This is the first report in the literature investigating WT1 in verrucous hemangioma in order to further clarify the nosology of this vascular anomaly. Despite the clinical features of verrucous hemangioma, which are similar to those seen in vascular malformations, verrucous hemangioma exhibited an immunoprofile similar to vascular neoplasms, according to WT1 and Glut-1 positivity.
We present the largest clinical experience with the European photopatch test baseline series hitherto reported. The results are similar to those underlying the above consensus process, reaffirming the usefulness of this series.
BACKGROUND AND OBJECTIVES:There is no consensus on optimal treatment duration for propranolol in infantile hemangioma (IH). We evaluated the efficacy and safety of oral propranolol solution administered for a minimum of 6 months up to a maximum of 12 months of age in high-risk IH.
METHODS:This single-arm, open-label, phase 3 study was conducted in patients aged 35 to 150 days with high-risk IH in 10 hospitals between 2015 and 2017. The study comprised a 6-month initial treatment period (ITP) plus continuation up to 12 months of age if complete success was not achieved, a follow-up, and a retreatment period. Patients received oral propranolol twice daily (3 mg/kg per day). The primary end point was the success rate at the end of the ITP. Furthermore, the persistence of IH response and efficacy of retreatment was evaluated.
RESULTS:The success rate after 6 months of treatment was 47%, increasing to 76% at the end of the ITP. Of the patients who achieved success, 68% sustained success for 3 months without treatment, and 24% required retreatment. Of the 8 patients who were retreated, 7 achieved success. Adverse events, reported by 80% of patients, were mild, which were expected in this population or known propranolol side effects.
CONCLUSIONS:Oral propranolol administered beyond 6 months and up to 12 months of age meaningfully increases the success rate in high-risk IH. Success was sustained in most patients up to 3 months after stopping treatment. Retreatment was efficacious, and the safety profile satisfactory.abstract
Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity | 541 Pediatric Dermatology BRIEF REPORT undiagnosed. 1 Only 4 cases have been reported of ACD to chlorhexidine in pediatric patients without underlying AD. 3-5 Darrigade et al reported the largest case series of pediatric patients with ACD to chlorhexidine. Epicutaneous patch testing for chlorhexidine digluconate was positive in 7 of 14 patients tested, whereas 8 of them exhibited positivity to benzyl alcohol and positivity to both allergens in 4 cases. 1Our work showcases the role of chlorhexidine as a cause for ACD in the pediatric population, especially, but not exclusively, among patients with AD. It is worth noting that a history of surgery at an early age was identified in one patient suggesting the possibility that sensitization had occurred then. We emphasize the clinical utility of ROAT as a simple initial diagnostic approach during the initial evaluation of a patient presenting with symptoms suggestive of ACD to chlorhexidine. The different commercial formulations of this antiseptic must be taken into account, as some regularly used excipients, such as benzyl alcohol, which can also cause ACD. 1 Furthermore, we must inform parents that chlorhexidine is not only present in antiseptic products but also as a component of cosmetics. 2 Last but not least, it is imperative to rule out immediate hypersensitivity reactions, as even mild cases of ACD can indicate a potential risk of acute hypersensitivity reactions following successive exposures to chlorhexidine. 6
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