Topical calcineurin inhibitors for pediatric periorificial dermatitis.

BACKGROUND: Data regarding the treatment of periorificial dermatitis with topical calcineurin inhibitors (TCI) in the pediatric population are limited. OBJECTIVE: To assess the clinical utility of TCI in pediatric patients with periorificial dermatitis. METHODS: A retrospective medical record review of all pediatric patients with periorificial dermatitis treated with TCIs was performed. Follow-up via telephone was performed to capture missing data. RESULTS: A total of 132 patients met the inclusion criteria. The median age at diagnosis was 4.2 years (interquartile range, 2.3-8.2). The median follow-up was 5.2 months (interquartile range, 2.1-11.7). Seventy-two patients had evaluable follow-up data. Of these, 48 (67%) patients were treated with TCI alone, 12 (16.7%) were treated with a combination of TCI and topical metronidazole, and 9 (12.5%) were treated with a combination of TCI and a systemic antibiotic. Complete response was noted in 68.8% of patients treated with TCI alone, in 75% of patients treated with TCI and metronidazole, and in 77.8% of patients treated with TCI and a systemic antibiotic. Adverse events were rare and mild in severity. CONCLUSION: Topical calcineurin inhibitors are an effective therapeutic option for pediatric patients with periorificial dermatitis and were well tolerated in this cohort.

Anxiety, Depression, and Suicidal Ideation amongst Patients with Facial Dermatoses (Acne, Rosacea, Perioral Dermatitis, and Folliculitis) in Lithuania.

BACKGROUND/OBJECTIVE: Skin diseases, especially those with visible manifestation, are considered to cause a major influence on global mental health. Therefore, we determined the prevalence and severity of anxiety, depression, and suicidal ideation in a large sample of patients with facial dermatoses, namely acne, rosacea, folliculitis, and perioral dermatitis. METHODS: The mental health of patients with facial dermatoses and respective controls was assessed using the Hospital Anxiety and Depression Scale and questions concerning suicidal ideation. RESULTS: The study included 543 patients with facial dermatoses and 497 healthy individuals. Anxiety was present in 37.6% of the patients (14.9% of controls), depression in 21.7% (6.8%), and suicidal thoughts in 9.8% (3.2%) (p < 0.001). Acne patients demonstrated the highest anxiety and depression subscale scores (mean ± standard deviation: 7.1 ± 0.25, 95% confidence interval (CI): 6.58-7.56; controls: 5 ± 0.23, 95% CI: 4.57-5.49). In rosacea 30% of the patients had depression symptoms (adjusted odds ratio (OR): 7.216, 95% CI: 4.122-12.632, p < 0.001), while in folliculitis patients 15.4% (OR: 3.138, 95% CI: 1.241-7.936, p = 0.016) had suicidal thoughts. Patients with anxiety symptoms and suicidal thoughts were on average younger than those without (28.3 ± 0.76 vs. 31.2 ± 0.66 years, p = 0.001 and 25.3 ± 0.98 vs. 30.5 ± 0.55 years, p = 0.007, respectively). CONCLUSION: Acne and rosacea are associated with anxiety, depression, and suicidal ideation in Lithuanian patients. Younger patients are more prone to report such symptoms than older ones.

Recalcitrant granulomatous periorificial dermatitis with good response to low-dose oral isotretinoin.

Granulomatous periorificial dermatitis is a clinical variant of periorificial dermatitis. We present the case of an 18-year-old girl with several reddish papular lesions in the perioral, perinasal, and periorbital regions unresponsive to conventional therapy. After 6 months of therapy with low-dose oral isotretinoin, the lesions fully remitted.

A case series of demodicosis in children.

Demodex mites are commensal inhabitants of the pilosebaceous unit that are typically absent or at low numbers in childhood. When they are present, they can cause a primary eruption or exacerbate an underlying facial dermatosis. Here we report five cases of demodicosis occurring in childhood, the clinical presentations, and responses to treatment. Papulopustular lesions predominate, prompting the advice "pustules on noses, think demodicosis!"

[Teledermatology in Switzerland : Set-up for and examples of dermatological treatment from a telemedicine center]. / Teledermatologie in der Schweiz : Anwendungsbeispiele zur Behandlung von dermatologischen Fragestellungen anhand eines telemedizinischen Zentrums.

BACKGROUND AND OBJECTIVES: In Switzerland, telemedicine has been an integral part of the health care system for many years and plays a significant role in basic medical care. Telemedicine is particularly suitable for skin diseases, thanks to the possibility of diagnostic imaging. The aim of this article is to point to services and structures needed using the example of a successful telemedicine center (Medgate Tele Clinic, Basel, Switzerland) and to illustrate the wide range of applications of telemedicine available in Switzerland based on examples from teledermatology. MATERIALS AND METHODS: This article describes how a telemedicine center functions, with particular emphasis on teledermatology. As examples, some of the dermatological disorders that have been treated only using teledermatology will be presented. RESULTS AND DISCUSSION: In about half of all cases, physicians working at the above-mentioned telemedicine center can complete treatment of their patients over the phone or video, so that no further appointment with a doctor is necessary. Many dermatological problems (such as pityriasis versicolor, perioral dermatitis or rosacea without eye involvement) can be treated particularly well with telemedicine.

New indications for topical ivermectin 1% cream: a case series study.

INTRODUCTION: Topical ivermectin is an effective treatment for inflammatory papulopustular rosacea in adults. Positive therapeutic effects of ivermectin due to its potential anti-inflammatory properties could be achieved in the other facial dermatoses. AIM: To assess the efficacy of topical ivermectin 1% cream therapy in mild and moderate perioral dermatitis (PD), seborrheic dermatitis (SD) and acne vulgaris (AV). MATERIAL AND METHODS: The study comprising 20 patients diagnosed with PD (8), SD (8) and AV (4) was conducted between November 2016 and July 2017. Two scales were applied to establish efficacy of the treatment: Investigator Global Assessment score (IGA) and Patient Global Assessment of Treatment (PGA). RESULTS: All patients responded to the treatment with topical ivermectin very well with a gradual reduction in inflammatory skin lesions. Complete or almost complete clearance (IGA score 0-1) was achieved in 20 cases. Four patients with PD achieved IGA 0-1 after 4 weeks of treatment, 1 patient after 5 weeks, 2 patients after 6 weeks and 1 patient after 12 weeks. In the total group of 8 patients with SD, 4 presented IGA 0 after 4 weeks of therapy, while 4 patients demonstrated IGA 1 after 6 weeks. Patients with AV required 8 and 10 weeks to obtain IGA 1. Nineteen patients of the studied group reported "very good" or "excellent" response to the therapy, only one patient with AV assessed therapy with topical ivermectin as "good". The adverse events were transient and manifested as mild-moderate desquamation, stinging and burning in 2 patients with PD. CONCLUSIONS: Topical ivermectin was well tolerated and beneficial for treatment of mild and moderate PD, SD and AV.

[Basis for the treatment of eczematous diseases in otorhinolaryngology]. / Grundlage der Behandlung ekzematöser Erkrankungen im HNO-Bereich.

According to Coombs and Gell, cell-mediated immune responses belong to type IV reactions and are borne mainly by T lymphocytes. The eliciting allergens are usually so-called haptens. Haptens are substances which develop to whole antigens only by binding to protein carriers. In otorhinolaryngology, delayed allergic hypersensitivities are apparent mainly as contact eczemata. Facial dermatitis, auricle and ear canal eczema as well as perioral eczema belong to the most common forms of contact dermatitis in ENT patients. The patient's medical history and morphology of the eczema give a strong indication for a proper diagnosis. Verification is carried out by patch test according to the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, The Association of the Scientific Medical Societies in Germany) guidelines. Hereby the most widespread contact allergens are tested in a so-called "standard block", which can be reduced to an individualized allergen spectrum, based on medical history. For therapy, allergen avoidance is the most important measure which should also be applied prophylactically. Moreover, antiinflammatory treatment of the contact eczema is carried out with tapering topical corticosteroids. Depending on the patient's age, location and severity of the contact eczema, newer class II or III preparations should be chosen. Skin care preparations are helpful to reduce corticosteroid consumption and are indicated additionally after the acute phase treatment. An important differential diagnosis of contact eczema is atopic dermatitis. Whilst contact dermatitis experiences healing by avoiding the triggering noxious agent, genetically determined atopic dermatitis shows a chronic, recurrent course. In addition to topical corticosteroids, calcineurin inhibitors have been approved for treatment of atopic eczema. In all eczema diseases, regular skin care is a necessary measure which contributes mainly to barrier repair.

The pathogenetic role of rod-shaped bacteria containing intracellular granules in the vellus hairs of a patient with perioral dermatitis: A comparison with perioral corticosteroid-induced rosacea.

The cause of perioral dermatitis is still unknown. We previously reported that rod-shaped bacteria (RB) containing intracellular granules were detected in cases of perioral dermatitis at a high incidence. The aim of this study was to study further the role of RB in perioral dermatitis. Altogether 10 patients with perioral dermatitis and eight patients with perioral corticosteroid-induced rosacea, who were referred to our department from 2009 to 2014, were examined for the presence of RB, using the tape-stripping toluidine blue method. RB were detected on the surfaces of the roots of vellus hairs from lesions in nine of the 10 patients with perioral dermatitis. In contrast, RB were not detected in any of the eight patients with perioral corticosteroid-induced rosacea. No RB were found in the perioral areas of other types of facial dermatitis, including atopic dermatitis and seboerrheic dermatitis or in 16 healthy controls. We treated four of the patients with perioral dermatitis with minocycline hydrochloride and five with cefcapene pivoxil hydrochloride hydrate. Three of the patients with perioral dermatitis who were treated with minocycline hydrochloride were cured in 3 to 8 weeks, while the five patients treated with cefcapene pivoxil hydrochloride hydrate were cured in 2 to 9 weeks. These results strongly suggest that RB (possible fusobacteria) play an important role in perioral dermatitis and that this is probably a distinct clinical entity from corticosteroid-induced rosacea. Cefcapene pivoxil hydrochloride hydrate seems to be an effective treatment for perioral dermatitis associated with RB.

A Case of Perioral Dermatitis Successfully Treated with Abrocitinib.

Perioral dermatitis (POD) is a chronic inflammatory skin disease that primarily affects females between the ages of 16 and 45. Conventional therapies face the challenge of limited efficacy and a high recurrence rate. In this report, we present the case of a 26-year-old male patient with POD who was successfully treated using the Janus kinase (JAK) inhibitor, abrocitinib. This treatment exhibited both good efficacy and safety. Abrocitinib, as a JAK inhibitor, holds promise as a potential therapy for cases of POD that might be resistant to conventional therapies.