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Comunidad de Especialistas en la piel de los más pequeños

A double-blind randomized placebo-controlled trial of topical tacrolimus 0.1% versus clobetasol propionate 0.05% in childhood vitiligo

 

N. Ho, E. Pope, M. Weinstein, S. Greenberg, C. Webster, B.R. Krafchik

Objective:  To assess comparative efficacy and safety of these two therapies and placebo.

Methods:  In this prospective study, children of 2-16 years of age with vitiligo, stratified into “facial”(n=55) and “non-facial”(n=45) groups, were randomized into three arms: CP 0.05% ointment (n =30), T 0.1% ointment (n=31) and placebo (n=29) for 6 months. Successful repigmentation, defined as > 50% improvement, was evaluated by comparing photographs taken at baseline and 2, 4, 6 months.

Results:  In the facial group, 58.33% of the CP 0.05% group responded successfully compared with 57.78% of the T 0.1% group, and in the non-facial group, 38.9% of the CP 0.05% group compared with 23% of the T 0.1% group (p= 0.3820). There was a significant difference in response between the CP 0.05% group vs placebo (p <0.0001) and the T 0.1% group vs placebo (p=0.0004). Spontaneous repigmentation was evaluated as 2.4%. No significant clinical adverse events were noted in any group.

Limitations:  Relatively small sample size; outcome measures based on digital photographs comparisons.

Conclusions:  Both CP 0.05% and T 0.1% ointments offer similar benefit in both paediatric facial and non facial vitiligo. The facial lesions responded faster than the non-facial ones.

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Apparent Life-Threatening Events in Presumably Healthy Newborns During Early Skin-to-Skin Contact

Virginie Andres, MDa, Patricia Garcia, MDa, Yves Rimet, MDb, Claire Nicaise, MDc, Umberto Simeoni, MDa

PEDIATRICS Vol. 127 No. 4 April 2011, pp. e1073-e1076

In each case, the incident occurred in a healthy infant who was in a prone position on his or her mother’s abdomen during early skin-to-skin contact. In most cases, the mother was primiparous, and in all cases the mother and infant were not observed during the initiation of skin-to-skin contact and breastfeeding. There are many benefits of early skin-to-skin contact and breastfeeding in the delivery room. However, in view of the risk of a rare but significant ALTE, we suggest that surveillance of newborns is needed. Although many ALTEs are apparently caused by obstruction, we suggest that a standardized investigational workup be performed after an ALTE.

Key Words: newborn • apparent life-threatening event • sudden death • skin-to-skin • delivery room

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Coexistence of polyarteritis nodosa and psoriatic arthritis in a child: an unreported association Polyarteritis nodosa and psoriatic arthitritis

Ignacio Oulego-Erroz, Sandra Gautreaux-Minaya, Jorge Martinez-Sáenz de Jubera, David Naranjo-Vivas, Santiago Fernéndez-Hernández and Manoel Muñíz-Fontán

Abstract

 We describe the case of an 11-year-old boy that presented with fever of unknown origin plus clinical signs of sacroiliitis, bilateral enthesitis of the plantar fascia, and skin psoriasis. He acutely developed erythematous and tender nodular lesions in the lower limbs that lasted around 3 weeks and spontaneously disappeared at the same time as the fever. He was diagnosed as having PAN and PA according to clinical and histological criteria. This is the first report of the coexistence of PAN and PA in a child indicating a possible relation (maybe cross-reactivity of an infectious agent) between PAN and spondiloarthritis.

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Caso Nº 158 Abril 20, 2011 (Caso con respuesta)

Caso Nº 158 Abril 20, 2011 (Caso con respuesta)

 

158-1p 158-2p 158-3p
158-4p 158-5p 158-9p
158-7p 158-8p 158-6p

El paciente trae reporte de biopsia:.

biopsiap

Perfil de laboratorio : dentro de límites normales

Serología hepatitis , B,C y HIV : negativos.

Cual es su diagnóstico?

Cual sería su conducta terapeútica ?


Respuesta al Caso

1. El diagnóstico tanto por clínica como por biopsia corresponde a Un Liquen Plano Diseminado
2. Cushing Secundario por esteroides sistémicos y tópicos por varios años.

Exámenes complementarios:
Rutina de laboratorio y serologías incluido hepatitis B y C normales
Tratamiento:
Se dicidió iniciar tratamiento con ciclosporina a razón de 5 mg/kg dia por 1 mes y 3 mg/kg/día por 1 mes y 2.5mg/kg/día por 1 mes con excelente evolución y omisión del tratamiento.
Se realizó control diario de la Tensión Arterial y creatinina sérica cada 15 dias, : normal
Actualmente está en remisión.

158r1p 158r6p 158r3p
158r4p 158r2p

Francisco Gonzalez
Hospital de Clínica Caracas

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Caso Nº 157 Abril 13, 2011 (Caso con respuesta)

Caso Nº 157 Abril 13, 2011 (Caso con respuesta)
thumb_157-2 thumb_157-3 thumb_157-4

Datos Laboratorio

  • Hb:13,7 gr/dl Hto:45,2
  • Plaquetas:258000/mm3
  • PT: 0,91 PTT: 2 Fibrinógeno:256,8
  • Leucocitos DLN
thumb_157-5 thumb_157-6 thumb_157-7

  • Cual es su Diagnóstico
  • Cual sería su Conducta Terapeútica
  • Solicitaría algún examen complementario

 

Dra. Ana María Sáenz de Cantele
Dra. Antonietta Cirocco
Dra. Rosmary Martín
Dra. Elisa Sciamanna
Dr. Francisco González
Cátedra de Dermatología
Hospital Universitario de Caracas
Universidad Central de Venezuela

 


 

Respuesta:

 respuesta-caso-157-ANGIOMA-EN-PENACHO.pdf  

 

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Oral Corticosteroid Use Is Effective for Cutaneous Hemangiomas An Evidence-Based Evaluation

Objectives: To determine the efficacy of systemic corticosteroid therapy in treating enlarging, problematic cutaneous hemangiomas and to assess the relationship of dose to response and adverse effects.

Design: A quantitative systematic literature review was performed and inclusion and exclusion criteria were applied.

Setting: Patients were treated in primary care, referral centers, and institutional practices. Most patients were ambulatory, although some required hospitalization.

Patients: Inclusion criteria were original case series with a minimum of 5 patients with enlarging, problematic cutaneous
hemangiomas treated with systemic corticosteroids.

Exclusion criteria were being older than 2 years, receiving simultaneous other treatments, being lost to follow-up, or having insufficient information.

Twenty-four original case series met inclusion criteria; 10 case series remained (184 patients) after exclusion criteria were applied.

Intervention: Patients were given a mean prednisone equivalent daily dose of 2.9 mg/kg (95% confidence interval [CI], 2.7-3.1 mg/kg) for a mean of 1.8 months (95% CI, 1.5-2.2 months).

Main Outcome Measures: Response and rebound rates and dose-response and adverse effects–response relationships
in responders vs nonresponders.

Results: Response was 84% (95% CI, 78%-89%; range, 60%-100%) and rebound was 36% (95% CI, 29%-44%;
range, 0%-65%). A significant difference was found between the mean dose administered to responders vs nonresponders (P,.001). No significant difference was observed as to the occurrence of adverse effects (P=.3).

Conclusion: Systemic corticosteroid treatment seems to be effective for problematic cutaneous hemangiomas of infancy.

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