PracticeUpdate Dermatology Best of 2018

EXPERT OPINION 25

lesions in sun-protected areas that do not respond as expected to therapy; in addi- tion, the key finding of follicular atrophy (ie, a hairless area) in pediatric CTCL patients that would prompt a biopsy. Dr. Elena Pope from the University of Toronto, who main- tains the pediatric cutaneous lymphoma registry, also presented a case of coexist- ing CTCL and lymphomatoid papulosis in the same child. This combination can por- tend a good prognosis. In general, CTCL only rarely progresses to advanced stages and only very rarely requires aggressive therapy in children. Antibiotic stewardship In 2016, dermatologists prescribed 8.2 mil- lion courses of oral antibiotics, including doxycycline and minocycline, for chronic inflammatory conditions including acne rosacea. This rate is higher for dermatologists than other specialties, and they prescribe antibiotics for longer periods. " " In 2016, dermatologists prescribed 8.2 million courses of oral antibiotics, including doxycycline and minocycline, for chronic inflammatory conditions including acne and

and rosacea. This rate is higher for der- matologists than other specialties, and they prescribe antibiotics for longer peri- ods. Prolonged use of these antibiotics can lead to the development of wide- spread tetracycline-resistant genes and multidrug-resistant organisms. Prudent use of antimicrobials such as benzoyl peroxide, which does not produce resist- ance, and prescribing oral antibiotics for a limited duration of time was suggested by Dr. George Zhanel, a professor in the Department of Medical Microbiology/ Infectious Diseases at the University of Manitoba. Orodental issues for patients with capillary malformation 3 Dr. David Darrow, an otolaryngologist from Eastern Virginia Medical School, reviewed care for patients with orodental manifes- tations of facial port-wine stains. Patients with capillary malformations that involve the oral cavity may experience early eruption of teeth, a lower alveolar ridge, enlarge- ment of lips, gums, and maxilla, abnormal and misplaced teeth, and bleeding gums. Unfortunately, dentists are often worried about providing routine care because of concerns related to bleeding. When stud- ied, hemorrhage from a dental procedure in these patients was exceedingly rare. These patients are at risk for gingival pocket for- mation due to tissue overgrowth, and

pocket formation may lead to periodontal disease. Goals of care include meticulous oral hygiene, with consideration for exci- sion of overgrown tissue. Of note, there is no evidence to support pulsed-dye laser surgery of the gingivae to prevent these complications. Risk of asthma and seasonal allergies in children with atopic dermatitis Dr. Joy Wan from the Children’s Hospital of Philadelphia offered insight into this topic, one often asked about by parents. Using the PEER data, including 3966 children with 3 years of follow-up, the investigators reported the greatest prevalence in sea- sonal allergic rhinitis in those patients with onset of atopic dermatitis in the first 2 years of life. Later onset was associated with a lower risk of seasonal allergies and asthma. This work supports the concept that pro- gression of the atopic march is tied to the age of onset of this disease. References 1. Yu J, Atwater AR, Brod B, et al. Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup. Dermatitis 2018;29(4):206-212. 2. Carrera C, Scope A, Dusza SW, et al. Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases. J Am Acad Dermatol 2018;78(2):278-288. 3. Dowling MB, Zhao Y, Darrow DH. Orodental manifestations of facial port-wine stains. J Am Acad Dermatol 2012;67(4):687-693. www.practiceupdate.com/c/72339

VOL. 2 • NO. 4 • 2018