Pediatric Dermatology

Tacrolimus and pimecrolimus may spring to mind first when atopic dermatitisis diagnosed, but it turns out that these topical immunomodulators are alsoeffective for a host of previously difficult-to-treat diseases. Granulomafaciale, Hailey Hailey disease, hand and foot eczema, and chronic actinicdermatitis are among the lengthy list of conditions these work well for,according to Mark Lebwohl, M.D., professor and chairman, departmentof dermatology, Mt. Sinai School of Medicine.

Interim data from three studies released at the 62nd annual conferenceof the American Academy of Dermatology support preliminary data presentedlast month demonstrating that tacrolimus ointment (Protopic, Fujisawa) ismore effective than pimecrolimus cream (Elidel, Novartis) in the treatmentof adult and pediatric patients with atopic dermatitis.

Laser and light therapies, while still controversial, are dramatically changing acne treatment. Rosacea patients also benefit from the more patient-friendly nondrug options. And drug therapies, including hormonal options, provide a strong hope that patients will have alternatives in treatment aimed at tackling severe acne in the future.

Five years ago, we marveled at the incredible advances in both medical and surgical dermatology. These included systemic retinoids for acne and keratinizing disorders, superpotent topical corticosteroids for even steroid-unresponsive dermatoses, photochemotherapy and narrow-band UVB phototherapy for psoriasis, and mycosis fungoides. They also included other difficult-to-treat skin problems, and sophisticated surgical modalities to improve photo-damaged skin and to help turn back the clock on skin aging in general. Five years ago, we celebrated, in these pages, 20 years of change in dermatology as reflected on the subjects that Dermatology Times covered for its readers.

Washington - Choosing patients with the appropriate weight and exercise history is critical to the long-term success of the liposuction procedure, according to Naomi Lawrence, M.D. "Liposuction is an excellent and efficacious procedure, when you pick the right candidate - someone with a stable weight," she said.

Waikoloa, Hawaii - A investigational foam preparation of clindamycin phosphate 1 percent (Actiza) provides a safe, effective, well-tolerated, and innovative new treatment for acne vulgaris, said Lawrence F. Eichenfield, MD, at the annual Hawaii Dermatology Seminar in January.

Bangkok, Thailand - Narrow band ultraviolet B (NBUVB) phototherapy can offer a well-tolerated and effective modality for achieving repigmentation of vitiligo in pediatric and adult Asian patients, said Natta Rajatanavin, M.D.

Anaheim Hills, Calif. - The new topical immunomodulators (TIMs) such as pimecrolimus (Elidel) and tacrolimus (Protopic) will reverse the growing number of cases of adult atopic dermatitis, predicts Cheryl Effron, M.D., a dermatologist in Anaheim Hills, Calif.

Waikoloa, Hawaii - A new foam formulation of the antifungal drug ketoconazole (Extina 2 percent, Connetics Corp.), currently under FDA review, seems to be more completely absorbed into the skin than the same ingredient in other formulations and could be more effective in the treatment of seborrheic dermatitis, said Linda F. Stein Gold, M.D., director of clinical research, Department of Dermatology, Henry Ford Health System, West Bloomfield, Mich.

Waikoloa, Hawaii - Not all hand dermatitis is latex-related, and patients with dermatitis need an appropriate diagnosis so they can avoid the causative agent. Topical corticosteroids are a temporary solution.

Waikoloa, Hawaii - A new foam formulation of the antifungal drug ketoconazole (Extina 2 percent, Connetics Corp.), currently under FDA review, seems to be more completely absorbed into the skin than the same ingredient in other formulations and could be more effective in the treatment of sehorrheic dermatitis, said Linda F. Stein Gold, M.D., director of clinical research, department of dermatology, Henry Ford Health System, West Bloomfield, Mich.

Barcelona - In two Phase IV efficacy studies designed to evaluate pimecrolimus 1 percent cream (Elidel?, Novartis Pharmaceuticals Corp.) under "real world" conditions, treatment with pimecrolimus 1 percent cream for up to six months was found to be safe and effective in infants, children, and adults who were suffering from atopic dermatitis with all degrees of severity and who had received a wide variety of previous treatments. Moreover, in both trials, subjects reported improvements in quality of life and a high degree of cosmetic acceptability, according to clinical investigators Lyn C. Guenther, M.D., F.R.C.P.C., Professor of Dermatology at the University of Western Ontario in London, Ontario, Can., and Sheila Fallon Friedlander, M.D., Associate Clinical Professor of Dermatology at Children's Hospital & UCSD Medical Center in San Diego, Calif. Results of both trials were presented at the 12th Congress of the European Academy of Dermatology and Venereology in Barcelona.

Waikoloa, Hawaii - A combination topical treatment regimen consisting of the calcineurin inhibitor tacrolimus 0.1 percent ointment (Protopic, Fujisawa) plus the moderate potency corticosteroid clocortolone pivalate 0.1 percent cream (Cloderm, Healthpoint) is more effective in the treatment of atopic dermatitis and associated with fewer side effects than monotherapy with either agent alone, said Alan B. Fleischer, Jr., M.D., at the annual Hawaii Dermatology Seminar in January.

Cincinnati - With wrestling season well under way, late fall and winter becomes a busy time for a sports dermatology clinic, said Brian B. Adams, M.D.

Waikoloa, HI - Bexarotene 1 percent gel (Targretin) is a useful alternative modality for the treatment of mycosis fungoides, said Joan Guitart, M.D., at the annual Hawaii Dermatology Seminar.

Miami - Dermatologists who ask the right questions when they see children with cutaneous conditions might discover that academic, emotional, or social problems are at the root of some of these skin disorders.

Moderator: What cosmetic dermatology issues are you most often encounteringin your practice today?

Atlanta - With laser resurfacing on the decline, dermatologists might see more complications with dermabrasion and peels, partly because the sheer number of these procedures is rising. However, other factors are also at play.

Philadelphia - Of all the cosmetic procedures that make hands appear younger, sclerotherapy delivers the most dramatic, long-lasting results, according to Lee Schulman, M.D., a phlebologist at Schulman Vein and Laser Center in New York City.

Craig G. Burkhart, M.P.H., M.D., has a flier for patients in his waiting room in Sylvania, Ohio. It is not your ordinary practice brochure. Rather, his is more personal. It features a series of pictures that a Toledo Blade newspaper photographer took of Dr. Burkhart when the dermatologist was 2 1/2 years old. It was his first haircut, and the photo was taken at the barbershop. The series starts with a picture of the toddler crying because he was about to lose his cute, curly locks. The pictures go on to show the range of emotions, with the last photo

Q How much life insurance coverage is recommended for a physician who has a family?

Washington -- When it comes to photoprotection, people expect too much from sunscreens.

Salt Lake City - Genetic testing for hereditary melanoma is currently being marketed to physicians.

Barcelona, Spain - Identifying the cause of itch is the key to treating it. New research is helping better characterize pruritus, leading to more effective therapies for this frustrating condition, according to physicians reporting at the 2003 meeting of the European Academy of Dermatology and Venereology (EADV).

Barcelona, Spain - New research demonstrates the pathophysiology of itch may be more complex than once believed. Recently discovered pruritic pathways, such as those involving proteases or neuropeptides, are opening doors to new therapeutic targets for this uncomfortable, hard-to-control phenomenon.

Baltimore - PUVA and phototherapy are safe and effective for the treatment of more than two dozen conditions, but of the dermatologists who provide these treatments, as many as half use them solely for psoriasis, according to Warwick L. Morison M.D., professor of dermatology, Johns Hopkins Medical School, Baltimore.

Washington, D.C. - Tacrolimus and pimecrolimus may spring to mind first when atopic dermatitis is diagnosed, but it turns out that these topical immunomodulators are also effective for a host of previously difficult-to-treat diseases. Granuloma faciale, Hailey Hailey disease, hand and foot eczema and chromic actinic dermatitis are among the lengthy list of conditions these work well for, according to Mark Lebwohl, M.D., Professor and Chairman, Department of Dermatology, Mt. Sinai School of Medicine.

Detroit - Topical treatment allows medication delivery directly to the skin with reduced systemic exposure compared to orally administered agents, but local drug application is not without risk to internal organ systems, according to Peter J. Aronson, M.D.

Montreal - Diagnosing unusual sexually transmitted infections can be a unique challenge, particularly for physicians lacking expertise in this area.

Danville, Pa. - Hand dermatitis can be difficult to diagnose and treat, according to Christen M. Mowad, M.D., assistant professor, department of dermatology, Geisinger Medical Center, Pennsylvania State College of Medicine.