Pediatric periorificial dermatitis: clinical course and treatment outcomes in 222 patients.

BACKGROUND: Periorificial dermatitis (POD) is a rosacea-like papulopustular facial eruption most commonly reported in young adult women. Although POD has been reported in children as young as 6 months of age, there are limited data on the diagnosis and management of POD in pediatric cases. METHODS: All children diagnosed with POD at the Dermatology Clinic at the University of North Carolina at Chapel Hill between June 2002 and March 2014 were included in the current study. Information related to demographics, associated risk factors, treatment prescribed, adverse effects, and response to treatment were obtained from a retrospective analysis of medical records. RESULTS: Of the 222 children identified, 55.4% were female, 62.2% Caucasian, and the average age at presentation to the clinic was 6.6 years. Although the etiology of POD remains uncertain, 29.3% reported a past medical history of atopic dermatitis, 14.9% reported a history of asthma and 58.1% reported a history of steroid use prior to POD onset. Fifty-nine percent were seen at a clinic visit for follow-up at an average of 3.8 months. Treatment often involved combining oral azithromycin with topical metronidazole or sodium sulfacetamide lotion. Of the patients with documented follow-up, 71.8% experienced complete resolution of POD. Recurrence of POD occurred in children dependent on inhaled steroids or nebulizers. Adverse effects were minimally noted, but included pigmentary changes (1.8%), worsening of symptoms (1.8%), gastrointestinal upset (0.9%), irritant dermatitis (0.9%), and xerosis (0.5%). CONCLUSION: This study discusses the clinical diagnosis and management of POD in pediatric cases.

Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms.

CONTEXT: Integrative medicine (IM) is a rapidly growing field whose providers report clinical success in treating significant stress, chronic pain, and depressive and anxiety symptoms. While IM therapies have demonstrated efficacy for numerous medical conditions, IM for psychological symptoms has been slower to gain recognition in the medical community. OBJECTIVE AND DESIGN: This large, cross-sectional study is the first of its kind to document the psychosocial profiles of 4182 patients at 9 IM clinics that form the BraveNet Practice-Based Research Network (PBRN). RESULTS: IM patients reported higher levels of perceived stress, pain, and depressive symptoms, and lower levels of quality of life compared with national norms. Per provider reports, 60% of patients had at least one of the following: stress (9.3%), fatigue (10.2%), anxiety (7.7%), depression (7.2%), and/or sleep disorders (4.8%). Pain, having both physiological and psychological components, was also included and is the most common condition treated at IM clinics. Those with high stress, psychological conditions, and pain were most frequently treated with acupuncture, IM physician consultation, exercise, chiropractic services, diet/nutrition counseling, and massage. CONCLUSION: With baseline information on clinical presentation and service utilization, future PBRN studies can examine promising interventions delivered at the clinic to treat stress and psychological conditions.