Pediatric Dermatology I Nanette B. Silverberg MD, Jonathan I. Silverberg MD, PhD, MPH PII: DOI: Reference:
S0738-081X(14)00042-X doi: 10.1016/j.clindermatol.2014.02.008 CID 6825
To appear in:
Clinics in Dermatology
Please cite this article as: Silverberg Nanette B., Silverberg Jonathan I., Pediatric Dermatology I, Clinics in Dermatology (2014), doi: 10.1016/j.clindermatol.2014.02.008
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
SC
RI P
T
Commentary:
Pediatric Dermatology I
NU
Nanette B. Silverberg, MD and Jonathan I. Silverberg, MD, PhD, MPH
MA
St. Luke’s-Roosevelt and Beth Israel Medical Centers, New York, NY
Nanette B. Silverberg, MD
PT
Department of Dermatology
ED
Contact:
CE
1090 Amsterdam Avenue, Suite 11D New York, NY 10025
AC
(212) 523-3888
Fax: (212) 523-5027
[email protected]
ACCEPTED MANUSCRIPT The last special issues on the subject of pediatric dermatology were published in 2000, 2002 and 2003. 1 2 3and much has changed, but many of the therapeutic
RI P
T
challenges that are faced in the care of children’s skin remain. Some of the therapeutic challenges faced include limited pharmacological data in children and
SC
workforce shortage in pediatric dermatology limiting access to subspecialty care.
NU
The recent expansion of publications in pediatric dermatology has led to the revision of outdated dogmatic tenets, like the belief that disfiguring illnesses, such
MA
as vitiligo or psoriasis, are purely cosmetic in nature without good therapies, when
ED
psychological and medical comorbidities are well documented and therapeutic
CE
PT
options abound.
Pediatric dermatology first came into the spotlight in 1960 when. Henry Perlman
AC
(1896-1993) wrote the first modern textbook in the field. 4 By 1975, the growing leaders in the field organized the Society for Pediatric Dermatology with dedicated scientific meetings now in their 39th year, and the journal Pediatric Dermatology, now in its 30th year.
Since that time, dozens of textbooks and atlases in pediatric dermatology have been published beginning with the text by Sidney Hurwitz (1928-1995),5 followed
ACCEPTED MANUSCRIPT by the large and expansive text of Lawrence Schachner and Ronald Hansen and more recently a variety of texts and atlases that have set the field apart as a sub-
RI P
T
specialty, worthy of pursuit6.
SC
At this time, pediatric dermatology is a vibrant, rapidly expanding field of dermatology. In 2004, the first specialty board in Pediatric Dermatology was
NU
administered by the American Board of Dermatology, Inc. Shortly, thereafter, the
MA
Accreditation Council for Graduate Medical Education accredited pediatric dermatology fellowships followed, now numbering 28.
ED
Background
PT
As the work force of Pediatric Dermatology has grown, so too the understanding of
CE
children and adolescent skin diseases has greatly expanded. In the past 20 years,
AC
tremendous advances have been made in the assessment and management of vascular birthmarks, genodermatoses, and melanocytic tumors. Significant attention has been paid to the care of children with acne and allergic reactions, the understanding of dermatitis from diaper, and the dilemmas associated with the diagnosis and treatment of such common conditions as atopic dermatitis. We have reached a true milestone in pediatric dermatology with the additional understanding of the psychological impact of disease on the growing child.
ACCEPTED MANUSCRIPT In this issue of Clinics in Dermatology, the first of multiple issues focusing on pediatric dermatology, the authors explore a variety of core issues in the
SC
RI P
T
understanding of skin disease from infancy to adolescence.
NU
Progress in Pediatric Dermatology Infantile hemangiomas affect 10-15% of infants. The understanding of this
MA
common vascular tumor has expanded rapidly over the past 15 years. We have a
ED
broader understanding of associated structural changes, such as in the PHACES or SACRAL syndromes. The serendipitous discovery of beta-blockers, both oral and
PT
topical, as a therapy for infantile hemangiomas has revolutionized the management
CE
of this disorder. Blei and Guarini focus on the work-up and therapeutics of these
AC
fascinating tumors, while Bernard Gontijo focuses on the complications associated with hemangiomas and management of these issues as they arise. These contributions provide an extremely in depth view of the topic.
Klunk, Domingues and Wiss review the many faces of diaper dermatitis. Issues tackled include the environmental burden of diapers, the allergic and irritant contact dermatitis associated with these the new complex products, and therapeutics of diaper dermatitis in infancy and early childhood.
ACCEPTED MANUSCRIPT
T
Dávila-Seijo, Hernández-Martín, and Torrelo explore the autoinflammatory
RI P
syndromes in great depth. These are inborn errors in the innate immune system that cause a variety of manifestations ranging from periodic multi-system illnesses with
SC
fever and inflammation to purpuric lesions mimicking Sweet’s syndrome. This
NU
new field in pediatric dermatology will surely expand in the next few years. While
MA
mutations in the innate immune system have resulted in Henoch-Schonlein purpura, polyarteritis nodosa, and erythema elevatum diutinum, polymorphisms in
PT
ED
these genes are likely to play a role in cutaneous illness in the general population.
CE
Other aberrant immune reactions in the skin can lead to the development of drug
AC
reactions or generalized vitiligo. Song and Sidbury provide a crystal clear review of the most common drug reactions noted in children. This article should become a classic review for residents and practicing physicians. A review of recent advances in vitiligo of childhood highlights that despite our knowledge of the disease, there are many therapeutic hurdles, including providing emotional support to children who are being bullied or teased for their appearance. Our Goal
ACCEPTED MANUSCRIPT The goal of this issue is to review the recent discoveries and emerging challenges in pediatric dermatology. Hopefully, this issue will serve as an important update
RI P
T
for general and pediatric dermatologists alike. The next issue in pediatric dermatology will further address hot topics in pediatric dermatology diseases of
NU
SC
pigmentation including nevi, infections and atopic dermatitis. Stay tuned!
MA
References
Oumeish OY. Pediatric Dermatology, Part I . Clin Dermatol 2000; 18: 637 - 748.
2
Oumeish OY. Pediatric dermatology, Part II. Clin Dermatol. 2002; 20:1. – 92.
3
Oumeish OY. Pediatric Dermatology, Part III. Clin Dermatol 2003; 21: 253 - 353
PT
4
ED
1
6
Hurwitz S. Clinical Pediatric Dermatology, 1st ed. WB Saunders, 1981
AC
5
CE
http://www.nytimes.com/1993/10/14/obituaries/henry-h-perlman-97-expert-indermatology.html, accessed July 5, 2013
Schachner LA, Hansen RC. Pediatric Dermatology. Churchill Livingstone 1988
S0738-081X(14)00042-X doi: 10.1016/j.clindermatol.2014.02.008 CID 6825
To appear in:
Clinics in Dermatology
Please cite this article as: Silverberg Nanette B., Silverberg Jonathan I., Pediatric Dermatology I, Clinics in Dermatology (2014), doi: 10.1016/j.clindermatol.2014.02.008
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
SC
RI P
T
Commentary:
Pediatric Dermatology I
NU
Nanette B. Silverberg, MD and Jonathan I. Silverberg, MD, PhD, MPH
MA
St. Luke’s-Roosevelt and Beth Israel Medical Centers, New York, NY
Nanette B. Silverberg, MD
PT
Department of Dermatology
ED
Contact:
CE
1090 Amsterdam Avenue, Suite 11D New York, NY 10025
AC
(212) 523-3888
Fax: (212) 523-5027
[email protected]
ACCEPTED MANUSCRIPT The last special issues on the subject of pediatric dermatology were published in 2000, 2002 and 2003. 1 2 3and much has changed, but many of the therapeutic
RI P
T
challenges that are faced in the care of children’s skin remain. Some of the therapeutic challenges faced include limited pharmacological data in children and
SC
workforce shortage in pediatric dermatology limiting access to subspecialty care.
NU
The recent expansion of publications in pediatric dermatology has led to the revision of outdated dogmatic tenets, like the belief that disfiguring illnesses, such
MA
as vitiligo or psoriasis, are purely cosmetic in nature without good therapies, when
ED
psychological and medical comorbidities are well documented and therapeutic
CE
PT
options abound.
Pediatric dermatology first came into the spotlight in 1960 when. Henry Perlman
AC
(1896-1993) wrote the first modern textbook in the field. 4 By 1975, the growing leaders in the field organized the Society for Pediatric Dermatology with dedicated scientific meetings now in their 39th year, and the journal Pediatric Dermatology, now in its 30th year.
Since that time, dozens of textbooks and atlases in pediatric dermatology have been published beginning with the text by Sidney Hurwitz (1928-1995),5 followed
ACCEPTED MANUSCRIPT by the large and expansive text of Lawrence Schachner and Ronald Hansen and more recently a variety of texts and atlases that have set the field apart as a sub-
RI P
T
specialty, worthy of pursuit6.
SC
At this time, pediatric dermatology is a vibrant, rapidly expanding field of dermatology. In 2004, the first specialty board in Pediatric Dermatology was
NU
administered by the American Board of Dermatology, Inc. Shortly, thereafter, the
MA
Accreditation Council for Graduate Medical Education accredited pediatric dermatology fellowships followed, now numbering 28.
ED
Background
PT
As the work force of Pediatric Dermatology has grown, so too the understanding of
CE
children and adolescent skin diseases has greatly expanded. In the past 20 years,
AC
tremendous advances have been made in the assessment and management of vascular birthmarks, genodermatoses, and melanocytic tumors. Significant attention has been paid to the care of children with acne and allergic reactions, the understanding of dermatitis from diaper, and the dilemmas associated with the diagnosis and treatment of such common conditions as atopic dermatitis. We have reached a true milestone in pediatric dermatology with the additional understanding of the psychological impact of disease on the growing child.
ACCEPTED MANUSCRIPT In this issue of Clinics in Dermatology, the first of multiple issues focusing on pediatric dermatology, the authors explore a variety of core issues in the
SC
RI P
T
understanding of skin disease from infancy to adolescence.
NU
Progress in Pediatric Dermatology Infantile hemangiomas affect 10-15% of infants. The understanding of this
MA
common vascular tumor has expanded rapidly over the past 15 years. We have a
ED
broader understanding of associated structural changes, such as in the PHACES or SACRAL syndromes. The serendipitous discovery of beta-blockers, both oral and
PT
topical, as a therapy for infantile hemangiomas has revolutionized the management
CE
of this disorder. Blei and Guarini focus on the work-up and therapeutics of these
AC
fascinating tumors, while Bernard Gontijo focuses on the complications associated with hemangiomas and management of these issues as they arise. These contributions provide an extremely in depth view of the topic.
Klunk, Domingues and Wiss review the many faces of diaper dermatitis. Issues tackled include the environmental burden of diapers, the allergic and irritant contact dermatitis associated with these the new complex products, and therapeutics of diaper dermatitis in infancy and early childhood.
ACCEPTED MANUSCRIPT
T
Dávila-Seijo, Hernández-Martín, and Torrelo explore the autoinflammatory
RI P
syndromes in great depth. These are inborn errors in the innate immune system that cause a variety of manifestations ranging from periodic multi-system illnesses with
SC
fever and inflammation to purpuric lesions mimicking Sweet’s syndrome. This
NU
new field in pediatric dermatology will surely expand in the next few years. While
MA
mutations in the innate immune system have resulted in Henoch-Schonlein purpura, polyarteritis nodosa, and erythema elevatum diutinum, polymorphisms in
PT
ED
these genes are likely to play a role in cutaneous illness in the general population.
CE
Other aberrant immune reactions in the skin can lead to the development of drug
AC
reactions or generalized vitiligo. Song and Sidbury provide a crystal clear review of the most common drug reactions noted in children. This article should become a classic review for residents and practicing physicians. A review of recent advances in vitiligo of childhood highlights that despite our knowledge of the disease, there are many therapeutic hurdles, including providing emotional support to children who are being bullied or teased for their appearance. Our Goal
ACCEPTED MANUSCRIPT The goal of this issue is to review the recent discoveries and emerging challenges in pediatric dermatology. Hopefully, this issue will serve as an important update
RI P
T
for general and pediatric dermatologists alike. The next issue in pediatric dermatology will further address hot topics in pediatric dermatology diseases of
NU
SC
pigmentation including nevi, infections and atopic dermatitis. Stay tuned!
MA
References
Oumeish OY. Pediatric Dermatology, Part I . Clin Dermatol 2000; 18: 637 - 748.
2
Oumeish OY. Pediatric dermatology, Part II. Clin Dermatol. 2002; 20:1. – 92.
3
Oumeish OY. Pediatric Dermatology, Part III. Clin Dermatol 2003; 21: 253 - 353
PT
4
ED
1
6
Hurwitz S. Clinical Pediatric Dermatology, 1st ed. WB Saunders, 1981
AC
5
CE
http://www.nytimes.com/1993/10/14/obituaries/henry-h-perlman-97-expert-indermatology.html, accessed July 5, 2013
Schachner LA, Hansen RC. Pediatric Dermatology. Churchill Livingstone 1988
