Search

Subcutaneous dupilumab, with or without topical therapy, is clinically proven to treat children with moderate-to-severe atopic dermatitis (AD). However, this well-researched biologic for AD in children is still among the most expensive medication in the world and not widely available in resource-poor areas. We share our experience managing four children with severe AD, aged 3 to 11, who poorly responded to oral systemic immunomodulators but successfully achieved rapid clinical remission when combined with subcutaneous dupilumab. No loading doses were administered to patients in this case series, and the maintenance dosages used were lower than the manufacturer's recommendations. This case series illustrates that oral immunomodulators in combination with subcutaneous dupilumab therapy are efficacious, safe, tolerable, and cost-effective for children with moderate-to-severe AD. This treatment strategy can be considered an alternative for children with AD recalcitrant to other available treatment options, especially when AD management is challenging in limited resource settings. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance in children with atopic dermatitis (AD) frequently goes unnoticed and can be associated with behavioral challenges. The aims of this study were to determine (a) the prevalence and factors associated with sleep disturbance and behavioral problems and (b) the correlation between sleep disturbance and behavioral problems in children with AD. Methods: This cross‐sectional study involved children aged 4–12 years old with moderate to severe AD. Age and sex‐matched healthy children were recruited as the comparison group. The Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess sleep disturbance and behavioral problems, respectively. Higher scores in both questionnaires signify more disturbance. Results: Seventy patients and 141 controls were recruited. Median (interquartile range) age of patients was 5 (4,8) years. Patients had later sleep time (p < 0.001), longer night awakening (p < 0.001), and shorter sleep duration (p < 0.001) compared to controls. CSHQ total scores and all its domains, except for sleep‐disordered breathing were significantly higher in patients compared to controls. Patients also had significantly higher SDQ total difficulties scores in all domains, except for peer problems. Severity of AD was significantly associated with high CSHQ and SDQ scores. There was a moderate positive correlation between the total CSHQ score and total SDQ score in patients (r = 0.532). Conclusions: Children with moderate‐to‐severe AD had significantly more sleep disturbance and more behavioral problems than their healthy peers. Sleep disturbance had a positive correlation with behavioral problems. Severity of AD was associated with sleep disturbance and behavioral problems. [ABSTRACT FROM AUTHOR]

Generalized Pustular Psoriasis (GPP) is a rare, severe, life-threatening form of psoriasis and accounts for up to 13.1% of all childhood psoriasis. Common first-line systemic treatment for pediatric patients with GPP include oral acitretin, cyclosporin and methotrexate which have varying efficacy and side effects but multiple interventions are often needed to induce remission and maintain long term control. Recently, the anti IL 17 A monoclonal antibody secukinumab have been shown to be effective in adult patients with GPP; however, there is lack of evidence of its usage in the pediatric population. We describe a case series of 4 pediatric patients with GPP who were treated with off-label use of secukinumab. All four patients had marked clearance and reduction in Generalized Pustular Psoriasis Area & Severity Score (GPPASI) within first 48 h of first injection with subsequent almost complete to complete clearance of skin lesions by 1 month follow up. In conclusion, secukinumab was found to be successful in inducing remission, with rapid clearance and maintaining remission, with or without combination with other systemic agents for pediatric GPP. [ABSTRACT FROM AUTHOR]

Background Atopic eczema ( AE) is a common chronic inflammatory skin disorder in children, with emollients and topical corticosteroids ( TCSs) commonly prescribed as treatment. There is no published guidance on the correct order of application of emollient and TCS in children with AE. Objective The objective of this study was to determine whether the order of application of emollient and TCS makes a difference in the severity of AE in children. Methods Forty-six patients ages 4 months to 5 years with moderate to severe AE were randomized to two groups: group A applied emollient followed by TCS 15 minutes later twice daily, and group B applied TCS followed by emollient 15 minutes later twice daily for 2 weeks. Results There was no statistically significant difference in the Eczema Area and Severity Index ( EASI) score, percentage of body surface area ( BSA) affected, or itch score between groups A and B (p > 0.05). Group A had statistically significant improvement in the EASI score, percentage BSA affected, and itch score from baseline to weeks 1 and 2; group B demonstrated statistically significant improvement only in the EASI score from baseline to week 1 and in itch score from baseline to week 2. There was no difference in adverse events between the groups. Conclusion This study suggests that the order of application of emollient and TCS does not matter in the treatment of AE in children and that parents can apply topical medications in whichever order they prefer. [ABSTRACT FROM AUTHOR]

Generalized pustular psoriasis (GPP) is a severe, life-threatening form of psoriasis. Deficiency of interleukin (IL)-36 receptor antagonist has been found in a subset of patients with GPP, which is usually more difficult to treat with conventional treatment. We report a case of a 4-year-old Malaysian-Chinese boy with GPP and homozygous mutation at c.115+6T>C within the interleukin-36 receptor antagonist (IL36RN) gene, who was treated successfully with off-label use of secukinumab monotherapy after failure of treatment with acitretin and cyclosporine A. [ABSTRACT FROM AUTHOR]