K. L. E. Hon

Does age or gender influence quality of life in children with atopic dermatitis

Background.  Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected.

Serum levels of cutaneous T-cell attracting chemokine (CTACK) as a laboratory marker of the severity of atopic dermatitis in children

There are at least 13 scoring systems for the assessment of disease severity in atopic dermatitis (AD). Each system has its problems with interobserver and intraobserver variability. Cutaneous T‐cell attracting chemokine (CTACK) is a skin‐specific chemoattractant which may correlate with AD severity and obviate the issue of observer reliability. We evaluated whether serum CTACK concentrations were associated with the severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Thirty‐seven Chinese children with AD (23 boys, 14 girls; aged 1–11 years) and 13 controls were recruited. The median (interquartile range) overall SCORAD for AD patients was 29.7 (20.3–49.7). Serum concentrations of CTACK and two other atopy‐related chemokines, macrophage‐derived chemokine (MDC) and thymus and activation‐regulated chemokine (TARC), were measured by sandwich enzyme immunoassay. There were significant correlations between SCORAD (r = 0.394, P = 0.016), its area (r = 0.528, P = 0.001) and intensity components (r = 0.429, P = 0.008) with serum levels of CTACK. The serum concentrations of inflammatory markers MDC and TARC also correlated with the CTACK concentrations (r = 0.618, P < 0.001, and r = 0.587, P = 0.001, respectively). Serum CTACK concentration appears to be a skin‐specific objective marker that correlates with various clinical and laboratory parameters of AD.

Filaggrin null mutations in childhood atopic dermatitis among the Chinese

Atopic dermatitis (AD) is associated with loss or reduced expression of filaggrin (FLG). We evaluated five FLG null mutations, namely R501X, 2282del4, R2447X, S2554X, and S2889X, in 174 Chinese children with AD and 191 matched controls. 2282del4, R2447X, S2554X and S2889X mutations were not found in these patients. Heterozygous carriage of R501X was only found in four male patients, and associated with long‐term disease severity. FLG mutations prevalent in Caucasian and other Asian populations are rarely found in our series.

Normative Data of Penile Length for Term Chinese Newborns

Careful examination and assessment of penile length in the newborn is important because micropenis is associated with hypothalamic disorders. This prospective cross-sectional study was designed to establish the norm of penile length for term Hong Kong Chinese newborns. 4,628 full-term healthy male newborns were enrolled in the study. Penile length was measured from pubic ramus to the tip of the glans penis by placing the end of a straight edge ruler against the pubic ramus. A gestation-associated graph of 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles for the penile length was created. The penile length was significantly correlated with gestational age, birth weight and body length. When compared with published data for other populations, Hong Kong newborns have significantly shorter penile length. The norm of the penile length is useful in diagnostic and therapeutics for the ethnic Chinese male newborns.

A survey of bathing and showering practices in children with atopic eczema

We evaluated the emollient use and bathing habits of children with atopic eczema (AE) managed at the paediatric dermatology clinic of a university teaching hospital, using children with noneczematous skin diseases as controls. Disease severity of AE in the preceding 12 months was evaluated by the Nottingham Eczema Severity Score. Three‐quarters of patients with or without eczema preferred showering to bathing. Patients with AE were more likely to use bath oils than soap and to use emollients after a bath/shower. Review cases, however, were more likely to take a shower and for a longer time (10–30 min) than first‐visit eczema patients. These habits did not vary with season or disease severity. Emulsifying ointment was the most commonly used agent for the bath/shower. Most patients applied emollient immediately after a bath/shower. However there were still significant proportions of AE patients who used soap (40% of first‐visit vs. 27% of review cases) and who did not apply emollients after a bath/shower (25% of first‐visit vs. 23% of review cases). It is important to determine whether this problem is due to inadequate patient education or whether other factors lead to poor compliance.

Severe acute respiratory syndrome (SARS) in children: epidemiology, presentation and management.

Abstract Severe acute respiratory syndrome (SARS) is a newly recognised and highly contagious respiratory infection caused by a new strain of coronavirus. The disease can result in progressive respiratory failure in adults and the mortality rate has been reported to be 8–15%. This infection spreads by droplet transmission and children appear to acquire SARS through close household contact exposure to infected adults. Disease severity is, however, much milder in the paediatric age group. The common laboratory findings in infected children and adolescents include lymphopaenia and elevated levels of lactate dehydrogenase and creatinine phosphokinase. Air space consolidation is commonly seen during the course of the illness although chest radiographs are normal on presentation in half of the cases. The pathophysiology of SARS appears to be related to immunological dysregulation in response to the coronavirus infection. The optimal treatment of SARS in children remains to be determined. No case fatality in infected children has been reported. The early and proper isolation of infected adults, meticulous infection control measures in the hospital setting, exhaustive contact tracing and quarantine measures are important steps in preventing the spread of the disease among health care workers and into the community. The development of a sensitive and rapid test for early diagnosis is underway. Further controlled trials are necessary to define the optimal treatment of this infection in children.

Which aeroallergens are associated with eczema severity

Summary We investigated if a correlation exists between aeroallergen sensitization and the severity of eczema. Data on aeroallergen response to skin‐prick testing (SPT) and disease severity of children with eczema (n = 119) were evaluated. Atopy, as defined by at least one positive response to aeroallergen skin prick testing, was found in > 90% of eczema patients. House dust mite was the most commonly sensitized aeroallergen, followed by cat fur. Dermatophagoides pteronyssinus and Dermatophagoides farinae sensitization were associated with eczema severity (present in 67% of the mild and 97% of the severe group; P = 0.001). However, there was no association between eczema severity and higher strengths of SPT response (defined as SPT > 1+ to dust mites or dust). Atopy to moulds, Bermuda grass, cockroach, cat and dog was less prevalent and was not associated with eczema severity. It is sensible to advise parents on specific avoidance strategies only in severely affected children who have a definitive history of eczema exacerbation by specific aeroallergens and who are not responsive to conventional treatment.

Topical 5-fluorouracil has no additional benefit in treating common warts with cryotherapy: a single-centre, double-blind, randomized, placebo-controlled trial.

The role of topical 5‐fluorouracil (5‐FU) in treating common warts is not well defined. We tried to evaluate the efficacy and adverse effects of combination cryotherapy and topical 5% 5‐FU ointment in the treatment of common warts. The study was a single‐centre, double‐blind randomized placebo‐controlled trial. In the study, 80 patients with common warts were randomized into two groups and underwent two 10‐second freeze/thaw cycles of cryotherapy with liquid nitrogen once every three weeks for a maximum of five treatments. Between treatments, patients applied either topical 5% 5‐FU ointment (group A) or placebo aqueous cream (group B) twice daily. The mean ± SD reduction in wart area was 58.57 ± 0.06% in group A and 65.29 ± 0.06% in group B. In total, 19 patients in group A and 24 patients in group B had wart size reduced by 75% or more (P = 0.50), while 12 patients in group A and 17 patients in group B had clearance of their warts (P = 0.245). Logistic regression with age, sex, smoking status, immune status, site, duration and number of warty lesions, history of previous treatment, and treatment group found that only a history of previous treatment and acral lesions were significant adverse predictors of improvement. There was no significant difference in the number of adverse events between the two groups, although there was a trend towards more pain and blistering associated with topical 5‐FU. We concluded that topical 5‐FU has no added benefit in treating common warts with cryotherapy.

Severe Congenital Myasthenia Gravis of the Presynaptic Type with Choline Acetyltransferase Mutation in a Chinese Infant with Respiratory Failure

We report a severe case of congenital myasthenia gravis in a Chinese newborn who presented with complete ptosis, severe hypotonia, dysphagia and respiratory insufficiency with recurrent apnea that required mechanical ventilatory support since birth. Routine neurophysiologic studies, including the 3-Hz repetitive stimulation test and electromyogram were normal. Neostigmine and edrophonium tests were also negative. However, decremental response to 3-Hz stimulation became apparent after depleting the muscles with trains of 10-Hz stimuli for 10 min. The infant was subsequently confirmed to have heterozygous mutations in the choline acetyltransferase genes, p.T553N and p.S704P. Both missense mutations are novel mutations. The child remained on positive pressure ventilation at 3 years of age despite treatment with high-dose anticholinesterase. This case highlights the difficulty of making an early diagnosis based on clinical presentation and routine electrophysiologic tests, especially when neonatologists are not familiar with this condition. Further, as there are different genetic defects causing different types of congenital myasthenia gravis, anticholinesterase therapy may be beneficial to some but detrimental to others. Therefore, the exact molecular diagnosis is an important guide to therapy. A high index of suspicion coupled with extended electrodiagnostic tests in clinically suspected patients will ensure the selection of appropriate genetic molecular study for confirming the diagnosis.

Severe acute respiratory syndrome: 'SARS' or 'not SARS'

Abstract:  Accurate clinical diagnosis of severe acute respiratory syndrome (SARS) based on the current World Health Organization definition is difficult and at times impossible at the early stage of the disease. Both false positive and false negative cases are commonly encountered and this could have far‐reaching detrimental effects on the patients, their family and the clinicians alike. Contact history is particularly important in diagnosing SARS in children as their presenting features are often non‐specific. The difficulty in making a correct diagnosis is further compounded by the lack of a sensitive rapid diagnostic test. Serology is not particularly helpful in the initial triaging of patients as it takes at least 3 weeks to become positive. Co‐infection and other treatable conditions should not be missed and conventional antibiotics should remain as part of the first‐line treatment regimen. We report five cases to illustrate the difficulties and dilemmas faced by clinicians in diagnosing SARS in children.