Etiology, management, and outcomes of pediatric telogen effluvium: A single-center study in the United States.

BACKGROUND/OBJECTIVES: Telogen effluvium (TE) is a diffuse, rapidly occurring non-scarring alopecia that can be a significant source of distress for patients and caregivers. To date, the disorder has not been extensively studied in a US pediatric patient population. This study aims to characterize the epidemiology, management, and disease course of pediatric TE. METHODS: A retrospective single-center analysis was conducted at the University of Miami including pediatric medical records from 2009 to 2021 with at least one clinic visit coded with the diagnosis of TE. RESULTS: 76 patients presented with a wide range of age at onset and hair loss duration. 67% of patients (n = 51) had an identified trigger, the most common being emotional stress and acute febrile illness, followed by nutritional deficiencies (specifically iron, ferritin, and vitamin D). Observation was the most common therapeutic approach. Of patients who had a follow-up evaluation (39%), different treatments resulted in similar rates of improvement. CONCLUSIONS: The results of this study demonstrate the variability in potential TE triggers, physical exam findings, and management in children, similar to what is currently observed and practiced in adult patients. Appropriate work-up for common triggers should be included during the initial visit. Greater evidence-based treatment approaches are needed for pediatric TE.

Provider perceptions and practices for appearance-related psychosocial distress caused by dermatologic disease in children.

BACKGROUND/OBJECTIVES: Differences in appearance are often stigmatized in society, and dermatologic disease can lead to psychological and social sequelae that significantly impact patient quality of life. However, discrepancy between patient-reported and physician-assessed psychological distress raises a question of how clinicians are prepared in recognizing and managing the psychosocial impact of a child's skin condition. We aim to identify current practices among healthcare providers toward properly addressing appearance-related psychosocial distress in pediatric dermatology patients. METHODS: Surveys assessing provider attitude and practices to appearance-related distress were distributed to members of the Society of Pediatric Dermatology via the Pediatric Dermatology Research Alliance, and Florida Chapter of American Academy of Pediatrics. RESULTS: Over half of respondents report encountering appearance-related psychosocial distress on a daily basis and believe screening to be important. However, only 14% use a validated screening tool and 18% screen all patients. Major obstacles to generalized screening were limited time and staffing. Self-reported knowledge and management of appearance-related psychosocial distress includes direct counseling and referrals to local support groups, mental health providers, specialized summer camps, and school-affiliated resources. Nevertheless, 86% expressed interest in learning more about appearance-related psychosocial distress, particularly about patient education and resources. CONCLUSIONS: Although clinicians frequently encounter appearance-related distress with pediatric dermatology patients, screening is selective and lacks standardization. Self-reported knowledge and management is comprehensive, but there is a need for increased training in patient education and resources.

Acute urticaria preceding other COVID-19-associated manifestations-A case report.

The novel coronavirus SARS-CoV-2 has been associated with a variety of dermatologic manifestations, often the predominant finding in otherwise asymptomatic or oligosymptomatic patients. Urticarial eruption is one example, but few cases have been reported among pediatric patients. We present a case of acute urticaria in a 6-month-old boy preceding other COVID-19 symptoms. The suspicion of a possible COVID-19-associated cutaneous manifestation prompted timely testing and diagnosis of SARS-CoV-2 infection.

Hydrolysed formula, delayed food introduction and fatty acids for atopic dermatitis prevention in infancy.

AIM: The role of nutrition in preventing atopic diseases including atopic dermatitis has recently gained interest in the medical community. Caregivers of infants and children at an increased risk for developing atopic dermatitis often employ exclusion diets or other measures in hopes of preventing the development of this burdensome disease. This paper reviews the current literature in regard to the role of preventative dietary measures in the context of atopic dermatitis, with a special focus on the topics of hydrolysed formula, early vs. delayed introduction of certain foods and fatty acid supplementation. METHODS: Literature pertaining to preventative dietary measures for infants at risk for atopic dermatitis was reviewed. RESULTS: Analysis of the literature suggests that hydrolysed formula should not be routinely offered to infants for prevention of atopic dermatitis. Formulas utilised should contain concentrations of polyunsaturated fatty acids similar to that in breast milk. Finally, infant caregivers should not delay or restrict introduction of food, which can be more harmful than helpful to the patient. CONCLUSION: Recommendations to caretakers providing for infants at risk for atopic dermatitis should include infant consumption of breast milk and avoid delayed introduction of foods.

A pediatric case of squamous cell cancer in situ in the setting of sclerodermatous graft-versus-host disease and voriconazole treatment.

Sclerodermatous graft-versus-host disease is a subtype of cutaneous chronic graft-versus-host disease that is characterized by sclerosis of the skin and subcutaneous tissue, resulting in debilitating contractures, among other life-threatening complications. Children with sclerodermatous graft-versus-host disease are at high risk of developing nonmelanoma skin cancer because of several risk factors, including young age at transplantation, prolonged immunosuppression, and exposure to photosensitizing antimicrobial prophylaxis such as voriconazole. The immunosuppression required to treat sclerodermatous graft-versus-host disease makes effectively treating nonmelanoma skin cancer and sclerodermatous graft-versus-host disease in the same patient challenging. We describe a challenging case of a 6-year-old boy with a history of sclerodermatous graft-versus-host disease and voriconazole exposure presenting with squamous cell carcinoma in situ on the left temple and actinic keratoses on the scalp treated with topical chemotherapy agents.

Beyond Psoriasis: Novel Uses for Biologic Response Modifiers in Pediatric Dermatology.

Dermatologists have witnessed the increasing availability of novel biologic response modifiers for the treatment of inflammatory and autoimmune diseases in recent years. The most common dermatologic indication for the use of biologic response modifiers in adults is psoriasis, but the U.S. Food and Drug Administration has not approved any of these agents for use in any dermatologic disease in children with the exception of omalizumab, and as such, use in this population is considered off-label. In this review, we focus on the use of these agents in children to treat inflammatory skin diseases other than psoriasis, including atopic dermatitis, hidradenitis suppurativa, pemphigus vulgaris, bullous pemphigoid, and toxic epidermal necrolysis, with an emphasis on the use of etanercept, infliximab, rituximab, omalizumab, and ustekinumab. By highlighting novel uses of these agents, particularly for the treatment of dermatologic conditions for which optimal therapies are yet to be established, we hope to raise awareness of the potential use of this class of medications to treat inflammatory skin diseases in children.

Biologic response modifiers and pediatric psoriasis.

The efficacy and safety of biologic response modifiers such as etanercept, adalimumab, infliximab, and ustekinumab have been demonstrated in the treatment of psoriasis in adults, but none are currently approved for the treatment of psoriasis in children in the United States, and only etanercept is approved for the treatment of psoriasis in children in the European Union. Through case reports, case series, and a large clinical trial of the use of etanercept, the literature supports the use of these agents to treat psoriasis in children. Data on the use of the tumor necrosis factor-α antagonists etanercept, adalimumab, and infliximab in the treatment of other inflammatory diseases in children-namely Crohn's disease, juvenile arthritis, and uveitis--support their safety profile in children.