PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

CONFERENCE COVERAGE 12

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.

PRACTICEUPDATE DERMATOLOGY