Timolol maleate 0.5% or 0.1% gel-forming solution for infantile hemangiomas: a retrospective, multicenter, cohort study.

Therapeutic options for superficial infantile hemangiomas (IH) are limited. Recently, timolol maleate gel, a topical nonselective beta-blocker, has been reported as a potentially effective treatment for superficial IH. This study is an extension of a previously published pilot study designed to further investigate the efficacy and safety and to identify predictors of good response of topical 0.5% or 0.1% timolol maleate gel-forming solution. This was a retrospective cohort study including patients enrolled from five centers. Patients were included if they were treated with timolol maleate 0.1% or 0.5% gel-forming solution and had photographic documentation of the IH and at least one follow-up visit. Patients with concomitant active treatment using other IH treatments were excluded. The primary endpoint was change in the appearance of IH as evaluated using a visual analog scale (VAS). Data from 73 subjects were available for final analysis. Timolol maleate gel-forming solution 0.5% was used in 85% (62/73) of patients, the remainder being treated with 0.1%. The median age at treatment initiation was 4.27 months (interquartile range [IQR] 2.63-7.21 mos), and patients were treated for a mean of 3.4 ± 2.7 months. All patients except one improved, with a mean improvement of 45 ± 29.5%. Predictors of better response were superficial type of hemangioma (p = 0.01), 0.5% timolol concentration (p = 0.01), and duration of use longer than 3 months (p = 0.04). Sleeping disturbance was noted in one patient. This study further demonstrates the efficacy and tolerability of topical timolol maleate and gradual improvement with longer treatment in patients with superficial IH.

Tanning device usage: what are parents thinking?

Tanning device usage is prevalent among adolescents. Few studies have assessed the role of parental influence on children's use of indoor tanning facilities. Our objective was to determine if children's tanning device usage is affected by parental knowledge of risks of indoor tanning or by parental tanning practices. A survey was administered to 160 parents of 328 children at a general pediatrics clinic and 204 parents of 367 children at a pediatric dermatology clinic (parents n=364, children n=695). Over half of all parents and 17% of all teenagers queried had previously used tanning devices. The level of parental knowledge did not predict tanning device usage by their children. However, parental tanning device usage was associated with increased usage by children (p<0.05). Children began using tanning devices on average more than 4 years earlier than their parents. Most parents (69%) never wanted their children to use tanning devices, but only 15% of parents had discussed them with their children. Therefore, health providers can provide an important service by initiating discussions about tanning devices. Additional measures, including legislation requiring parental consent for indoor tanning, are needed to reduce tanning device usage by minors.

Skin cancer prevention in the primary care setting: assessment using a standardized patient.

Our objective was to utilize the standardized patient technique in assessing the ability of primary care physicians to identify and counsel primary prevention for patients at high risk for skin cancer. A secondary goal was to test the feasibility of this technique as a measure of actual physician behaviors in the outpatient setting. We used a convenience sample of 15 primary care physicians. The standardized patient was an 18-year-old woman with skin phototype I. She presented to physicians as needing a general physical examination for a summer lifeguard job at a beach. She stated a family history of skin cancer. Physician performances were rated using a standard checklist completed by the standardized patient following each visit. We found that none of the physicians asked questions specifically related to skin phototype or sun exposure habits such as childhood sunburns. Only 13% asked about mole changes. For counseling, 67% of physicians recommended sunscreen use; only 7% discussed sunscreen types or procedures for effective use. Only 13% counseled other skin protective behaviors. No significant differences by physician gender were found in these areas; however, female physicians counseled more global health behaviors than male physicians (p < or = 0.01). Our pilot data suggest that little skin cancer primary prevention counseling is performed for high-risk patients. The standardized patient technique worked well in obtaining outcome data for physicians' preventive practices.

UV light abuse and high-risk tanning behavior among undergraduate college students.

BACKGROUND: The failure of skin cancer prevention efforts to alter tanning behaviors may be a result of the addictive nature of UV light. OBJECTIVE: This study attempts to determine the prevalence of UV light substance-related disorder (SRD). METHODS: A survey was administered to undergraduate college students. The cut down, annoyed, guilty, eye-opener questionnaire was used to determine existence of SRD. RESULTS: Of 385 respondents, 12% scored positively on the cut down, annoyed, guilty, eye-opener indicating SRD. Women, indoor tanners, students with tanning family and friends, and frequent tanners were significantly more likely than their peers to score positively. LIMITATIONS: The small size is a limitation of this study as results may not be generalizable to larger populations. There also may be self-report bias. CONCLUSIONS: A significant proportion of college students demonstrate evidence of SRD with respect to UV light.

Pediatric atopic dermatitis: should we treat it differently?

Atopic dermatitis is an extremely common childhood skin disease that can have far-reaching impact on patients and families. Pediatric patients, particularly infants, pose special concerns for parents and providers, and equal emphasis must be placed on both nonpharmacologic and prescription interventions. Concerns for adverse effects of prescription therapies and a universal parental fear of an undetected allergy are hallmarks of pediatric atopic dermatitis care. The purpose of the present study is to highlight important educational and therapeutic strategies designed to optimally care for this patient population.