Heidi Splete

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

Youth who harass their peers via the Internet are significantly more likely to suffer from behavioral and psychosocial problems than youth who don't harass others online, based on data from interviews with 1,500 adolescents aged 10–17 years reported in the August issue of the Journal of Adolescent Health.

Although the analysis of Internet harassment is relatively new, the existing data suggest that children and adolescents who harass others online have mental health problems similar to the problems observed in off-line bullies. These problems include substance use, delinquency, and poor relationships with family members or caregivers, reported Michele L. Ybarra, Ph.D., of Internet Solutions for Kids Inc. of Irvine, Calif., and her colleagues.

To assess the nature of Internet harassment and the implications for adolescent health, the researchers reviewed data from the Second Youth Internet Safety Survey, a telephone questionnaire conducted in the United States between March and June 2005.

The survey included questions about how often the teens had used the Internet to harass or embarrass someone, and how many times they had made rude comments to someone online. The survey also included questions to assess behavior problems and off-line bullying (J. Adolesc. Health 2007;41:189–95).

Based on how often they reported engaging in any type of Internet harassment, the respondents were classified as “limited” (one to two times), “occasional” (three to five times), or “frequent” (six or more times) harassers.

Overall, 6% of the youth met the criteria for frequent harassers, another 6% met the criteria for occasional harassers, and 17% met the criteria for limited harassers.

Boys were three times more likely than girls to be frequent online bullies, while girls were twice as likely as boys to be limited online bullies. Off-line aggression problems were nine times more likely and rule-breaking behavior was seven times more likely among youth who were frequent online bullies.

The findings emphasize the need to ask children and adolescents about experiences with Internet harassment as victims, perpetrators, or both. “Youth who are limited or occasional perpetrators may represent an opportunity to intervene early,” the researchers noted.

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA) (Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients. The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications. “That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands. “We are the health care safety net for our community,” Ms. Schon said.

For more information or to order Physician Practice Patient Safety Assessment materials, visit www.physiciansafetytool.org

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

WASHINGTON — Clinicians ignored more than half of drug allergy warnings generated by computerized physician order entry programs, based on a review of nearly 30,000 medication orders for 2,732 hospitalized patients.

To determine how often allergy warnings for medications were overridden and why, Philip J. Schneider of the Ohio State University, Columbus, and colleagues analyzed data from four 1-week intervals and one 16-week interval between August 2003 and February 2005. They presented their findings in a poster at a conference sponsored by the National Patient Safety Foundation.

Computerized physician order entry (CPOE) programs allow physicians and other qualified clinicians to enter medication orders directly into a database. Once a prescription has been entered into the database, the system generates alerts regarding patient allergies and potential drug-drug interactions.

Clinicians overrode warnings in 56% of the orders, and changed the medication in 44% of the orders. A total of 54% of physician medication decisions overrode the warnings, compared with decisions by pharmacists (55%) and nurses (61%). The most commonly cited reason for overriding the warnings was that the patient had tolerated the drug in the past. Other reasons included "not a true allergy," "medical reason outweighed risk," and "physician/pharmacist approved."

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.

CHICAGO — A new oral formulation of the antifungal drug terbinafine significantly improved tinea capitis in children aged 4-12 years compared with griseofulvin oral suspension, based on efficacy data from 1,286 children in the largest study of the medication to date.

These findings were presented in a poster by Dr. Sheila Friedlander at the annual meeting of the Society for Pediatric Dermatology.

Children with confirmed positive cultures for tinea capitis who were randomized to receive terbinafine had a significantly higher complete cure rate (combined mycologic and clinical cure rates) after 6 weeks of daily treatment and 10 weeks of follow-up, compared with those who received griseofulvin (45% vs. 39%), said Dr. Friedlander, a pediatric dermatologist at the University of California, San Diego Medical Center.

The new terbinafine formulation (Lamisil oral granules) consists of coated granules that can be sprinkled on food so children can swallow them easily. Both terbinafine and griseofulvin are dosed by body weight. The study was supported in part by Novartis Pharmaceuticals Corp.

Adverse event rates were similar between the two groups. About half of the patients in each group reported at least one adverse event, but almost all were mild or moderate; only 1.6% of the terbinafine patients and 1.2% of the griseofulvin patients discontinued their medications because of adverse events. The most common complaints included vomiting, diarrhea, headache, and abdominal pain.

The mycologic cure rate alone was significantly higher in the terbinafine group compared with the griseofulvin group (62% vs. 56%). The clinical cure rate alone was higher, but not significantly higher, in the terbinafine group compared with the griseofulvin group (63% vs. 59%). Terbinafine was most effective against Trichophyton tonsurans, which is the organism most often associated with tinea capitis, Dr. Friedlander and her associates wrote.

CHICAGO — Several genetically based periodic fever syndromes have skin signs that may help clinicians identify the syndromes on the rare occasions when they occur, Dr. Kathryn M. Edwards said at the annual meeting of the Society for Pediatric Dermatology.

Although these syndromes, called familial periodic fever syndromes, are rare, knowing something about them will "allow you to think more about how we control fever and inflammatory processes in children," noted Dr. Edwards, professor of pediatrics at Vanderbilt University, Nashville, Tenn.

"Periodic fever is a very specific diagnosis," said Dr. Edwards, an expert vaccinologist who has conducted research for the National Institutes of Health. Periodic fevers are fevers that recur at intervals lasting from a few days to a few weeks separated by totally symptom-free intervals.

"We tend to think that most often fever is due to recurrent infections," Dr. Edwards said. Consequently, many patients with periodic fever syndromes may be told that they have recurrent infections or possibly neoplasia. But a periodic fever syndrome is actually a form of autoinflammatory disorder. "Generally periodic fevers that have been present for more than 2 years are never associated with infection or malignancy," she explained.

Dr. Edwards cited one of the few studies that characterized children with periodic fever syndromes, compared with daily fevers that were associated with other illness. Overall, the 29 children with periodic fevers tended to be younger at the onset of the fever (often less than 1 year of age), had a longer duration of symptoms before they were referred for further evaluation, and had higher maximum fever temperatures, compared with 11 children with daily fevers (J. Pediatr. 1996;129:419-23).

About a quarter of the periodic fever patients had a nonspecific rash, but so did the children with daily fevers. Comorbid rash and fever isn't enough to diagnose a familial periodic fever syndrome. But pharyngitis and oral ulcers or adenopathy were seen much more often in patients with periodic fever during their intervals of fever than in those with daily fevers.

"But by and large when [children with periodic fevers] are not febrile they are totally normal, and the parents say that their kids are the healthiest on the block," Dr. Edwards said. The familial syndromes are characterized by identified genetic defects that inhibit the body's ability to control inflammation, and genetic testing is needed to confirm a diagnosis of these syndromes.

There are distinct patterns of ancestry for familial periodic fever syndromes and the genes have been circulating for generations, said Dr. Edwards. "The familial febrile syndromes are not easy to diagnose, and if you have a patient who you suspect has one of these syndromes, please contact the NIH for genotyping," she said.

Following are the familial periodic fever syndromes she described:

▸ Familial Mediterranean Fever (FMF). FMF is linked to a recessive gene known as MEFV. Many patients experience secondary amyloidosis, in which a protein buildup in various organs and tissues can impede their functions. FMF is common in Jewish families of Spanish, Portuguese, or Middle Eastern descent, but it is rare in Jewish families of European descent, Dr. Edwards noted.

Clinical features include serositis and scrotal swelling, and the periodic attacks of fever often begin in childhood. The most common dermatologic manifestation is a distinctive erysipeloid rash on the lower extremities that occurs in about 15% of children with this syndrome. Studies have shown that about half of these patients also report arthritis in one ankle, knee, or hip.

The fever attacks in FMF patients occur at regular intervals, and they usually respond to treatment within 12-72 hours. Colchicine treatment has been shown to be effective in preventing the fever episodes (and the subsequent rash), although not in treating the acute attacks of fever once they occur. "If you treat people with FMF regularly with colchicine, they don't get attacks of fever and they don't get amyloidosis, so it is important that FMF is diagnosed," Dr. Edwards said.

▸ Hyperimmunoglobulinemia D Syndrome (HIDS). HIDS has an early onset (the median age of onset is 6 months), and recurrent attacks of fever persist throughout the patient's life. Febrile attacks usually last for 3-7 days at irregular intervals ranging from 4 to 8 weeks. Clinical features include cervical adenitis, vomiting, and diarrhea. A patient with HIDS may present to a dermatologist with a maculopapular rash, with petechiae and purpura that appear during a febrile attack. Generalized lymphadenopathy and rash are very common in these patients.

Distinctive laboratory features include an elevated IgD but this elevation is not present in all HIDS patients. The gene for HIDS has been mapped to chromosome 12 and at least 8 different mutations or deletions have been seen, but the syndrome is most likely to occur in people with Dutch or French ancestry, Dr. Edwards said.

▸ Tumor Necrosis Factor-Receptor Associated Periodic Syndrome (TRAPS). Children with TRAPS may have a lifelong history of febrile episodes that last 2-3 weeks at a time, but the febrile episodes only occur 2-3 times per year.

Conjunctivitis and raised red lesions distinguish TRAPS from other familial periodic fever syndromes. One study of 25 TRAPS patients showed that 21 (84%) had erythematous patches, including both wavy and circular lesions (N. Engl. J. Med. 2001;345:1748-57). Other clinical features of TRAPS include myalgia, arthralgia, and abdominal pain.

Skin manifestations are much more common with TRAPS than with the other familial periodic fever syndromes. "Almost all of these children will have skin lesions that may persist even when the fever is gone," Dr. Edwards noted.

When a febrile episode occurs, TNF receptors are suppressed, which creates an uncontrolled inflammatory response. Consequently, TNF inhibitors can be used to treat these patients, Dr. Edwards said.

▸ Muckle-Wells Syndrome/Familial Cold Urticaria. These two syndromes are both associated with mutations of the CIAS1 gene family. Mutations in these genes lead to autoinflammatory syndromes in which large numbers of cytokines are generated, which means that amyloidosis is very frequent in these individuals.

Patients with Muckle-Wells syndrome (MWS) generally present with urticaria and progressive sensorineural loss and deafness. Because MWS is a disease of dominant genes, the parent may show signs of hearing problems, which should prompt clinicians to include MWS in the differential diagnosis of recurrent urticaria and fever.

By contrast, patients with familial cold urticaria will present not only with urticaria and wheals, but with complaints of painful joints, chills, and fever. Febrile episodes in patients with familial cold urticaria generally occur several hours after exposure to cold. Both syndromes are associated with German, English, French, and North American ancestry.

CHICAGO — Several genetically based periodic fever syndromes have skin signs that may help clinicians identify the syndromes on the rare occasions when they occur, Dr. Kathryn M. Edwards said at the annual meeting of the Society for Pediatric Dermatology.

Although these syndromes, called familial periodic fever syndromes, are rare, knowing something about them will "allow you to think more about how we control fever and inflammatory processes in children," noted Dr. Edwards, professor of pediatrics at Vanderbilt University, Nashville, Tenn.

"Periodic fever is a very specific diagnosis," said Dr. Edwards, an expert vaccinologist who has conducted research for the National Institutes of Health. Periodic fevers are fevers that recur at intervals lasting from a few days to a few weeks separated by totally symptom-free intervals.

"We tend to think that most often fever is due to recurrent infections," Dr. Edwards said. Consequently, many patients with periodic fever syndromes may be told that they have recurrent infections or possibly neoplasia. But a periodic fever syndrome is actually a form of autoinflammatory disorder. "Generally periodic fevers that have been present for more than 2 years are never associated with infection or malignancy," she explained.

Dr. Edwards cited one of the few studies that characterized children with periodic fever syndromes, compared with daily fevers that were associated with other illness. Overall, the 29 children with periodic fevers tended to be younger at the onset of the fever (often less than 1 year of age), had a longer duration of symptoms before they were referred for further evaluation, and had higher maximum fever temperatures, compared with 11 children with daily fevers (J. Pediatr. 1996;129:419-23).

About a quarter of the periodic fever patients had a nonspecific rash, but so did the children with daily fevers. Comorbid rash and fever isn't enough to diagnose a familial periodic fever syndrome. But pharyngitis and oral ulcers or adenopathy were seen much more often in patients with periodic fever during their intervals of fever than in those with daily fevers.

"But by and large when [children with periodic fevers] are not febrile they are totally normal, and the parents say that their kids are the healthiest on the block," Dr. Edwards said. The familial syndromes are characterized by identified genetic defects that inhibit the body's ability to control inflammation, and genetic testing is needed to confirm a diagnosis of these syndromes.

There are distinct patterns of ancestry for familial periodic fever syndromes and the genes have been circulating for generations, said Dr. Edwards. "The familial febrile syndromes are not easy to diagnose, and if you have a patient who you suspect has one of these syndromes, please contact the NIH for genotyping," she said.

Following are the familial periodic fever syndromes she described:

▸ Familial Mediterranean Fever (FMF). FMF is linked to a recessive gene known as MEFV. Many patients experience secondary amyloidosis, in which a protein buildup in various organs and tissues can impede their functions. FMF is common in Jewish families of Spanish, Portuguese, or Middle Eastern descent, but it is rare in Jewish families of European descent, Dr. Edwards noted.

Clinical features include serositis and scrotal swelling, and the periodic attacks of fever often begin in childhood. The most common dermatologic manifestation is a distinctive erysipeloid rash on the lower extremities that occurs in about 15% of children with this syndrome. Studies have shown that about half of these patients also report arthritis in one ankle, knee, or hip.

The fever attacks in FMF patients occur at regular intervals, and they usually respond to treatment within 12-72 hours. Colchicine treatment has been shown to be effective in preventing the fever episodes (and the subsequent rash), although not in treating the acute attacks of fever once they occur. "If you treat people with FMF regularly with colchicine, they don't get attacks of fever and they don't get amyloidosis, so it is important that FMF is diagnosed," Dr. Edwards said.

▸ Hyperimmunoglobulinemia D Syndrome (HIDS). HIDS has an early onset (the median age of onset is 6 months), and recurrent attacks of fever persist throughout the patient's life. Febrile attacks usually last for 3-7 days at irregular intervals ranging from 4 to 8 weeks. Clinical features include cervical adenitis, vomiting, and diarrhea. A patient with HIDS may present to a dermatologist with a maculopapular rash, with petechiae and purpura that appear during a febrile attack. Generalized lymphadenopathy and rash are very common in these patients.

Distinctive laboratory features include an elevated IgD but this elevation is not present in all HIDS patients. The gene for HIDS has been mapped to chromosome 12 and at least 8 different mutations or deletions have been seen, but the syndrome is most likely to occur in people with Dutch or French ancestry, Dr. Edwards said.

▸ Tumor Necrosis Factor-Receptor Associated Periodic Syndrome (TRAPS). Children with TRAPS may have a lifelong history of febrile episodes that last 2-3 weeks at a time, but the febrile episodes only occur 2-3 times per year.

Conjunctivitis and raised red lesions distinguish TRAPS from other familial periodic fever syndromes. One study of 25 TRAPS patients showed that 21 (84%) had erythematous patches, including both wavy and circular lesions (N. Engl. J. Med. 2001;345:1748-57). Other clinical features of TRAPS include myalgia, arthralgia, and abdominal pain.

Skin manifestations are much more common with TRAPS than with the other familial periodic fever syndromes. "Almost all of these children will have skin lesions that may persist even when the fever is gone," Dr. Edwards noted.

When a febrile episode occurs, TNF receptors are suppressed, which creates an uncontrolled inflammatory response. Consequently, TNF inhibitors can be used to treat these patients, Dr. Edwards said.

▸ Muckle-Wells Syndrome/Familial Cold Urticaria. These two syndromes are both associated with mutations of the CIAS1 gene family. Mutations in these genes lead to autoinflammatory syndromes in which large numbers of cytokines are generated, which means that amyloidosis is very frequent in these individuals.

Patients with Muckle-Wells syndrome (MWS) generally present with urticaria and progressive sensorineural loss and deafness. Because MWS is a disease of dominant genes, the parent may show signs of hearing problems, which should prompt clinicians to include MWS in the differential diagnosis of recurrent urticaria and fever.

By contrast, patients with familial cold urticaria will present not only with urticaria and wheals, but with complaints of painful joints, chills, and fever. Febrile episodes in patients with familial cold urticaria generally occur several hours after exposure to cold. Both syndromes are associated with German, English, French, and North American ancestry.

CHICAGO — Several genetically based periodic fever syndromes have skin signs that may help clinicians identify the syndromes on the rare occasions when they occur, Dr. Kathryn M. Edwards said at the annual meeting of the Society for Pediatric Dermatology.

Although these syndromes, called familial periodic fever syndromes, are rare, knowing something about them will "allow you to think more about how we control fever and inflammatory processes in children," noted Dr. Edwards, professor of pediatrics at Vanderbilt University, Nashville, Tenn.

"Periodic fever is a very specific diagnosis," said Dr. Edwards, an expert vaccinologist who has conducted research for the National Institutes of Health. Periodic fevers are fevers that recur at intervals lasting from a few days to a few weeks separated by totally symptom-free intervals.

"We tend to think that most often fever is due to recurrent infections," Dr. Edwards said. Consequently, many patients with periodic fever syndromes may be told that they have recurrent infections or possibly neoplasia. But a periodic fever syndrome is actually a form of autoinflammatory disorder. "Generally periodic fevers that have been present for more than 2 years are never associated with infection or malignancy," she explained.

Dr. Edwards cited one of the few studies that characterized children with periodic fever syndromes, compared with daily fevers that were associated with other illness. Overall, the 29 children with periodic fevers tended to be younger at the onset of the fever (often less than 1 year of age), had a longer duration of symptoms before they were referred for further evaluation, and had higher maximum fever temperatures, compared with 11 children with daily fevers (J. Pediatr. 1996;129:419-23).

About a quarter of the periodic fever patients had a nonspecific rash, but so did the children with daily fevers. Comorbid rash and fever isn't enough to diagnose a familial periodic fever syndrome. But pharyngitis and oral ulcers or adenopathy were seen much more often in patients with periodic fever during their intervals of fever than in those with daily fevers.

"But by and large when [children with periodic fevers] are not febrile they are totally normal, and the parents say that their kids are the healthiest on the block," Dr. Edwards said. The familial syndromes are characterized by identified genetic defects that inhibit the body's ability to control inflammation, and genetic testing is needed to confirm a diagnosis of these syndromes.

There are distinct patterns of ancestry for familial periodic fever syndromes and the genes have been circulating for generations, said Dr. Edwards. "The familial febrile syndromes are not easy to diagnose, and if you have a patient who you suspect has one of these syndromes, please contact the NIH for genotyping," she said.

Following are the familial periodic fever syndromes she described:

▸ Familial Mediterranean Fever (FMF). FMF is linked to a recessive gene known as MEFV. Many patients experience secondary amyloidosis, in which a protein buildup in various organs and tissues can impede their functions. FMF is common in Jewish families of Spanish, Portuguese, or Middle Eastern descent, but it is rare in Jewish families of European descent, Dr. Edwards noted.

Clinical features include serositis and scrotal swelling, and the periodic attacks of fever often begin in childhood. The most common dermatologic manifestation is a distinctive erysipeloid rash on the lower extremities that occurs in about 15% of children with this syndrome. Studies have shown that about half of these patients also report arthritis in one ankle, knee, or hip.

The fever attacks in FMF patients occur at regular intervals, and they usually respond to treatment within 12-72 hours. Colchicine treatment has been shown to be effective in preventing the fever episodes (and the subsequent rash), although not in treating the acute attacks of fever once they occur. "If you treat people with FMF regularly with colchicine, they don't get attacks of fever and they don't get amyloidosis, so it is important that FMF is diagnosed," Dr. Edwards said.

▸ Hyperimmunoglobulinemia D Syndrome (HIDS). HIDS has an early onset (the median age of onset is 6 months), and recurrent attacks of fever persist throughout the patient's life. Febrile attacks usually last for 3-7 days at irregular intervals ranging from 4 to 8 weeks. Clinical features include cervical adenitis, vomiting, and diarrhea. A patient with HIDS may present to a dermatologist with a maculopapular rash, with petechiae and purpura that appear during a febrile attack. Generalized lymphadenopathy and rash are very common in these patients.

Distinctive laboratory features include an elevated IgD but this elevation is not present in all HIDS patients. The gene for HIDS has been mapped to chromosome 12 and at least 8 different mutations or deletions have been seen, but the syndrome is most likely to occur in people with Dutch or French ancestry, Dr. Edwards said.

▸ Tumor Necrosis Factor-Receptor Associated Periodic Syndrome (TRAPS). Children with TRAPS may have a lifelong history of febrile episodes that last 2-3 weeks at a time, but the febrile episodes only occur 2-3 times per year.

Conjunctivitis and raised red lesions distinguish TRAPS from other familial periodic fever syndromes. One study of 25 TRAPS patients showed that 21 (84%) had erythematous patches, including both wavy and circular lesions (N. Engl. J. Med. 2001;345:1748-57). Other clinical features of TRAPS include myalgia, arthralgia, and abdominal pain.

Skin manifestations are much more common with TRAPS than with the other familial periodic fever syndromes. "Almost all of these children will have skin lesions that may persist even when the fever is gone," Dr. Edwards noted.

When a febrile episode occurs, TNF receptors are suppressed, which creates an uncontrolled inflammatory response. Consequently, TNF inhibitors can be used to treat these patients, Dr. Edwards said.

▸ Muckle-Wells Syndrome/Familial Cold Urticaria. These two syndromes are both associated with mutations of the CIAS1 gene family. Mutations in these genes lead to autoinflammatory syndromes in which large numbers of cytokines are generated, which means that amyloidosis is very frequent in these individuals.

Patients with Muckle-Wells syndrome (MWS) generally present with urticaria and progressive sensorineural loss and deafness. Because MWS is a disease of dominant genes, the parent may show signs of hearing problems, which should prompt clinicians to include MWS in the differential diagnosis of recurrent urticaria and fever.

By contrast, patients with familial cold urticaria will present not only with urticaria and wheals, but with complaints of painful joints, chills, and fever. Febrile episodes in patients with familial cold urticaria generally occur several hours after exposure to cold. Both syndromes are associated with German, English, French, and North American ancestry.

CHICAGO — Intermittent treatment with tacrolimus ointment kept atopic dermatitis under control with no need for corticosteroids in children and adolescents aged 2-15 years whose conditions had stabilized.

Because concerns persist about the long-term effects of corticosteroid use by children and teens, safe and effective alternatives for the long-term management of atopic dermatitis (AD) are needed. Because the black box warning attached to tacrolimus (Protopic) says that continuous use should be avoided, Dr. Amy S. Paller of Northwestern University, Chicago, and her colleagues designed a plan that involved applying tacrolimus ointment to the affected skin three times weekly for 40 weeks.

The treatment goal was to prevent flares in patients whose AD had stabilized. The trial of the protocol's safety and effectiveness was sponsored by Astellas Pharma US Inc., and the researchers presented their findings in a poster at the annual meeting of the Society for Pediatric Dermatology.

A total of 206 patients were randomized, but 54 discontinued the study. The most common reason for discontinuation was loss to follow-up (15 patients). Ten children dropped out because of uncontrolled rebound exacerbation of their AD, and five dropped out because of an adverse event.

Overall, the patients who received tacrolimus ointment had significantly fewer relapse days (47) than those who received a control ointment containing alclometasone (76 days). In addition, the tacrolimus patients remained stable for significantly more days before their first relapses (116 days vs. 31 days), the investigators reported.

Although there was no difference between the groups in the number of children who relapsed at least once, only 6% of the children in the tacrolimus group relapsed for up to 3 days during the study period. In the control group, 19% of the children relapsed for up to 6 days.

The most common adverse events reported by tacrolimus patients were burning and itching at the application site, which reflects results from previous safety studies. The incidence of adverse events was similar between the two groups. In general, tacrolimus ointment has a safety record similar to that of corticosteroid ointment for the initial treatment of moderate to severe AD in children, Dr. Paller and her associates noted.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Intermittent treatment with tacrolimus ointment kept atopic dermatitis under control with no need for corticosteroids in children and adolescents aged 2-15 years whose conditions had stabilized.

Because concerns persist about the long-term effects of corticosteroid use by children and teens, safe and effective alternatives for the long-term management of atopic dermatitis (AD) are needed. Because the black box warning attached to tacrolimus (Protopic) says that continuous use should be avoided, Dr. Amy S. Paller of Northwestern University, Chicago, and her colleagues designed a plan that involved applying tacrolimus ointment to the affected skin three times weekly for 40 weeks.

The treatment goal was to prevent flares in patients whose AD had stabilized. The trial of the protocol's safety and effectiveness was sponsored by Astellas Pharma US Inc., and the researchers presented their findings in a poster at the annual meeting of the Society for Pediatric Dermatology.

A total of 206 patients were randomized, but 54 discontinued the study. The most common reason for discontinuation was loss to follow-up (15 patients). Ten children dropped out because of uncontrolled rebound exacerbation of their AD, and five dropped out because of an adverse event.

Overall, the patients who received tacrolimus ointment had significantly fewer relapse days (47) than those who received a control ointment containing alclometasone (76 days). In addition, the tacrolimus patients remained stable for significantly more days before their first relapses (116 days vs. 31 days), the investigators reported.

Although there was no difference between the groups in the number of children who relapsed at least once, only 6% of the children in the tacrolimus group relapsed for up to 3 days during the study period. In the control group, 19% of the children relapsed for up to 6 days.

The most common adverse events reported by tacrolimus patients were burning and itching at the application site, which reflects results from previous safety studies. The incidence of adverse events was similar between the two groups. In general, tacrolimus ointment has a safety record similar to that of corticosteroid ointment for the initial treatment of moderate to severe AD in children, Dr. Paller and her associates noted.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Intermittent treatment with tacrolimus ointment kept atopic dermatitis under control with no need for corticosteroids in children and adolescents aged 2-15 years whose conditions had stabilized.

Because concerns persist about the long-term effects of corticosteroid use by children and teens, safe and effective alternatives for the long-term management of atopic dermatitis (AD) are needed. Because the black box warning attached to tacrolimus (Protopic) says that continuous use should be avoided, Dr. Amy S. Paller of Northwestern University, Chicago, and her colleagues designed a plan that involved applying tacrolimus ointment to the affected skin three times weekly for 40 weeks.

The treatment goal was to prevent flares in patients whose AD had stabilized. The trial of the protocol's safety and effectiveness was sponsored by Astellas Pharma US Inc., and the researchers presented their findings in a poster at the annual meeting of the Society for Pediatric Dermatology.

A total of 206 patients were randomized, but 54 discontinued the study. The most common reason for discontinuation was loss to follow-up (15 patients). Ten children dropped out because of uncontrolled rebound exacerbation of their AD, and five dropped out because of an adverse event.

Overall, the patients who received tacrolimus ointment had significantly fewer relapse days (47) than those who received a control ointment containing alclometasone (76 days). In addition, the tacrolimus patients remained stable for significantly more days before their first relapses (116 days vs. 31 days), the investigators reported.

Although there was no difference between the groups in the number of children who relapsed at least once, only 6% of the children in the tacrolimus group relapsed for up to 3 days during the study period. In the control group, 19% of the children relapsed for up to 6 days.

The most common adverse events reported by tacrolimus patients were burning and itching at the application site, which reflects results from previous safety studies. The incidence of adverse events was similar between the two groups. In general, tacrolimus ointment has a safety record similar to that of corticosteroid ointment for the initial treatment of moderate to severe AD in children, Dr. Paller and her associates noted.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — A nonsteroidal cream that contains glycyrrhetinic acid (2%) and hyaluronic acid is a safe, effective therapy for mild to moderate atopic dermatitis in infants and young children, based on data from 142 patients aged 6 months to 12 years presented at the annual meeting of the Society for Pediatric Dermatology.

The nonsteroidal cream MAS063DP, which is marketed as Atopiclair, demonstrated safety and effectiveness in adults aged 18-84 years with mild to moderate AD in a randomized, double-blind, placebo-controlled study of 218 patients (J. Drugs Dermatol. 2006;5:236-44).

To assess the safety and effectiveness of the cream in children, Dr. Mark Boguniewicz, of the National Jewish Medical and Research Center in Denver, and his colleagues randomized 72 patients to application of the test cream three times daily and 70 patients to application of a placebo cream three times a day for 43 days. The study was sponsored by Sinclair Pharmaceuticals Ltd. and Graceway Pharmaceuticals LLC.

After 8 days, 39% of the patients in the test group met criteria for "almost clear," whereas none of the placebo patients met these criteria, based on the Investigator's Global Assessment scale. After 22 days, 77% of the test group met criteria for "clear" or "almost clear," whereas none of the placebo patients met these criteria. By the end of the study at 43 days, 78% of the test patients were "clear" or "almost clear," compared with fewer than 7% of the placebo patients.

Itchiness also decreased significantly in the test group during the study period. The average scores (on a scale of 0-100 mm) on the Visual Analog Scale, which compared the same lesion at baseline and on the last day of the study, dropped from 60 mm to 13 mm in the test group and from 66 mm to 57 mm in the placebo group.

By the study's end, 81% of the patients and caregivers in the test group reported either "good improvement" or "total resolution," compared with 10% of the placebo group. Similarly, 81% of patients and caregivers in the test group said that they would "definitely" or "likely" continue to use the cream. All reported adverse events were defined as mild to moderate. The most common complaints—a burning sensation on the skin and fever—occurred with the same frequency in both the test and placebo groups (6.9% vs. 7.1%, respectively). The 26 patients who needed rescue medication at any time during the study included significantly fewer patients from the test group (6 patients) than from the placebo group (20 patients).

Atopiclair is approved by the Food and Drug Administration for marketing in the United States, a spokesperson for Sinclair Pharmaceuticals said in an interview, and "has no restrictions on age or duration of use," according to the product Web site.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — A nonsteroidal cream that contains glycyrrhetinic acid (2%) and hyaluronic acid is a safe, effective therapy for mild to moderate atopic dermatitis in infants and young children, based on data from 142 patients aged 6 months to 12 years presented at the annual meeting of the Society for Pediatric Dermatology.

The nonsteroidal cream MAS063DP, which is marketed as Atopiclair, demonstrated safety and effectiveness in adults aged 18-84 years with mild to moderate AD in a randomized, double-blind, placebo-controlled study of 218 patients (J. Drugs Dermatol. 2006;5:236-44).

To assess the safety and effectiveness of the cream in children, Dr. Mark Boguniewicz, of the National Jewish Medical and Research Center in Denver, and his colleagues randomized 72 patients to application of the test cream three times daily and 70 patients to application of a placebo cream three times a day for 43 days. The study was sponsored by Sinclair Pharmaceuticals Ltd. and Graceway Pharmaceuticals LLC.

After 8 days, 39% of the patients in the test group met criteria for "almost clear," whereas none of the placebo patients met these criteria, based on the Investigator's Global Assessment scale. After 22 days, 77% of the test group met criteria for "clear" or "almost clear," whereas none of the placebo patients met these criteria. By the end of the study at 43 days, 78% of the test patients were "clear" or "almost clear," compared with fewer than 7% of the placebo patients.

Itchiness also decreased significantly in the test group during the study period. The average scores (on a scale of 0-100 mm) on the Visual Analog Scale, which compared the same lesion at baseline and on the last day of the study, dropped from 60 mm to 13 mm in the test group and from 66 mm to 57 mm in the placebo group.

By the study's end, 81% of the patients and caregivers in the test group reported either "good improvement" or "total resolution," compared with 10% of the placebo group. Similarly, 81% of patients and caregivers in the test group said that they would "definitely" or "likely" continue to use the cream. All reported adverse events were defined as mild to moderate. The most common complaints—a burning sensation on the skin and fever—occurred with the same frequency in both the test and placebo groups (6.9% vs. 7.1%, respectively). The 26 patients who needed rescue medication at any time during the study included significantly fewer patients from the test group (6 patients) than from the placebo group (20 patients).

Atopiclair is approved by the Food and Drug Administration for marketing in the United States, a spokesperson for Sinclair Pharmaceuticals said in an interview, and "has no restrictions on age or duration of use," according to the product Web site.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — A nonsteroidal cream that contains glycyrrhetinic acid (2%) and hyaluronic acid is a safe, effective therapy for mild to moderate atopic dermatitis in infants and young children, based on data from 142 patients aged 6 months to 12 years presented at the annual meeting of the Society for Pediatric Dermatology.

The nonsteroidal cream MAS063DP, which is marketed as Atopiclair, demonstrated safety and effectiveness in adults aged 18-84 years with mild to moderate AD in a randomized, double-blind, placebo-controlled study of 218 patients (J. Drugs Dermatol. 2006;5:236-44).

To assess the safety and effectiveness of the cream in children, Dr. Mark Boguniewicz, of the National Jewish Medical and Research Center in Denver, and his colleagues randomized 72 patients to application of the test cream three times daily and 70 patients to application of a placebo cream three times a day for 43 days. The study was sponsored by Sinclair Pharmaceuticals Ltd. and Graceway Pharmaceuticals LLC.

After 8 days, 39% of the patients in the test group met criteria for "almost clear," whereas none of the placebo patients met these criteria, based on the Investigator's Global Assessment scale. After 22 days, 77% of the test group met criteria for "clear" or "almost clear," whereas none of the placebo patients met these criteria. By the end of the study at 43 days, 78% of the test patients were "clear" or "almost clear," compared with fewer than 7% of the placebo patients.

Itchiness also decreased significantly in the test group during the study period. The average scores (on a scale of 0-100 mm) on the Visual Analog Scale, which compared the same lesion at baseline and on the last day of the study, dropped from 60 mm to 13 mm in the test group and from 66 mm to 57 mm in the placebo group.

By the study's end, 81% of the patients and caregivers in the test group reported either "good improvement" or "total resolution," compared with 10% of the placebo group. Similarly, 81% of patients and caregivers in the test group said that they would "definitely" or "likely" continue to use the cream. All reported adverse events were defined as mild to moderate. The most common complaints—a burning sensation on the skin and fever—occurred with the same frequency in both the test and placebo groups (6.9% vs. 7.1%, respectively). The 26 patients who needed rescue medication at any time during the study included significantly fewer patients from the test group (6 patients) than from the placebo group (20 patients).

Atopiclair is approved by the Food and Drug Administration for marketing in the United States, a spokesperson for Sinclair Pharmaceuticals said in an interview, and "has no restrictions on age or duration of use," according to the product Web site.

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Assume noncompliance when treating atopic dermatitis in teenage patients, said Dr. Jon M. Hanifin, a dermatologist at Oregon Health and Science University in Portland.

"Managing atopic dermatitis in teenagers is not for the faint of heart," said Dr. Hanifin, a specialist in atopic dermatitis who has served as a consultant for multiple pharmaceutical companies.

Dr. Hanifin shared some tips on treating atopic dermatitis (AD) in teenagers at the annual meeting of the Society for Pediatric Dermatology, including these:

▸ Keep the parents out of the room except for the start and end of the visit. "You have to get the parents out of the room to find out what's going on," he said.

▸ Ask the teens to call the office if the treatment isn't going well and encourage them to schedule their appointments.

▸ Offer psychiatric consultation. Some of these teens genuinely want some help other than their parents yelling at them.

▸ Don't shy away from systemic medications. Try methotrexate for moderate to severe cases of AD in adolescents because it is less expensive than cyclosporin, Dr. Hanifin said. He often starts teen atopic dermatitis patients with 2.5 mg of methotrexate for 4 of 7 days each week, which has been more effective than a once-weekly dose of 15 mg in many of his teen patients.

But clinicians must remember that making time for consistent AD care is rarely a priority for a busy teenager, he noted.

CHICAGO — Assume noncompliance when treating atopic dermatitis in teenage patients, said Dr. Jon M. Hanifin, a dermatologist at Oregon Health and Science University in Portland.

"Managing atopic dermatitis in teenagers is not for the faint of heart," said Dr. Hanifin, a specialist in atopic dermatitis who has served as a consultant for multiple pharmaceutical companies.

Dr. Hanifin shared some tips on treating atopic dermatitis (AD) in teenagers at the annual meeting of the Society for Pediatric Dermatology, including these:

▸ Keep the parents out of the room except for the start and end of the visit. "You have to get the parents out of the room to find out what's going on," he said.

▸ Ask the teens to call the office if the treatment isn't going well and encourage them to schedule their appointments.

▸ Offer psychiatric consultation. Some of these teens genuinely want some help other than their parents yelling at them.

▸ Don't shy away from systemic medications. Try methotrexate for moderate to severe cases of AD in adolescents because it is less expensive than cyclosporin, Dr. Hanifin said. He often starts teen atopic dermatitis patients with 2.5 mg of methotrexate for 4 of 7 days each week, which has been more effective than a once-weekly dose of 15 mg in many of his teen patients.

But clinicians must remember that making time for consistent AD care is rarely a priority for a busy teenager, he noted.

CHICAGO — Assume noncompliance when treating atopic dermatitis in teenage patients, said Dr. Jon M. Hanifin, a dermatologist at Oregon Health and Science University in Portland.

"Managing atopic dermatitis in teenagers is not for the faint of heart," said Dr. Hanifin, a specialist in atopic dermatitis who has served as a consultant for multiple pharmaceutical companies.

Dr. Hanifin shared some tips on treating atopic dermatitis (AD) in teenagers at the annual meeting of the Society for Pediatric Dermatology, including these:

▸ Keep the parents out of the room except for the start and end of the visit. "You have to get the parents out of the room to find out what's going on," he said.

▸ Ask the teens to call the office if the treatment isn't going well and encourage them to schedule their appointments.

▸ Offer psychiatric consultation. Some of these teens genuinely want some help other than their parents yelling at them.

▸ Don't shy away from systemic medications. Try methotrexate for moderate to severe cases of AD in adolescents because it is less expensive than cyclosporin, Dr. Hanifin said. He often starts teen atopic dermatitis patients with 2.5 mg of methotrexate for 4 of 7 days each week, which has been more effective than a once-weekly dose of 15 mg in many of his teen patients.

But clinicians must remember that making time for consistent AD care is rarely a priority for a busy teenager, he noted.

CHICAGO — Short-term treatment with oral corticosteroids doesn't appear to prevent infants with hemangiomas from achieving normal height, based on data from a study of 44 children with infant hemangiomas who were treated with corticosteroids for an average of 14 months.

All but two children (95%) had grown to within two standard deviations of their predicted normal heights by the time they were approximately 5 years old. The predicted normal heights were based on the average midparental height, which is a formula for predicting a child's normal adult height based on the heights of both parents. For the general population, the expected future height falls within two standard deviations of the midparental height.

"Our research question was whether short-term corticosteroids impacted long-term growth," said Dr. Perla Lansang, who presented the findings at the annual meeting of the Society for Pediatric Dermatology.

The efficacy of treating large infant hemangiomas with oral corticosteroids has been well documented, but short-term growth retardation is a common side effect and the potential for long-term growth retardation remains a concern, said Dr. Lansang, a dermatologist who conducted the study at the Hospital for Sick Children, Toronto, as part of a resident research award from the society.

The study population included 8 boys and 36 girls with hemangiomas who were treated with oral corticosteroids at the hospital between January 2000 and December 2005. Children with other metabolic conditions or those who were taking corticosteroids for other reasons were excluded. The children started taking oral corticosteroids at an average of 3 months of age, and the average dosage was 2.2 mg/kg per day. Although all the children experienced growth retardation while taking the steroids, the steepest drop off the growth curve occurred primarily during the first 3 to 4 months of treatment, Dr. Lansang noted.

The children's growth resumed after an average of 8 months of treatment, but the most rapid increase in catch-up growth occurred during the first 2 years after the children stopped taking corticosteroids. The mechanism of action for growth velocity patterns after the discontinuation of steroid use is not well understood, but by the end of the study most of the children were on track to achieve their normal height based on midparental height, Dr. Lansang said. The findings may ease clinicians' and parents' concerns about long-term growth outcomes for these children.

CHICAGO — Short-term treatment with oral corticosteroids doesn't appear to prevent infants with hemangiomas from achieving normal height, based on data from a study of 44 children with infant hemangiomas who were treated with corticosteroids for an average of 14 months.

All but two children (95%) had grown to within two standard deviations of their predicted normal heights by the time they were approximately 5 years old. The predicted normal heights were based on the average midparental height, which is a formula for predicting a child's normal adult height based on the heights of both parents. For the general population, the expected future height falls within two standard deviations of the midparental height.

"Our research question was whether short-term corticosteroids impacted long-term growth," said Dr. Perla Lansang, who presented the findings at the annual meeting of the Society for Pediatric Dermatology.

The efficacy of treating large infant hemangiomas with oral corticosteroids has been well documented, but short-term growth retardation is a common side effect and the potential for long-term growth retardation remains a concern, said Dr. Lansang, a dermatologist who conducted the study at the Hospital for Sick Children, Toronto, as part of a resident research award from the society.

The study population included 8 boys and 36 girls with hemangiomas who were treated with oral corticosteroids at the hospital between January 2000 and December 2005. Children with other metabolic conditions or those who were taking corticosteroids for other reasons were excluded. The children started taking oral corticosteroids at an average of 3 months of age, and the average dosage was 2.2 mg/kg per day. Although all the children experienced growth retardation while taking the steroids, the steepest drop off the growth curve occurred primarily during the first 3 to 4 months of treatment, Dr. Lansang noted.

The children's growth resumed after an average of 8 months of treatment, but the most rapid increase in catch-up growth occurred during the first 2 years after the children stopped taking corticosteroids. The mechanism of action for growth velocity patterns after the discontinuation of steroid use is not well understood, but by the end of the study most of the children were on track to achieve their normal height based on midparental height, Dr. Lansang said. The findings may ease clinicians' and parents' concerns about long-term growth outcomes for these children.

CHICAGO — Short-term treatment with oral corticosteroids doesn't appear to prevent infants with hemangiomas from achieving normal height, based on data from a study of 44 children with infant hemangiomas who were treated with corticosteroids for an average of 14 months.

All but two children (95%) had grown to within two standard deviations of their predicted normal heights by the time they were approximately 5 years old. The predicted normal heights were based on the average midparental height, which is a formula for predicting a child's normal adult height based on the heights of both parents. For the general population, the expected future height falls within two standard deviations of the midparental height.

"Our research question was whether short-term corticosteroids impacted long-term growth," said Dr. Perla Lansang, who presented the findings at the annual meeting of the Society for Pediatric Dermatology.

The efficacy of treating large infant hemangiomas with oral corticosteroids has been well documented, but short-term growth retardation is a common side effect and the potential for long-term growth retardation remains a concern, said Dr. Lansang, a dermatologist who conducted the study at the Hospital for Sick Children, Toronto, as part of a resident research award from the society.

The study population included 8 boys and 36 girls with hemangiomas who were treated with oral corticosteroids at the hospital between January 2000 and December 2005. Children with other metabolic conditions or those who were taking corticosteroids for other reasons were excluded. The children started taking oral corticosteroids at an average of 3 months of age, and the average dosage was 2.2 mg/kg per day. Although all the children experienced growth retardation while taking the steroids, the steepest drop off the growth curve occurred primarily during the first 3 to 4 months of treatment, Dr. Lansang noted.

The children's growth resumed after an average of 8 months of treatment, but the most rapid increase in catch-up growth occurred during the first 2 years after the children stopped taking corticosteroids. The mechanism of action for growth velocity patterns after the discontinuation of steroid use is not well understood, but by the end of the study most of the children were on track to achieve their normal height based on midparental height, Dr. Lansang said. The findings may ease clinicians' and parents' concerns about long-term growth outcomes for these children.

The Centers for Disease Control and Prevention's updated recommendations for the 2007-2008 flu season emphasize vaccinating health care personnel and catching up previously unvaccinated children aged 6 months to 8 years with two doses of vaccine.

The CDC's Advisory Committee on Immunization Practices (ACIP) published its updated flu vaccination recommendations for the 2007-2008 flu season in Morbidity and Mortality Weekly Report (MMWR 2007;56RR-6:1-40). New recommendations for the upcoming flu season include the following:

▸ For health care administrators. Treat the vaccination of health care personnel as a patient safety issue and implement ways to encourage all health care providers to get flu shots. For example, require signed statements from all health care providers who decline flu vaccination.

▸ For clinicians. In addition to those who were not previously vaccinated, those children aged 6 months to 8 years who received only one dose of flu vaccine in earlier years should receive two doses this year. Administer a second dose of the trivalent inactivated influenza vaccine (TIV) at least 4 weeks after the first dose. Clinicians who are using the live, attenuated influenza vaccine (LAIV) for these children should give a second dose at least 6-10 weeks after the first dose.

The TIV may be used for any person aged 6 months and older, including those with high-risk conditions.

The LAIV is currently approved only for healthy, nonpregnant individuals aged 5-49 years. The influenza vaccine for the 2007-2008 season contains a new strain called A/Solomon Islands/3/2006 (H1N1)-like, along with two strains that have been used in previous vaccines: A/Wisconsin/67/2005 (H3N2)-like and B/Malaysia/2506/2004-like viruses.

Vaccination coverage continues to fall short of the CDC's recommendations, and the CDC encourages clinicians to be proactive about vaccinating their patients and to offer vaccination throughout the flu season.

As in recent years, the CDC recommends annual vaccination for the following groups:

▸ Anyone (including school-aged children) who wants to reduce the risk of getting or transmitting the flu.

▸ All children aged 6 months to 4 years.

▸ All adults aged 50 years and older.

▸ Children and teens aged 6 months to 18 years who receive long-term aspirin therapy.

▸ Pregnant women or women who plan to be pregnant during the flu season.

▸ All persons with chronic pulmonary, cardiovascular, liver, kidney, or metabolic disorders, including diabetes but excluding hypertension.

▸ All persons with conditions that could impede respiratory function (such as cognitive dysfunction, spinal cord injuries, or other neuromuscular problems).

▸ All immunosuppressed persons.

▸ Health care personnel.

▸ Healthy household contacts and caregivers of children younger than 5 years or of adults aged 50 years and older.

▸ Healthy household contacts and caregivers of anyone with a medical condition that increases the risk for complications from influenza.

▸ Individuals in nursing homes or chronic care facilities.

Any updates to the 2007-2008 flu season vaccination recommendations will be posted on the CDC's Web site at www.cdc.gov/flu

The Centers for Disease Control and Prevention's updated recommendations for the 2007-2008 flu season emphasize vaccinating health care personnel and catching up previously unvaccinated children aged 6 months to 8 years with two doses of vaccine.

The CDC's Advisory Committee on Immunization Practices (ACIP) published its updated flu vaccination recommendations for the 2007-2008 flu season in Morbidity and Mortality Weekly Report (MMWR 2007;56RR-6:1-40). New recommendations for the upcoming flu season include the following:

▸ For health care administrators. Treat the vaccination of health care personnel as a patient safety issue and implement ways to encourage all health care providers to get flu shots. For example, require signed statements from all health care providers who decline flu vaccination.

▸ For clinicians. In addition to those who were not previously vaccinated, those children aged 6 months to 8 years who received only one dose of flu vaccine in earlier years should receive two doses this year. Administer a second dose of the trivalent inactivated influenza vaccine (TIV) at least 4 weeks after the first dose. Clinicians who are using the live, attenuated influenza vaccine (LAIV) for these children should give a second dose at least 6-10 weeks after the first dose.

The TIV may be used for any person aged 6 months and older, including those with high-risk conditions.

The LAIV is currently approved only for healthy, nonpregnant individuals aged 5-49 years. The influenza vaccine for the 2007-2008 season contains a new strain called A/Solomon Islands/3/2006 (H1N1)-like, along with two strains that have been used in previous vaccines: A/Wisconsin/67/2005 (H3N2)-like and B/Malaysia/2506/2004-like viruses.

Vaccination coverage continues to fall short of the CDC's recommendations, and the CDC encourages clinicians to be proactive about vaccinating their patients and to offer vaccination throughout the flu season.

As in recent years, the CDC recommends annual vaccination for the following groups:

▸ Anyone (including school-aged children) who wants to reduce the risk of getting or transmitting the flu.

▸ All children aged 6 months to 4 years.

▸ All adults aged 50 years and older.

▸ Children and teens aged 6 months to 18 years who receive long-term aspirin therapy.

▸ Pregnant women or women who plan to be pregnant during the flu season.

▸ All persons with chronic pulmonary, cardiovascular, liver, kidney, or metabolic disorders, including diabetes but excluding hypertension.

▸ All persons with conditions that could impede respiratory function (such as cognitive dysfunction, spinal cord injuries, or other neuromuscular problems).

▸ All immunosuppressed persons.

▸ Health care personnel.

▸ Healthy household contacts and caregivers of children younger than 5 years or of adults aged 50 years and older.

▸ Healthy household contacts and caregivers of anyone with a medical condition that increases the risk for complications from influenza.

▸ Individuals in nursing homes or chronic care facilities.

Any updates to the 2007-2008 flu season vaccination recommendations will be posted on the CDC's Web site at www.cdc.gov/flu

The Centers for Disease Control and Prevention's updated recommendations for the 2007-2008 flu season emphasize vaccinating health care personnel and catching up previously unvaccinated children aged 6 months to 8 years with two doses of vaccine.

The CDC's Advisory Committee on Immunization Practices (ACIP) published its updated flu vaccination recommendations for the 2007-2008 flu season in Morbidity and Mortality Weekly Report (MMWR 2007;56RR-6:1-40). New recommendations for the upcoming flu season include the following:

▸ For health care administrators. Treat the vaccination of health care personnel as a patient safety issue and implement ways to encourage all health care providers to get flu shots. For example, require signed statements from all health care providers who decline flu vaccination.

▸ For clinicians. In addition to those who were not previously vaccinated, those children aged 6 months to 8 years who received only one dose of flu vaccine in earlier years should receive two doses this year. Administer a second dose of the trivalent inactivated influenza vaccine (TIV) at least 4 weeks after the first dose. Clinicians who are using the live, attenuated influenza vaccine (LAIV) for these children should give a second dose at least 6-10 weeks after the first dose.

The TIV may be used for any person aged 6 months and older, including those with high-risk conditions.

The LAIV is currently approved only for healthy, nonpregnant individuals aged 5-49 years. The influenza vaccine for the 2007-2008 season contains a new strain called A/Solomon Islands/3/2006 (H1N1)-like, along with two strains that have been used in previous vaccines: A/Wisconsin/67/2005 (H3N2)-like and B/Malaysia/2506/2004-like viruses.

Vaccination coverage continues to fall short of the CDC's recommendations, and the CDC encourages clinicians to be proactive about vaccinating their patients and to offer vaccination throughout the flu season.

As in recent years, the CDC recommends annual vaccination for the following groups:

▸ Anyone (including school-aged children) who wants to reduce the risk of getting or transmitting the flu.

▸ All children aged 6 months to 4 years.

▸ All adults aged 50 years and older.

▸ Children and teens aged 6 months to 18 years who receive long-term aspirin therapy.

▸ Pregnant women or women who plan to be pregnant during the flu season.

▸ All persons with chronic pulmonary, cardiovascular, liver, kidney, or metabolic disorders, including diabetes but excluding hypertension.

▸ All persons with conditions that could impede respiratory function (such as cognitive dysfunction, spinal cord injuries, or other neuromuscular problems).

▸ All immunosuppressed persons.

▸ Health care personnel.

▸ Healthy household contacts and caregivers of children younger than 5 years or of adults aged 50 years and older.

▸ Healthy household contacts and caregivers of anyone with a medical condition that increases the risk for complications from influenza.

▸ Individuals in nursing homes or chronic care facilities.

Any updates to the 2007-2008 flu season vaccination recommendations will be posted on the CDC's Web site at www.cdc.gov/flu