New therapies in pediatric dermatology.

PURPOSE OF REVIEW: There have been many new developments in therapeutic modalities for the treatment of pediatric dermatological diseases in the past year. Advances in the treatment of atopic dermatitis, psoriasis, infantile hemangiomas and dystrophic epidermolysis bullosa will be discussed. The following review will update the reader on these exciting new possibilities for patient care and future directions for research to improve the lives of children suffering from skin diseases. RECENT FINDINGS: This review will discuss recent articles describing the use of topical tacrolimus for maintenance of remission in atopic dermatitis, utility of nurse educators in atopic dermatitis, safety and efficacy of etanercept for the treatment of psoriasis in children, narrow band ultraviolet B phototherapy for atopic dermatitis and psoriasis, use of topical timolol for infantile hemangiomas and bone marrow transplantation for dystrophic epidermolysis bullosa. SUMMARY: There are many new interesting, potentially useful therapeutic modalities emerging in pediatric dermatology. New treatments for atopic dermatitis, psoriasis, infantile hemangiomas and dystrophic epidermolysis bullosa are reviewed.

A meta-analysis on the effectiveness of propranolol for the treatment of infantile airway haemangiomas.

OBJECTIVE: To study the effectiveness of propranolol in infantile airway haemangiomas and compare the effectiveness of propranolol vs. different therapies. METHODS: A literature search of Ovid, Embase, the Cochrane database, Google™ Scholar, and Medline using PubMed as the search engine was performed to identify studies that analysed the effect of propranolol treatment in children with airway haemangiomas. Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS: Thirteen studies, comprising 36 patients were included in the analysis. Propranolol was found to be an effective intervention for the resolution of infantile airway haemangiomas (P<0.00001). Meta-analysis of effectiveness of propranolol vs. steroids, CO(2) laser, or vincristine showed that propranolol is the most effective treatment. CONCLUSIONS: This meta-analysis demonstrated that propranolol should be recommended as a first-line treatment in infantile airway haemangiomas. However, because of the possible side effects of propranolol, current infantile haemangioma treatment centres recommend a full cardiovascular and respiratory review be performed prior to initiation of therapy.

Successful combination therapy for severe infantile hemangiomas: case report and literature search.

Infantile hemangiomas are common benign vascular tumors of infancy. Although the majority of uncomplicated hemangiomas involute spontaneously, rapid-growth lesions with complications need early active intervention. On the other hand, severe and complicated lesions can be difficult to treat. Recently, we successfully treated two cases of giant severe infantile facial hemangiomas using local application of bleomycin and pulsed dye laser along with systemic application of dexamethasone. Our results suggest that the multiple modalities of bleomycin, laser, and corticosteroid are a safe and effective approach for early therapeutic intervention of severe facial hemangiomas.

Treating vascular lesions.

The treatment of acquired vascular lesions is one of the most commonly requested and performed cutaneous laser procedures. Furthermore, every year, 40,000 children are born in the United States each with congenital vascular lesions and malformations. Laser treatment of vascular lesion is based on the principle of selective photothermolysis, conceived in the 1980s. A variety of different lasers and light sources have since been used in the treatment of vascular lesions: lasers with wavelengths between green and yellow, near infrared lasers, and broadband light sources. Despite limitations, this remains the treatment of choice today. This publication addresses acquired and congenital vascular lesions as different entities and proposes a separation of vascular lesions into those that can easily be treated from those where clearance is difficult. Different treatment modalities and the various endpoints of individual vascular lesions will be discussed.

Iontophoresis of lidocaine for anesthesia during pulsed dye laser treatment of port-wine stains.

Port-wine stains may be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm. However, the discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions. Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use. We performed a prospective double-blind, placebo-controlled evaluation of the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port-wine stains. Eleven patients with port-wine stains completed the initial phase of the study. Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 (P less than .0001), with no significant difference between these treatments. Follow-up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port-wine stains, despite significant decreases in perfusion, as measured by laser Doppler velocimetry, of port-wine stain areas receiving iontophoresis of lidocaine with epinephrine. Iontophoresis of lidocaine HCl 4% with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy.