Miriam Weinstein

Expanding the therapeutic repertoire of infantile haemangiomas: cohort-blinded study of oral nadolol compared with propranolol

occurrence in male and female siblings. J Am Acad Dermatol 2008; 58 (Suppl. 2):AB91. 9 Miteva M, Aber C, Torres F, Tosti A. Frontal fibrosing alopecia occurring on scalp vitiligo: report of four cases. Br J Dermatol 2011; 165:445–7. 10 Miteva M, Whiting D, Harries M et al. Frontal fibrosing alopecia in black patients. Br J Dermatol 2012; 167:208–10. 11 Thier R, Brüning T, Roos PH et al. Markers of genetic susceptibility in human environmental hygiene and toxicology: the role of selected CYP, NAT and GST genes. Int J Hyg Environ Health 2003; 206:149–71. 12 Saurat JH, Kaya G, Saxer-Sekulic N et al. The cutaneous lesions of dioxin exposure: lessons from the poisoning of Victor Yushchenko. Toxicol Sci 2012; 125:310–17. 13 Miteva M, Tosti A. Treatment options for alopecia: an update, looking to the future. Expert Opin Pharmacother 2012; 13:1271–81.

A double-blind, randomized, placebo-controlled trial of topical tacrolimus 0·1% vs. clobetasol propionate 0·05% in childhood vitiligo.

Background  Both clobetasol propionate 0·05% (CP 0·05%) and tacrolimus 0·1% (T 0·1%) ointments have been shown to be efficacious and safe in treating vitiligo in the paediatric population.

Kasabach–Merritt phenomenon: a single centre experience

Objective:  Kasabach–Merritt phenomenon (KMP) can lead to life‐threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution.

Colonization with community-acquired methicillin-resistant Staphylococcus aureus in children with atopic dermatitis: a cross-sectional study

Background  Bacterial infection with Staphylococcus aureus is a common complication of atopic dermatitis (AD). The incidence of community‐acquired methicillin‐resistant S. aureus infection (MRSA) in the AD population is unknown.

Vincristine and Corticosteroids as First-Line Treatment of Kasabach-Merritt Syndrome in Kaposiform Hemangioendothelioma:

Background: Historically, patients with the consumptive coagulopathy Kasabach-Merritt syndrome (KMS) have been treated with systemic corticosteroids as first-line therapy, but many patients do not respond. Recently, there have been increasing reports of the use of the chemotherapeutic drug vincristine in these patients. Objective: To report a case of a newborn with a kaposiform hemangioendothelioma (KHE) of the right leg associated with KMS treated successfully with vincristine and oral corticosteroids. Methods: The patients chart and the literature on the subject were reviewed using Medline and PubMed. Results: Treatment with vincristine and corticosteroids lead to sustained shrinking of the tumor and correction of the thrombocytopenia and coagulopathy through 1 year of age. We believe this is the first report in the North American literature of corticosteroids and vincristine being used concomitantly as first-line therapy for KHE with KMS. Conclusion: Vincristine and corticosteroids should be considered first-line treatment for KMS.

The efficacy of trimethoprim in wound healing of patients with epidermolysis bullosa: A feasibility trial

BACKGROUND There are no systemic therapies known to facilitate wound healing in patients with recessive dystrophic epidermolysis bullosa (RDEB). OBJECTIVES We sought to assess the feasibility of a trial to examine the efficacy of trimethoprim (TMP) in healing chronic wounds in patients with RDEB and to examine the effect of TMP on lesion counts, quality of life, and emergence of antibiotic resistance. METHODS We conducted a feasibility study using a prospective, randomized, double-blinded, placebo-controlled, crossover design. The study took place between October 2006 and September 2007 in the epidermolysis bullosa clinic at the Hospital for Sick Children in Toronto, Ontario, Canada. Liquid TMP or placebo was given orally or via gastrostomy tube in two divided doses for 2 months; the main outcome measure was a decrease in surface area of selected chronic wounds. RESULTS Ten subjects with RDEB were enrolled in the study; 7 completed both study arms (4 male, 3 female). Age at enrollment was 14 ± 5.4 years. Although all patients showed improved wound healing on TMP, the crossover analysis, TMP versus placebo, approached but did not reach statistical significance (P = .08). While receiving TMP, 6 of 7 patients had more than 50% reduction in chronic wound surface area; while receiving placebo, 2 of 6 patients had more than 50% reduction in wound surface area (P = .03). Secondary outcome measures did not achieve statistical significance. LIMITATIONS Small sample size is a limitation. CONCLUSIONS This proof-of-concept study demonstrates the potential efficacy of TMP in improving wound healing in RDEB, and provides useful information for further prospective studies.

Propranolol in the management of infantile hemangiomas: clinical response and predictors.

Background: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. Objective: To assess the clinical response to and predictors of propranolol use in the treatment of IH. Methods: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. Results: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size (p = .017). Conclusions: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.

Bullous Henoch-Schönlein Purpura in Children: A Report of 6 Cases and Review of the Literature

Henoch-Schönlein purpura (HSP) is the most common vasculitis occurring in childhood. Clinical presentation involves the classic tetrad of abdominal pain, nonthrombocytopenic purpura, arthritis, and renal involvement. Dermatological manifestations of HSP are characteristic of the condition and consist of palpable purpura and edema of the lower extremities and buttocks. The clinical spectrum of HSP is highly variable; however, vesicles and bullae have rarely been reported as the presenting feature. To date, there are 14 case reports of bullous HSP in the literature in English. The authors report 6 additional cases of bullous HSP, including a recurrent case, presenting to the Hospital for Sick Children in Toronto, Canada.

The Skin Microbiome in Atopic Dermatitis and Its Relationship to Emollients

Background: Human-associated bacterial communities on the skin, skin microbiome, likely play a central role in development of immunity and protection from pathogens. In atopic patients, the skin bacterial diversity is smaller than in healthy subjects. Objective: To review treatment strategies for atopic dermatitis in Canada, taking the skin microbiome concept into account. Methods: An expert panel of 8 Canadian dermatologists explored the role of skin microbiome in clinical dermatology, specifically looking at atopic dermatitis. Results: The panel reached consensus on the following: (1) In atopic patients, the skin microbiome of lesional atopic skin is different from nonlesional skin in adjacent areas. (2) Worsening atopic dermatitis and smaller bacterial diversity are strongly associated. (3) Application of emollients containing antioxidant and antibacterial components may increase microbiome diversity in atopic skin. Conclusion: The skin microbiome may be the next frontier in preventive health and may impact the approach to atopic dermatitis treatment.

Doxycycline-induced cutaneous inflammation with systemic symptoms in a patient with acne vulgaris.

Background: Doxycycline is a commonly prescribed antibiotic for the treatment of acne vulgaris. Often preferred to other tetracyclines due to a safer and milder side-effect profile, doxycycline is more frequently prescribed as a treatment of this common condition. Objective: To present a case report of a young patient who developed skin eruptions over the extremities; myalgias; fatigue; swelling involving the face, hands, and feet; headache; and mood changes after 2 years of using doxycycline. She promptly developed similar symptoms after a rechallenge with doxycycline 1 year later. Results/Conclusion: This important finding will make practitioners more vigilant to the side effects of this medication despite its current safety profile and regardless of the time that a patient is using it.