Shehla Admani

Methylisothiazolinone: a case of perianal dermatitis caused by wet wipes and review of an emerging pediatric allergen.

Methylisothiazolinone (MI) is a preservative found in cosmetic, personal hygiene, and industrial products. It has been characterized as a moderate to strong sensitizer and is an emerging allergen in the pediatric population. We discuss a case of perianal dermatitis in a child caused by contact allergy to MI‐containing wet wipes.

Beneficial effects of early pulsed dye laser therapy in individuals with infantile hemangiomas.

Author(s): Admani, Shehla; Krakowski, Andrew C; Nelson, John S; Eichenfield, Lawrence F; Friedlander, Sheila F

iPad—Increasing Nickel Exposure in Children

We discuss allergic contact dermatitis to the iPad to highlight a potential source of nickel exposure in children.

Residual Scarring From Hidradenitis Suppurativa: Fractionated CO2 Laser as a Novel and Noninvasive Approach

Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that can have a significant psychosocial impact, both with the active disease and with residual scarring. Although a wide variety of treatment options exist for HS, to our knowledge there are no reported modalities aimed specifically at treating HS scarring. We describe the case of an adolescent female who received medical management of intramammary HS followed by successful treatment with fractionated 10 600-nm carbon dioxide laser for her residual cribriform scarring. We believe there is great potential for the use of fractionated carbon dioxide laser to improve short- and long-term psychosocial outcomes of HS, promote physical scar remodeling, and possibly alter the disease process itself.

Characterization of Lipoprotein Composition and Function in Pediatric Psoriasis Reveals a More Atherogenic Profile

Psoriasis is associated with increased cardiovascular disease (CVD) in adults, but the risk profile of children with psoriasis remains to be fully characterized. We measured lipoprotein composition and function in 44 pediatric psoriasis patients and 44 age- and sex-matched healthy controls, using NMR spectroscopy and a validated ex vivo assay of high density lipoprotein (HDL) cholesterol efflux capacity (CEC). Mean age was 13.0 years and the population was ethnically diverse. Children with psoriasis had higher waist-hip ratios (0.85 vs. 0.80; p<0.002) and insulin resistance measures (log transformed HOMA-IR 0.65 vs. 0.41; p=0.07). Despite comparable traditional lipid values, having psoriasis was associated with higher apolipoprotein B concentrations (72.4 vs. 64.6; p=0.02), decreased large HDL particles (5.3 vs. 6.7; p<0.01), and reduced CEC after adjusting for age, sex, fasting glucose, HOMA-IR, systolic blood pressure, body mass index, apolipoprotein A-1, and HDL cholesterol concentration (beta -0.22, p=0.02). Pediatric psoriasis patients have a more atherogenic cardiometabolic risk profile, with evidence of insulin resistance and lipoprotein dysfunction by particle size, number, and functional assessment. These findings may provide a basis for the observed link later in life between psoriasis and CVD and support the need to screen and educate young patients to minimize later complications.

Invited Commentary: Recommendation for a North American Pediatric Patch Test Series

Given the increased recognition of pediatric allergic contact dermatitis and lack of patch testing consensus in children, we present a minimum basic 20-allergen North American pediatric series, for screening children ages 6–12 with suspected contact allergy.

Belt Buckles—Increasing Awareness of Nickel Exposure in Children: A Case Report

Children, especially those with atopic dermatitis, are at risk for nickel sensitization and subsequent dermatitis from metal-containing objects, namely belt buckles. We describe allergic contact dermatitis in 12 children with peri-umbilical nickel dermatitis (with and without generalized involvement) caused by dimethylglyoxime-positive belt buckles. The patients’ symptoms resolved with avoidance of the nickel-containing products.

Evaluation and treatment of acne from infancy to preadolescence

Acne vulgaris is a common inflammatory skin condition affecting most individuals at some point during their lives. Although acne is more commonly seen in adolescents, it can be seen in younger patients as well. It can be useful to classify pediatric acne based on the age of presentation as infantile, mid‐childhood, or preadolescent. We describe a practical approach to the evaluation and treatment of acne in each of these age groups.

Treatment of Actinic Cheilitis Using a 1,927-nm Thulium Fractional Laser

Actinic cheilitis (AC) is a precancerous condition of the lip that primarily affects people with Fitzpatrick skin types I and II as a result of chronic exposure to solar irradiation. Additional factors include poor oral hygiene, chronic lip irritation, and excessive tobacco use. The clinical spectrum of AC is varied and may include erythema, leukoplakia, scaling, atrophy, dryness, fissures, ulcers, and loss of the vermilion border. As with actinic keratosis (AK), AC has the potential to undergo malignant transformation into invasive squamous cell carcinoma (SCC). Although the exact rate of malignant conversion is unknown, SCC of the lip is the most common malignancy of the oral cavity and is more aggressive than SCCs in other sites, so early diagnosis and effective treatment of AC is necessary to curtail its malignant transformation.

Safety and efficacy of topical timolol treatment of infantile haemangioma: A prospective trial.

DEAR EDITOR, Topical timolol therapy is considered a relatively ‘safer’ alternative for the treatment of infantile haemangiomas (IH); however, sufficient supportive pharmacokinetic data does not exist. Most efficacy studies have not evaluated systemic absorption. To our knowledge, this is the first prospective trial (trial registration: NCT02145884) to assess the clinical response of proliferating IH to topical timolol maleate 0 5% gel-forming solution and to determine if systemic absorption occurred. The study was approved by the University of California San Diego institutional review board and 26 infants with IH were enrolled. These infants, aged 5–24 weeks, did not require systemic treatment and received timolol for 4 months. IH ≤ 2 cm in diameter received one drop twice daily; larger lesions received two drops twice daily. The patients were assessed at baseline, 2 and 4 weeks, and every 4 weeks thereafter; vital signs were obtained and IH size and colour were assessed. Standardized front, oblique and side view photographs were taken. A blood sample was obtained at week 2 to assess for systemic absorption. Significant response was defined as a smaller and lighter coloured haemangioma; minimal response as either a smaller or lighter haemangioma; and lack of response as either no change or an increase in height or colour. Logistic regression was used to calculate odds ratios for significant vs. minimal response. To assess timolol blood level, we used two-sample t-tests and Fisher’s exact tests. With blood level as a continuous variable, we used Spearman correlations. Facial location (42%) was most common, and there was an equal distribution at other sites (limb, scalp and trunk, 19% each). Size ranged from 0 02 to 10 5 cm. (A table of patient characteristics is available on request from the authors). The average time of timolol application before the blood draw was 3 45 h. Each drop (0 05 mL) of drug contained 0 25 mg of timolol. The mean dose of timolol was therefore 0 12 mg kg 1 daily. Six infants withdrew from the study before completion for reasons of convenience. In total, 20 patients were assessed for response at 16 weeks; 40% had a significant response to treatment, 95% (95% confidence interval 75 1–99 8%, P < 0 001) had at least a minimal response and one child did not respond. Of the infants, 24 underwent blood level analysis; 38% had detectable levels ranging from 0 3 to 1 6 ng mL . A significant relationship was found between blood level and dose (mg kg 1 daily) (Fig. 1). Infants with a detectable level had an average dose twice as high (0 18 mg kg 1 daily) as those without a detectable level (0 09 mg kg 1 daily) (P = 0 003). Per-protocol analysis did not reveal a significant relationship between the likelihood of a significant response to treatment and ascertainable blood level, chronological or gestational age, prematurity, sex, birth weight, ethnicity, dose, time from application or location. No relationship was noted between the risk factors (e.g. prematurity) evaluated and timolol blood levels. Ascertainable blood levels were noted in 44% of patients with treated scalp lesions, as compared with 0% on the face, 33% on the limbs and 22% on the trunk. A Kruskal–Wallis test showed significant differences between the locations after the level was normalized by dose, to account for the different size of IH (P = 0 034). A comparison between locations demonstrated that the plasma level on the face was different from the scalp (P = 0 003). No adverse effects were noted in our patients. Two other studies have investigated systemic absorption of topical timolol in infants with IH. One utilized abnormal Holter-monitoring findings as a surrogate marker for absorption and found a higher risk in patients treated with > 0 2 mg kg 1 daily. The other study evaluated urine timolol levels in treated patients, but neither prospectively evaluated plasma timolol levels in all patients. Most data on systemic absorption comes from ophthalmic or cardiology investigations. In one of the few studies that included children, five received one drop of timolol 0 25% solution twice daily in each eye 0·0 0·5 1·0 1·5 0· 00 0· 10 0· 20 0· 30