Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey.

BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. OBJECTIVES: The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. METHODS: Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. RESULTS: The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg(-1) per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg(-1) vs. 2 mg kg(-1) vs. > 2 mg kg(-1) , the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33-1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04-5·46, P = 0·04, Ptrend < 0·001. CONCLUSIONS: The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.

The treatment of severe atopic dermatitis in childhood with narrowband ultraviolet B phototherapy.

BACKGROUND: There is a lack of data regarding the use of narrowband ultraviolet B (NB-UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB-UVB in children with AD. AIM: We undertook a retrospective review of children with severe eczema who had undergone NB-UVB consecutively in our department between 1999 and 2005. METHODS: All children with AD who had undergone NB-UVB consecutively in our department between 1999 and 2005 were identified from the phototherapy database. Their clinical notes were reviewed for information on age, sex, skin type, minimal erythema dose (MED), adjuvant therapy, previous therapy, adverse effects, number of exposures, cumulative dose, response to treatment and length of remission. RESULTS: In total, 50 children (83%) completed more than 10 exposures of NB-UVB. Complete clearance or minimal residual activity was achieved in 20 children (40%). A good improvement was achieved in a further 10 children (23%), and a moderate improvement in 13 (26%). Children with MEDs > 390 mJ/cm2 were more likely to clear, and this was found to be statistically significant (P = 0.02). Overall, the treatment was well tolerated and the median length of remission was 3 months. CONCLUSION: NB-UVB is an effective treatment for children with severe AD. Children with MEDs > 390 mJ/cm2 are more likely to clear. Further studies are needed to evaluate the efficacy of NB-UVB and long-term safety in treating children with severe AD.

Photodynamic therapy for superficial basal cell carcinoma and Bowen's disease.

Photodynamic therapy (PDT) is an effective treatment for superficial basal cell carcinoma (BCCs) and Bowen's disease. Several studies have reported complete response rates of 80-95% and an excellent cosmetic outcome. Bowen's disease and superficial basal cell carcinomas characteristically affect older patients who may also have associated difficulties with mobility. Using a portable PDT light source we were able to deliver PDT in a community setting with the aim of providing a more convenient service for patients. This randomised study confirmed that community delivered PDT is a viable treatment option and can be administered safely in the community by a trained dermatology nurse. The results from patient questionnaires suggest that community delivered PDT is more convenient to the patient, and also cost effective.