Journal of The American Academy of Dermatology, Dec 1, 2021
The majority of infantile hemangioma (IH) can be managed conservatively but for those requiring a... more The majority of infantile hemangioma (IH) can be managed conservatively but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before five weeks of age to mitigate the risk of sequelae. The majority of infants can be commenced on propranolol in the outpatient setting and the most frequently employed dosing regimen is 1mg/kg twice daily. In the future, β-blockers with a more selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered and for small, superficial IH, topical timolol maleate or pulsed dye laser may be considered. Where IH involute with cutaneous sequelae a range of interventions have been reported including surgery, laser and embolization. IH have a well described clinical trajectory and avail themselves to diagnosis and management via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID19 pandemic.
Journal of The American Academy of Dermatology, Dec 1, 2021
Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly... more Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly understood but thought to represent an aberrant response of pluripotent stem cells to stimuli such as hypoxia and the renin-angiotensin-system. IH usually appears during the first few weeks of life and follows a characteristic natural trajectory of proliferation and involution. Their clinical appearance depends on their depth and distribution. Classification comprises superficial, mixed and deep IH as well as IH with minimal or arrested growth. Multifocal IHs are more likely to be associated with infantile hepatic hemangioma, and although the need for screening based on a specific number of IH has been recently debated, 5 remains the most widely acceptable cut off point. Large facial or lumbar IH warrants investigation for PHACE and LUMBAR syndrome, respectively. Complications of IH include ulceration, obstruction or functional impairment, hypothyroidism, and cosmetic sequelae. Differential diagnoses mostly consist of other vascular tumors and vascular malformations, though IH may sometimes mimic non-vascular tumors or developmental anomalies. Diagnosis is usually clinical and biopsy rarely indicated. High-frequency ultrasonography may help with the differential diagnosis, particularly with subcutaneous lesions. Referral to other specialists may be required in specific cases.
s presented at the 34th Annual Meeting, 20–23 May 2001 The Australasian College of Dermatologists... more s presented at the 34th Annual Meeting, 20–23 May 2001 The Australasian College of Dermatologists 34th Annual Meeting, May 2001 A7 SKIN SURGERY SYMPOSIUM
A 7-year-old boy born to consanguineous parents had suffered from palmoplantar keratoderma and ch... more A 7-year-old boy born to consanguineous parents had suffered from palmoplantar keratoderma and chronic gingivitis since the age of 3 months. He was diagnosed with Papillon-Lefèvre syndrome. Genetic testing confirmed that he was homozygous with a point mutation in exon 6 of the cathepsin C gene. One year after initiating treatment with acitretin 10 mg oral daily and trimethoprim-sulfamethoxazole, the patient's skin remains almost lesion-free, and he has new teeth that erupted during treatment and are free of periodontal disease.
The Australasian journal of dermatology, Jan 5, 2018
The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect... more The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on r...
Although most infantile haemangiomas do not require treatment due to a natural history of spontan... more Although most infantile haemangiomas do not require treatment due to a natural history of spontaneous involution, some require early intervention. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol. Infants with haemangiomas that are life threatening, at risk of ulceration, or at risk of causing a significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. Oral propranolol is safe and effective and in most healthy infants oral propranolol can be started in an outpatient setting.
To implement an intervention program for reducing the prevalence of scabies in a large Northern T... more To implement an intervention program for reducing the prevalence of scabies in a large Northern Territory Aboriginal community. Prospective, longitudinal screening, intervention and follow-up study. All children aged 5 years and under in one of the largest Aboriginal communities in the Northern Territory, total population, approximately 2,200 (95% Indigenous). A decrease in prevalence of scabies, infected scabies and non-scabies pyoderma over seven months. The number of children aged 5 years and under screened intially and at the three follow-up screenings ranged from 201 to 242 (more than 98% of those eligible on each occasion). The prevalences of scabies, infected scabies and non-scabies pyoderma before intervention were 35%, 12% and 11%, respectively. At 6 weeks postintervention these had decreased to 3%, 1% and 4%, respectively; low prevalences were maintained at four and seven months. This intervention, which was based on community motivation, involvement and control, successfu...
Journal of The American Academy of Dermatology, Dec 1, 2021
The majority of infantile hemangioma (IH) can be managed conservatively but for those requiring a... more The majority of infantile hemangioma (IH) can be managed conservatively but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before five weeks of age to mitigate the risk of sequelae. The majority of infants can be commenced on propranolol in the outpatient setting and the most frequently employed dosing regimen is 1mg/kg twice daily. In the future, β-blockers with a more selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered and for small, superficial IH, topical timolol maleate or pulsed dye laser may be considered. Where IH involute with cutaneous sequelae a range of interventions have been reported including surgery, laser and embolization. IH have a well described clinical trajectory and avail themselves to diagnosis and management via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID19 pandemic.
Journal of The American Academy of Dermatology, Dec 1, 2021
Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly... more Infantile hemangioma (IH) is the most common pediatric vascular tumor. Its pathogenesis is poorly understood but thought to represent an aberrant response of pluripotent stem cells to stimuli such as hypoxia and the renin-angiotensin-system. IH usually appears during the first few weeks of life and follows a characteristic natural trajectory of proliferation and involution. Their clinical appearance depends on their depth and distribution. Classification comprises superficial, mixed and deep IH as well as IH with minimal or arrested growth. Multifocal IHs are more likely to be associated with infantile hepatic hemangioma, and although the need for screening based on a specific number of IH has been recently debated, 5 remains the most widely acceptable cut off point. Large facial or lumbar IH warrants investigation for PHACE and LUMBAR syndrome, respectively. Complications of IH include ulceration, obstruction or functional impairment, hypothyroidism, and cosmetic sequelae. Differential diagnoses mostly consist of other vascular tumors and vascular malformations, though IH may sometimes mimic non-vascular tumors or developmental anomalies. Diagnosis is usually clinical and biopsy rarely indicated. High-frequency ultrasonography may help with the differential diagnosis, particularly with subcutaneous lesions. Referral to other specialists may be required in specific cases.
s presented at the 34th Annual Meeting, 20–23 May 2001 The Australasian College of Dermatologists... more s presented at the 34th Annual Meeting, 20–23 May 2001 The Australasian College of Dermatologists 34th Annual Meeting, May 2001 A7 SKIN SURGERY SYMPOSIUM
A 7-year-old boy born to consanguineous parents had suffered from palmoplantar keratoderma and ch... more A 7-year-old boy born to consanguineous parents had suffered from palmoplantar keratoderma and chronic gingivitis since the age of 3 months. He was diagnosed with Papillon-Lefèvre syndrome. Genetic testing confirmed that he was homozygous with a point mutation in exon 6 of the cathepsin C gene. One year after initiating treatment with acitretin 10 mg oral daily and trimethoprim-sulfamethoxazole, the patient's skin remains almost lesion-free, and he has new teeth that erupted during treatment and are free of periodontal disease.
The Australasian journal of dermatology, Jan 5, 2018
The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect... more The Australasian Psoriasis Collaboration has developed a clinical practice narrative with respect to the relationship between psoriasis, its treatment and infection. The cutaneous microbiome of patients with psoriasis is different to those without psoriasis, although the significance of this is unclear. Whilst a wide range of microorganisms has been associated with psoriasis (including β-haemolytic streptococci, Staphylococcus aureus, Porphyromonas gingivalis, Candida albicans, Chlamydia psittaci, human immunodeficiency virus and hepatitis C virus), there is limited evidence that antimicrobial therapy is of direct benefit in preventing flares of psoriasis. Psoriasis is independently associated with an increased risk of serious infection, but the absolute risk is low. The risk of serious infections is further increased with immune-modulatory treatments. The decision whether to, and when to, stop or resume immune-modulatory treatment after a serious infection has occurred depends on r...
Although most infantile haemangiomas do not require treatment due to a natural history of spontan... more Although most infantile haemangiomas do not require treatment due to a natural history of spontaneous involution, some require early intervention. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol. Infants with haemangiomas that are life threatening, at risk of ulceration, or at risk of causing a significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. Oral propranolol is safe and effective and in most healthy infants oral propranolol can be started in an outpatient setting.
To implement an intervention program for reducing the prevalence of scabies in a large Northern T... more To implement an intervention program for reducing the prevalence of scabies in a large Northern Territory Aboriginal community. Prospective, longitudinal screening, intervention and follow-up study. All children aged 5 years and under in one of the largest Aboriginal communities in the Northern Territory, total population, approximately 2,200 (95% Indigenous). A decrease in prevalence of scabies, infected scabies and non-scabies pyoderma over seven months. The number of children aged 5 years and under screened intially and at the three follow-up screenings ranged from 201 to 242 (more than 98% of those eligible on each occasion). The prevalences of scabies, infected scabies and non-scabies pyoderma before intervention were 35%, 12% and 11%, respectively. At 6 weeks postintervention these had decreased to 3%, 1% and 4%, respectively; low prevalences were maintained at four and seven months. This intervention, which was based on community motivation, involvement and control, successfu...
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