12 / 28
2017 AADANNUALMEETING
Dr Sarah Chamlin’s take-aways
Dr Chamlin, Associate Professor of Pediatrics and Dermatology at Northwestern University Feinberg
School of Medicine and member of the Advisory Board for
PracticeUpdate Dermatology
, offers her key
“take-aways” from the pre-ADD meeting sponsored by The Society for Pediatric Dermatology.
New tools for your therapeutic toolbox
–
Erin Mathes
Use of – and FDA approval of – both systemic and topical
agents for pediatric skin disease most often lag behind
use and approval for adults. Dr Mathes presented many
new cutting-edge options for the treatment of skin dis-
ease in children. This talk was practical and rich with
useful information.
•
The use of crisaborole ointment and dupilumab injec-
tions for children with atopic dermatitis was presented.
Many practitioners treating atopic dermatitis struggle
with patient and parent steroid phobia, and many chil-
dren are undertreated because of the fear of potential
steroid side effects. Topical crisaborole, a phosphodi-
esterase-4 inhibitor, is now available as an ointment for
use in children and is approved for children 2 years of
age and older. Of note, very promising phase III trials
were reviewed with more than 1500 study participants.
Highlights include the indication for mild-moderate
atopic dermatitis, and a high vehicle response rate
possibly due to its petrolatum base. There may be
prescribing limitations due to potentially cumbersome
prior authorisation requirements. Dr Mathes proposes
that crisaborole will likely be a useful addition to, but will
not replace, topical steroids. Data from two randomized
double-blind placebo-controlled trials of dupilumab in
adults were reviewed, and significant improvements
in all atopic dermatitis parameters including disease
severity, itch, anxiety and depression were noted. With
this therapy, patients got better quickly and had fewer
skin infections in the treatment group vs the placebo
group. A pediatric trial has been completed, with no
results yet available.
•
Can we prevent atopic dermatitis in high-risk infants?
Data from a study by Dr Eric Simpson and colleagues
suggest that we can. Emollient use within 3 weeks of
birth in high-risk infants significantly reduced the inci-
dence of atopic dermatitis at 6 months of age.
1
•
Oral tofacitinib and topical bimatoprost were sug-
gested as possible therapy for children with alopecia
areata.
2
A trial of tofacitinib in teens with alopecia
areata reported 9 responders and 4 nonresponders.
Unfortunately, relapse was common in this trial, with
an average time to relapse of 8.5 weeks after stopping
the drug, and chronic long-term systemic therapy is
harder to accept in children until long-term side effects
are known. Topical bimatoprost is another treatment
option, albeit an expensive one, which is unproven in
large studies for alopecia areata.
•
Both topical and oral ivermectin, used in adults with
rosacea, can also be useful for therapy of perioral
dermatitis and rosacea in children.
•
Topical compounded sirolimus 1% cream may be of
therapeutic benefit for superficial type of microcystic
lymphatic malformations.
It also may be effective for
use in conjunction with pulsed dye laser treatment for
more recalcitrant port wine stains.
•
Consider topical timolol 0.5% GFS with occlusion for
treatment of pyogenic granulomas.
While case reports
show efficacy, consider systemic absorption, which can
limit use in young children.
Pediatric pain management & procedural pain
control –
Amy Baxter
Pearls for performing procedures in children were offered
by Dr Baxter, a pediatric emergency department physician.
•
Needle phobia has increased in children
and directly cor-
relates with the greatly increased number of vaccinations
given to children since 1983. Before 1983, approximately
six vaccines were administered early in life. Currently, over
30 vaccinations are given by the age of 6 years.
•
Topical ELMA and LMX are commonly used for topical
anesthesia in pediatric procedures,
and Glad Press’n
Seal food wrap was suggested to cover the application
site. This plastic wrap can be removed from skin and
hair-bearing areas with less pain than a Tegaderm
dressing.
•
EMLA cream takes 60 minutes to work, vasoconstricts
for the first 1.5 hours, and provides deeper skin pen-
etration
than other topical anesthetics. Approximately
2% of users have a petechial skin reaction.
•
LMX, lidocaine in a liposomal delivery cream, works in
about 20 minutes and diffuses away in about 20 min-
utes.
For improved efficacy, rub this on when applying
and occlude for 20 to 30 minutes.
CONFERENCE COVERAGE
12
PRACTICEUPDATE DERMATOLOGY