Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Pediatric Dermatology Case Studies: Management of Infantile Hemangiomas and Toxic Erythema of Chemotherapy
Description
The presentation covers two pediatric dermatology cases: one involving a 5-week-old girl with an infantile hemangioma and the other an 18-year-old male with chemotherapy-related toxic erythema. In the first case, the infant's hemangioma exhibited worsening despite treatment with Propranolol, leading to significant complications like ulcerations and vision impairment. The dermatologist explored alternative therapies and eventually opted for surgical debulking after collaborative consultations with vascular anomaly experts and plastic surgeons, resulting in improved symptoms. The second case involved a patient with T cell acute lymphoblastic leukemia who developed a severe erythematous rash following chemotherapy, eventually leading to extensive epidermal detachment and hospitalization. Despite aggressive treatment measures, the patient's condition deteriorated, highlighting the challenges in managing toxic reactions from chemotherapy. The clinician reflected on potential adjustments in patient monitoring, intervention timing, and the value of involving specialists in similar future cases to better address the complex needs of these patients.
View moreConclusions
- Propranolol is generally effective for treating infantile hemangiomas, but a small percentage of patients may not respond.
- Alternative treatments such as sirolimus or vincristine can be considered for patients who do not respond to Propranolol.
- Timely intervention with alternative therapies is crucial for effectively managing recalcitrant infantile hemangiomas to avoid complications.
- Collaboration with interdisciplinary colleagues can improve patient management strategies and outcomes.
- Toxic erythema of chemotherapy (TEC) is a severe reaction that can lead to significant morbidity and mortality in affected patients.
- The clinical course of TEC may be insidious and can complicate treatment decisions, leading to delayed interventions and negative outcomes.
- Guidelines for managing severe cases of TEC are limited; therefore, timely referral to specialized units may improve care.
- Awareness of potential complications, including infections, can help mitigate risks associated with chemotherapy-induced skin reactions.
- Dávila-Osorio VL, Iznardo H, Roé E, Puig L, Baselga E. Propranolol-resistant infantile hemangioma successfully treated with sirolimus. Pediatr Dermatol. 2020 Jul;37(4):684-686. doi: 10.1111/pde.14163.
- Kaylani S, Theos AJ, Pressey JG. Treatment of infantile hemangiomas with sirolimus in a patient with PHACE syndrome. Pediatr Dermatol. 2013 Nov-Dec;30(6):e194-7. doi: 10.1111/pde.12023.
- Caussé S, Aubert H, Saint-Jean M, Puzenat E, Bursztejn AC, Eschard C, Mahé E, Maruani A, Mazereeuw-Hautier J, Dreyfus I, Miquel J, Chiaverini C, Boccara O, Hadj-Rabia S, Stalder JF, Barbarot S; Groupe de Recherche Clinique en Dermatologie Pédiatrique. Propranolol-resistant infantile haemangiomas. Br J Dermatol. 2013 Jul;169(1):125-9. doi: 10.1111/bjd.12417.
- Kleinman EP, Blei F, Adams D, Greenberger S. Sirolimus for diffuse intestinal infantile hemangioma with PHACE features: systematic review. Pediatr Res. 2023 May;93(6):1470-1479. doi: 10.1038/s41390-022-02325-z.
- Wasserman JD, Mahant S, Carcao M, Perlman K, Pope E. Vincristine for successful treatment of steroid-dependent infantile hemangiomas. Pediatrics. 2015 Jun;135(6):e1501-5. doi: 10.1542/peds.2014-2542.