RESUMO
BACKGROUND: Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE: The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS: A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS: Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS: These guidelines provide evidence-based recommendations for the management of acne vulgaris.
Assuntos
Acne Vulgar , Antibacterianos , Peróxido de Benzoíla , Fármacos Dermatológicos , Ácidos Dicarboxílicos , Doxiciclina , Isotretinoína , Ácido Salicílico , Espironolactona , Humanos , Acne Vulgar/tratamento farmacológico , Isotretinoína/administração & dosagem , Isotretinoína/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Peróxido de Benzoíla/administração & dosagem , Peróxido de Benzoíla/uso terapêutico , Ácidos Dicarboxílicos/administração & dosagem , Ácidos Dicarboxílicos/uso terapêutico , Espironolactona/administração & dosagem , Espironolactona/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Medicina Baseada em Evidências/normas , Administração Oral , Retinoides/administração & dosagem , Retinoides/uso terapêutico , Tetraciclinas/administração & dosagem , Tetraciclinas/uso terapêutico , Adolescente , Minociclina/administração & dosagem , Minociclina/uso terapêutico , Criança , Administração Cutânea , Anticoncepcionais Orais Combinados/administração & dosagem , Anticoncepcionais Orais Combinados/uso terapêutico , Quimioterapia Combinada , Feminino , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Injeções Intralesionais , Adulto , Cortodoxona/análogos & derivados , PropionatosRESUMO
Many baby cleansers are promoted as hypoallergic products; however, these claims are not typically validated. This study assessed the 50 best-selling baby cleansers from online retailer Amazon for potential allergens. We found that the presence of most marketing claims, including "hypoallergenic" or "allergy-tested," did not correlate with the number of potential allergens in a cleanser. Furthermore, the total number of marketing claims of a cleanser was positively correlated with the number of allergens, highlighting the discordance between marketing claims and allergen content in baby cleansers.
Assuntos
Alérgenos , Humanos , Alérgenos/efeitos adversos , Lactente , Prevalência , Dermatite Alérgica de Contato/etiologia , Detergentes/efeitos adversos , Cuidado do Lactente/métodosRESUMO
are that the contents of this article are their own original unpublished findings. Title: Comparison of potential contact allergens in best-selling adult and baby cleansers Authors: Jayden Galamgam1 MD, Sasan D Noveir2 BA, Carol E Cheng1 MD Affiliations: 1Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA, 2 David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA Corresponding Author: Jayden Galamgam MD, Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, Email: jgalamgam@mednet.ucla.edu.
Assuntos
Alérgenos , Humanos , Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Adulto , Lactente , Detergentes/efeitos adversosRESUMO
BACKGROUND: Dermatologists and other providers play essential roles in managing the dermatologic care of pediatric patients. This study aims to identify patterns and elucidate factors associated with receiving dermatologic care in the United States. METHODS: The National Ambulatory Medical Care Survey (NAMCS) was used to identify pediatric patients with dermatologic diagnoses from 2009 to 2015. Clinical and demographic information were evaluated, and visit diagnoses were stratified based on provider type (dermatologists vs. non-dermatologists). Multivariate logistic regression analysis was used to identify key predictors of outpatient dermatology care for pediatric patients. National estimates of diagnoses were procured using weights provided within the NAMCS database to project disease incidence. RESULTS: A total of 85,217,557 pediatric patients (survey-weighted) were observed during the study period. Of the sampled patients, 29.3% were evaluated by dermatologists, while 70.7% were seen by non-dermatology providers. Atopic dermatitis was the most common diagnosis encountered by dermatologists in ages 0-3 years, while unspecified contact dermatitis was the most common diagnosis reported by non-dermatologists in all age groups. On multivariable logistic regression, ≥1 year of age, Caucasian race, private insurance versus Medicaid, residence in a metropolitan area, referral from another provider, and longer appointment wait time were associated with an increased likelihood of being evaluated by a dermatologist compared to a non-dermatologist. CONCLUSIONS: Non-dermatologists are responsible for the majority of pediatric dermatologic care. For pediatric patients, health disparities by race, insurance status, and rurality present significant challenges to being evaluated by a dermatologist.
Assuntos
Dermatite Atópica , Dermatite de Contato , Dermatologia , Dermatopatias , Humanos , Criança , Estados Unidos/epidemiologia , Assistência Ambulatorial , Pesquisas sobre Atenção à Saúde , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , BrancosRESUMO
Severe mosquito bite allergy (SMBA) is characterized by necrotic skin lesions and systemic symptoms. Chronic active Epstein-Barr virus (EBV) infection, when superimposed with SMBA, is a key driver for catastrophic clinical consequences, such as uncontrolled lymphoproliferation. This interplay is of clinical significance due to its association with hemophagocytic lymphohistiocytosis (HLH) and/or EBV-driven malignancies. Here, we report a case of SMBA that developed in a 14-year-old Hispanic boy that led to fatal secondary HLH.
Assuntos
Infecções por Vírus Epstein-Barr , Hipersensibilidade , Mordeduras e Picadas de Insetos , Linfo-Histiocitose Hemofagocítica , Transtornos Linfoproliferativos , Adolescente , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4 , Humanos , Mordeduras e Picadas de Insetos/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Transtornos Linfoproliferativos/diagnóstico , MasculinoRESUMO
An increased number of melanocytic nevi and lentigines have been reported in patients with two types of autosomal recessive congenital ichthyosis (ARCI): lamellar ichthyosis and nonbullous congenital ichthyosiform erythroderma. These melanocytic lesions may have clinical and dermoscopic features of atypia, necessitating close surveillance. Here, we report two interesting cases of pediatric patients with harlequin ichthyosis (HI) who developed increased melanocytic nevi and lentigines. These cases are unique in that the patients presented at a younger age and one patient had a darker skin phototype than previously described in the literature.
Assuntos
Ictiose Lamelar/complicações , Lentigo/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Ictiose Lamelar/terapia , Lentigo/etiologia , Masculino , Nevo Pigmentado/etiologia , Neoplasias Cutâneas/etiologia , Conduta ExpectanteRESUMO
BACKGROUND: Caregiver-oriented quality of life (QoL) research in alopecia areata is limited. No study has used a parent-tailored survey to examine the relationship between QoL and severity of alopecia as measured by Severity of Alopecia Tool (SALT) scores. OBJECTIVES: This is a prospective study that describes QoL in parents of pediatric patients with all subtypes of alopecia areata and investigates the relationship between QoL and severity of disease, duration of disease, and age of patients. METHODS: Pediatric patients and their parents were invited to participate during clinic visits. Participating parents completed the Quality of Life in a Child's Chronic Disease Questionnaire (QLCCDQ) and the Family Dermatology Life Quality Index (FDLQI). A subset of children completed the Children's Dermatologic Life Quality Index (CDLQI). SALT scores at time of survey completion were recorded. RESULTS: In total, 153 patients were included. Significant mild-to-moderate negative correlations were found between SALT scores and FDLQI scores, QLCCDQ scores, and QLCCDQ emotional domain scores. Age of child correlated negatively with QLCCDQ scores but not FDLQI scores. No significant correlation was found between duration of disease and FDLQI scores, QLCCDQ scores, or QLCCDQ emotional domain scores. LIMITATIONS: This study is limited by its small sample size and cross-sectional design. CONCLUSIONS: Impaired parent QoL might be associated with increasing severity of disease and age of affected child but not duration of disease. Providers should tailor counseling accordingly and help parents set realistic expectations for long-term experience with the disease.
Assuntos
Alopecia em Áreas/psicologia , Alopecia/psicologia , Pais/psicologia , Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Lichen nitidus is a benign inflammatory dermatosis that typically presents in a localized distribution. We present the rare case of a 6-year-old boy with a 1-year history of generalized lichen nitidus with limited access to narrowband ultraviolet B phototherapy. Over the course of a summer, he had complete and lasting resolution of generalized lichen nitidus after daily natural sunlight exposure. This case demonstrates a rare variant of lichen nitidus and a practical treatment alternative to in-office phototherapy.
Assuntos
Helioterapia , Líquen Nítido/terapia , Criança , Humanos , MasculinoRESUMO
BACKGROUND: Pediatric leukemia cutis (LC) is often difficult to diagnose due to similarity in appearance to other dermatologic diseases. Several case reports and smaller case series have been published in the medical literature, but studies on larger cohorts of children with LC are lacking. OBJECTIVE: This study aimed to better characterize the clinical features, course, and prognosis of LC in the pediatric population. METHODS: We performed a retrospective case series of 31 patients diagnosed with LC at Boston Children's Hospital and the Children's Hospital of Philadelphia. RESULTS: The number and morphology of LC lesions varied among patients, with the head and lower extremities being the most common sites of involvement. Leukemia cutis presented concomitantly with systemic leukemia in the majority of cases. Most cases of LC arose during initial leukemia episodes, rather than with relapsed leukemia. Acute myeloid leukemia was the subtype most frequently associated with LC, followed by acute lymphoblastic leukemia. Diagnosis altered treatment timing and therapeutic decisions. CONCLUSION: Children most often present concomitantly with LC and systemic leukemia. Since the morphology and distribution of LC varies, physicians must maintain a high index of suspicion for this diagnosis, as the presence of LC may change the management of systemic leukemia.
Assuntos
Leucemia/patologia , Neoplasias Cutâneas/patologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Leucemia/terapia , Masculino , Estudos Retrospectivos , Neoplasias Cutâneas/terapia , Adulto JovemRESUMO
Orf is a zoonotic parapoxvirus typically transmitted to humans by a bite from goats or sheep. We present an unusual case of multiple orf lesions on the fingers of a 13-month-old child who was bitten by a goat and subsequently developed progressive swelling, blistering, and necrotic papulonodules of the hand followed by an additional diffuse, pruritic, papular rash. A primary diagnosis of orf infection was confirmed using real-time polymerase chain reaction, and the diffuse eruption was clinically consistent with an id reaction. Extensive necrosis and papular id reaction associated with orf rarely have been described.
Assuntos
Dermatite/virologia , Ectima Contagioso/diagnóstico , Animais , Mordeduras e Picadas , Dermatite/tratamento farmacológico , Difenidramina/uso terapêutico , Ectima Contagioso/tratamento farmacológico , Exantema/etiologia , Glucocorticoides/administração & dosagem , Cabras , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Lactente , Masculino , Vírus do Orf , Reação em Cadeia da Polimerase em Tempo Real , Pele/patologia , Pele/virologia , Triancinolona/administração & dosagemAssuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Isotretinoína/administração & dosagem , Administração Oral , Adolescente , Adulto , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Recidiva , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Condylomata acuminata (CA), or anogenital warts, are typically benign lesions caused by human papillomavirus infection. Although they are rare, immunocompromised individuals are at a higher risk of CA undergoing transformation into invasive anal squamous cell carcinoma (SCC). These patients need aggressive evaluation and management. Treatment of CA is challenging, particularly for immunocompromised hosts, in whom warts are resistant to treatment and commonly recur. Currently, there is no gold standard treatment for CA, especially in children and immunodeficient individuals. We report the case of a 15-year-old immunocompromised girl with severe recalcitrant condyloma that resolved after a course of systemic 5-fluorouracil, mitomycin C, and radiation therapy for SCC.
Assuntos
Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Condiloma Acuminado/terapia , Doenças dos Genitais Femininos/terapia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/terapia , Neoplasias Vulvares/terapia , Adolescente , Antimetabólitos Antineoplásicos/uso terapêutico , Antígenos CD4/imunologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Evolução Fatal , Feminino , Fluoruracila/uso terapêutico , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/virologia , Humanos , Hospedeiro Imunocomprometido , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Tomografia por Emissão de Pósitrons , Neoplasias Vulvares/patologia , Neoplasias Vulvares/virologiaAssuntos
Braquiterapia , Doença de Darier/radioterapia , Radioterapia de Intensidade Modulada , Pele/efeitos da radiação , Adulto , Terapia Combinada , Doença de Darier/diagnóstico , Fracionamento da Dose de Radiação , Feminino , Humanos , Indução de Remissão , Pele/patologia , Resultado do TratamentoRESUMO
Acne vulgaris is a common condition affecting adolescents that they often choose to treat on their own rather than seek out and follow medical advice. Using data from an anonymous survey administered to 1,214 students in public middle and high schools in New Jersey, we compared the self-reported acne frequency, severity, and beliefs of students based on their help-seeking behaviors, treatment choices, and treatment adherence. Chi-square analyses were performed for data comparison. A large proportion of students in this sample (57%) treated their own acne, and a much smaller proportion (17%) have sought medical care. Students who saw a health professional reported acne of higher frequency and severity than those who did not (p = 0.01). Severity also appeared to affect treatment adherence, with students who adhered to recommended treatments reporting more frequent (p < 0.001) and more severe (p = 0.02) acne than those who chose to self-treat. Beliefs and knowledge varied most significantly according to treatment adherence. In conclusion, most adolescent students treat their own acne. Self-assessment of acne severity plays a significant role in the tendency to seek out and adhere to medical treatment. Beliefs and knowledge may also affect adherence, suggesting a role for physicians to influence adherence rates through patient education. Because the majority of students are getting information from nonphysician sources, there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information.
Assuntos
Acne Vulgar/tratamento farmacológico , Atitude Frente a Saúde , Fármacos Dermatológicos/uso terapêutico , Autoavaliação (Psicologia) , Acne Vulgar/diagnóstico , Adolescente , Criança , Comportamento de Escolha , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Autorrelato , Índice de Gravidade de Doença , Estudantes/estatística & dados numéricos , Resultado do TratamentoRESUMO
Acne vulgaris is a common condition among adolescents regardless of age, gender, and race. We compare the frequency, severity, help-seeking behavior, treatment, and beliefs about acne among students based on race, ethnicity, gender, and age. Anonymous surveys were administered to 1,214 students aged 10-19 years of varied gender, race, and ethnicity in public middle and high schools in New Jersey. Results showed the frequency and severity of acne were high (76% and 65%, respectively) and more prevalent in white compared to non-white respondents (RR = 1.13, 95% CI = 1.04-1.24 and RR = 1.22, 95% CI = 1.09-1.37, respectively), and also in older compared to younger ages (RR = 1.24, 95% CI = 1.17-1.32 and RR = 1.43, 95% CI = 1.32-1.55, respectively). The majority of respondents (83%) reported never having seen a physician for their acne; however, those reporting acne of some severity were more likely to have seen a physician compared with those who did not report acne (21% vs. 8%, p < 0.001). Blacks who reported mild or moderate severity of acne were more likely to have seen a health professional compared to white respondents with same the acne severity (RR = 3.63, 95% CI = 2.06-6.37 and RR = 3.06, 95% CI = 2.02-4.65, respectively). Conversely, Hispanic respondents with mild or moderate acne were less likely to have seen a health professional compared to whites with the same acne severity (RR = 0.56, 95% CI = 0.35-0.89 and RR = 0.47, 95% CI = 0.26-0.86, respectively). Beliefs about external factors affecting acne also varied by race and ethnicity. In conclusion, the severity, frequency, and beliefs about acne all play a role in help-seeking behaviors, which vary to a significant extent by race and ethnicity.