HCPLive

The week leading up to and during the American Academy of Dermatology (AAD) 2024 Annual Meeting, as well as the Society for Pediatric Dermatology (SPD) Pre-AAD meeting has been a viable moment to reflect on recent major advances in the treatment capability of rare skin diseases including epidermolysis bullosa (EB).

At a time when 2 agents—beremagene geperpavec (B-VEC; VYJUVEK) and birch triterpenes topical gel (Filsuvez)—recently received US Food and Drug Administration (FDA) and a third—pz-cel—is awaiting decision this year, dermatologists will have a suddenly robust armamentarium for the rare, blistering and potentially fatal condition.

All the same, greater emphasis must be put on timely and adequate diagnostic practices in order to optimize the benefit of new treatments. This latest 

 Clinical Quiz tests readers’ knowledge on the diagnosis of EB, based on recommendations published in 

Do you know how to proceed through EB diagnoses? Take the quiz to find out!

To evaluate the presence of specific proteins related to EB 

Immediate referral to a general practitioner 

 Laboratory diagnosis after informed consent 

Genetic testing without clinical evaluation

It allows for immediate surgical intervention 

It enables early prognostication of disease severity 

It eliminates the need for genetic counseling

Has C, Liu L, Bolling MC, Charlesworth AV, El Hachem M, Escámez MJ, Fuentes I, Büchel S, Hiremagalore R, Pohla-Gubo G, van den Akker PC, Wertheim-Tysarowska K, Zambruno G. Clinical practice guidelines for laboratory diagnosis of epidermolysis bullosa. Br J Dermatol. 2020 Mar;182(3):574-592. doi: 10.1111/bjd.18128. Epub 2019 Aug 9. PMID: 31090061; PMCID: PMC7064925.

Articles

Take our latest 5-question quiz based on the recommended strategies of laboratory-based diagnosis of epidermolysis bullosa.

Clinical Quiz: Diagnosing Epidermolysis Bullosa

Methotrexate has been a common treatment for a number of pediatric and adult dermatoses for more than 70 years. An immunosuppressant, there are a number of supporting reasons to incorporate methotrexate into dermatologic care—but there are also pediatric-specific risks and outcomes to be wary of, as well.

Society for Pediatric Dermatology (SPD) 2024 Pre-AAD Meeting

 in San Diego, CA, this year, this latest 

 Clinical Quiz tests readers’ knowledge on the SPD’s recommended management of methotrexate in pediatric patients with conditions including atopic dermatitis, psoriasis, alopecia areata and more. The 5-question quiz is based on recommendations from the SPD’s Patient Perspectives handout, originally published in 

How would you fare in treating young patients with acne? Take the quiz below!

Blood counts, liver, and kidney function tests 

Lalor L, Todd P. Society for Pediatric Dermatology. Patient Perspectives: What is methotrexate and how does it work? 

 Vol. 40, No. 5 (2023). https://pedsderm.net/site/assets/files/1028/spd_methotrexate_color-1.pdf

In recognition of the Pre-AAD 2024 meeting, take our quiz based on Society for Pediatric Dermatology resources.

Clinical Quiz: Methotrexate for Pediatric Dermatoses

A number of patient populations have been subject to greater and more variable opportunities in their care due to the recent boom of dermatologic treatment breakthroughs. Chief among those populations are pediatric and adolescent acne patients, who represent a notable majority of those affected by clinical-grade cases of the skin condition.

 Clinical Quiz tests readers’ knowledge on the SPD’s recommended strategies for pediatric and adolescent acne management. The 5-question quiz is based on recommendations from the society’s Patient Perspectives handout, originally published in 

At bedtime to avoid sunlight inactivation

Throughout the day for continuous coverage

To reduce the risk of bacterial resistance

To enhance the effectiveness of the medications

To protect the skin from increased sun sensitivity

Leave on the skin for 3 to 5 minutes before rinsing off

Apply using the "5-dot" method on specific facial locations

Rub vigorously to ensure deep penetration

Aggarwal S, Cyrulnik A, Ilyas E, Stein S, et al. Society for Pediatric Dermatology. Patient Perspectives: Acne Information. 

 Vol. 31, No. 6 (2014). https://pedsderm.net/site/assets/files/1028/spd_acne_long_updated.pdf

Clinical Quiz: Pediatric Acne Treatment Recommendations

There have been more than 180,000 cases of 

 detected via PCR or antigen testing in the US since the beginning of 2022, per data from the Centers for Disease Control and Prevention (CDC). Since September alone, cases have neared 140,000 going into early December—generally the time at which cases of the common pediatric virus actually increase.

The terms “unprecedented” and “epidemic” have been unfortunately combined to described the presence or risk of numerous viral outbreaks since 2020. Even this year, continued challenges with COVID-19 control combined with early influenza burdens and the monkeypox outbreak highlighted the strain of circulating viruses in distinct patient populations and the corresponding hospital and emergency departments treating them.

But few pose as concerning a threat as RSV, the common young-age respiratory virus without a vaccine and impacting children with truly unprecedented reach this year.

 recap interview, Steven Selbst, MD, pediatric emergency medicine physician at Nemours Children’s Hospital, discussed with sister publication 

 how the early onset of RSV has affected the flow and treatment of pediatric patients in hospitals.

“It’s unbelievable how many cases of RSV we’ve seen in the last few weeks since the end of the summer,” Selbst said. “I’ve been around for many seasons of RSV, but this is probably the worst we’ve had in terms of the number and severity cases.”

Many theories persist as to why RSV has been so particularly surgent in 2022; many experts point to COVID-19 as a co-driver. Selbst noted that children may have been previously less exposed to viruses and bacteria due to masking and social distancing during the pandemic, and thus may have weaker immune systems. Physicians have also been surprised by the timing of the RSV season, which is generally a winter-onset issue.

On the matter of prevention, Selbst has observed growing talk around RSV vaccine candidates—none of which are currently approved by the US Food and Drug Administration (FDA). He shared particular hope for Pfizer’s investigative vaccine, which in phase 3 data shared last month showed its efficacy in preventing RSV-borne respiratory tract illness in newborns when administered to pregnant moths. Unfortunately, the vaccine is a prospect for approval in 2023.

Selbst provided advice for his colleagues navigating the current epidemic, stressing the limited availability and capability of emergency departments during this wave.

“Our emergency departments are already overwhelmed across the country, and there isn’t much we’re going to be able to do for that baby who has a mild case,” he said. “There is no magic treatment for RSV; we recommend nasal suctioning and monitoring the baby, and certainly pediatricians can do that with their parents and family from home.”

Selbst also stressed stewardship for antibiotics, noting the national shortage on amoxicillin has been tied to the RSV epidemic—a correlation that confuses him. “Amoxicillin is not useful for RSV, so I would hope pediatricians are not overusing antibiotics during this epidemic,” he said.

Among infants ≤2 months old, he highly recommends parents and pediatricians look for signs of presenting and worsening disease: poor oxygen saturation, dehydration, low urine output, labored breathing, retractions, head bobbing and grunting.

“Be very careful with young infants,” he said. “Babies less than 2 months of age, I would not take any chances. If that baby has bronchiolitis, we want to see that baby in the hospital and there’s a good chance we’re going to admit them because those babies usually end up in the intensive care unit.”

Videos

A pediatric emergency medicine physician discusses the epidemic factors that still perturb experts, and the status of vaccination and treatment strategies.