Pediatric Dermatology

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Drug exposure tested

Washington -- In the treatment of moderate-to-severe atopic dermatitis, pimecrolimus (Elidel) cream 1 percent is less likely than tacrolimus (Protopic) ointment 0.1 percent to be systemically absorbed, according to Zoe Draelos, M.D., lead investigator of a blind treatment trial that compared systemic exposure levels of the two topical drugs.

Washington - "Control of itching is critical to the management of atopic dermatitis in children, and Elidel safely and rapidly controls itching in many cases," said Joseph F. Fowler, Jr., M.D., Clinical Professor of Dermatology at the University of Louisville and one of the investigators in a large, multicenter clinical trial evaluating the safety and efficacy of pimecrolimus 1 percent cream (Elidel, Novartis) for the treatment of mild to moderate atopic dermatitis in children. Previous clinical research had demonstrated that adults with atopic dermatitis can experience relief from pruritus as early as two days following first treatment with pimecrolimus 1 percent cream, but similar research had not been carried out in a pediatric population. Data from this Phase IV pediatric study were analyzed to determine the time to first pruritus improvement during the initial seven days of treatment.

Miami, Fla. - Dermatologists face extraordinary difficulties in their efforts to heal the wounds of epidermolysis bullosa (EB) patients because of the genetic absence of anchoring structures, such as anchoring fibrils and hemidesmosomes. While there has been significant progress in the science of identifying the structural defects and genetic sites of damage that lead to this disease, wound healing remains a great challenge, according to Lawrence Schachner, M.D., professor of dermatology, professor of pediatrics and interim chair at the University of Miami School of Medicine, Miami, Fla.

Washington ?? Dermatologists have to remember not to do away with classical medicine and rely solely on molecular tests when making a diagnosis, according to a presenter at a meeting of the Society for Pediatric Dermatology here.

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.

A chronicle of the Times

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.

Long-term results

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.

Acne advantages

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.

Foam effective drug mover

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.

Hand over the culprit

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.

Over the rainbow

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.

Atopic dermatitis duo

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.

Sporting skin infection

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.

Bexarotene benefits

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.

Detective work

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.

Reassurance

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.