RESUMEN
Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.
Asunto(s)
Onicomicosis , Adolescente , Humanos , Niño , Onicomicosis/diagnóstico , Onicomicosis/tratamiento farmacológico , Antifúngicos/uso terapéutico , Uñas , Administración Oral , Europa (Continente)RESUMEN
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
Asunto(s)
Antifúngicos/uso terapéutico , Tiña del Cuero Cabelludo/diagnóstico , Tiña del Cuero Cabelludo/tratamiento farmacológico , Adulto , Niño , Cabello/microbiología , Humanos , Cuero Cabelludo/microbiología , TrichophytonRESUMEN
The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology, pediatrics, pediatric dermatology and pediatric rheumatology as well as policymakers and insurance funds. They were developed by dermatologists and pediatric dermatologists in collaboration with pediatric rheumatologists using a formal consensus process (S2k). The guidelines highlight topics such as disease severity, quality of life, treatment goals as well as problems associated with off-label drug therapy in children. Trigger factors and diagnostic aspects are discussed. The primary focus is on the various topical, systemic and UV-based treatment options available and includes recommendations for use and treatment algorithms. Other aspects addressed herein include vaccinations in children and adolescents with psoriasis as well as various disease subtypes such as guttate psoriasis, diaper psoriasis, pustular psoriasis and psoriatic arthritis. Finally, we also provide recommendations for imaging studies and the diagnostic workup to rule out tuberculosis prior to initiating systemic treatment. Note: This article constitutes part 1 of the Sk2 guidelines for the treatment of psoriasis in children and adolescents. Part 2 will be published in the next issue. It contains chapters on UV therapy, systemic treatment, tonsillectomy and antibiotics, vaccinations, guttate psoriasis, psoriatic arthritis, complementary medicine, as well as imaging studies and diagnostic workup to rule out tuberculosis prior to systemic treatment.
Asunto(s)
Guías de Práctica Clínica como Asunto/normas , Psoriasis/tratamiento farmacológico , Psoriasis/patología , Administración Tópica , Adolescente , Artritis Psoriásica/diagnóstico , Niño , Preescolar , Comorbilidad , Consenso , Dermatología , Humanos , Lactante , Recién Nacido , Uso Fuera de lo Indicado/estadística & datos numéricos , Psoriasis/psicología , Psoriasis/radioterapia , Calidad de Vida/psicología , Reumatología , Índice de Severidad de la Enfermedad , Rayos UltravioletaRESUMEN
The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology, pediatrics, pediatric dermatology and pediatric rheumatology as well as policymakers and insurance funds. They were developed by dermatologists and pediatric dermatologists in collaboration with pediatric rheumatologists using a formal consensus process (S2k). The guidelines highlight topics such as disease severity, quality of life, treatment goals as well as problems associated with off-label drug therapy in children. Trigger factors and diagnostic aspects are discussed. The primary focus is on the various topical, systemic and UV-based treatment options available and includes recommendations for use and treatment algorithms. Other aspects addressed herein include vaccinations in children and adolescents with psoriasis as well as various disease subtypes such as guttate psoriasis, diaper psoriasis, pustular psoriasis and psoriatic arthritis. Finally, we also provide recommendations for imaging studies and the diagnostic workup to rule out tuberculosis prior to initiating systemic treatment. Note: This article constitutes part 2 of the Sk2 guidelines for the treatment of psoriasis in children and adolescents. Part 1 was published in last month's issue. It contained introductory remarks and addressed aspects of diagnosis and topical treatment.
Asunto(s)
Fármacos Dermatológicos/administración & dosificación , Psoriasis/terapia , Adolescente , Antibacterianos/administración & dosificación , Factores Biológicos/administración & dosificación , Biosimilares Farmacéuticos/administración & dosificación , Niño , Esquema de Medicación , Humanos , Inmunosupresores/administración & dosificación , Cuidados de la Piel/métodos , Tonsilectomía , Terapia Ultravioleta/métodos , VacunaciónRESUMEN
Juvenile localized scleroderma (jLS), also known as morphea, is an orphan disease. Pediatric guidelines regarding diagnosis, assessment, and management are lacking.Our objective was to develop minimum standards of care for diagnosis, assessment, and management of jLS. A systematic review was undertaken to establish the pediatric evidence for assessment and monitoring of jLS. An expert panel, including members of the Pediatric Rheumatology European Society (PRES) Scleroderma Working Group, were invited to a consensus meeting where recommendations were developed based on evidence graded by the systematic review and, where evidence was lacking, consensus opinion. A nominal technique was used where 75% consensus was taken as agreement. Recommendations for diagnosis, assessment, and management were developed. Due to a lack of pediatric evidence, these were primarily consensus driven. Careful assessment for extra-cutaneous manifestations including synovitis, brain involvement, and uveitis were key features together with joint assessments between Dermatology and Rheumatology to improve and standardize care. CONCLUSION: Management of jLS is varied. These recommendations should help provide standardization of assessment and care for those with this rare and potentially debilitating condition. What is Known: ⢠Children with juvenile localized scleroderma (jLS) are managed by a number of specialties including pediatric rheumatologists and dermatologists, sometimes in shared clinics. Studies have shown that management varies considerably and that there are notable differences between specialties [1]. ⢠There is very little published guidance on management of jLS. What is new: ⢠These recommendations aim to standardize diagnosis, assessment, and management through review of pediatric evidence and consensus agreement. ⢠Joint review of patients by both pediatric rheumatologists and dermatologists is recommended.
Asunto(s)
Esclerodermia Localizada/terapia , Nivel de Atención , Niño , Consenso , Humanos , Tamizaje Masivo/métodos , Guías de Práctica Clínica como Asunto , Calidad de Vida , Esclerodermia Localizada/diagnósticoRESUMEN
Ichthyoses are a group of rare genetic skin disorders that pose numerous clinical challenges, in particular with respect to the correct diagnosis and appropriate management. The present update of the German ichthyosis guidelines addresses recent diagnostic advances that have resulted in the Sorèze consensus classification. In this context, we provide an updated diagnostic algorithm, taking into account clinical features as well as the molecular genetic basis of these disorders. Moreover, we highlight current therapeutic approaches such as psychosocial support, balneotherapy, mechanical scale removal, topical therapy, and systemic retinoid therapy. General aspects such as the indication for physical therapy, ergotherapy, or genetic counseling are also discussed. The present update was consented by an interdisciplinary consensus conference that included dermatologists, pediatricians, human geneticists, and natural scientists as well as representatives of the German patient support organization Selbsthilfe Ichthyose e. V.
Asunto(s)
Adhesión a Directriz , Ictiosis/diagnóstico , Ictiosis/terapia , Adolescente , Adulto , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Predisposición Genética a la Enfermedad/genética , Alemania , Humanos , Ictiosis/clasificación , Ictiosis/genética , Lactante , Recién Nacido , Masculino , Embarazo , Pronóstico , Adulto JovenRESUMEN
Psoriasis is nowadays regarded as a multifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives a short overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.
Asunto(s)
Exantema , Psoriasis , Humanos , Adolescente , Niño , Calidad de Vida , Factor de Necrosis Tumoral alfa/efectos adversos , Psoriasis/terapia , Piel/patología , Factores Biológicos/efectos adversosRESUMEN
With an incidence of approximately 4% infantile hemangiomas are the most common vascular tumors in children and show characteristic growth dynamics. In order to avoid erroneous treatment, they need to be differentiated from other vascular tumors (granuloma pyogenicum and kaposiform hemangioendothelioma) and vascular malformations. Of all infantile hemangiomas 85% are uncomplicated and undergo spontaneous resolution starting towards the end of the first year of life. First-line treatment for complicated infantile hemangiomas (15%), i.e. those with imminent obstruction (eyes and nose), ulceration or permanent disfigurement, is oral propranolol (2â¯mg/kg BW and day for at least 6 months).
Asunto(s)
Hemangioma Capilar , Hemangioma , Neoplasias de Tejido Vascular , Neoplasias Cutáneas , Neoplasias Vasculares , Niño , Humanos , Hemangioma/diagnóstico , Diagnóstico Diferencial , Neoplasias Vasculares/complicaciones , Neoplasias Cutáneas/diagnóstico , Propranolol/uso terapéutico , Hemangioma Capilar/diagnóstico , Neoplasias de Tejido Vascular/complicacionesRESUMEN
Psoriasis is nowadays regarded as a multifactorial, inflammatory, immune-mediated systemic condition with predominant involvement of the skin. It starts in about one third of cases in childhood and adolescence and is often accompanied by marked impairment of the quality of life of sufferers and their parents. Aside from genetic disposition, trigger factors such as streptococcal infections are notably involved in manifestation and in exacerbations. The harmful role of comorbidities even in the young, particularly of obesity, has been well documented. Treatment options have considerably improved following the approval of five biologic agents in childhood but are still insufficiently used. The present article gives a short overview of current knowledge and the recommendations of the updated German guideline. Besides frequent types, unusual presentations such as pustular psoriasis, psoriasis dermatitis, and paradoxical psoriasis induced by tumor necrosis factor alpha (TNF-α) inhibitors are addressed.
Asunto(s)
Enfermedades del Recién Nacido/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutáneas/diagnóstico , Dermoscopía , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Enfermedades del Recién Nacido/cirugía , Masculino , Nevo Pigmentado/cirugía , Pronóstico , Reoperación , Neoplasias Cutáneas/cirugía , Grabación en VideoRESUMEN
Voriconazole is a second-generation triazole antifungal approved for the treatment of invasive fungal infections, particularly with Aspergillus, Candida, Fusarium, and Scedosporium spp. Frequently reported adverse effects of voriconazole include visual disturbance (21 %), elevated liver enzymes (15.6 %) and rashes (7 %), which are largely attributable to drug-induced photosensitivity. We report a case of serious phototoxicity in a 8 year old boy who underwent chemotherapy for AML. He received voriconazole for the treatment and subsequent re-infection prophylaxis after pulmonary aspergillosis. One year after the start of therapy he developed blistering eruptions on his face after minimal sunlight exposure. Recent reports about the development of squamous cell carcinoma and melanoma, respectively, in children during and after oral therapy with voriconazole seem to warrant systematic follow-up investigations of all voriconazole-treated patients.
Asunto(s)
Dermatitis Fotoalérgica/diagnóstico , Dermatitis Fotoalérgica/etiología , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Pirimidinas/efectos adversos , Triazoles/efectos adversos , Antifúngicos/efectos adversos , Niño , Dermatitis Fotoalérgica/prevención & control , Diagnóstico Diferencial , Erupciones por Medicamentos/prevención & control , Humanos , Masculino , VoriconazolRESUMEN
There are many anatomical and functional differences between the skin of young children and adult skin. As a consequence, the skin is more easily irritated by topical agents. There is also increased transcutaneous absorption; the latter effect is amplified by underlying conditions such as ichthyoses and atopic dermatitis with defects of the epidermal barrier. Common topical agents such as salicylic acid and lactic acid can cause life-threatening intoxications. The relevance of transcutaneous absorption of "hidden" ingredients such as polyethylene glycol and preservatives is unknown at present. By emulsifying endogenous barrier lipids, emulsifiers can promote skin dryness. We review the effects of common emollients and their suitability for skin care in children, particularly with the aim to reduce exposure to potential contact allergens and inadvertent emollient activity.
Asunto(s)
Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/prevención & control , Emolientes/administración & dosificación , Emolientes/efectos adversos , Hipersensibilidad/prevención & control , Ictiosis/inducido químicamente , Ictiosis/prevención & control , Vehículos Farmacéuticos/efectos adversos , Niño , Fármacos Dermatológicos/efectos adversos , HumanosRESUMEN
In 2005, an Internet-based network for the support of patients with congenital melanocytic nevi in German-speaking countries was started (http://www.naevus-netzwerk.de). Along with detailed information for patients and parents, the home-page includes a nevus registry which is based on an electronic questionnaire and which aims at providing data on the long-term course of nevi estimated to reach > 10 cm in largest diameter. In the past, congenital melanocytic nevi have been subject to various mythological interpretations ("Tierfellnävus", lit."animal coat nevus";"Muttermal"). Today an increasing body of reliable scientific data allows a differentiated reflection of the risk of malignant transformation and has led to progress in the diagnostic and therapeutic management. Recent findings from the literature and considerations from scientific meetings are reviewed.