Heidi Splete

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Infantile hemangiomas treated with propranolol recurred in 25% of children after discontinuation of propranolol in a retrospective study of nearly 1,000 patients, according to findings published online March 7 in Pediatrics.

“Identifying risk factors for rebound growth could affect treatment strategies, particularly duration of therapy,” wrote Dr. Sonal D. Shah of the University of California, San Francisco, and colleagues.

Wikimedia Commons/Zeimusu/Public Domain

The study population was the largest to date, the researchers noted, and included 980 children seen at 10 academic centers between 2008 and 2013. Most were term (82%) and female (77%). The average age at the start of treatment was 6 months, and a visual analog scale was used to determine the children’s response to treatment (Pediatrics. 2016. doi: 10.1542/peds.2015-1754). Overall, hemangiomas rebounded in 231 patients (25%). Of these, 191 (83%) required treatment modification. The mean age before initial hemangioma rebound was 17 months, after a mean treatment duration of 11 months.

“The most potent risk factor for rebound was the presence of a deep infantile hemangioma component (i.e., deep or mixed morphology), which was also noted in other studies,” the researchers wrote.

In a multivariate analysis, deep hemangiomas and mixed hemangiomas were significantly more likely (odds ratio, 3.3 and 2.4, respectively) to rebound than superficial hemangiomas, and rebounds were significantly more likely among girls than boys (OR, 1.7).

“The exact reasons for this are uncertain, but it appears that girls are intrinsically more predisposed not only to hemangioma development but also to growth,” Dr. Shah and associates said.

Children least likely to rebound were those who discontinued or tapered propranolol between ages 12 and 18 months, and this group was used as a reference group. By comparison, the odds of rebound were notably high among children who discontinued when they were younger than 9 months (OR, 2.4). The odds ratios for rebound when propranolol was discontinued at ages 18-21 months, 21-24 months, and older than 24 months were 2.0, 1.7, and 2.5, respectively.

The results were limited by the fact that most patients represented more severe cases that were referred for additional treatment, Dr. Shah and associates said. However, the findings suggest that recognizing the risk factors for rebound could aid clinicians when planning therapy.

Lead author Dr. Shah had no relevant financial conflicts to disclose. Several coauthors reported serving as investigators or consultants for Pfizer and for Pierre Fabre Dermatology, which manufactures the propranolol product used in the study. The study was supported by the University of California, San Francisco, Pediatric Dermatology research fund.

Emotionally abused children are 52% more likely to develop migraine in young adulthood than are those who were never abused, based on longitudinal survey data from nearly 15,000 individuals.

“Childhood maltreatment, and especially emotional abuse, is a common, likely under-recognized occurrence, which has enduring consequences for health throughout life. The association of emotional abuse with migraine has not heretofore been well studied, being the subject of only population-based study,” lead author Dr. Gretchen E. Tietjen of the University of Toledo (Ohio) said in an interview in advance of the presentation of the study at the annual meeting of the American Academy of Neurology in Vancouver in April.

Dr. Tietjen and her colleagues assessed data from 14,484 adults aged 24-32 years who took part in wave four of the National Longitudinal Study of Adolescent to Adult Health. Of these, 2,061 (14%) reported a migraine diagnosis, and 1,246 (60%) of those diagnosed with migraines reported some type of childhood abuse. A total of 6,088 (49%) individuals without migraine reported some type of childhood abuse.

Overall, the odds of migraine in adulthood was 55% higher in children who reported emotional abuse, physical abuse, or sexual abuse, compared with those who reported no childhood abuse, after controlling for age, race, sex, and income (odds ratio, 1.55; 95% confidence interval, 1.35-1.77). However, only emotional abuse remained significantly associated with increased odds for migraine after controlling for other types of abuse (OR, 1.52; 95% CI, 1.34-1.73).

Emotional abuse was assessed by asking, “How often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?” Physical abuse was defined as being hit with a fist, kicked, or thrown down on the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations.

Controlling for depression and anxiety weakened the associations between childhood abuse overall and likelihood of migraine in young adulthood, as well as for emotional abuse in particular, but the relationships remained statistically significant (OR, 1.32 and 1.33, respectively).

Dr. Tietjen said she was surprised by the absence of an association between migraine and physical and sexual abuse after controlling for other types of abuse.

“Sexual and physical abuse may be less frequent, occur over a briefer duration, and if limited, lead in some cases to resilience,” Dr. Tietjen noted. “Emotional abuse is likely more insidious, being ingrained in the fabric of the family dynamic. It may occur over years without recognition or intervention,” she said. “This type of abuse may cause more cumulative stress, with subsequent dysregulation of the HPA axis, immune, autonomic, and metabolic systems,” she added. 

The study does not show cause and effect, the researchers noted, and more research is needed. But the findings suggest that clinicians might consider childhood abuse when counseling adult migraine patients.

“In migraineurs, childhood abuse, particularly emotional abuse, is common and possibly causally related,” Dr. Tietjen said. “Knowledge of adverse childhood experiences allows physicians to identify migraineurs at higher risk for psychiatric disease, pain comorbidities, and conditions associated with inflammation. These patients would likely benefit from exposure to cognitive behavioral therapy strategies, in order to decrease neurophysiological responses to stress,” she noted.

“There are currently therapies which reverse stress-induced epigenetic changes, which might be particularly useful in the subset of migraineurs who have been abused,” said Dr. Tietjen. Her next steps for research involve studying the effect of early life stress on factors such as pain sensitivity, anxiety, and depression.

The University of Toledo and the Clair Martig Endowment funded the study.

Emotionally abused children are 52% more likely to develop migraine in young adulthood than are those who were never abused, based on longitudinal survey data from nearly 15,000 individuals.

“Childhood maltreatment, and especially emotional abuse, is a common, likely under-recognized occurrence, which has enduring consequences for health throughout life. The association of emotional abuse with migraine has not heretofore been well studied, being the subject of only population-based study,” lead author Dr. Gretchen E. Tietjen of the University of Toledo (Ohio) said in an interview in advance of the presentation of the study at the annual meeting of the American Academy of Neurology in Vancouver in April.

Dr. Tietjen and her colleagues assessed data from 14,484 adults aged 24-32 years who took part in wave four of the National Longitudinal Study of Adolescent to Adult Health. Of these, 2,061 (14%) reported a migraine diagnosis, and 1,246 (60%) of those diagnosed with migraines reported some type of childhood abuse. A total of 6,088 (49%) individuals without migraine reported some type of childhood abuse.

Overall, the odds of migraine in adulthood was 55% higher in children who reported emotional abuse, physical abuse, or sexual abuse, compared with those who reported no childhood abuse, after controlling for age, race, sex, and income (odds ratio, 1.55; 95% confidence interval, 1.35-1.77). However, only emotional abuse remained significantly associated with increased odds for migraine after controlling for other types of abuse (OR, 1.52; 95% CI, 1.34-1.73).

Emotional abuse was assessed by asking, “How often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?” Physical abuse was defined as being hit with a fist, kicked, or thrown down on the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations.

Controlling for depression and anxiety weakened the associations between childhood abuse overall and likelihood of migraine in young adulthood, as well as for emotional abuse in particular, but the relationships remained statistically significant (OR, 1.32 and 1.33, respectively).

Dr. Tietjen said she was surprised by the absence of an association between migraine and physical and sexual abuse after controlling for other types of abuse.

“Sexual and physical abuse may be less frequent, occur over a briefer duration, and if limited, lead in some cases to resilience,” Dr. Tietjen noted. “Emotional abuse is likely more insidious, being ingrained in the fabric of the family dynamic. It may occur over years without recognition or intervention,” she said. “This type of abuse may cause more cumulative stress, with subsequent dysregulation of the HPA axis, immune, autonomic, and metabolic systems,” she added. 

The study does not show cause and effect, the researchers noted, and more research is needed. But the findings suggest that clinicians might consider childhood abuse when counseling adult migraine patients.

“In migraineurs, childhood abuse, particularly emotional abuse, is common and possibly causally related,” Dr. Tietjen said. “Knowledge of adverse childhood experiences allows physicians to identify migraineurs at higher risk for psychiatric disease, pain comorbidities, and conditions associated with inflammation. These patients would likely benefit from exposure to cognitive behavioral therapy strategies, in order to decrease neurophysiological responses to stress,” she noted.

“There are currently therapies which reverse stress-induced epigenetic changes, which might be particularly useful in the subset of migraineurs who have been abused,” said Dr. Tietjen. Her next steps for research involve studying the effect of early life stress on factors such as pain sensitivity, anxiety, and depression.

The University of Toledo and the Clair Martig Endowment funded the study.

Emotionally abused children are 52% more likely to develop migraine in young adulthood than are those who were never abused, based on longitudinal survey data from nearly 15,000 individuals.

“Childhood maltreatment, and especially emotional abuse, is a common, likely under-recognized occurrence, which has enduring consequences for health throughout life. The association of emotional abuse with migraine has not heretofore been well studied, being the subject of only population-based study,” lead author Dr. Gretchen E. Tietjen of the University of Toledo (Ohio) said in an interview in advance of the presentation of the study at the annual meeting of the American Academy of Neurology in Vancouver in April.

Dr. Tietjen and her colleagues assessed data from 14,484 adults aged 24-32 years who took part in wave four of the National Longitudinal Study of Adolescent to Adult Health. Of these, 2,061 (14%) reported a migraine diagnosis, and 1,246 (60%) of those diagnosed with migraines reported some type of childhood abuse. A total of 6,088 (49%) individuals without migraine reported some type of childhood abuse.

Overall, the odds of migraine in adulthood was 55% higher in children who reported emotional abuse, physical abuse, or sexual abuse, compared with those who reported no childhood abuse, after controlling for age, race, sex, and income (odds ratio, 1.55; 95% confidence interval, 1.35-1.77). However, only emotional abuse remained significantly associated with increased odds for migraine after controlling for other types of abuse (OR, 1.52; 95% CI, 1.34-1.73).

Emotional abuse was assessed by asking, “How often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?” Physical abuse was defined as being hit with a fist, kicked, or thrown down on the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations.

Controlling for depression and anxiety weakened the associations between childhood abuse overall and likelihood of migraine in young adulthood, as well as for emotional abuse in particular, but the relationships remained statistically significant (OR, 1.32 and 1.33, respectively).

Dr. Tietjen said she was surprised by the absence of an association between migraine and physical and sexual abuse after controlling for other types of abuse.

“Sexual and physical abuse may be less frequent, occur over a briefer duration, and if limited, lead in some cases to resilience,” Dr. Tietjen noted. “Emotional abuse is likely more insidious, being ingrained in the fabric of the family dynamic. It may occur over years without recognition or intervention,” she said. “This type of abuse may cause more cumulative stress, with subsequent dysregulation of the HPA axis, immune, autonomic, and metabolic systems,” she added. 

The study does not show cause and effect, the researchers noted, and more research is needed. But the findings suggest that clinicians might consider childhood abuse when counseling adult migraine patients.

“In migraineurs, childhood abuse, particularly emotional abuse, is common and possibly causally related,” Dr. Tietjen said. “Knowledge of adverse childhood experiences allows physicians to identify migraineurs at higher risk for psychiatric disease, pain comorbidities, and conditions associated with inflammation. These patients would likely benefit from exposure to cognitive behavioral therapy strategies, in order to decrease neurophysiological responses to stress,” she noted.

“There are currently therapies which reverse stress-induced epigenetic changes, which might be particularly useful in the subset of migraineurs who have been abused,” said Dr. Tietjen. Her next steps for research involve studying the effect of early life stress on factors such as pain sensitivity, anxiety, and depression.

The University of Toledo and the Clair Martig Endowment funded the study.

Approximately one-third of chikungunya patients who acquired the disease during Caribbean travel reported postchikungunya muscle pain, joint pain, and joint swelling, according to data for 28 patients seen at a single center in 2014. The findings were published in Travel Medicine and Infectious Disease (2016. doi: 10.1016/j.tmaid.2016.01.009).

The researchers contacted 19 of the patients approximately 13 months after their original diagnoses. Of these, 37% described ongoing rheumatic problems; 32% reported joint pain, 32% reported joint swelling, and 26% reported muscle pain.

CDC/Cynthia Goldsmith

Dr. Cosmina Zeana of Bronx-Lebanon Hospital Center, New York, and colleagues initially identified 28 adult patients with a median age of 52 years. Most were Hispanic (96%) and half were women (54%). The average length of stay in the Caribbean was 30 days, and 82% had visited the Dominican Republic. The follow-up data were collected via a telephone questionnaire.

Chikungunya has become endemic in Latin America, the researchers noted. “Of increasing concern is the occurrence of persistent rheumatic and general disabling symptoms that can last for several years following acute infection,” they wrote. Transmission of chikungunya has been documented throughout the Caribbean, but this study is the first known assessment of postchikungunya rheumatologic disorders among individuals diagnosed with acute chikungunya after traveling to the Caribbean in particular, they added.

At follow-up, three patients without preexisting rheumatic disease met criteria for diffuse postchikungunya (pCHIK) musculoskeletal disorders. In addition, four patients with preexisting rheumatic disease reported an increase in symptom severity including worsening knee osteoarthritis in both knees (one patient) and increased joint involvement (three patients).

Significantly more patients with preexisting disease reported using pain medication, compared with those without preexisting disease. However, no significant differences appeared in the percentage of patients in each group reporting other symptoms including joint pain, muscle pain, and joint swelling.

Nearly all the patients presented for acute care with fever (99%), joint pain (89%), myalgia (70%), and joint swelling (68%). The median pain level was 8 on a scale of 1-10.

Other symptoms reported at the time of acute diagnosis included gastrointestinal problems (59%), headache (48%), and rash (48%). Almost half the patients (46%) required inpatient care, with complications including hypotensive episodes, syncope, electrolyte imbalance, and thrombocytopenia.

“Patients seeking pretravel health care in preparation for a trip to the Caribbean – as to any other CHIK-endemic 185 region – need to be comprehensively counseled about the health risks related to the acute stage of the infection as well as related to the risk for developing a potentially long-lasting rheumatic disorder,” the researchers said.

“An integrated care plan for patients with acute CHIK consisting of follow-up appointments with the primary care provider and a rheumatologist with the aim of reducing the time to identify patients with pCHIK rheumatic disorders and initiation of optimal disease management may be useful and need further study,” they added.

The findings were limited by several factors including small sample size, use of self-reports, and narrow geographic range. The researchers had no financial conflicts to disclose.

Approximately one-third of chikungunya patients who acquired the disease during Caribbean travel reported postchikungunya muscle pain, joint pain, and joint swelling, according to data for 28 patients seen at a single center in 2014. The findings were published in Travel Medicine and Infectious Disease (2016. doi: 10.1016/j.tmaid.2016.01.009).

The researchers contacted 19 of the patients approximately 13 months after their original diagnoses. Of these, 37% described ongoing rheumatic problems; 32% reported joint pain, 32% reported joint swelling, and 26% reported muscle pain.

CDC/Cynthia Goldsmith

Dr. Cosmina Zeana of Bronx-Lebanon Hospital Center, New York, and colleagues initially identified 28 adult patients with a median age of 52 years. Most were Hispanic (96%) and half were women (54%). The average length of stay in the Caribbean was 30 days, and 82% had visited the Dominican Republic. The follow-up data were collected via a telephone questionnaire.

Chikungunya has become endemic in Latin America, the researchers noted. “Of increasing concern is the occurrence of persistent rheumatic and general disabling symptoms that can last for several years following acute infection,” they wrote. Transmission of chikungunya has been documented throughout the Caribbean, but this study is the first known assessment of postchikungunya rheumatologic disorders among individuals diagnosed with acute chikungunya after traveling to the Caribbean in particular, they added.

At follow-up, three patients without preexisting rheumatic disease met criteria for diffuse postchikungunya (pCHIK) musculoskeletal disorders. In addition, four patients with preexisting rheumatic disease reported an increase in symptom severity including worsening knee osteoarthritis in both knees (one patient) and increased joint involvement (three patients).

Significantly more patients with preexisting disease reported using pain medication, compared with those without preexisting disease. However, no significant differences appeared in the percentage of patients in each group reporting other symptoms including joint pain, muscle pain, and joint swelling.

Nearly all the patients presented for acute care with fever (99%), joint pain (89%), myalgia (70%), and joint swelling (68%). The median pain level was 8 on a scale of 1-10.

Other symptoms reported at the time of acute diagnosis included gastrointestinal problems (59%), headache (48%), and rash (48%). Almost half the patients (46%) required inpatient care, with complications including hypotensive episodes, syncope, electrolyte imbalance, and thrombocytopenia.

“Patients seeking pretravel health care in preparation for a trip to the Caribbean – as to any other CHIK-endemic 185 region – need to be comprehensively counseled about the health risks related to the acute stage of the infection as well as related to the risk for developing a potentially long-lasting rheumatic disorder,” the researchers said.

“An integrated care plan for patients with acute CHIK consisting of follow-up appointments with the primary care provider and a rheumatologist with the aim of reducing the time to identify patients with pCHIK rheumatic disorders and initiation of optimal disease management may be useful and need further study,” they added.

The findings were limited by several factors including small sample size, use of self-reports, and narrow geographic range. The researchers had no financial conflicts to disclose.

Approximately one-third of chikungunya patients who acquired the disease during Caribbean travel reported postchikungunya muscle pain, joint pain, and joint swelling, according to data for 28 patients seen at a single center in 2014. The findings were published in Travel Medicine and Infectious Disease (2016. doi: 10.1016/j.tmaid.2016.01.009).

The researchers contacted 19 of the patients approximately 13 months after their original diagnoses. Of these, 37% described ongoing rheumatic problems; 32% reported joint pain, 32% reported joint swelling, and 26% reported muscle pain.

CDC/Cynthia Goldsmith

Dr. Cosmina Zeana of Bronx-Lebanon Hospital Center, New York, and colleagues initially identified 28 adult patients with a median age of 52 years. Most were Hispanic (96%) and half were women (54%). The average length of stay in the Caribbean was 30 days, and 82% had visited the Dominican Republic. The follow-up data were collected via a telephone questionnaire.

Chikungunya has become endemic in Latin America, the researchers noted. “Of increasing concern is the occurrence of persistent rheumatic and general disabling symptoms that can last for several years following acute infection,” they wrote. Transmission of chikungunya has been documented throughout the Caribbean, but this study is the first known assessment of postchikungunya rheumatologic disorders among individuals diagnosed with acute chikungunya after traveling to the Caribbean in particular, they added.

At follow-up, three patients without preexisting rheumatic disease met criteria for diffuse postchikungunya (pCHIK) musculoskeletal disorders. In addition, four patients with preexisting rheumatic disease reported an increase in symptom severity including worsening knee osteoarthritis in both knees (one patient) and increased joint involvement (three patients).

Significantly more patients with preexisting disease reported using pain medication, compared with those without preexisting disease. However, no significant differences appeared in the percentage of patients in each group reporting other symptoms including joint pain, muscle pain, and joint swelling.

Nearly all the patients presented for acute care with fever (99%), joint pain (89%), myalgia (70%), and joint swelling (68%). The median pain level was 8 on a scale of 1-10.

Other symptoms reported at the time of acute diagnosis included gastrointestinal problems (59%), headache (48%), and rash (48%). Almost half the patients (46%) required inpatient care, with complications including hypotensive episodes, syncope, electrolyte imbalance, and thrombocytopenia.

“Patients seeking pretravel health care in preparation for a trip to the Caribbean – as to any other CHIK-endemic 185 region – need to be comprehensively counseled about the health risks related to the acute stage of the infection as well as related to the risk for developing a potentially long-lasting rheumatic disorder,” the researchers said.

“An integrated care plan for patients with acute CHIK consisting of follow-up appointments with the primary care provider and a rheumatologist with the aim of reducing the time to identify patients with pCHIK rheumatic disorders and initiation of optimal disease management may be useful and need further study,” they added.

The findings were limited by several factors including small sample size, use of self-reports, and narrow geographic range. The researchers had no financial conflicts to disclose.

Unwanted tattoos, beware: Picosecond pulse duration lasers shatter tattoo particles with lower fluence and fewer treatments than nanosecond pulses, according to Dr. Emil A. Tanghetti.

“Picosecond pulse duration lasers open a new mechanism for breaking up tattoo particles that is not currently accessible using nanosecond laser pulses,” he said at the meeting held by Global Academy for Medical Education.

Courtesy Dr. Tanghetti

The targets in tattoo removal treatment are the individual tattoo particles, which generally range from 40 to 100 nm and are loosely packed, said Dr. Tanghetti of the Center for Dermatology and Laser Surgery in Sacramento, Calif.

When using nanosecond pulses, “Graphite particles common in tattoo removal have a larger absorption at 755 nm vs. 1064 nm,” he noted. Although the fluence is greater for the 1064 nm, the energy absorbed in the target particles is greater (16%-40% higher) for 755 nm, combined with epidermal and dermal screening.

By contrast, the picosecond pulse provides a sufficiently powerful impact to shatter small tattoo particles, and the picosecond pulse duration is 7-10 times shorter than a Q-switched Nd:YAG and 70-100 times shorter than a Q-switched Alexandrite laser, Dr. Tanghetti explained. The greater photomechanical impact means that less fluence is required.

The picosecond laser allows for fewer treatments with “significantly better clearance,” including stubborn green and blue tattoos (with only the 755-nm devices) and previously treated but hard-to-clear tattoos, he said. Clinical data show effective treatment of tattoos with one-half to one-third of the fluence and one-half the number of treatments needed to achieve the same result with a nanosecond laser, he added.

“These devices work in different ways and have different powers,” he said in an interview. “The one strong point about Alexandrite technology is that it works much better for green and blue.”

Dr. Tanghetti noted that the picosecond Alexandrite nonablative laser with the fractional optic focus lens array can be useful because of the minimal downtime with no need for anesthesia, and the focus lens allows for targeting of pigment as well as acne scars. “This type of device can be an important asset in a practice with active working clients, as well as patients with darker skin, and those with acne scars and dyspigmentation where downtime and postinflammatory hyperpigmentation is a concern,” he said.

The picosecond devices, “add a new dimension to what we can do,” he remarked.

Dr. Tanghetti disclosed serving as an advisor for Cynosure and receiving discounts on equipment from the company.

Global Academy and this news organization are owned by the same company.

hsplete@frontlinemedcom.com

Unwanted tattoos, beware: Picosecond pulse duration lasers shatter tattoo particles with lower fluence and fewer treatments than nanosecond pulses, according to Dr. Emil A. Tanghetti.

“Picosecond pulse duration lasers open a new mechanism for breaking up tattoo particles that is not currently accessible using nanosecond laser pulses,” he said at the meeting held by Global Academy for Medical Education.

Courtesy Dr. Tanghetti

The targets in tattoo removal treatment are the individual tattoo particles, which generally range from 40 to 100 nm and are loosely packed, said Dr. Tanghetti of the Center for Dermatology and Laser Surgery in Sacramento, Calif.

When using nanosecond pulses, “Graphite particles common in tattoo removal have a larger absorption at 755 nm vs. 1064 nm,” he noted. Although the fluence is greater for the 1064 nm, the energy absorbed in the target particles is greater (16%-40% higher) for 755 nm, combined with epidermal and dermal screening.

By contrast, the picosecond pulse provides a sufficiently powerful impact to shatter small tattoo particles, and the picosecond pulse duration is 7-10 times shorter than a Q-switched Nd:YAG and 70-100 times shorter than a Q-switched Alexandrite laser, Dr. Tanghetti explained. The greater photomechanical impact means that less fluence is required.

The picosecond laser allows for fewer treatments with “significantly better clearance,” including stubborn green and blue tattoos (with only the 755-nm devices) and previously treated but hard-to-clear tattoos, he said. Clinical data show effective treatment of tattoos with one-half to one-third of the fluence and one-half the number of treatments needed to achieve the same result with a nanosecond laser, he added.

“These devices work in different ways and have different powers,” he said in an interview. “The one strong point about Alexandrite technology is that it works much better for green and blue.”

Dr. Tanghetti noted that the picosecond Alexandrite nonablative laser with the fractional optic focus lens array can be useful because of the minimal downtime with no need for anesthesia, and the focus lens allows for targeting of pigment as well as acne scars. “This type of device can be an important asset in a practice with active working clients, as well as patients with darker skin, and those with acne scars and dyspigmentation where downtime and postinflammatory hyperpigmentation is a concern,” he said.

The picosecond devices, “add a new dimension to what we can do,” he remarked.

Dr. Tanghetti disclosed serving as an advisor for Cynosure and receiving discounts on equipment from the company.

Global Academy and this news organization are owned by the same company.

hsplete@frontlinemedcom.com

Unwanted tattoos, beware: Picosecond pulse duration lasers shatter tattoo particles with lower fluence and fewer treatments than nanosecond pulses, according to Dr. Emil A. Tanghetti.

“Picosecond pulse duration lasers open a new mechanism for breaking up tattoo particles that is not currently accessible using nanosecond laser pulses,” he said at the meeting held by Global Academy for Medical Education.

Courtesy Dr. Tanghetti

The targets in tattoo removal treatment are the individual tattoo particles, which generally range from 40 to 100 nm and are loosely packed, said Dr. Tanghetti of the Center for Dermatology and Laser Surgery in Sacramento, Calif.

When using nanosecond pulses, “Graphite particles common in tattoo removal have a larger absorption at 755 nm vs. 1064 nm,” he noted. Although the fluence is greater for the 1064 nm, the energy absorbed in the target particles is greater (16%-40% higher) for 755 nm, combined with epidermal and dermal screening.

By contrast, the picosecond pulse provides a sufficiently powerful impact to shatter small tattoo particles, and the picosecond pulse duration is 7-10 times shorter than a Q-switched Nd:YAG and 70-100 times shorter than a Q-switched Alexandrite laser, Dr. Tanghetti explained. The greater photomechanical impact means that less fluence is required.

The picosecond laser allows for fewer treatments with “significantly better clearance,” including stubborn green and blue tattoos (with only the 755-nm devices) and previously treated but hard-to-clear tattoos, he said. Clinical data show effective treatment of tattoos with one-half to one-third of the fluence and one-half the number of treatments needed to achieve the same result with a nanosecond laser, he added.

“These devices work in different ways and have different powers,” he said in an interview. “The one strong point about Alexandrite technology is that it works much better for green and blue.”

Dr. Tanghetti noted that the picosecond Alexandrite nonablative laser with the fractional optic focus lens array can be useful because of the minimal downtime with no need for anesthesia, and the focus lens allows for targeting of pigment as well as acne scars. “This type of device can be an important asset in a practice with active working clients, as well as patients with darker skin, and those with acne scars and dyspigmentation where downtime and postinflammatory hyperpigmentation is a concern,” he said.

The picosecond devices, “add a new dimension to what we can do,” he remarked.

Dr. Tanghetti disclosed serving as an advisor for Cynosure and receiving discounts on equipment from the company.

Global Academy and this news organization are owned by the same company.

hsplete@frontlinemedcom.com

Cyclosporine and oral antihistamine therapy showed inconsistent effects on clinical and laboratory markers of atopic dermatitis in older children and adults, based on data from a study of 48 patients.

A total of 25 patients aged 16-42 years received oral cyclosporine and 23 patients aged 15-32 years received oral antihistamine therapy. The patients’ laboratory findings were reviewed, including high-sensitivity C-reactive protein (CRP) and thymus and activation-regulated chemokine (TARC).

©aniaostudio/Thinkstock.com

Overall, TARC levels were significantly lower after oral cyclosporine therapy, compared with before therapy. Basophil counts in peripheral blood, however, were significantly higher after the therapy than before. After antihistamine therapy, serum high-sensitivity CRP levels and basophil counts in peripheral blood were significantly decreased, compared with before therapy.

“A combination of these two therapies may be more effective for the treatment of AD in adults,” noted study author Dr. Tsutomu Ohtsuka of International University of Health and Welfare Hospital in Nasushiobara, Japan.

The study was published in the June issue of the International Journal of Dermatology (Int. J. Dermatol. 2015;54:648-55 [doi:10.1111/ijd.12374]).

Find the full article online here.

hsplete@frontlinemedcom.com

Cyclosporine and oral antihistamine therapy showed inconsistent effects on clinical and laboratory markers of atopic dermatitis in older children and adults, based on data from a study of 48 patients.

A total of 25 patients aged 16-42 years received oral cyclosporine and 23 patients aged 15-32 years received oral antihistamine therapy. The patients’ laboratory findings were reviewed, including high-sensitivity C-reactive protein (CRP) and thymus and activation-regulated chemokine (TARC).

©aniaostudio/Thinkstock.com

Overall, TARC levels were significantly lower after oral cyclosporine therapy, compared with before therapy. Basophil counts in peripheral blood, however, were significantly higher after the therapy than before. After antihistamine therapy, serum high-sensitivity CRP levels and basophil counts in peripheral blood were significantly decreased, compared with before therapy.

“A combination of these two therapies may be more effective for the treatment of AD in adults,” noted study author Dr. Tsutomu Ohtsuka of International University of Health and Welfare Hospital in Nasushiobara, Japan.

The study was published in the June issue of the International Journal of Dermatology (Int. J. Dermatol. 2015;54:648-55 [doi:10.1111/ijd.12374]).

Find the full article online here.

hsplete@frontlinemedcom.com

Cyclosporine and oral antihistamine therapy showed inconsistent effects on clinical and laboratory markers of atopic dermatitis in older children and adults, based on data from a study of 48 patients.

A total of 25 patients aged 16-42 years received oral cyclosporine and 23 patients aged 15-32 years received oral antihistamine therapy. The patients’ laboratory findings were reviewed, including high-sensitivity C-reactive protein (CRP) and thymus and activation-regulated chemokine (TARC).

©aniaostudio/Thinkstock.com

Overall, TARC levels were significantly lower after oral cyclosporine therapy, compared with before therapy. Basophil counts in peripheral blood, however, were significantly higher after the therapy than before. After antihistamine therapy, serum high-sensitivity CRP levels and basophil counts in peripheral blood were significantly decreased, compared with before therapy.

“A combination of these two therapies may be more effective for the treatment of AD in adults,” noted study author Dr. Tsutomu Ohtsuka of International University of Health and Welfare Hospital in Nasushiobara, Japan.

The study was published in the June issue of the International Journal of Dermatology (Int. J. Dermatol. 2015;54:648-55 [doi:10.1111/ijd.12374]).

Find the full article online here.

hsplete@frontlinemedcom.com