Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis.

BACKGROUND: Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking. OBJECTIVES: To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases. METHODS: We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure. RESULTS: Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject. CONCLUSIONS: Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.

[Congenital nevi in childhood]. / Kongenitale Nävi im Kindesalter.

Nevi represent congenital hamartomatous malformations of various components of the skin. The most common forms are congenital melanocytic nevi (CMN) and nevi of epithelial origin (epidermal and organoid nevi). Large CMN in particular can lead to severe complications and the management of those affected represents a challenge from birth. In contrast to previous assumptions, the risk of malignancy from CMN is considered to be relatively low however, this may be relevantly increased in certain situations. Possible extracutaneous symptoms in cases of central nervous system (CNS) involvement should not be underestimated and early imaging investigations are part of the routine diagnostic procedure. Surgical measures are still very important in the treatment of CMN but the indications must be weighed up for each individual case. Patients often experience marked stigmatization due to disfigurement by their birthmark and this needs to be taken into consideration for their treatment. The most common epithelial nevi are sebaceous nevi. In 2-13 % of cases additional tumors occur within this nevus and early surgical excision is indicated in most cases, not least for aesthetic reasons. If generalized spreading of epidermal nevi occurs, additional investigations are necessary to exclude associated ophthalmological, cardiac or neurological malformations.