TREatment of ATopic eczema (TREAT) Registry Taskforce: protocol for a European safety study of dupilumab and other systemic therapies in patients with atopic eczema.

Abstract: A long-term prospective observational safety study is essential to fully characterize the safety profile of systemic immunomodulating therapies for patients with atopic eczema. The TREatment of ATopic eczema (TREAT) […]

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Pharmacokinetics and Safety of Apremilast in Pediatric Patients With Moderate to Severe Plaque Psoriasis: Results From a Phase 2 Open-Label Study.

Abstract: No oral systemic treatments are approved for pediatric psoriasis patients.To evaluate pharmacokinetics (PK) and safety of apremilast, an oral phosphodiesterase 4 inhibitor, in pediatric psoriasis patients.This phase 2, multicenter, […]

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Ivermectin safety in infants and children under 15 kg treated for scabies: A multicentric Observational study.

Scabies is a frequent condition in infants and children. Only topical treatments have been approved in infants but some of them are poorly tolerated. Oral ivermectin is approved for the treatment of scabies in several countries but its use in infants and children weighing < 15 kg is off-label.To assess the safety of ivermectin in infants and young children and to collect data on ivermectin efficacy in these age groups.This study was performed in the Dermatology and Paediatric Dermatology departments of 28 French centres between July 2012 and November 2015. Physicians treating an infant or child weighing < 15 kg for scabies with oral ivermectin were asked to send back a completed standardised and anonymous questionnaire. The data were subsequently analysed.Data were collected on 170 infants and children ranging in age from 1 to 64 months, with body weight of 4 to 14·5 kg, who were treated with oral ivermectin. The mean received dose was 223 ?g/kg and 89% of the patients received a systematic second dose. Concomitant topical treatment was administered to 73% of patients. Adverse events were reported in seven patients (4%) and were not severe. At the follow-up visit, 139 (85%) patients had achieved healing. Factors significantly associated with healing were an ivermectin dose > 200 ?g/kg (p=0·0005), and a delay between those two doses of < 10 days (p=0·0247).Our findings suggest the safety and efficacy of ivermectin for the treatment of scabies in infants and young children. This article is protected by copyright. All rights reserved.

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Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review.

Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants.To investigate the triggers, clinical manifestations, and treatment of pediatric EM.Systematic literature review of pediatric EM.After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children.Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias.Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.

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Influence of prenatal and early-life exposures on food allergy and eczema in infancy: a birth cohort study.

Few prospective birth cohort studies are available on the effects of prenatal and early-life exposures on food allergy and eczema among Chinese children. The aim of this study was to evaluate the influence of prenatal and early-life exposures on food allergy and eczema during the first year of life in a prospective birth cohort study.This study was based on a prospective, observational birth cohort of 976 mother-child pairs in three Streets in Changsha, China from January to December 2015. Data on prenatal, early-life exposures and allergic outcomes were obtained from questionnaires collected at birth, and 1, 3, 6, 8, and 12?months of age. Multivariate logistic regression models were performed to estimate the effects of prenatal and early-life exposures on food allergy and eczema.Common risk factors for food allergy and eczema in infancy were parental history of allergy, while moderate eggs consumption (3-4 times/week) during pregnancy was protective for both of them compared with low consumption (? 2 times/week). Factors only associated with food allergy were maternal aquatic products consumption during pregnancy, number of older siblings and age of solid food introduction, whereas factors only associated with eczema were maternal milk or milk products consumption during pregnancy, maternal antibiotic exposure during pregnancy, season of birth and antibiotic exposure through medication during the first year of life.Our study suggests that factors associated with food allergy and eczema are multifaceted, which involving hereditary, environmental and nutritional exposures. Furthermore, differential factors influence the development of food allergy and eczema in infants.

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Dermatomyositis Part I: Clinical Features and Pathogenesis.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically heterogeneous and can be difficult to diagnose. Cutaneous manifestations sometimes vary and may or may not parallel myositis and systemic involvement in time course and/or severity. Recent developments in our understanding of myositis-specific antibodies (MSAs) have the potential to change the diagnostic landscape of DM for dermatologists. Although phenotypic overlap exists, anti-Mi2, MDA5, NXP2, TIF1, and SAE antibodies may be correlated with distinct DM subtypes in terms of cutaneous manifestations, systemic involvement, and malignancy risk. This review highlights new findings on the DM-specific MSAs and their clinical associations in both adults and children.

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Quality of life and psychological impact in the photodermatoses: a systematic review.

The photodermatoses affect large proportions of the population but their impact on quality of life (QoL) and psychological health has not been reviewed. Several tools are available to evaluate QoL and psychological impacts.To systematically review current literature to identify tools used to assess QoL and psychological impacts in patients with photodermatoses, and to summarise reported findings.A systematic search of Pubmed, OVID Medline, PsycInfo and CINAHL was performed for articles investigating QoL and/or psychological impact in patients with photodermatoses, published between 1960-September 2018.20 studies were included; 19 incorporated QoL assessment while 3 evaluated psychological morbidity. Six QoL tools were found to be used: Dermatology Life Quality Index (DLQI), Children’s DLQI, Family DLQI, Skindex (versions 16, 29), Erythropoietic Protoporphyria Quality-of-Life (EPP-QOL) and EuroQoL. Between 31-39% of photosensitive patients reported very large impact on QoL (DLQI>10). Employment/education, social/leisure activities and clothing choices were particularly affected. Only one tool was specifically designed for a photodermatosis (EPP-QOL). Four tools were used to evaluate psychological impact: the Hospital Anxiety and Depression Scale, Fear of Negative Evaluation, brief COPE and Illness Perception Questionnaire-Revised. Levels of anxiety and depression were approximately double British population data. Patients with facial involvement, female gender and younger age at onset showed more psychological morbidity.Several tools have been used to assess QoL in the photodermatoses, and confirm substantial impact on QoL. Development of specific, validated QoL measures would address their unique impacts. Research delineating their psychological comorbidity is sparse and requires further exploration. This article is protected by copyright. All rights reserved.

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Evaluation of responsiveness and estimation of smallest detectable change (SDC) and minimal important change (MIC) scores for the Childhood Atopic Dermatitis Impact Scale.

The Childhood Atopic Dermatitis Impact Scale (CADIS) is an instrument to measure quality of life (QoL) in young children affected by atopic dermatitis (AD) and their parents.We aimed to evaluate the responsiveness (sensitivity to change), smallest detectable change (SDC) and minimal important change (MIC) of the CADIS.Parents and primary caregivers of 300 young children completed the CADIS and a global rating of their child’s skin condition at baseline and four-week follow-up. Kruskal-Wallis-tests, Wilcoxon-tests and effect sizes were used to assess responsiveness. The SDC can be seen as a change beyond measurement error. Anchor-based, distribution-based, and an integration of both methods were used to estimate the MIC.270 families provided data at baseline and 228 at follow-up. The CADIS total change score and most of the domain scores had moderate to strong correlations with the skin change score. Patients were grouped according to the skin change score which served as an anchor. Children whose parents noted an improvement of the skin, showed lower CADIS scores at follow-up (p < .001). For the SDC we obtained score changes of 1·34 points on the total score and less than 1·0 points on each domain score. All detected MIC values passed the SDC cut-off.The CADIS is sensitive to change towards improvement of QoL. A change greater than 12% on the total score or each domain score very likely represents a clinically important change. This article is protected by copyright. All rights reserved.

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Epidemiological, clinical, histological, and immunohistochemical study on hypopigmented epitheliotropic T-cell dyscrasia and hypopigmented mycosis fungoides.

Hypopigmented dermatoses, more evident in dark-skinned people, are a frequent cause of consultation. Their etiology includes a wide range of dermatoses, from benign to malignant diseases. The clinical presentation appears very similar between them, making the correct diagnoses and management a challenge.Clinical records and histopathological biopsies were identified and compared in patients of the “Dr. Manuel Gea González” General Hospital throughout a 16-year period with the presumptive diagnosis of hypopigmented epitheliotropic T-cell dyscrasia (HTCD) or hypopigmented mycosis fungoides (HMF). Immunostaining analysis was performed in each specimen, the panel of antibodies used was: CD3, CD4, CD7, CD8, CD20, and CD62L.Thirty cases of 81 patients found in the registries were included in this study. The main age group was formed by children younger than 15 years old. The main clinical differences between both entities were gender, presence of plaques, and neck lesions. The most significant histopathological parameters used to differentiate both diagnoses were: severity of lymphocytic infiltration, the extent of epidermotropism, folliculotropism, presence of Pautrier’s microabscesses, lymphocytes with cerebriform nuclei, and dermal fibroplasia. No immunohistochemical differences were found between them.The clinical distinction between HTCD and HMF continues to be a challenge, therefore an extensive clinicopathological correlation must be performed. AbCD7 and AbCD62L were not useful to differentiate both dermatoses. This paper suggests that HTCD and HMF should be considered as the beginning and the end of the same clinical spectrum.

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Management of Pediatric Plaque Psoriasis using Biologics.

Psoriasis is a chronic inflammatory disease with clinical manifestations of the skin that affect both adults and children. In adults, biologics have revolutionized the treatment of moderate to severe plaque psoriasis where clear or almost clear is a tangible goal. Recently, research on biologics has been extended to children. The introduction of these new therapeutic options has outpaced the limited guidelines in this population.To provide a review of current data on biologics, with a proposal for a clinically relevant treatment algorithm on the management of moderate to severe plaque psoriasis in the pediatric population.A Canadian panel with expertise in psoriasis, pediatric dermatology and/or experience with consensus recommendation processes was selected to review the current landscape of pediatric psoriasis and clinical data on biologics plus identify special considerations for baseline work-up and monitoring. Recommendations were reviewed and edited by each expert in an iterative process.A treatment algorithm for moderate to severe plaque psoriasis in pediatric patients is presented, incorporating approved biologics. Guidance on baseline screening and ongoing monitoring is also provided. Ultimately, treatment choice depends on the patient and his/her caregiver, with consideration of comorbidities, impact on quality of life, and relevant safety aspects.

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