A Retrospective Study on Alopecia Areata in Children: Clinical Characteristics and Treatment Choices.

BACKGROUND: Although children are affected frequently with alopecia areata (AA), data are limited on clinical characteristics and treatment choices. MATERIALS AND METHODS: We retrospectively reviewed the records of the pediatric dermatology department over a 12-year period to identify children with AA. Clinical data were collected. RESULTS: Three hundred and sixty-four children with AA were identified, aged 1-12 years, 214 males and 150 females. The mean age of onset was 6.6 years (±3.3). The disease presented with patches on the scalp in the majority (90.7%), whereas only 6 children had alopecia totalis or universalis. The most commonly prescribed treatment was topical steroids (69.1%), followed by the combination of topical steroids and minoxidil 2% (14.3%). Oral steroids were prescribed in only 16 children. Follow-up at 3 months was available for only 70 children and the majority (84.3%) had some hair regrowth. Hair regrowth was unrelated to the number of plaques (p = 0.257), disease location (p = 0.302), and atopy (p = 0.999). Hair regrowth only correlated with the type of treatment (p = 0.003) with potent topical and intralesional steroids giving the best results. CONCLUSION: AA usually presents with a mild form in children, and potent topical steroids are the mainstay of treatment.

Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers.

BACKGROUND: Nodular melanoma (NM) is more likely to be fatal compared with other melanoma subtypes, an effect attributed to its greater Breslow thickness. METHODS: Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United States, and Australia between 2006 and 2015, were analyzed by multivariable logistic regression analysis, with emphasis on thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival. All statistical tests were two sided. RESULTS: In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included. Compared with T1 SSM, T1 NM was less likely to have regression (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI = 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm2, P < .001). Cox multivariable analysis showed a higher risk for melanoma-specific death for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting for center heterogeneity, the difference was statistically significant only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis). CONCLUSIONS: T1 NM (compared with T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.

Association of Skin Examination Behaviors and Thinner Nodular vs Superficial Spreading Melanoma at Diagnosis.

Importance: Early melanoma detection strategies include skin self-examination (SSE), physician skin examination (PSE), and promotion of patient knowledge about skin cancer. Objective: To investigate the association of SSE, PSE, and patient attitudes with the detection of thinner superficial spreading melanoma (SSM) and nodular melanoma (NM), the latter of which tends to elude early detection. Design, Setting, and Participants: This cross-sectional, questionnaire-based, multicenter study identified patients with newly diagnosed cutaneous melanoma at 4 referral hospital centers in the United States, Greece, and Hungary. Among 920 patients with a primary invasive melanoma, 685 patients with SSM or NM subtype were included. Interventions: A standardized questionnaire was used to record sociodemographic information, SSE and PSE practices, and patient perceptions in the year prior to diagnosis. Main Outcomes and Measures: Data were analyzed according to histologic thickness, with a 2-mm cutoff for thinner SSM and NM. Results: Of 685 participants (mean [SD] age, 55.6 [15.1] years; 318 [46%] female), thinner melanoma was detected in 437 of 538 SSM (81%) and in 40 of 147 NM (27%). Patients who routinely performed SSE were more likely to be diagnosed with thinner SSM (odds ratio [OR], 2.61; 95% CI, 1.14-5.40) but not thinner NM (OR, 2.39; 95% CI, 0.84-6.80). Self-detected clinical warning signs (eg, elevation and onset of pain) were markers of thicker SSM and NM. Whole-body PSE was associated with a 2-fold increase in detection of thinner SSM (OR, 2.25; 95% CI, 1.16-4.35) and thinner NM (OR, 2.67; 95% CI, 1.05-6.82). Patient attitudes and perceptions focusing on increased interest in skin cancer were associated with the detection of thinner NM. Conclusions and Relevance: Our findings underscore the importance of complementary practices by patients and physicians for the early detection of melanoma, including regular whole-body PSE, SSE, and increased patient awareness.

Assessing the associations of daily respiratory symptoms and lung function in schoolchildren using an Air Quality Index for ozone: Results from the RESPOZE panel study in Athens, Greece.

BACKGROUND: Air Quality indicators or indices (AQIs) are mainly used for communicating the air pollution levels and risk to the general population. However, very few epidemiological studies have used AQIs for characterizing exposure. OBJECTIVE: In the framework of the RESPOZE panel study we evaluated the association of daily ozone AQI levels with the daily occurrence of respiratory symptoms and Peak Expiratory Flow (PEF) and compared the effects with those estimated using measurements from fixed outdoor monitoring sites, in the city of Athens, Greece. MATERIALS AND METHODS: A panel of 97 children, aged 10-11years, was followed intensively for 35days (5weeks) during the academic year 2013-14. PEF and symptoms were recorded daily by each child. Two ozone AQIs classifying the air quality into 7 categories of increasing severity, were calculated; one characterizing the whole Athens area and one the local area around the child's residence and school. Measurements from fixed sites were also used. Mixed effects models for repeated measurements were applied, adjusting for several confounders. RESULTS: Increasing ozone levels were associated with increased incidence of symptoms, but the strongest and most statistically significant associations were found with the local air quality characterization with the AQI. Specifically, an increase in AQI-local by one category was associated with 34% (95% CI: 9%, 64%) increased odds of stuffy nose. When the AQI categories were "Bad" and "Severe", an increase in the incidence of cough was observed (OR 3.05 (95% CI: 1.29, 7.22) and 6.42 (95% CI: 1.47, 28.03) respectively). We did not observe a statistically significant association between AQI and PEF. CONCLUSION: Our results show that the use of an AQI based on local conditions may be advantageous over the use of only measurements when investigating the effects of air pollution on health outcomes for improving communication of risk to the public.