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[What's new in pediatric dermatology?]
1Unité de dermatologie pédiatrique et centre de référence des maladies rares de la peau, hôpital Pellegrin-Enfants, CHU de Bordeaux, 33076 Bordeaux Cedex, France.
Insights
Propranolol is a safe and effective treatment for infantile hemangiomas, with long-term safety data showing no unexpected side effects. Topical timolol, however, requires caution due to potential systemic absorption and adverse events in infants.
Area of Science:
- Pediatric Dermatology
- Vascular Anomalies
- Atopic Dermatitis
- Infectious Diseases
Background:
- Infantile hemangiomas (IH) are associated with syndromes like PHACE and LUMBAR.
- Propranolol is effective for IH, but safety concerns persist.
- Topical beta-blockers for IH show systemic absorption risks.
- mTOR inhibitors are being explored for vascular malformations.
- Skin barrier defects contribute to atopic dermatitis and sensitization.
- Viral outbreaks cause dermatological manifestations and neurological complications.
Purpose of the Study:
- To review current therapeutic options and emerging research in pediatric dermatology.
- To highlight safety considerations for established and novel treatments.
- To discuss advancements in understanding pathophysiology and future targeted therapies.
Main Methods:
- Literature review of recent studies on infantile hemangiomas, vascular malformations, atopic dermatitis, and infectious dermatoses.
- Analysis of safety data for propranolol and topical timolol.
- Evaluation of emerging treatments like mTOR inhibitors and crisaborole.
- Discussion of genetic advancements and viral outbreak impacts.
Main Results:
- Propranolol demonstrates a favorable long-term safety profile in thousands of children.
- Topical timolol carries risks of systemic absorption and adverse effects (e.g., bradycardia) in low-birthweight infants.
- mTOR inhibitors show variable success in vascular malformations.
- Crisaborole offers limited efficacy in pediatric atopic dermatitis, comparable to emollients.
- Viral infections like Zika and enteroviruses present significant dermatological and neurological challenges.
Conclusions:
- Propranolol remains a cornerstone therapy for infantile hemangiomas with proven safety.
- Cautious use of topical timolol is advised due to systemic absorption risks.
- Further research is needed for mTOR inhibitors in vascular malformations.
- Targeted therapies based on genetic insights hold future promise.
- Management of viral-induced dermatoses requires ongoing vigilance.
Abstract:
The association of a birth defect and a segmental hemangioma is well established, a consensus concerning evaluation and monitoring of infants with PHACE or LUMBAR syndromes has been published. The efficacy of propranolol in infantile hemangioma is proven; however there were still unresolved issues concerning the safety in children; after 8 years of use on thousands of children safety data collection did not show any unexpected side effects. Topical treatment of infantile hemangiomas with beta-blockers, such as timolol, is very popular, but recent publications revealed a significant systemic absorption that could be responsible for severe side effects, such as bradycardia, in low birthweight infants. As a consequence, this therapeutic option should be considered with caution. In the last 2 years mTOR inhibitors have been tested in low-flow vascular malformations with varying success, but progress remains to be done in the treatment of vascular abnormalities. Today, genetics has led to advances in the understanding of the pathophysiology and in the future targeted therapies could probably be feasible. Skin barrier deficiency is responsible for the development of allergic phenomena in atopic patients, since it has been shown that sensibilisation, even to food, could probably be induced by skin contact. Unfortunately, the topical treatment with crisaborole, a phosphodiesterase 4 inhibitor, does not look like a revolution in children atopic dermatitis, its efficacy seems equivalent to emollient application. In the field of infectious diseases, changes in viral outbreaks are the most reported. Furthermore epidemic Zika virus, enteroviruses are responsible for expanded dermatological manifestations and also severe meningoencephalitis. Paraviral character of various eruptions, such as gloves and socks syndrome or eruptive pseudoangiomatosis is challenged.