Anderson, Katelyn R

ABSTRACTBackgroundRecent data demonstrate increased incidence of Infantile hemangioma (IH) over the past several decades. However, little is known about current trends in healthcare utilization and medication prescribing in patients with IH in the United States (US), particularly since the discovery and uptake of beta‐blockers as standard of care treatment.MethodsWe examined US ambulatory visits in infants (age ≤ 1 years) with any hemangioma (International Classification of Diseases [ICD] 9th Revision codes 228.00, 228.01, or 228.09 in the National Ambulatory Medical Care Survey [NAMCS] 2009–2015, and ICD 10th Revision code D18.0 in the NAMCS 2016–2019). We further trended the prescription of topical and systemic IH treatments during this period.ResultsYears of visit were bundled into 5‐year bins to minimize standard errors for the trend tests. The number of visits related to IH significantly increased from 878,725 (95% CI: 439,376–1,318,074) in 2009–2013 to 1,431,913 (95% CI: 940,036–1,923,790, p = 0.022) in 2014–2019. The number of visits with resulting timolol prescription concurrently significantly increased from 16,279 (95% CI: 0–40,600) to 424,845 (95% CI: 380,786–468,903, p < 0.001), while the increase in the number of propranolol prescriptions was nonsignificant (from 162,323 [95% CI: 0–331,537] to 208,139 [95% CI: 0–558,709], p = 0.652).ConclusionsThe US healthcare utilization for IH has been on the rise between 2009 and 2019, likely owing to increased awareness, earlier diagnosis, and enhanced therapies. While topical beta‐blocker prescriptions have significantly increased during that period of time, systemic beta‐blocker prescription rates have not.

Atopic dermatitis affects 20% to 25% of children and has significant impact on quality of life of patients and families. Recent studies of the pathogenesis of AD highlight the interplay between a defective skin barrier, immune dysfunction, and the cutaneous microbiome. Standard of care for AD treatment includes topical corticosteroids for active disease and moisturization to repair the barrier defect. Emerging treatments include dupilumab and Janus kinase (JAK) inhibitors. Reduction of triggers and proactive treatment with topical corticosteroids and/or topical calcineurin inhibitors can reduce flares. Treatment plans should be clear and as simple as possible to maximize adherence.

ABSTRACT Orofacial granulomatosis (OFG) is a rare syndrome that can occur in association with Crohn's disease (CD). The electronic medical record was searched for “OFG” and “CD.” A total of 297 patients were identified, and relevant data were abstracted. Five patients met inclusion criteria. Most (80%) had ileocolonic CD with nonstricturing/nonpenetrating phenotype. The most common treatments included intralesional corticosteroids (4 patients), oral corticosteroids (3 patients), and anti-TNF agents, specifically infliximab (3 patients). Intralesional corticosteroid administration was followed by partial response in 3 patients, but recurrences were common following initial injection. One patient had no response to topical or oral corticosteroids, antihistamines, or oral antibiotics, but partial response to intralesional corticosteroids and infliximab. None of the patients had complete response to any therapies directed at this condition. OFG may be characterized by partial response, often requiring long-term therapy. Additional investigations into novel treatments may improve future clinical outcomes.

Cervicofacial vascular anomalies can result in morbidity, pain, and cosmetic concerns in affected individuals. Each anomaly has its own unique natural history, treatment, and associations with underlying genetic syndromes. For optimal patient care, it is important for the neuroradiologist to accurately recognize and characterize these entities to ensure appropriate treatment and management. In this review, we discuss the general characteristics, classifications, and imaging features associated with the most common vascular anomalies such as hemangiomas, arteriovenous malformations and fistulas, capillary malformations, venous malformations, and lymphatic malformations in the context of associated syndromes. Additionally, we discuss novel imaging techniques that aid in identifying these vascular anomalies.

AbstractBackground/ObjectivesSpecific maternal risk factors have recently been identified in the development of infantile hemangiomas (IH), including gestational diabetes (GDM), maternal antihypertensive medication use or gestational hypertension (GHTN), maternal progesterone use, and artificial reproductive technologies (ART). We sought to explore the change in incidence of these risk factors over time and determine their association with the increased incidence of hemangiomas over 35 years, as previously reported.MethodsThe charts of 869 mother and infant pairs (infants previously diagnosed with IH between January 1, 1976, and December 31, 2010) were reviewed for prenatal complications. Rates of the prenatal complications over the 35‐year period in birth mothers of infants diagnosed with IH were determined and evaluated by year of diagnosis (1976‐1990, 1991‐2000, and 2001‐2010).ResultsOver the 35‐year period in which the incidence of IH was previously examined, maternal age at delivery, prepregnancy body mass index (BMI), use of ART, maternal progesterone use, placental abnormalities, and GDM also increased.ConclusionsGDM, ART, and maternal progesterone use increased over the past 35 years, mirroring the previously reported trend of increasing incidence of IH. Maternal age and BMI also increased in mothers of infants with IH. Further exploration of this association may direct future research in the pathogenesis of infantile hemangiomas.

A 17-year-old male was transferred to the pediatric intensive care unit for evaluation of acute liver failure. He was recently released from an alcohol treatment center with acute onset of chest pain. Cardiac workup was negative but he was found to have abnormal coagulation studies and elevated liver transaminases. Other evaluations included a normal toxicology screen and negative acetaminophen level. Autoimmune and infectious workups were normal providing no identifiable cause of his acute liver failure. He initially denied any ingestions or illicit drug use but on further query he admitted taking niacin in an attempt to obscure the results of an upcoming drug test. Niacin has been touted on the Internet as an aid to help pass urine drug tests though there is no evidence to support this practice. Niacin toxicity has been associated with serious multisystem organ failure and fulminant hepatic failure requiring liver transplantation. Pediatric providers should be aware of the risks associated with niacin toxicity and other experimental medical therapies that may be described on the Internet or other nonreputable sources.