Characteristics and complications of anogenital infantile hemangiomas: A multicenter retrospective analysis.

BACKGROUND: Infantile hemangiomas (IHs) of the anogenital region remain poorly characterized. OBJECTIVE: To examine the distribution, ulceration rate, and associated congenital anomalies of anogenital IHs. METHODS: Retrospective study at 8 tertiary referral centers. RESULTS: A total of 435 infants with an IH of the anogenital region were enrolled (of which, 319 [73%] were girls). Congenital anomalies were present in 6.4% (n = 28) of infants with an anogenital IH. Segmental or partial segmental anogenital IHs ulcerated in 72% (n = 99 of 138) of infants, whereas 45% (n = 133 of 297) of focal anogenital IHs experienced ulceration (P < .001). In a multivariable logistic regression analysis, segmental or partial segmental morphology (adjusted odds ratio [aOR], 2.70; 95% CI, 1.60-4.64), mixed type (aOR, 3.44; 95% CI, 2.01-6.07), and perianal (aOR, 3.01; 95% CI, 1.53-6.12) and buttocks location (aOR, 2.08; 95% CI, 1.17-3.76) had increased odds of ulceration. Segmental or partial segmental IHs of the genitalia were confined to distinct anatomic territories and were predominantly distributed unilaterally, with a linear demarcation at the perineal raphe. LIMITATIONS: Possible selection bias, given recruitment at tertiary referral centers. CONCLUSION: This study improves our understanding of high-risk features of anogenital IHs and demonstrates that genital segmental or partial segmental IHs develop within distinct anatomic territories.

Hidradenitis Suppurativa in the Pediatric Population: An International, Multicenter, Retrospective, Cross-sectional Study of 481 Pediatric Patients.

Importance: Hidradenitis suppurativa (HS) in pediatric patients has been understudied. Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition. Objective: To describe the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with HS. Design, Setting, and Participants: International, multicenter, retrospective medical record review of pediatric patients (aged 1-18 years) with a clinical diagnosis of HS carried out in 10 dermatology clinics across the US, Canada, Israel, Australia, and Italy from January 1996 to January 2017. Main Outcomes and Measures: Patient demographics, clinical features, severity, associated comorbidities, and treatments in pediatric patients with HS. Results: This cross-sectional study included 481 patients diagnosed with HS. Overall, 386 (80%) were girls. The mean (SD) age of disease onset was 12.5 (2.9) years, and the mean (SD) age at diagnosis was 14.4 (3.5) years. Family history of HS was present in 111 of 271 (41%) patients. First signs/symptoms reported at disease onset were cyst/abscess in 229 of 481 (48%), pain/tenderness in 118 of 481 (25%), and papules/pustules in 117 of 481 (24%). At initial dermatologic assessment, 233 of 481 (48%) patients already had evidence of skin scarring. Disease severity (Hurley staging) was documented in 288 of 481 (60%) patients (47% stage 1, 45% stage 2 and 8% stage 3). Comorbid conditions were reported in 406 of 481 (85%) patients, the most common being obesity (263/406 [65%]) and acne vulgaris (118/406 [29%]). Complications occurred in 378 of 481 (79%) patients, the most common of which were scars or contractures (301/378 [80%]). Conclusions and Relevance: The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS. Pediatric patients with HS are likely to present with other comorbidities. Prospective observational and interventional studies are needed to better understand clinical course and optimal treatments for pediatric HS.

The Risk of Anal Carcinoma After Anogenital Warts in Adults Living With HIV.

Importance: In the US, incidence of and mortality due to anal carcinoma are rising faster than for most other cancers. Identifying populations who have a higher risk of developing anal cancers is critical to target preventive interventions. Objective: To assess the risk of developing anal carcinoma in adults living with HIV who have a history of anogenital warts. Design, Setting, and Participants: This longitudinal cohort study included adults living with HIV from 14 clinics in Washington, DC, and at least 18 months of follow-up. Data were collected from January 1, 2011, to March 31, 2017, and analyzed from June 1, 2019, to October 31, 2020. Exposures: Development of warts in the anal or genital region identified by diagnosis codes. Main Outcomes and Measures: Individuals with anal carcinoma were identified by diagnosis codes or anal biopsy results. Results: A total of 6515 participants were enrolled (4720 male [72.4%] at birth; mean [SD] age, 49.9 [12.7] years), and 383 (5.9%) developed anogenital warts during the study period. Patients who were diagnosed with anogenital warts were more likely to subsequently develop anal carcinoma (17 of 383 [4.4%]) compared with participants without a history of anogenital warts (17 of 6132 [0.3%]) (P < .001). After adjusting for covariates, the odds of developing anal carcinoma were 12.79 (95% CI, 6.19-26.45; P < .001) times higher in individuals with a history of anogenital warts compared with individuals without a history of anogenital warts. Conclusions and Relevance: These findings suggest that adults living with HIV who have a history of anogenital warts have a substantially increased risk of developing anal carcinoma. Clinicians should counsel individuals living with HIV who have anogenital warts on this risk.

The national burden of inpatient dermatology in adults.

BACKGROUND: Management of inpatient skin disease represents a unique subspecialty within dermatology. OBJECTIVE: To assess the national burden of inpatient dermatology in adults. METHODS: Using the 2014 National Inpatient Sample, we performed a retrospective cohort study of adults hospitalized for dermatologic conditions. RESULTS: In 2014, there were 644,320 weighted hospitalizations principally for skin disease in adults, which cost the health care system $5.04 billion. Overall, skin disease was diagnosed in 1 in 8 hospitalized adults. Dermatologic hospitalizations were associated with a lack of medical insurance (odds ratio [OR], 2.27; 95% confidence interval [CI], 2.20-2.34), residence in a low-income community (OR, 1.10; 95% CI, 1.07-1.13), and small (OR, 1.27; 95% CI, 1.23-1.32) or rural hospitals (OR, 1.38; 95% CI, 1.32-1.44). Racial minorities were less likely to be hospitalized for skin disease than were whites (for blacks: OR, 0.77; 95% CI, 0.75-0.79; for Hispanics: OR, 0.85; 95% CI, 0.83-0.8; for Asians: OR, 0.59; 95% CI, 0.55-0.64). Only 0.47% of patients admitted for skin disease experienced in-hospital mortality; however, mortality rates were high in hospitalizations for cutaneous lymphomas (9.19%) and malignant melanoma (6.54%). LIMITATIONS: We could not assess the impact of inpatient dermatology consultations on hospitalization outcomes. CONCLUSIONS: Skin disease is highly prevalent among hospitalized patients.

Hospital readmissions among patients with skin disease: A retrospective cohort study.

BACKGROUND: Hospital readmissions represent a potential target for reducing unnecessary health care expenditures; however, readmissions following dermatology hospitalizations remain poorly characterized. OBJECTIVE: To assess the frequency and demographics of readmissions for skin disease. METHODS: We performed a retrospective cohort study of dermatology hospitalizations by using the 2014 Nationwide Readmissions Database. RESULTS: Readmissions following dermatologic hospitalizations cost the American health care system $1.05 billion in 2014. The 30-day rate of all-cause readmission following the 647,251 weighted index admissions for skin disease was 12.63%. Readmission was most common following hospitalizations for cutaneous lymphomas (39.63%), connective tissue disorders (26.28%), and cutaneous congenital abnormalities (23.86%). Predictors of readmission included public insurance with Medicaid (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.53-1.70) or Medicare (OR, 1.55; 95% CI, 1.48-1.62), residence in a low-income community (OR, 1.14; 95% CI, 1.09-1.20), an increased number of chronic conditions (OR, 4.46; 95% CI, 4.15-4.79), and a large hospital (OR, 1.10; 95% CI, 1.05-1.16). Urban (OR, 0.90; 95% CI, 0.87-0.94) and rural (OR, 0.78; 95% CI, 0.73-0.82) nonteaching hospitals were protective against readmissions from skin disease. LIMITATIONS: We were unable to assess the impact of inpatient dermatology consultations on hospital readmission rates. CONCLUSIONS: There are significant health care and demographic disparities in readmissions for skin disease.

Inpatient burden of pediatric dermatology in the United States.

BACKGROUND/OBJECTIVES: It is known that inpatient care accounts for a significant portion of health care expenditures, but the national burden of inpatient pediatric dermatology is poorly characterized. We sought to assess risk factors, conditions, and financial costs associated with pediatric hospitalizations for skin disease. METHODS: We performed a cross-sectional study of pediatric dermatology hospitalizations using the 2012 Kids' Inpatient Database, which samples 80% of non-birth-related pediatric admissions from 44 states to generate national estimates. The demographic characteristics of children admitted for dermatologic and nondermatologic conditions were compared, and the financial costs of these admissions were analyzed. RESULTS: In 2012, there were 74 229 (95% confidence interval (CI) = 68 620-79 978) pediatric dermatology hospitalizations, accounting for 4.2% of all pediatric admissions and $379.8 million (95% CI = $341.3-418.4 million) in health care costs. Bacterial infections (n = 59 115, 95% CI = 54 669-63 561), viral diseases (n = 3812, 95% CI = 3457-4167), and noncancerous skin growths (n = 2931, 95% CI = 2318-3545) were the most common conditions requiring hospitalization. The highest mean cost per hospitalization was for admissions for cutaneous lymphomas ($58 294, 95% CI = $31 694-84 893), congenital skin abnormalities ($24 186, 95% CI = $16 645-31 728), and ulcers ($17 064, 95% CI = $14 683-19 446). Pediatric dermatology hospitalizations were most strongly associated with living in a low-income community (odds ratio (OR) = 1.22, 95% CI = 1.16-1.29) and the South (OR = 1.32, 95% CI = 1.19-1.46) and being uninsured (OR = 1.35, 95% CI = 1.26-1.45) or having Medicaid insurance (OR = 1.17, 95% CI = 1.13-1.22). CONCLUSION: Skin disease is a common cause of hospitalizations in children, and there are disparities in these admissions that could reflect inadequate access to outpatient pediatric dermatologists.

Incidence of Venous Thromboembolism in Transgender Women Receiving Oral Estradiol.

INTRODUCTION: One of the most serious known adverse effects of feminizing cross-sex hormone therapy (CSHT) is venous thromboembolism (VTE); however, no study has assessed the incidence of VTE from the hormone therapies used in the United States because previous publications on this topic have originated in Europe. CSHT in the United States typically includes estradiol with the antiandrogen spironolactone, whereas in Europe estradiol is prescribed with the progestin cyproterone acetate. AIM: To estimate the incidence of VTE from the standard feminizing CSHTs used in the United States. METHODS: A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed. MAIN OUTCOME MEASURE: The primary outcomes of interest were deep vein thrombosis or pulmonary emboli. RESULTS: From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient. Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years. CONCLUSION: There was a low incidence of VTE in this population of transgender women receiving oral estradiol.

Integrative genome-wide analysis reveals cooperative regulation of alternative splicing by hnRNP proteins.

Understanding how RNA binding proteins control the splicing code is fundamental to human biology and disease. Here, we present a comprehensive study to elucidate how heterogeneous nuclear ribonucleoparticle (hnRNP) proteins, among the most abundant RNA binding proteins, coordinate to regulate alternative pre-mRNA splicing (AS) in human cells. Using splicing-sensitive microarrays, crosslinking and immunoprecipitation coupled with high-throughput sequencing (CLIP-seq), and cDNA sequencing, we find that more than half of all AS events are regulated by multiple hnRNP proteins and that some combinations of hnRNP proteins exhibit significant synergy, whereas others act antagonistically. Our analyses reveal position-dependent RNA splicing maps, in vivo consensus binding sites, a surprising level of cross- and autoregulation among hnRNP proteins, and the coordinated regulation by hnRNP proteins of dozens of other RNA binding proteins and genes associated with cancer. Our findings define an unprecedented degree of complexity and compensatory relationships among hnRNP proteins and their splicing targets that likely confer robustness to cells.