Subject(s)
PUVA Therapy/methods , Skin Diseases/drug therapy , Administration, Oral , Administration, Topical , Ficusin/administration & dosage , Foot Dermatoses/drug therapy , Hand Dermatoses/drug therapy , Humans , PUVA Therapy/adverse effects , Photosensitizing Agents/administration & dosage , Treatment OutcomeABSTRACT
BACKGROUND: Oral propranolol is widely prescribed as first-line treatment for infantile haemangiomas (IHs). Anecdotally, prescribing practice differs widely between centres. OBJECTIVES: The Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce was founded to establish patterns of use of propranolol in IHs. METHODS: Participating centres entered data on all of their patients who had completed treatment with oral propranolol for IHs, using an online data capture tool. RESULTS: The study cohort comprised 1097 children from 39 centres in eight European countries. 76·1% were female and 92·8% had a focal IH, with the remainder showing a segmental, multifocal or indeterminate pattern. The main indications for treatment were periocular location (29·3%), risk of cosmetic disfigurement (21·1%) and ulceration and bleeding (20·6%). In total 69·2% of patients were titrated up to a maintenance regimen, which consisted of 2 mg kg(-1) per day (85·8%) in the majority of cases. 91·4% of patients had an excellent or good response to treatment. Rebound growth occurred in 14·1% upon stopping, of whom 53·9% were restarted and treatment response was recaptured in 91·6% of cases. While there was no significant difference in the treatment response, comparing a daily maintenance dose of < 2 mg kg(-1) vs. 2 mg kg(-1) vs. > 2 mg kg(-1) , the risk of adverse events was significantly higher: odds ratio (OR) 1 vs. adjusted OR 0·70, 95% confidence interval (CI) 0·33-1·50, P = 0·36 vs. OR 2·38, 95% CI 1·04-5·46, P = 0·04, Ptrend < 0·001. CONCLUSIONS: The PITCH survey summarizes the use of oral propranolol across 39 European centres, in a variety of IH phases, and could be used to inform treatment guidelines and the design of an interventional study.
Subject(s)
Antineoplastic Agents/administration & dosage , Hemangioma/drug therapy , Propranolol/administration & dosage , Skin Neoplasms/drug therapy , Administration, Oral , Antineoplastic Agents/adverse effects , Dose-Response Relationship, Drug , Female , Humans , Infant , Male , Propranolol/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: Chronic pustular dermatoses are severe and debilitating autoinflammatory conditions that can have a monogenic basis. Their clinical features are, however, complex with considerable overlap. Null and missense mutations in the genes encoding interleukin (IL)-1 family (IL-1 and IL-36) anti-inflammatory receptor antagonist (Ra) cytokines can underlie the development of severe pustular dermatoses. OBJECTIVE: We present a clinical and genetic study of four children of Pakistani descent with similar clinical presentations and treatment course, each of whom suffers from a severe pustular dermatosis, initially described as a pustular variant of psoriasis. We use DNA sequencing to refine the diagnosis of two of the children studied. METHODS: Bidirectional Sanger sequencing was performed on the coding regions of the IL-1Ra and IL-36Ra genes (IL1RN and IL36RN, respectively), for the four affected children and their parents. RESULTS: We identified a novel homozygous missense mutation in IL36RN in two siblings, and showed the molecular basis of the condition to be both distinct from psoriasis and distinct between the two families studied. CONCLUSIONS: We describe a novel mutation which underpins the diagnosis of childhood pustular dermatosis. Molecular diagnostics can be used to aid the clinical diagnosis and potential treatment of autoinflammatory conditions.
Subject(s)
DNA/genetics , Interleukins/genetics , Mutation, Missense , Psoriasis/genetics , Skin Diseases/genetics , Adult , DNA Mutational Analysis , Female , Homozygote , Humans , Infant , Infant, Newborn , Interleukins/metabolism , Male , Pedigree , Psoriasis/metabolism , Psoriasis/pathology , Receptors, Interleukin-1/antagonists & inhibitors , Siblings , Skin Diseases/metabolism , Skin Diseases/pathologySubject(s)
Granuloma Annulare/etiology , Lightning Injuries/complications , Adult , Humans , Keloid/etiology , MaleSubject(s)
Dermatology/methods , Pediatrics/methods , Quality of Life , Skin Diseases/psychology , Surveys and Questionnaires , Adolescent , Bulgaria , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Translations , United KingdomABSTRACT
BACKGROUND: There is a lack of data regarding the use of narrowband ultraviolet B (NB-UVB) phototherapy in children with atopic dermatitis (AD). Many centres use this mode of treatment for children with AD; however, there have only been two previous studies observing the effect of NB-UVB in children with AD. AIM: We undertook a retrospective review of children with severe eczema who had undergone NB-UVB consecutively in our department between 1999 and 2005. METHODS: All children with AD who had undergone NB-UVB consecutively in our department between 1999 and 2005 were identified from the phototherapy database. Their clinical notes were reviewed for information on age, sex, skin type, minimal erythema dose (MED), adjuvant therapy, previous therapy, adverse effects, number of exposures, cumulative dose, response to treatment and length of remission. RESULTS: In total, 50 children (83%) completed more than 10 exposures of NB-UVB. Complete clearance or minimal residual activity was achieved in 20 children (40%). A good improvement was achieved in a further 10 children (23%), and a moderate improvement in 13 (26%). Children with MEDs > 390 mJ/cm2 were more likely to clear, and this was found to be statistically significant (P = 0.02). Overall, the treatment was well tolerated and the median length of remission was 3 months. CONCLUSION: NB-UVB is an effective treatment for children with severe AD. Children with MEDs > 390 mJ/cm2 are more likely to clear. Further studies are needed to evaluate the efficacy of NB-UVB and long-term safety in treating children with severe AD.
Subject(s)
Dermatitis, Atopic/radiotherapy , Ultraviolet Therapy , Adolescent , Child , Chronic Disease , Female , Follow-Up Studies , Humans , Male , Retrospective StudiesSubject(s)
Calcinosis/pathology , Skin Neoplasms/pathology , Adolescent , Calcinosis/surgery , Elbow , Humans , Male , Skin Neoplasms/surgerySubject(s)
Aminolevulinic Acid/therapeutic use , Leg Ulcer/drug therapy , Photochemotherapy/methods , Photosensitizing Agents/therapeutic use , Aged , Chronic Disease , Female , Humans , Leg Ulcer/microbiology , Methicillin Resistance , Staphylococcal Skin Infections/drug therapy , Wound Healing/physiologyABSTRACT
BACKGROUND: Allergic contact dermatitis (ACD) increases with age, and a prevalence of between 13.3% and 24.5% has been reported. Patch testing infants may be particularly difficult, and false-positive reactions may occur. OBJECTIVES: The purpose of this retrospective study was to determine whether the site of primary dermatitis in children could predict a diagnosis of ACD. The current frequency of sensitization in children was also evaluated and the main sensitizing substances among children were verified. METHODS: Between 1995 and 2004, 500 children were patch tested and entered on to the patch test database at Leeds General Infirmary. Analysis of the database included identifying the presenting patterns of eczema and reviewing the patch test results for each child. RESULTS: Of the children, 133 (27%) had one or more positive patch test result. The effect of age on the likelihood of a positive patch test was highly significant (P < 0.001). Girls were significantly more likely to have a positive patch test compared with boys: odds ratio for a positive test 0.62 (95% confidence interval 0.41-0.95; P = 0.029). Type IV allergy to nickel (33%) was the most frequent finding. Reactions to fragrance mix (18%), cobalt (11%), mercapto chemicals, Myroxylon pereirae and p-phenylenediamine (each 8%) were the next most common. No statistical significance was found in the relationship between the site of primary dermatosis and a positive patch test result. CONCLUSIONS: The pattern of presenting dermatitis in children should not determine referral for patch testing. Any child with persistent eczema should be referred for patch testing.
Subject(s)
Dermatitis, Allergic Contact/diagnosis , Adolescent , Age Factors , Allergens/adverse effects , Child , Child, Preschool , Dermatitis, Allergic Contact/etiology , Dermatitis, Allergic Contact/pathology , Female , Humans , Infant , Infant, Newborn , Male , Nickel/adverse effects , Patch Tests , Referral and Consultation , Retrospective Studies , Sex Factors , Statistics as TopicABSTRACT
Photodynamic therapy (PDT) is an effective treatment for superficial basal cell carcinoma (BCCs) and Bowen's disease. Several studies have reported complete response rates of 80-95% and an excellent cosmetic outcome. Bowen's disease and superficial basal cell carcinomas characteristically affect older patients who may also have associated difficulties with mobility. Using a portable PDT light source we were able to deliver PDT in a community setting with the aim of providing a more convenient service for patients. This randomised study confirmed that community delivered PDT is a viable treatment option and can be administered safely in the community by a trained dermatology nurse. The results from patient questionnaires suggest that community delivered PDT is more convenient to the patient, and also cost effective.
Subject(s)
Bowen's Disease/drug therapy , Carcinoma, Basal Cell/drug therapy , Photochemotherapy/methods , Skin Neoplasms/drug therapy , Adult , Aged , Biopsy, Needle , Bowen's Disease/mortality , Bowen's Disease/pathology , Carcinoma, Basal Cell/mortality , Carcinoma, Basal Cell/pathology , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Staging , Prognosis , Prospective Studies , Risk Assessment , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Survival Rate , Treatment Outcome , United Kingdom/epidemiologySubject(s)
Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Eczema, Dyshidrotic/drug therapy , Immunoglobulin G/administration & dosage , Receptors, Tumor Necrosis Factor/administration & dosage , Adult , Drug Administration Schedule , Etanercept , Female , Humans , Injections, Subcutaneous , Recurrence , Treatment OutcomeABSTRACT
Natural rubber latex (NRL) allergy has been recognized as a public health concern. NRL allergy frequently occurs in healthcare professionals. In this retrospective study we report the changing frequency of Type I NRL allergy amongst healthcare workers suffering from hand dermatitis referred to our department between 1996 and 2003. We identified 224 healthcare workers from the patch test database with a diagnosis of hand dermatitis who had undergone NRL skin prick testing (SPT). We report the SPT results, patch test results and diagnoses for each individual. The percentage of positive SPT to NRL in healthcare workers decreased from 62% in 1996 to 10% in 2003. Type IV allergy to fragrance mix (13%) was the most frequent cause of allergic contact dermatitis. Thiuram mix (8%) and carba mix (4%) were the most frequent indicators of type IV allergy to chemicals in rubber gloves. Fragrance allergy was the most frequent type IV allergen found in healthcare workers with hand dermatitis. We conclude that hand care preparations free from fragrance allergens should be available in all areas of clinical work.
