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BACKGROUND: Leg ulcers in adults are a major public health concern. Their incidence increases with age and many causes have been identified, predominantly associated with vascular diseases. Leg ulcers in children and teenagers are less frequent. The aim of our study was to identify the causes of leg ulcers in children and teenagers, and to evaluate their management. METHODS: This retrospective multicenter study was conducted by members of the Angio-dermatology Group of the French Society of Dermatology and of the French Society of Pediatric Dermatology. Data from children and teenagers (< 18 years), seen between 2008 and 2020 in 12 French hospitals for chronic leg ulcer (disease course>4 weeks), were included. RESULTS: We included 27 patients, aged from 2.3 to 17.0 years. The most frequent causes of leg ulcer were: general diseases (n=9: pyoderma gangrenosum, dermatomyositis, interferonopathy, sickle cell disease, prolidase deficiency, scleroderma, Ehlers-Danlos syndrome), vasculopathies (n=8: hemangioma, capillary malformation, arteriovenous malformation), trauma (n=4: bedsores, pressure ulcers under plaster cast), infectious diseases (n=4: pyoderma, tuberculosis, Buruli ulcer) and neuropathies (n=2). Comorbidities (59.3%) and chronic treatments (18.5%) identified as risk factors for delayed healing were frequent. The average time to healing was 9.1 months. DISCUSSION: Leg ulcers are less frequent in children and teenagers than in adults and their causes differ from those in adults. Comorbidities associated with delayed healing must be identified and managed. Children and teenagers tend to heal faster than adults, but a multidisciplinary management approach is necessary.
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Úlcera da Perna , Pioderma Gangrenoso , Úlcera Varicosa , Adolescente , Criança , Pré-Escolar , França/epidemiologia , Humanos , Úlcera da Perna/epidemiologia , Úlcera da Perna/etiologia , Úlcera da Perna/terapia , Estudos Retrospectivos , Úlcera Varicosa/terapia , CicatrizaçãoRESUMO
Objetivo. Evaluar indicadores de salud oral en niños y adolescentes con parálisis cerebral en Lima-Perú. Métodos. Estudio observacional, descriptivo y transversal de una muestra de 171 pacientes de dos centros de referencia nacional especializados, periodo 2012- 2013, que cumplieron los criterios de inclusión. Para los índices de higiene oral (IHO) de Greene & Vermillion, índice de dientes cariados, perdidos y obturados (CPOD) y análisis de maloclusión dentaria (MD) se evaluaron 126 niños (6,0-11,9 años) y 45 adolescentes (12,0-19,0 años). Resultados. El IHO fue de 2,55 (malo) en el 91,8%, IHO regular en el 8,2% y ninguno mostró IHO bueno, observándose el mismo comportamiento en ambos grupos etarios. La prevalencia de caries fue 100% y CPOD de 4,55 ±1,56; los niños registraron CPOD de 4,52 ±1,537 y los adolescentes CPOD de 4,64 ±1,626. El 74,3% mostró MD, los niños evidenciaron MD en el 69,8% y los adolescentes mostraron 86,7%. En los niños, se observó relación molar (RM) Clase I derecha en el 42,1% e izquierda en el 44,4%; los adolescentes evidenciaron RM Clase III derecha en el 42,2% e izquierda en el 37,8%. Para los niños, el overbite (OB) no fue registrable en el 33,3% y normal en el 29,4%; en adolescentes, se registró OB normal en el 40%. Se observó con mayor frecuencia línea media dentaria desviada hacia el lado izquierdo. Conclusiones. En la mayoría de niños y adolescentes con parálisis cerebral de centros especializados se encontró alto índice de caries CPOD, mala higiene oral y presencia de maloclusiones.
Objective. To evaluate oral health indicators in children and adolescents with cerebral palsy in Lima-Peru. Methods. An observational, descriptive and cross-sectional study of a sample of 171 patients from two specialized national referral centers for the 2012- 2013 period who met the inclusion criteria. For the Greene & Vermillion oral hygiene index (OHI), decayed, missing and filled teeth (DMFT) and the dental malocclusion (DM) analysis, 126 children (6.0-11.9 years-old) and 45 adolescents (12.0-19.0 years- old) were evaluated. Results. The OHI was 2.55 (poor hygiene) in the 91.8%, regular OHI in the 8.2% and no one showed a good IHO, observing the same behavior in both age groups. The prevalence of caries was 100% and the DMFT was 4.55 ± 1.56; the children registered a DMFT of 4.52 ± 1.537 and the adolescents 4.64 ± 1.626. The DM was present in 74.3%; the children showed a 69,8% of DM and the adolescents showed 86.7%. In children, a right class I molar relationship (MR) was observed in 42.1% and a left MR in 44.4%; the adolescents showed right Class III in 42.2% and left in 37.8%. In children, the overbite (OB) was not registered in the 33.3% of the cases and it was normal in the 29.4%; the adolescents registered a normal OB in 40%. It was more frequently observed a deviation of the dental midline to the left. Conclusions. In most children and adolescents with cerebral palsy from specialized centers, a high index of DMFT caries, poor oral hygiene and the presence of malocclusions were found.
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INTRODUCTION: Leg ulcers in adults are a major public health concern. Incidence is increasing with age and there are many causes, with a predominance of vascular etiology. Leg ulcers in children and teenagers are less known and few studies have been conducted to investigate them. OBJECTIVE: The aim of our study was to examine the causes of leg ulcers in children and teenagers. MATERIAL AND METHODS: We conducted a retrospective monocentric study in the Victor-Dupouy hospital in Argenteuil, in children and teenagers who consulted in our center, between 2008 and 2018, for a chronic leg ulcer (disease course>4 weeks). RESULTS: Ten patients were included, two boys and eight girls, aged from 7 to 15.3 years old. The most frequent etiologies were: supine ulcers (n=2) and infectious (n=2). The others etiologies were: sores under cast (n=1), sickle cell disease (n=1), dermatomyositis (n=1), post trauma (n=1), Pyoderma gangrenosum (n=1), ulcer on hemangioma (n=1). CONCLUSION: Infectious causes and supine ulcers were the most frequent etiologies found in our study. These results should be completed by other observations in a multicentric study, currently underway in order to have a better knowledge of the etiologies of leg ulcers in this population and of their clinical course.
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Úlcera da Perna/etiologia , Adolescente , Idade de Início , Criança , Feminino , França , Humanos , Úlcera da Perna/diagnóstico , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Von Willebrand disease (VWD) and hemophilia A and B are the most common types of hereditary coagulation-factor deficiencies. The frequency and type of complications of skin surgery in these patients are unknown. The increasing incidence of skin cancer prompted us to reflect upon this issue. While the incidence of skin cancer is increasing, the complications of skin surgery or ablative laser treatment remain unknown in this population. AIM: The aim of this study was to determine the frequency of bleeding complications during and after skin surgery in patients with a hereditary coagulation-factor deficiency (hemophilia or VWD). PATIENTS AND METHODS: We conducted a retrospective study in patients with hemophilia A or B or VWD undergoing skin surgery or ablative laser treatment at the Dermatology Department of the Cochin Hospital in Paris, France. RESULTS: Fourteen procedures were performed in 8 patients. Three episodes of bleeding occurred (n=3/14, 21.4%): one hematoma, one delayed bleed and one immediate bleed. None of these complications required surgical revision or resuscitation. DISCUSSION: The rate of hemorrhagic complications was higher than in the general population. However, these complications can be considered non-serious and the risk-benefit ratio remains favorable. Multidisciplinary management and coordination with the reference hemophilia center are mandatory in this population to establish a coagulation-factor (CF) substitution protocol suited to the disease characteristics and the surgical procedure.