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Background: Pediatric patients with moderate-to-severe atopic dermatitis (AD) often experience a high disease burden and have a high risk of persistent disease. Standard-of-care immunosuppressive systemic treatments have been used off-label for AD in pediatric patients despite concerns for suboptimal safety with continuous use and risk of relapse upon discontinuation. The biologic agent dupilumab is the first systemic treatment approved for moderate-to-severe AD in children as young as 6 months. Long-term safety and efficacy data in this patient population are needed to inform continuous AD management. Objectives: The purpose of this work was to determine the long-term safety and efficacy of dupilumab treatment up to 1 year in an open-label extension (OLE) study [LIBERTY AD PED-OLE (NCT02612454)] in children aged 6 months to 5 years with moderate-to-severe AD who previously participated in the 16-week, double-blind, phase 3 LIBERTY AD PRESCHOOL trial (NCT03346434 part B; parent study) and were subsequently enrolled in PED-OLE. Methods: In PED-OLE, patients received dupilumab every 4 weeks according to a weight-tiered regimen (body weight ≥ 5 kg to < 15 kg: 200 mg; ≥ 15 kg to < 30 kg: 300 mg). Results: Data for 142 patients were analyzed, 60 of whom had completed the 52-week visit at time of database lock. Mean age at baseline was 4.1 y [SD, 1.13; range, 1.0–5.9 years]. A majority (78.2%) of patients reported ≥ 1 treatment-emergent adverse event (TEAE), most of which were mild or moderate and transient. The most frequently reported TEAEs were nasopharyngitis (19.7%), cough (15.5%), and pyrexia (14.1%). One TEAE led to treatment discontinuation (severe urticaria, which resolved in 1 day). By week 52, 36.2% of patients had achieved an Investigator's Global Assessment score of 0/1 (clear/almost clear skin), and 96.6%, 79.3%, and 58.6% had at least 50%, 75%, or 90% improvement, respectively, in Eczema Area and Severity Index scores. Conclusions: Consistent with results seen in adults, adolescents, and older children (aged 6–11 years), treatment with dupilumab for up to 1 year in children aged 6 months to 5 years with inadequately controlled moderate-to-severe AD demonstrated an acceptable long-term safety profile and sustained efficacy. These results support the long-term continuous use of dupilumab in this patient population. Trial Registration: ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B). Plain Language Summary: Atopic dermatitis (AD) is a chronic inflammatory skin disease that often results in a high disease burden in young children and their families. Patients often need long-term treatment to control their disease symptoms, including itch and rash. Dupilumab treatment for 16 weeks has shown benefits in children aged 6 months to 5 years with moderate-to-severe AD, with an acceptable safety profile. As AD is likely to continue from childhood into adolescence and adulthood, there is a need for data supporting long-term use of dupilumab in young children. In this study, children who completed the 16-week study continued dupilumab treatment for up to 1 year, receiving 200 mg or 300 mg of dupilumab (depending on the child's bodyweight) every 4 weeks. Through the year of treatment, 78.2% of patients reported at least one side effect, most of which were mild or moderate. Only one patient interrupted treatment because of severe skin rash (hives), which was resolved in 1 day. At the end of the year, 36.2% of patients had clear or almost clear skin, and almost all (96.6%) achieved at least 50% improvement in their extent and severity of disease. Additionally, 79.3%, and 58.6% had at least 75% or 90% improvement in their extent and severity of disease. In summary, consistent with results seen in adults, adolescents, and older children, this study showed that 1-year dupilumab treatment provides continued benefits with an acceptable safety profile. These results support long-term continuous use of dupilumab in children aged 6 months to 5 years with moderate-to-severe AD. 5SqqskjZPmoHiNU8WnfbXp What is the long-term safety and efficacy profile in young children with moderate-to-severeatopic dermatitis treated with dupilumab? [ABSTRACT FROM AUTHOR]

Background: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory bone disease requiring immunosuppressive treatment in half of patients. Monoclonal tumor necrosis factor inhibitors (TNFi) are often used as effective second-line off-label therapies. However, paradoxical psoriasis can occur in a subset of patients exposed to monoclonal TNFi and can prompt conversion to alternate therapy if severe. Objective: The aim of this study was to determine the efficacy and safety of golimumab, a fully humanized TNFi, in children with CRMO, including those who develop paradoxical psoriasis after exposure to other monoclonal TNFi. Methods: A retrospective chart review was conducted of patients with CRMO who received golimumab in a single center between 01 June, 2018 and 31 December, 2020. Patients who were diagnosed before 21 years of age and followed up for CRMO at least once after receiving ≥ 3 months of golimumab were included. Extracted data included patient demographics, whole-body MRI lesion counts, clinically relevant data, laboratory results, patient-reported outcomes, and psoriasis burden. Linear mixed models with log-transformed outcomes were used to assess changes in the outcomes over time. The random effect is included in the model to account for the within-subject correlation of repeated measures. p-values and 95% confidence intervals were reported. Results: Eighteen patients were included. Patients were observed for a median of 9.95 months [interquartile range 3.84–15.64]. The median age at the initiation of golimumab was 10.95 years [9.86–13.77] and the median duration of disease between the disease onset and the initiation of golimumab was 2.60 years [1.66–3.62]. Ten patients received golimumab via intravenous route and eight patients received golimumab via subcutaneous route. The median dose was 1.64 mg/kg/month [1.46, 2]. Fourteen patients were previously treated with disease-modifying antirheumatic drugs and 17 with other TNFi. Patients treated with golimumab showed significant improvement in median physician global assessment for CRMO from 2.00 [1.00–3.00] to 0.00 [0.00–0.25] by the fourth visit (p < 0.001), with median erythrocyte sedimentation rate (ESR) decreasing significantly from 12.00 [6.75–23.75] to 5.00 [3.00–10.00] by the fourth visit (p < 0.05). The median number of lesions on MRI decreased significantly from 3.50 [2.00–5.50] to 0.50 [0.00–4.25] lesions per patient (p < 0.01). Nine out of 12 patients who had previous paradoxical psoriasis associated with adalimumab or infliximab had persistent active psoriasis at study baseline. For patients with psoriasis at study baseline, the prevalence of psoriasis had decreased from 100% to approximately 50–57% at the following visits. Of the 18 patients initiated on golimumab in this study, there was only one new case of mild psoriasis in a patient with previously resolved infliximab-associated paradoxical psoriasis. No serious infections or adverse events were noted during the study. Two patients in the study showed clinical improvement with concomitant golimumab and ustekinumab with no reported adverse side effects or increased effects in these patients over a 16-month interval, showing that this combination can be safe and effective for children with CRMO. Conclusion: In our experience, golimumab has been shown to be a safe and effective therapy for CRMO and demonstrated improvement in paradoxical psoriasis in many patients. Longer follow-up periods would be helpful to develop longer term outcomes data for patients with CRMO and overall paradoxical psoriasis risk. [ABSTRACT FROM AUTHOR]

Introduction: Nemolizumab, a new monoclonal antibody that targets the receptor alpha of the neuroimmune cytokine interleukin-31 (IL-31), has shown efficacy in atopic dermatitis (AD) in adults. This study evaluated the pharmacokinetics (PK) and safety of nemolizumab in adolescents with moderate to severe AD as well as the relationship between nemolizumab concentrations and clinical efficacy and the effect of nemolizumab on protein biomarkers. Methods: Open-label, 16-week study of nemolizumab in patients aged 12–17 years with moderate to severe AD (baseline EASI ≥ 16, IGA ≥ 3, and BSA ≥ 10%) and associated pruritus with baseline average daily peak pruritus numeric rating scale (PP-NRS) intensity of at least 4. Nemolizumab was administered subcutaneously as a loading dose of 60 mg at baseline, followed by 30 mg every 4 weeks until week 12 with background topical corticosteroids (TCS) or calcineurin inhibitors (TCI). Subsequently patients were followed for 8 weeks more. Stratum corneum (SC) and plasma samples were collected for biomarker assessments. Results: Twenty patients participated, with a mean age of 14.8 ± 1.6 years. The PK of nemolizumab was described by a one-compartment model with linear elimination, a first-order absorption, and a mean half-life of 16.7 ± 4.1 days. Mean trough concentrations ranged from 2935 ± 1029 ng/mL to 3292 ± 2018 ng/mL over the 16-week treatment period. There was a marked improvement in rash, itch, and sleep with a decrease from baseline to week 16 in EASI by 66.5 ± 32.5%, in PP-NRS by 43.2 ± 37%, and in sleep disturbance numeric rating scale by 53.5 ± 47.8%. The popPK and PK/PD analyses confirmed that model-predicted exposure and efficacy of nemolizumab were similar in adolescents compared to adults receiving the same dosing regimens. Age did not impact PK parameters, while the main source of PK variability was body weight. Analyses of SC samples identified a panel of AD-related pro-inflammatory biomarkers that were upregulated in lesional skin (compared to non-lesional skin) and correspondingly downregulated in clinical responders to nemolizumab (based on EASI75 and PP-NRS ≥ 4). Four biomarkers (CCL20, CCL22, CCL27, and VEGF) had changes that were 1.9–3.5-fold higher in EASI responders than in EASI non-responders (all p < 0.05). Analysis showed no significant correlation between plasma biomarkers and clinical scores. Adverse events were experienced by 33.3% of subjects (n = 6) and were primarily mild or moderate in severity. Conclusions: Nemolizumab PK and safety profiles in adolescents with moderate to severe AD are consistent with previous nemolizumab studies in adults. PK/PD models demonstrate similar exposure–response profiles in 12- to 17-year-old adolescents and adults for three clinical endpoints (EASI, IGA, and PP-NRS). Nemolizumab treatment reversed AD-related pro-inflammatory biomarkers in skin, indicating that the neuroimmune cytokine IL-31 is an important mediator of multiple pathways in AD. Clinical Trial Registration: Clinicaltrials.gov NCT03921411. [ABSTRACT FROM AUTHOR]

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD. [ABSTRACT FROM AUTHOR]

Tumor necrosis factor alpha inhibitors (TNFi) are widely used in children with autoimmune and autoinflammatory conditions. Although TNFi are approved to treat psoriasis, they have also been shown to paradoxically induce psoriasiform lesions. In this review, we aim to focus on the clinical presentation and management of paradoxical psoriasis after exposure to TNFi in children with juvenile idiopathic arthritis (JIA), inflammatory bowel disease (IBD), or chronic nonbacterial osteomyelitis (CNO). A narrative review of the literature was performed given the limited number of publications on this topic. Children with IBD, CNO, and JIA have a higher risk of developing psoriasis at baseline, which increases after TNFi use in those with JIA and IBD. Risk factors for paradoxical psoriasis remain incompletely defined, and patients with IBD and/or CNO develop paradoxical psoriasis more commonly than those with JIA. Sex, race, and family history were not significantly associated with paradoxical psoriasis. The most commonly implicated TNFi include infliximab and adalimumab. Paradoxical psoriasis occurs in a similar distribution on the body to isolated psoriatic lesions and is morphologically indistinguishable. In many instances, topical therapies are effective in treating psoriasis and children can continue on TNFi for their primary disease. If lesions are severe or unacceptable to patients, TNFi may be switched or discontinued. Further research is needed to better characterize risk factors and understand the mechanism of disease pathogenesis. Pediatric health care providers who prescribe TNFi should counsel families regarding the risk of paradoxical psoriasis prior to starting the medication and monitor for new cutaneous eruptions. [ABSTRACT FROM AUTHOR]

Background: Pediatric atopic dermatitis(AD) is very common, but its management is frustrating for the dermatologist, child and parents alike as this chronic inflammatory skin disease is marked with numerous difficult to control flares. Although country specific guidelines for AD exist, there is paucity of data with respect to dedicated topical care regimens for AD management in pediatric population. Purpose: This is a broad based review exploring various topical practices and management options to manage pediatric AD during flares and in remissions. Scope: The PubMed database was searched (to 1 June 2020) for English-language articles containing the keywords atopic dermatitis, atopic eczema, topical calcineurin inhibitor(TCI), topical corticosteroid(TCS), topical phosphodiesterase inhibitors, crisaborole, topical therapy. Articles focusing on topical managment for children with AD were chosen for further review. A limitation is that this is not a systematic review of the literature. We have relied heavily on The Indian Dermatology Expert Board Members 2019 Management Guidelines on AD and the 2014 American Academy of Dermatology (AAD) guidelines, soon to be updated. In our review, we focus on Skin directed therapies to repair and maintain healthy skin barrier, suppress inflammatory response, control flares, control itch and manage infectious triggers. Topicals can be used as first line therapy in mild AD, adjuvant for moderate-severe AD or as maintenance to keep the disease in remission. Topical therapy in AD is not limited to TCS, TCI, Crisaborole or newer molecules but also involves moisturization, emollient care and bathing practices; which have been discussed. Conclusion: Multiple topical therapies and practices have been successfully used to treat children with AD. An understanding of the available treatment options will help dermatologists striving to achieve best practice in the management of pediatric AD. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is the most common inflammatory skin condition in pediatric patients. AD has long been associated with comorbidities including food allergies, asthma, and allergic rhinitis, but recent literature has expanded this list to include attention-deficit/hyperactivity disorder and depression. AD has tremendous impact on quality of life for both affected children and their families. Improved understanding of AD pathogenesis, particularly regarding skin barrier dysfunction, the role of the cutaneous microbiome, and immune dysregulation, has spawned exciting new therapeutic directions. Although good skin care and appropriate use of topical corticosteroids remain first-line treatment, more precisely targeted treatments hold great promise. A recently approved topical phosphodiesterase inhibitor, crisaborole, and a subcutaneously administered interleukin-4/interleukin-13 blocker, dupilumab, are the first of what will likely be many new treatment options for patients with AD. [Pediatr Ann. 2020;49(3):e140-e146.]. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic systemic inflammatory disease requiring long-term management. However, availability of long-term AD treatments with an acceptable risk-benefit profile is limited in pediatric patients. This ongoing phase 3 open-label extension (OLE; NCT02612454) enrolled patients aged 6 months to 17 years with moderate-to-severe AD. Patients were treated with dupilumab (weight-based dosing): 200 mg every 4 weeks (q4w; 5–14 kg), 300 mg q4w (15–29 kg) and 200 mg q2w (30–59 kg). Here we report safety data (cutoff date July 31, 2021) for 180 patients aged 6 months to 5 years who enrolled in the OLE. Of the 180 patients reported, 122 (67.8%) completed up to 16 weeks of the study, 30 (16.7%) up to Week 52 and 15 (8.3%) up to Week 156. A total of 167 (92.8%) patients were continuing treatment at the time of data cutoff. At baseline, the mean (SD) age was 3.9 (1.3) years. One hundred and nine (60.6%) patients reported treatment-emergent adverse events (TEAEs); the most common were nasopharyngitis (12.8%), upper respiratory tract infection (11.7%) and pyrexia (11.7%). One (0.6%) patient had a treatment-related severe TEAE (urticaria) that led to study drug discontinuation. Two (1.1%) patients had serious TEAEs (anaphylactic reaction and pneumonia mycoplasmal) of severe and moderate intensity, respectively. Both serious TEAEs were unrelated to treatment. Long-term safety of dupilumab in this pediatric population was generally consistent with the known dupilumab safety profile in adults and older pediatric patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Curbside consultations are common in pediatric dermatology. There are both associated risks and benefits. Email, text messaging, and cell phone cameras have greatly facilitated this practice. We sought to characterize the nature of this practice among pediatric dermatologists and highlight concerns. Methods: A 21‐question anonymous survey was sent to the 486 active members of the Society for Pediatric Dermatology. Results: There were 156 responses (32%). Over 45% of respondents received at least six consults per week. About half (49%) spent 6 minutes or more per case. Almost none of these consultations (3%) were compensated or captured in work relative value units. Most (87%) did not document or have a practice or institutional policy in place to address these consultations. A similar majority (80%) were uncertain if their existing liability insurance covered these activities. Over three‐quarters (76%) of respondents did not think or were unsure that Health Insurance Portability and Accountability Act concerns were appropriately addressed. Conclusions: Curbside consultations in pediatric dermatology are common. They increase access, promote collegiality, and can be used for educational gain. They are also generally not compensated, consume considerable time, risk liability exposure for providers, and potentially compromise patient confidentiality. Effort should be made to standardize this practice so that the benefits are not outweighed by risks. [ABSTRACT FROM AUTHOR]

A great deal of changes have come to the therapeutic treatment of atopic dermatitis, including major advances in treating moderate to severe disease. It is important to treat atopic dermatitis because it has major impact on risk for comorbidities and quality of life. [ABSTRACT FROM AUTHOR]

Alopecia areata (AA) is a common autoimmune nonscarring alopecia. AA presents heterogeneously and is influenced by both environmental and genetic factors. Diagnosis is clinical after ruling out other local or systemic causes of alopecia. Standard first-line therapy is typically topical steroids, but the response can be frustrating. Novel treatment options have shown great promise in the management of the refractory disease. We review initial data on topical and systemic Janus kinase inhibitors (tofacitinib, ruxolitinib, and baricitinib), topical bimatoprost, simvastatin/ezetimibe, and excimer laser therapy among others within the context of a general approach to AA management. [ABSTRACT FROM AUTHOR]

Purpose of Review: Tremendous advances have been made in the field of atopic dermatitis in the past 5 years. We will explore developments in burden of disease, co-morbidities, pathogenesis, prevention, and management. Recent Findings: The tremendous burden moderate to severe atopic dermatitis (AD) places on families from a medical, psychosocial, and financial perspective has been characterized. Epidemiologic studies have identified intriguing new associations beyond the well-characterized 'atopic march' of food allergies, asthma, and hay fever. Studies of primary prevention have gained traction including the remarkable impacts of early emollient therapy. Basic advances have simultaneously elucidated the nature of atopic inflammation, setting the stage for an explosion of new potential therapeutic targets. After a fallow period of nearly 15 years without a substantial therapeutic advance, this year has already seen two new FDA-approved treatments for AD. Summary: AD has a tremendous impact on quality of life with an underappreciated burden of disease; there are important newly described co-morbidities including ADHD and anemia; new insights into etio-pathogenesis have paved the way for novel topical therapies like crisaborole, and new systemic interventions like dupilumab. [ABSTRACT FROM AUTHOR]

Eosinophilic pustular folliculitis ( EPF) is a rare cutaneous disorder that typically occurs in three clinical contexts: men, individuals who are immunosuppressed or have human immunodeficiency virus, and infants. A fourth subtype occurring 2 to 3 months after hematopoietic stem cell transplantation ( HSCT) has recently been described in several adults. We report two cases of EPF arising in children after HSCT. It is important to recognize this form of EPF after HSCT and differentiate it from graft-versus-host disease since it responds readily to topical steroids and appears to have an excellent prognosis. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection. The lifelong prevalence of AD is over 20 % in affluent countries. When a child with severe AD is not responding to optimized topical therapy including phototherapy, and relevant triggers cannot be identified or avoided, systemic therapy should be considered. If studies show early aggressive intervention can prevent one from advancing along the atopic march, and relevant triggers such as food allergies cannot be either identified or avoided, systemic therapy may also play a prophylactic role. Though the majority of evidence exists in adult populations, four systemic non-specific immunosuppressive or immunomodulatory drugs have demonstrated efficacy in AD and are used in most patients requiring this level of intervention regardless of age: cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine. This article reviews the use of these medications as well as several promising targeted therapies currently in development including dupilumab and apremilast. We briefly cover several other systemic interventions that have been studied in children with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Trichodysplasia spinulosa ( TS) is an uncommon skin disease characterized by a folliculocentric papular eruption and keratin spine formation, classically appearing on the central face and ears. It occurs in immunosuppressed patients and is linked to a viral etiology. Diagnostic tests including polymerase chain reaction ( PCR) are available for detection of the TS-associated polyomavirus. Effective treatment options include topical cidofovir and oral valganciclovir. We present a case diagnosed using PCR with skin scrapings and treated using physical extraction of the keratin spicules. Significant improvement was noted, suggesting a safe, cost-effective treatment alternative. [ABSTRACT FROM AUTHOR]

The past year has produced several new clinical guidelines germane to paediatric dermatology, as well as important work related to rheumatologic overlap disorders, psoriasis comorbidities, pigmented lesions and quality of life impact. This review highlights common diagnoses and treatments useful for the practicing paediatrician. [ABSTRACT FROM AUTHOR]

Incorrect diagnoses during child abuse evaluations are serious. Because skin lesions are common in abuse, it is important to consider cutaneous mimics of physical abuse. The current study prospectively identified cutaneous mimics in a cohort of children evaluated for possible physical abuse. This is a secondary analysis of data from the Examining Siblings To Recognize Abuse research network's prospective, observational, cross-sectional study involving 20 U.S. child abuse teams. Subjects were younger than 10 years old and were evaluated by child abuse physicians ( CAPs) for concerns of physical abuse. CAPs prospectively documented whether mimics were identified during their physical abuse evaluations. Details of each patient with cutaneous mimics were evaluated to determine the types of mimics, which part of the evaluations identified mimics, and the perceived abuse likelihood. Of 2,890 children evaluated for physical abuse, 137 had at least one mimic identified and 69 had some cutaneous mimic components. Although 985 of 2,753 (39%) subjects without mimics had high levels of abuse concern, only 9 of 137 (6%) children with mimics had high levels of abuse concern (p < 0.001). Of 69 children with cutaneous mimics, 56 (81%) were diagnosed by history and physical examination. Cutaneous abuse mimics were identified in 2.4% of children evaluated for physical abuse. Although it was eventually determined that there was little or no concern for abuse in 84% of children with cutaneous mimics, a small number were physically abused. CAP evaluation may be valuable in recognizing children with cutaneous mimics who also were abused. [ABSTRACT FROM AUTHOR]

Classic viral exanthems, such as measles, rubella, and Fifth disease, have great historical significance and, despite vaccine successes, still occur both in the United States and across the world. Because they are either less commonly seen (e.g., measles) or recognized by pediatricians (e.g., Fifth disease), viral exanthems that present to dermatology clinics are often 'atypical' and may cause diagnostic confusion. This article will first review a general approach to the patient with a possible viral exanthem, discuss several current issues germane to 'classic' exanthems, and delve into greater detail regarding atypical presentations. [ABSTRACT FROM AUTHOR]

Infantile hemangiomas ( IH) are benign tumors of endothelial-like cells. Occurring in 4.5% of children, they are the most common tumor of childhood. The great majority of patients with IH will not need treatment, but 10% require systemic treatment. Many treatments have been described for the treatment of IH, but the Food and Drug Administration has not approved any. Over the last decade, numerous reports of successful treatment of IH with propranolol have been published. Despite its widespread use, little is known regarding the proper dosing, safety monitoring, and during of treatment or long-term outcomes for propranolol treatment of IH. Given its potential side effects, detailed education regarding proper administration of the medication as well as warning signs to watch for is necessary for parents and caretakers. Herein, we provide a parental handout that practitioners can individually tailor for use in their clinics when educating parents and caretakers about the use of propranolol for IH. Updates will also need to be made as more is learned regarding the optimal dosing and safety monitoring when using propranolol for this indication. [ABSTRACT FROM AUTHOR]

Objectives. To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas.Study Design. Retrospective review.Setting. Academic tertiary care pediatric hospital.Subjects and Methods. Forty-nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3-hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting.Results. Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3-hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure.Conclusions. In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues. [ABSTRACT FROM PUBLISHER]

An editorial is presented on the treatment of children with atopic dermatitis (AD). Topics include that Ad is a condition that makes skin red and itchy and its prevalence in children; that Food & Drug Administration (FDA) approved dupilumab and crisaborole in 2017 and the systemic medication of prednisone; and taht the disease can cause increased risk for depression, suicidal ideation, and suicide.

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. [ABSTRACT FROM AUTHOR]

Examines the characteristics of CHIME syndrome in children. Disruption of myelinated fibers; Development of acute lymphoblastic leukemia; Management of the syndrome.

We present the case of a 12-year-old-girl who developed lichenoid dermatitis approximately 1 year after starting leflunomide for juvenile idiopathic arthritis. The eruption resolved promptly with discontinuation of the suspected culprit agent, supportive of a lichenoid drug eruption, but she subsequently developed markedly dystrophic nails with lichen planus-like features. A biopsy of her cutaneous findings at the time of initial presentation demonstrated lichenoid dermatitis, and a nail matrix biopsy was deferred given clinical correlation. Prominent nail changes in lichenoid drug eruptions, particularly in children, are rare but should be considered in children with new-onset nail dystrophy. [ABSTRACT FROM AUTHOR]

A photoquiz concerning a pediatric health problem of a 14 years old girl with fever, oral ulcerations, arthralgias and other physical indications is presented.

A letter to the editor is presented in response to an article published in previous issues regarding capillary malformations.

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided. [ABSTRACT FROM AUTHOR]

This article focuses on black-box warning for tacrolimus and pimecrolimus. The U.S. Food and Drug Administration mandated a black-box warning label for the topical nonsteroidal anti-inflammatory agents tacrolimus and pimecrolimus. The reasons for that decision, and the implications for clinicians, are summarized below. Tacrolimus ointment and pimecrolimus cream are topical nonsteroidctl anti-inflammatory agents indicated for otopic dermatitis in patients aged 2 years and older in whom conventional therapy is either ineffective or inadvisable because of concerns about adverse effects.