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A study of cutaneous tuberculosis in children
3234 A study of cutaneous tuberculosis in children Sumit Sethi, MBBS, MD, Maulana Azad Medical College and Associated Hospitals, New Delhi, India; Vijay Garg, MBBS, MD, Maulana Azad Medical College and Associated Hospitals, New Delhi, India; Rashmi Sarkar, MBBS, MD, Maulana Azad Medical College and Associated Hospitals, New Delhi, India; Arvind Mishra, MBBS, MD, Sanjay Gandhi Memorial Hospital, New Delhi, India Background: Cutaneous tuberculosis is still highly prevalent in India and continues to be an important cause of morbidity in children. Aim: The study the clinical spectrum of pediatric cutaneous tuberculosis and to correlate them with Mantoux reactivity and BCG vaccination status. Materials and methods: A prospective observational study was conducted on patients attending an outpatient dermatology department of a tertiary care hospital in Delhi to analyze the clinical pattern of cutaneous tuberculosis in paediatric population. A detailed clinical examination, investigations, such as hemogram, serology for HIV, Mantoux test, chest X-ray, cytology, and histopathology were carried out in all children. They were treated with antitubercular therapy (directly observed treatment short course-DOTS regimen), and the clinical response was followed up. Results: Twenty children (#16 years) out of a total of 55 patients seen with cutaneous tuberculosis during a 1-year period, were included in this study. Of these, 8 (40%) had lupus vulgaris (LV), 7 (35%) had scrofuloderma (SD), 5 (25%) had lichen scrofulosorum (LS), 3 (15%) had tubercular gumma and 1 (5%) had tuberculosis verrucosa cutis (TBVC). Four (20%) patients concomitantly had more than one type of skin tuberculosis. Affirmative clinicopathologic correlation was observed in all the patients. Regional lymph nodes were involved in seven (35%) patients, 3 (15%) patients had lung involvement while 1 (5%) each had involvement of GIT and bone. No correlation was found between Mantoux reactivity and the extent of disease. Of the 17 (85%) children in whom the data regarding vaccination status was available, 7 (35%) had been vaccinated and 10 (50%) had not. Among the vaccinated group no child had disseminated disease. Three children in the nonvaccinated group had disseminated disease. Family history of tuberculosis was positive in seven (35%) patients. HIV test was negative by ELISA in all patients. Conclusion: BCG vaccination at birth seems to provide protection against disseminated disease in children. However, BCG coverage still remains poor in migrant population from villages. The main source of childhood cutaneous tuberculosis is infected household contacts and chemoprophylaxis needs to be more widely adapted in Indian pediatric population. Due to immaturity of immune system in children, systemic association is common and warrants a thorough look for underlying focus.
randomized treatment (MTX, ADA 0.4, ADA 0.8) were any event 463.0, 362.8, 387.2; serious event 3.2, 4.0, 9.8. There were no serious infections. Conclusion: In this pediatric population, efficacy was maintained through 52 weeks of ADA treatment. Overall safety profile was similar for both ADA doses. No malignancies and no deaths related to study drug were reported. AbbVie Inc participated in the study design; study research; collection, analysis and interpretation of data; and writing, reviewing and approving of this publication. All authors had access to the data, and participated in the development and review.
Limitations: Small sample size. Commercial support: None identified.
3258 Adalimumab long-term safety/efficacy results for pediatric patients with chronic plaque psoriasis from a phase 3, randomized study Kim Papp, K. Papp Clinical Research and Probity Medical Research, University of Western Ontario, Waterloo, Ontario, Canada; Danielle Marcoux, CHU SainteJustine Montreal, Montreal, Quebec, Canada; Ian Landells, Nexus Clinical Research and Memorial University of Newfoundland, St. John’s, Newfoundland, Canada; Lisa Weibel, University Children’s Hospital, Z€ urich, Switzerland; Pierre-Dominique Ghislain, UCL St. Luc, Brussel, Belgium; Kristina Unnebrink, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany; David Williams, AbbVie Inc, North Chicago, IL, United States Introduction: Results of long-term safety and efficacy of TNF-a—inhibitor adalimumab (ADA) are reported for pediatric patients (pts) with severe chronic plaque psoriasis who participated in the 52-week (wk) follow-up period (PerD) of this phase 3 trial (NCT01251614). Methods: This multisite international study included a 16-wk double-blind treatment PerA, a 36-wk treatment withdrawal PerB, a 16-wk ADA double-blind retreatment PerC, and a 52-week follow-up PerD conducted in parallel to the blinded periods. In PerA, pts were randomized 1:1:1 to ADA 0.8 mg/kg every other week (eow); ADA 0.4 mg/kg eow; or MTX 0.1-0.4 mg/kg weekly. ADA pts received matching MTX placebo; MTX pts received matching ADA placebo. Responders were pts achieving $75% improvement in Psoriasis Area Severity Index (PASI75) and Physician’s Global Assessment 0 or 1 (PGA 0/1). PerD participants included: (1) nonresponders at end of PerA continued to PerD and received open-label (OL) ADA 0.8; (2) pts maintaining disease control in PerB off treatment continued in PerD off treatment; (3) responders at end of PerA who lost disease control in PerB, and at completion of PerC, continued in PerD on respective blinded PerC treatment (ADA 0.8 if initially randomized to MTX or ADA 0.8; ADA 0.4 if initially randomized to ADA0.4). All pts could switch to OL ADA 0.8 in PerD. Results: Of 114 enrolled pts, mean age was 13.0 years, range 5-18. All 108 pts who entered PerD received ADA except 8 who entered off-treatment in PerB and maintained disease control off-treatment in Per D. Treatment groups for efficacy are defined by PerA dose/PerD dose: MTX (N ¼ 37)/ADA 0.8 (N ¼ 36); ADA 0.4 (N ¼ 39)/0.4 (N ¼ 36); ADA 0.8 (N ¼ 38)/0.8 (N ¼ 36). PASI75 was achieved at wk16 PerA by 32.4%, 43.6%, 57.9%, respectively; at wk16 PerD by 86.1%, 50.0%, 61.1%, respectively; and at wk52 PerD by 86.1%, 47.2%, 72.2%, respectively. PGA 0/1 was achieved at wk16 PerA by 40.5%, 41.0%, 60.5%, respectively; at wk16 PerD by 77.8%, 38.9%, 50.0%, respectively; and at wk52 PerD by 75.0%, 50.0%, 55.6%, respectively. Treatment-emergent adverse events per 100 pt years in PerD by initial
MAY 2016
3373 Body dysmorphic disorder and suicidal ideation in a 15-year-old girl who witnessed sexual abuse Dimitre Dimitrov, MD, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom; Tanyo Tanev, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom; Ruth Taylor, MBChB, PhD, Barts and the London School of Medicine and Dentistry; Queen Mary University of London, London, UK, United Kingdom; Anthony Bewley, MBChB, MD, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom A 15-year-old female patient attended our psychodermatology clinic with body dysmorphic disorder, acne and a scar on her abdomen. During the consultation the patient complained, her skin conditions had an enormously negative impact on her life. She avoided social activities and isolated herself at home most of the time. She was diagnosed with having depression and social anxiety disorder. She was also suicidal. Her acne was treated with topical agents and a referral was made to child mental health department. During the consultation with the psychiatrist became clear that the patient had witnessed sexual abuse four years previously. At this time her body dysmorphic disorder symptoms started. She was commenced on Sertraline and referred to a counsellor for cognitive behavioral therapy. Her suicidal ideation stopped and her depression settled with this and her dermatologic treatments. The patient was referred as well to plastic surgeons for correction of her abdominal scar. Research to date has indicated that childhood abuse in general is associated with psychiatric disorders and suicidal ideations in later life. Research has examined the unique association between body dysmorphic disorder and suicidal ideation on one hand and childhood sexual abuse on the other. A study examining all form of child abuse in body dysmorphic disorder patients found that 28.0% of participants (75 subjects) reported sexual abuse. Even more interesting was the severity of sexual abuse was significantly associated with current body dysmorphic disorder severity. Our case emphasizes the need for dermatology health care professionals to ask about sexual abuse in childhood/early life, especially when a patient present with body dysmorphic disorder and suicidal ideation. Dermatologists often shy away of checking about sexual abuse and suicidal ideation in their patients. But body dysmorphic disorder and social anxiety disorder are more commonly associated with sexual abuse than dermatologists may realize. Commercial support: None identified.
J AM ACAD DERMATOL
AB209
randomized treatment (MTX, ADA 0.4, ADA 0.8) were any event 463.0, 362.8, 387.2; serious event 3.2, 4.0, 9.8. There were no serious infections. Conclusion: In this pediatric population, efficacy was maintained through 52 weeks of ADA treatment. Overall safety profile was similar for both ADA doses. No malignancies and no deaths related to study drug were reported. AbbVie Inc participated in the study design; study research; collection, analysis and interpretation of data; and writing, reviewing and approving of this publication. All authors had access to the data, and participated in the development and review.
Limitations: Small sample size. Commercial support: None identified.
3258 Adalimumab long-term safety/efficacy results for pediatric patients with chronic plaque psoriasis from a phase 3, randomized study Kim Papp, K. Papp Clinical Research and Probity Medical Research, University of Western Ontario, Waterloo, Ontario, Canada; Danielle Marcoux, CHU SainteJustine Montreal, Montreal, Quebec, Canada; Ian Landells, Nexus Clinical Research and Memorial University of Newfoundland, St. John’s, Newfoundland, Canada; Lisa Weibel, University Children’s Hospital, Z€ urich, Switzerland; Pierre-Dominique Ghislain, UCL St. Luc, Brussel, Belgium; Kristina Unnebrink, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany; David Williams, AbbVie Inc, North Chicago, IL, United States Introduction: Results of long-term safety and efficacy of TNF-a—inhibitor adalimumab (ADA) are reported for pediatric patients (pts) with severe chronic plaque psoriasis who participated in the 52-week (wk) follow-up period (PerD) of this phase 3 trial (NCT01251614). Methods: This multisite international study included a 16-wk double-blind treatment PerA, a 36-wk treatment withdrawal PerB, a 16-wk ADA double-blind retreatment PerC, and a 52-week follow-up PerD conducted in parallel to the blinded periods. In PerA, pts were randomized 1:1:1 to ADA 0.8 mg/kg every other week (eow); ADA 0.4 mg/kg eow; or MTX 0.1-0.4 mg/kg weekly. ADA pts received matching MTX placebo; MTX pts received matching ADA placebo. Responders were pts achieving $75% improvement in Psoriasis Area Severity Index (PASI75) and Physician’s Global Assessment 0 or 1 (PGA 0/1). PerD participants included: (1) nonresponders at end of PerA continued to PerD and received open-label (OL) ADA 0.8; (2) pts maintaining disease control in PerB off treatment continued in PerD off treatment; (3) responders at end of PerA who lost disease control in PerB, and at completion of PerC, continued in PerD on respective blinded PerC treatment (ADA 0.8 if initially randomized to MTX or ADA 0.8; ADA 0.4 if initially randomized to ADA0.4). All pts could switch to OL ADA 0.8 in PerD. Results: Of 114 enrolled pts, mean age was 13.0 years, range 5-18. All 108 pts who entered PerD received ADA except 8 who entered off-treatment in PerB and maintained disease control off-treatment in Per D. Treatment groups for efficacy are defined by PerA dose/PerD dose: MTX (N ¼ 37)/ADA 0.8 (N ¼ 36); ADA 0.4 (N ¼ 39)/0.4 (N ¼ 36); ADA 0.8 (N ¼ 38)/0.8 (N ¼ 36). PASI75 was achieved at wk16 PerA by 32.4%, 43.6%, 57.9%, respectively; at wk16 PerD by 86.1%, 50.0%, 61.1%, respectively; and at wk52 PerD by 86.1%, 47.2%, 72.2%, respectively. PGA 0/1 was achieved at wk16 PerA by 40.5%, 41.0%, 60.5%, respectively; at wk16 PerD by 77.8%, 38.9%, 50.0%, respectively; and at wk52 PerD by 75.0%, 50.0%, 55.6%, respectively. Treatment-emergent adverse events per 100 pt years in PerD by initial
MAY 2016
3373 Body dysmorphic disorder and suicidal ideation in a 15-year-old girl who witnessed sexual abuse Dimitre Dimitrov, MD, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom; Tanyo Tanev, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom; Ruth Taylor, MBChB, PhD, Barts and the London School of Medicine and Dentistry; Queen Mary University of London, London, UK, United Kingdom; Anthony Bewley, MBChB, MD, The Royal London Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK, United Kingdom A 15-year-old female patient attended our psychodermatology clinic with body dysmorphic disorder, acne and a scar on her abdomen. During the consultation the patient complained, her skin conditions had an enormously negative impact on her life. She avoided social activities and isolated herself at home most of the time. She was diagnosed with having depression and social anxiety disorder. She was also suicidal. Her acne was treated with topical agents and a referral was made to child mental health department. During the consultation with the psychiatrist became clear that the patient had witnessed sexual abuse four years previously. At this time her body dysmorphic disorder symptoms started. She was commenced on Sertraline and referred to a counsellor for cognitive behavioral therapy. Her suicidal ideation stopped and her depression settled with this and her dermatologic treatments. The patient was referred as well to plastic surgeons for correction of her abdominal scar. Research to date has indicated that childhood abuse in general is associated with psychiatric disorders and suicidal ideations in later life. Research has examined the unique association between body dysmorphic disorder and suicidal ideation on one hand and childhood sexual abuse on the other. A study examining all form of child abuse in body dysmorphic disorder patients found that 28.0% of participants (75 subjects) reported sexual abuse. Even more interesting was the severity of sexual abuse was significantly associated with current body dysmorphic disorder severity. Our case emphasizes the need for dermatology health care professionals to ask about sexual abuse in childhood/early life, especially when a patient present with body dysmorphic disorder and suicidal ideation. Dermatologists often shy away of checking about sexual abuse and suicidal ideation in their patients. But body dysmorphic disorder and social anxiety disorder are more commonly associated with sexual abuse than dermatologists may realize. Commercial support: None identified.
J AM ACAD DERMATOL
AB209