Pediatric Literature Updates

Lucia Diaz, MD, chief of pediatric and adolescent dermatology, associate director of the dermatology residency program, and assistant professor of medicine and pediatrics at Dell Medical School at the University of Texas in Austin, Texas, provided an overview of new pediatric literature in the joint session, “Updates on Adult and Pediatric Literature.” During her session, Diaz reviewed clinical scenarios and questions that may arise in a physician’s practice and articles that will help resolve difficult pediatric cases.

Case 1: A healthy one month old baby girl with a large red birthmark on her face referred to a dermatology clinic for laser treatments.

In this case review, Diaz began by explaining that a large red mark on an infant’s face should immediately tell a doctor that it is an important case to be treated immediately. One of the first considerations for the clinical presentations described by Diaz is Sturge-Weber syndrome (SWS), a neurological condition present at birth. Angiomas can eventually lead to port birthmarks on the face. The forehead and upper eyelid are high risk areas for port wine and SWS stains. Laser treatment is the best option for infants with SWS or port wine stains.

“I usually start at a month old, if I can, just to get more optimal responses of 50% to 90% clearance with 8 to 10 sessions,” Diaz said.

Case 2: A 6 month old female, previously healthy, with a large painful lesion on her leg and sleep problems after treatment.

Diaz diagnosed this patient with ulcerated hemangiomas. Beta-blockers are currently the best standard of treatment for preventing ulceration in pediatric patients. Propranolol is generally the go-to beta-blocker selection because it has the most literature and safety data and is already approved by the United States Food and Drug Administration. Pain control and wound care are important considerations with painful ulcerated hemangiomas in pediatric patients, but some patients may have significant sleep disturbances with beta-blockers because they cross the blood-brain barrier. When considering other beta-blockers, some studies refer to oral nadolol as an effective alternative. According to a study referenced by Diaz, oral nadolol was not inferior to oral propranolol and had a good safety profile overall.

“The group included 71 patients and they were mostly evenly distributed. What really came out was that nadolol was not inferior to propranolol and it led to faster resolution in terms of how quickly the lesions reduced. Also, there was an improvement in color and other factors,” Diaz said.

Reference

Diaz L. Update on adult and pediatric literature. Presented at the 2022 Society of Dermatology Physician Assistant Conference; November 17-20, 2022; Miami, Florida.

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