune system dysfunction. In recent years, the role of maternal factors or intrauterine environment exposure on childhood allergic diseases has been attracted attention, and the hypothesis that allergic diseases originate from the fetal period has been postulated. Maternal exposures called "early life exposure", such as nutritional factors during pregnancy (folate, vitamin D, vitamin E and polyunsaturated fatty acid) and tobacco exposure, home environmental exposure may be related with childhood atopic dermatitis. This article would focus on the recent research about maternal nutritional factors and family environmental exposure during pregnancy on offspring's atopic dermatitis.

Efficacy of probiotics in pediatric atopic dermatitis: Asystematic review and meta-analysis.

Atopic dermatitis (AD) is a prevailing skin disease in childhood. Several studies have appraised probiotics as a strategy for treating AD. We aimed to assess the validity of probiotics in the treatment of AD in children. We systematically searched the PubMed/MEDLINE, Embase, Scopus, EBSCO, Web of Science and Cochrane library databases for randomized controlled trials (RCTs) that assessed the effect of probiotic treatment on SCORAD value in pediatric patients with AD compared with a placebo group between 1 January 2010 and 1 January 2023. The risk of bias and the certainty of evidence were assessed using Cochrane ROB 2.0. A total of 10 outcomes from 9 RCTs involving 1000 patients were included. Three of these outcomes were analyzed as dichotomous variables in 373 patients. The other seven were analyzed for continuous variables in 627 patients. A meta-analysis of the random-effect model of the dichotomous variables demonstrated no significant difference between the probiotic and control groups [OR=1.75, 95% confidence interval (CI) (0.70, 4.35), p=0.23, I2 =68%]. A meta-analysis of the random-effect model of continuous variables demonstrated significant differences between the probiotic and control groups [MD=-4.24, 95% CI (-7.78, -0.71), p=0.002, I2 =71%]. Subgroup analysis of continuous variables showed that the effects of children's age, treatment duration and probiotic species on the SCORAD value were not statistically significant. Evidence on the improvement effect of probiotics on pediatric patients with AD is limited. This study showed that single-strain probiotic treatment exerts a positive effect on AD. Restricted to the quantity and quality of incorporated studies, these conclusions have yet to be validated by high-quality studies.