Parental Assessment of Infantile Hemangioma Cosmetic Clinical Outcomes: Results of the Spanish Hemangioma Nationwide Prospective Cohort.

BACKGROUND: Functional impairment is the main consideration when it comes to choosing therapy for infantile hemangiomas (IH). However, since most hemangiomas are treated for cosmetic reasons, it is important to know the cosmetic outcome assessed by the parents. OBJECTIVE: To evaluate the aesthetic outcomes of IH, considering the characteristics of the lesions and the treatments used. PATIENTS AND METHODS: The Spanish Infantile Hemangioma Nationwide Prospective Cohort (2016-2022) recruited all consecutive patients diagnosed with IH in 12 Spanish hospitals. The children included had two photos of the IH lesion (at both baseline and at the end of the study). A panel of parents blindly assessed all available photos using a scale from 0 (worst cosmetic outcomes) to 10 (best cosmetic outcomes). The different scores - both before and after treatment - as well as the outcomes percent considered excellent (>9) were described and compared. We analyzed the effect of receiving different therapies and performed causal model analyses estimating the mean treatment effect of parents' assessments. RESULTS: The median follow-up was 3.1 years. A total of 824 photos were evaluated. Baseline aesthetic impact was higher in the propranolol group vs the topical timolol and observation treatment groups (1.85 vs 3.14 vs 3.66 respectively; p<0.001). After treatment, the aesthetic impact was similar between both treatment groups (7.59 vs 7.93 vs 7.90; p>0.2). The causal model could only be applied to the comparison between topical timolol and observation, revealing no differences whatsoever. CONCLUSION: This is the first prospective cohort to analyze the aesthetic outcome of IH. The final aesthetic results of the three therapies were similar, with nearly 40% of patients achieving excellent aesthetic outcomes.

Baseline description of the Spanish Academy of Dermatology infantile haemangioma nationwide prospective cohort. Comparison of patients treated with propranolol in routine clinical practice with previous pivotal clinical trial data. / Descripción basal de la cohorte prospectiva de hemangioma infantil a nivel nacional de la Asociación Española de Dermatología. Comparación de los pacientes tratados con propranolol en la práctica clínica rutinaria y los datos de un ensayo clínico pivotal previo.

BACKGROUND: There are several therapeutic options for infantile haemangiomas (IH). Propranolol is used according to a pivotal trial. We aimed to describe the characteristics of IH in clinical practice, including the therapies used, and to compare the characteristics of patients treated with propranolol with those of the trial to assess its external validity. METHODS: Consecutive patients attending 12 Spanish hospitals from June 2016 to October 2019 were included (n=601). RESULTS: The mean age was 3.9 (SD:1.9) months, with a 2:1 female-to-male ratio. Most IHs were localized (82%, 495), superficial (64%, 383) and located in the face (25%, 157) and trunk (31%, 188). Median size was 17 (IR: 10-30) x 12 (IR: 7-20) mm. Complications were found in 16 (3%) patients. Treatment was initiated for 52% (311). Most patients received timolol (76%, 237); propranolol was reserved for complications or high-risk IHs. Aesthetic impairment was the main reason for starting therapy (64%, 199). Several characteristics of the patients and IHs treated with propranolol are similar to those of the pivotal clinical trial, but 1/3 of IHs did not reach the minimum diameter to meet the inclusion criteria, and important prognostic information was not reported. CONCLUSIONS: As most patients receive treatment for aesthetic impairment, there is a need to better understand the aesthetic results of therapies and to increase evidence on the use of timolol, which is currently the most common therapy. Propranolol is being used in a population generally similar to that of the trial; however, this statement cannot be definitely confirmed.

[Teledermatology. Review of 917 teleconsults]. / Teledermatología. Revisión de 917 teleconsultas.

INTRODUCTION: Teledermatology is been currently introduced as a diagnostic tool in the daily practice of the dermatologist. Many published works regarding teleconsult show the high sensitivity and economic saving of this technique as a diagnostic method. MATERIAL AND METHODS: In this article we report our experience with nearly 1,000 teleconsults carried out in a period of two years, from October 2004 to October 2006. RESULTS: The majority of the 917 teleconsults performed were for benign lesions, notably seborrheic keratosis in 201 cases; among malignant lesions actinic keratosis appeared in 161 cases and melanoma was diagnosed in 5 cases. Fifty-eight percent of teleconsults have been arranged for a face-to-face consult in order to perform adequate treatment, in 90 % of cases, or to confirm diagnosis or carry out complementary exams, in 10 % of cases. CONCLUSION: The image is the gold standard for dermatological diagnosis. Currently, digital phototography gives us such a high image quality that, based on our experience, it can be stated that a neoplastic lesion that cannot be diagnosed by a high quality digital image with the available technology, rarely could be diagnosed in a face-to-face consult without the aid of complementary exams.

[Woolly hair nevus associated with an ipsilateral linear epidermal nevus]. / Nevus de pelo lanoso asociado a nevus epidérmico lineal ipsilateral.

We report a 4-year-old boy with two areas of woolly hair in the right parietotemporal region and a linear epidermal nevus in the areas of woolly hair as well as in the ipsilateral hemiface and chin. Evaluation by scanning electron microscopy showed woolly hair with oval transverse section and longitudinal groove. A complete examination ruled out associated anomalies.