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Pediatric Hospitalist Michael Beck, MD, FAAP, Measures Success By Others’ Success
Young boys sometimes see a firefighter or a police officer in the line of duty and decide that’s what they want to be when they get older. Michael Beck, MD, FAAP, saw his pediatrician that way.
“He was a very humanistic provider and found joy in serving children and their families,” Dr. Beck says. “I saw how a pediatrician could influence others and make the world a better place and still have fun serving a vulnerable patient population.”
His career in pediatric hospital medicine, though?
“It was largely pure luck,” Dr. Beck admits. “When I was seeking my first job, I was offered a position that was 50/50 internal medicine and pediatrics but purely a hospitalist position.”
Dr. Beck has risen through academic hospitalist ranks the past 15 years and now serves as the division chief of pediatric hospital medicine at Penn State Children’s Hospital at Milton S. Hershey (Pa.) Medical Center. He is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: What was medical school and residency like for you? Was there a single moment you knew “I can do this”?
Answer: I always have been filled with self-doubt, which is a perpetual motivator for me. I guess I believed I could do hospital-based work when I started knowing the majority of what was going on with patients after hearing residents discuss cases and I knew what the labs, studies, and exam findings were going to be before I saw the patient.
Q: What do you like most about working as a hospitalist?
A: The acuity and pathology of cases. I get to see cases that some people only read about. It is very intellectual challenging, and I get to work with and learn from specialists every day.
Q: What do you dislike most?
A: Some of the cases are devastating to families. It is always important to remind yourself—and the team—that some of the diagnoses we help make affect families and the patient in very profound ways.
Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?
A: Dr. Barbara Ostrov. I learned what it really means to be a servant-leader. I witnessed her work ethic and saw that a leader of others should lead by example and be willing to work twice what is expected of others. She is always nonjudgmental and professional, yet forthright, when dealing with contentious situations. She trumpets the work of others, not her own, and sees others’ successes as her success. In the end, I believed she worked for me, not the other way around.
Q: Have you tried to mentor others? Why or why not?
A: Yes. As a division chief, I want others to succeed. The best quote I have read was by Richard Branson [CEO of Virgin]: “Train people so that they can leave, but treat them so they want to stay.”
Q: What’s the biggest change you’ve seen in HM in your career?
A: It has moved from a clinical service to a robust area of research and strong researchers.
Q: What’s the biggest change you would like to see in HM?
A: If hospital medicine is positioning itself to be a specialty with fellowship training, with access to knowledge different from PCPs, then I believe we should function like other specialty services with a different skill set. We should own our discharge process and follow-up plans. We should follow up with patients in a discharge clinic setting to review clinical course, health literacy issues, labs, and studies and even order follow-up studies based on incoming results.
Q: For group leaders, why is it important for you to continue seeing patients?
A: As a clinician leader, my charge is to foster teamwork and create a shared vision for improvement and change. This is not possible to do from an office space or conference room separate from where the work gets done.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust and rapport in five to 10 minutes. Caring for a hospitalized patient, when they are surrounded by loved ones, is stressful and anxiety-provoking. Delivering information in a way that is honest and empathetic and timely without the benefit of having a personal historic connection with a patient is always challenging.
Q: What aspect of patient care is most rewarding?
A: Making a diagnosis in a patient that has eluded diagnosis for weeks or months.
Q: What aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: Today’s learners have different expectations from mine [in terms] of what they want to get from a career in medicine. While I don’t always agree with them, it is the reality and puts me in a position to discuss and understand the rationale of a changing mindset. As a physician leader, it is important to understand this because it helps me create an environment that fosters successful recruitment and retention.
Q: You mention wanting to tackle the issue of physician burnout? Why is that something important to you?
A: I personally lived through it and felt the effects it had on the relationships I had with family, friends, medical students, residents, and patients. I know what it felt like to be angry, cynical, and distanced from those I cared about and from those whom I was charged with caring for. I never forgot how isolated [you] can feel in an academic center even when surrounded by hundreds. I vowed that if I ever found my way to a leadership position, I would begin by creating an environment that emphasized morale, honesty, integrity, and professionalism. If I succeeded in this, the other organizational missions of education, patient care, quality, and value would follow.
Since 2012, our division has monitored burnout, work-life balance, and, more recently, physician engagement. Although we take care of the sickest children in the region, our group supports each other, recognizing and respectful of the fact that we each have different comfort levels, skill sets, but we also have fun. Patients, nurses, social workers, care coordinators, and clerks see this. Like I teach the residents, you never get a second chance to make a first impression, but you also never get a second chance to make a last one, so make all interactions count. TH
Richard Quinn is a freelance writer in New Jersey.
Young boys sometimes see a firefighter or a police officer in the line of duty and decide that’s what they want to be when they get older. Michael Beck, MD, FAAP, saw his pediatrician that way.
“He was a very humanistic provider and found joy in serving children and their families,” Dr. Beck says. “I saw how a pediatrician could influence others and make the world a better place and still have fun serving a vulnerable patient population.”
His career in pediatric hospital medicine, though?
“It was largely pure luck,” Dr. Beck admits. “When I was seeking my first job, I was offered a position that was 50/50 internal medicine and pediatrics but purely a hospitalist position.”
Dr. Beck has risen through academic hospitalist ranks the past 15 years and now serves as the division chief of pediatric hospital medicine at Penn State Children’s Hospital at Milton S. Hershey (Pa.) Medical Center. He is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: What was medical school and residency like for you? Was there a single moment you knew “I can do this”?
Answer: I always have been filled with self-doubt, which is a perpetual motivator for me. I guess I believed I could do hospital-based work when I started knowing the majority of what was going on with patients after hearing residents discuss cases and I knew what the labs, studies, and exam findings were going to be before I saw the patient.
Q: What do you like most about working as a hospitalist?
A: The acuity and pathology of cases. I get to see cases that some people only read about. It is very intellectual challenging, and I get to work with and learn from specialists every day.
Q: What do you dislike most?
A: Some of the cases are devastating to families. It is always important to remind yourself—and the team—that some of the diagnoses we help make affect families and the patient in very profound ways.
Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?
A: Dr. Barbara Ostrov. I learned what it really means to be a servant-leader. I witnessed her work ethic and saw that a leader of others should lead by example and be willing to work twice what is expected of others. She is always nonjudgmental and professional, yet forthright, when dealing with contentious situations. She trumpets the work of others, not her own, and sees others’ successes as her success. In the end, I believed she worked for me, not the other way around.
Q: Have you tried to mentor others? Why or why not?
A: Yes. As a division chief, I want others to succeed. The best quote I have read was by Richard Branson [CEO of Virgin]: “Train people so that they can leave, but treat them so they want to stay.”
Q: What’s the biggest change you’ve seen in HM in your career?
A: It has moved from a clinical service to a robust area of research and strong researchers.
Q: What’s the biggest change you would like to see in HM?
A: If hospital medicine is positioning itself to be a specialty with fellowship training, with access to knowledge different from PCPs, then I believe we should function like other specialty services with a different skill set. We should own our discharge process and follow-up plans. We should follow up with patients in a discharge clinic setting to review clinical course, health literacy issues, labs, and studies and even order follow-up studies based on incoming results.
Q: For group leaders, why is it important for you to continue seeing patients?
A: As a clinician leader, my charge is to foster teamwork and create a shared vision for improvement and change. This is not possible to do from an office space or conference room separate from where the work gets done.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust and rapport in five to 10 minutes. Caring for a hospitalized patient, when they are surrounded by loved ones, is stressful and anxiety-provoking. Delivering information in a way that is honest and empathetic and timely without the benefit of having a personal historic connection with a patient is always challenging.
Q: What aspect of patient care is most rewarding?
A: Making a diagnosis in a patient that has eluded diagnosis for weeks or months.
Q: What aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: Today’s learners have different expectations from mine [in terms] of what they want to get from a career in medicine. While I don’t always agree with them, it is the reality and puts me in a position to discuss and understand the rationale of a changing mindset. As a physician leader, it is important to understand this because it helps me create an environment that fosters successful recruitment and retention.
Q: You mention wanting to tackle the issue of physician burnout? Why is that something important to you?
A: I personally lived through it and felt the effects it had on the relationships I had with family, friends, medical students, residents, and patients. I know what it felt like to be angry, cynical, and distanced from those I cared about and from those whom I was charged with caring for. I never forgot how isolated [you] can feel in an academic center even when surrounded by hundreds. I vowed that if I ever found my way to a leadership position, I would begin by creating an environment that emphasized morale, honesty, integrity, and professionalism. If I succeeded in this, the other organizational missions of education, patient care, quality, and value would follow.
Since 2012, our division has monitored burnout, work-life balance, and, more recently, physician engagement. Although we take care of the sickest children in the region, our group supports each other, recognizing and respectful of the fact that we each have different comfort levels, skill sets, but we also have fun. Patients, nurses, social workers, care coordinators, and clerks see this. Like I teach the residents, you never get a second chance to make a first impression, but you also never get a second chance to make a last one, so make all interactions count. TH
Richard Quinn is a freelance writer in New Jersey.
Young boys sometimes see a firefighter or a police officer in the line of duty and decide that’s what they want to be when they get older. Michael Beck, MD, FAAP, saw his pediatrician that way.
“He was a very humanistic provider and found joy in serving children and their families,” Dr. Beck says. “I saw how a pediatrician could influence others and make the world a better place and still have fun serving a vulnerable patient population.”
His career in pediatric hospital medicine, though?
“It was largely pure luck,” Dr. Beck admits. “When I was seeking my first job, I was offered a position that was 50/50 internal medicine and pediatrics but purely a hospitalist position.”
Dr. Beck has risen through academic hospitalist ranks the past 15 years and now serves as the division chief of pediatric hospital medicine at Penn State Children’s Hospital at Milton S. Hershey (Pa.) Medical Center. He is one of eight new members of Team Hospitalist, The Hospitalist’s volunteer editorial advisory board.
Question: What was medical school and residency like for you? Was there a single moment you knew “I can do this”?
Answer: I always have been filled with self-doubt, which is a perpetual motivator for me. I guess I believed I could do hospital-based work when I started knowing the majority of what was going on with patients after hearing residents discuss cases and I knew what the labs, studies, and exam findings were going to be before I saw the patient.
Q: What do you like most about working as a hospitalist?
A: The acuity and pathology of cases. I get to see cases that some people only read about. It is very intellectual challenging, and I get to work with and learn from specialists every day.
Q: What do you dislike most?
A: Some of the cases are devastating to families. It is always important to remind yourself—and the team—that some of the diagnoses we help make affect families and the patient in very profound ways.
Q: Did you have a mentor during your training or early career? If so, who was the mentor, and what were the most important lessons you learned from him/her?
A: Dr. Barbara Ostrov. I learned what it really means to be a servant-leader. I witnessed her work ethic and saw that a leader of others should lead by example and be willing to work twice what is expected of others. She is always nonjudgmental and professional, yet forthright, when dealing with contentious situations. She trumpets the work of others, not her own, and sees others’ successes as her success. In the end, I believed she worked for me, not the other way around.
Q: Have you tried to mentor others? Why or why not?
A: Yes. As a division chief, I want others to succeed. The best quote I have read was by Richard Branson [CEO of Virgin]: “Train people so that they can leave, but treat them so they want to stay.”
Q: What’s the biggest change you’ve seen in HM in your career?
A: It has moved from a clinical service to a robust area of research and strong researchers.
Q: What’s the biggest change you would like to see in HM?
A: If hospital medicine is positioning itself to be a specialty with fellowship training, with access to knowledge different from PCPs, then I believe we should function like other specialty services with a different skill set. We should own our discharge process and follow-up plans. We should follow up with patients in a discharge clinic setting to review clinical course, health literacy issues, labs, and studies and even order follow-up studies based on incoming results.
Q: For group leaders, why is it important for you to continue seeing patients?
A: As a clinician leader, my charge is to foster teamwork and create a shared vision for improvement and change. This is not possible to do from an office space or conference room separate from where the work gets done.
Q: As a hospitalist, seeing most of your patients for the very first time, what aspect of patient care is most challenging?
A: Establishing trust and rapport in five to 10 minutes. Caring for a hospitalized patient, when they are surrounded by loved ones, is stressful and anxiety-provoking. Delivering information in a way that is honest and empathetic and timely without the benefit of having a personal historic connection with a patient is always challenging.
Q: What aspect of patient care is most rewarding?
A: Making a diagnosis in a patient that has eluded diagnosis for weeks or months.
Q: What aspect of teaching in the 21st century is most difficult? And what is most enjoyable?
A: Today’s learners have different expectations from mine [in terms] of what they want to get from a career in medicine. While I don’t always agree with them, it is the reality and puts me in a position to discuss and understand the rationale of a changing mindset. As a physician leader, it is important to understand this because it helps me create an environment that fosters successful recruitment and retention.
Q: You mention wanting to tackle the issue of physician burnout? Why is that something important to you?
A: I personally lived through it and felt the effects it had on the relationships I had with family, friends, medical students, residents, and patients. I know what it felt like to be angry, cynical, and distanced from those I cared about and from those whom I was charged with caring for. I never forgot how isolated [you] can feel in an academic center even when surrounded by hundreds. I vowed that if I ever found my way to a leadership position, I would begin by creating an environment that emphasized morale, honesty, integrity, and professionalism. If I succeeded in this, the other organizational missions of education, patient care, quality, and value would follow.
Since 2012, our division has monitored burnout, work-life balance, and, more recently, physician engagement. Although we take care of the sickest children in the region, our group supports each other, recognizing and respectful of the fact that we each have different comfort levels, skill sets, but we also have fun. Patients, nurses, social workers, care coordinators, and clerks see this. Like I teach the residents, you never get a second chance to make a first impression, but you also never get a second chance to make a last one, so make all interactions count. TH
Richard Quinn is a freelance writer in New Jersey.
Common allergic dermatitis culprits are hiding in plain sight
MINNEAPOLIS – When it comes to allergic contact dermatitis in children, the answer is sometimes hiding in plain sight. Cleansers, moisturizers, shampoos, detergents – all can contain ingredients that provoke significant reactions, yet many of these ingredients are not on the most common testing panels.
Erin Warshaw, MD, professor of dermatology at the University of Minnesota, reviewed common but often unsuspected causes of allergic dermatitis in the pediatric population at the annual meeting of the Society for Pediatric Dermatology.
Even some hypoallergenic and frequently recommended products can contain preservatives and other ingredients that provoke allergic reactions, according to Dr. Warshaw. A chief culprit is methylisothiazolinone (MI), a preservative that came into common use as formaldehyde has been gradually phased out.
“If there’s anything I could emphasize from this talk, it’s MI, MI, MI. This is the major epidemic of our time in the contact dermatitis world,” Dr. Warshaw said. Upcoming publications, she added, will place MI in the top five most common contact allergens. “MI is in everything, including things you would think would be hypoallergenic,” she said. She recommended looking at ingredient labels with a keen eye when making testing decisions.
Despite MI’s status as a frequent culprit, it’s not an allergen that appears on common test kits, Dr. Warshaw pointed out. For example, it’s absent from one of the most commonly used test kits, the Thin-Layer Rapid Use Epicutaneous Patch (T.R.U.E. test).
The T.R.U.E. test, said Dr. Warshaw, has reasonable sensitivity – it can detect 71% of relevant positive patch tests (RPPTs) in children. However, she added, a recent study showed that about 23% of children reacted to a supplemental allergen. “That’s significant. One quarter of these individuals only reacted to a preservative … or a sunscreen, or an acrylate. These aren’t on the T.R.U.E. test.”
Decyl glucoside is another frequent culprit that is not included in commercial patch test kits. “It’s really an important emerging allergen,” said Dr. Warshaw, noting that it commonly cross-reacts with coco and lauryl glucoside, frequently found in fragrance-free products. “It’s always humbling when we find the allergen in the product we’ve recommended to our patients.”
Other important allergens not on the T.R.U.E. test include propolis, tocopherol, oxybenzone, and many surfactants and botanicals.
In order to avoid a confounding reaction to aluminum, Dr. Warshaw recommends testing using plastic-backed test chambers, such as IQ chambers, rather than Finn chambers, which are aluminum backed.
When working with families to track down allergens in the pediatric population, Dr. Warshaw adjusts her approach from what she would use for adults.
“What do I do differently in kids? First of all, I set expectations for children and parents,” she said. Some of the most frequent parental questions deal with food allergies, so she allots time to explain the rationale for not testing for food allergens when allergic contact dermatitis is suspected.
For many patients, “I try and frame that there is probably baseline eczema, and our goal is to try to figure out if there is an allergy in addition to that that is contributing to the flares,” she said. She makes sure to convey that “all it takes is one exposure every 3 weeks; that will keep this reaction going.”
However, she’s judicious in interpreting equivocal results. “I feel a responsibility not to label children with an allergy” if results are unclear. Finally, providing enough time is key, said Dr. Warshaw, who allots an hour for reviewing final testing results.
The take-home points? It’s worthwhile to patch test children, since over half of children will have at least one RPPT. Also, contact dermatitis can be an overlay on preexisting allergic dermatitis, so patch testing can still be helpful for these children. Supplemental allergens are important in patch testing, “especially in children with a negative test to a screening series,” Dr. Warshaw said.
She recommended accessing the Contact Allergen Management Program (CAMP) database, found on the American Contact Dermatitis Society website. The list is a searchable database that generates a list of “safe” products that don’t contain a given allergen. This resource is available for society members, but a member’s access code can be shared among faculty members at academic institutions, she said. Patients can also be given unique codes that will give them access for life, so they can use the CAMP database on a computer or via a smartphone app.
Dr. Warshaw reported no relevant financial disclosures.
On Twitter @karioakes
MINNEAPOLIS – When it comes to allergic contact dermatitis in children, the answer is sometimes hiding in plain sight. Cleansers, moisturizers, shampoos, detergents – all can contain ingredients that provoke significant reactions, yet many of these ingredients are not on the most common testing panels.
Erin Warshaw, MD, professor of dermatology at the University of Minnesota, reviewed common but often unsuspected causes of allergic dermatitis in the pediatric population at the annual meeting of the Society for Pediatric Dermatology.
Even some hypoallergenic and frequently recommended products can contain preservatives and other ingredients that provoke allergic reactions, according to Dr. Warshaw. A chief culprit is methylisothiazolinone (MI), a preservative that came into common use as formaldehyde has been gradually phased out.
“If there’s anything I could emphasize from this talk, it’s MI, MI, MI. This is the major epidemic of our time in the contact dermatitis world,” Dr. Warshaw said. Upcoming publications, she added, will place MI in the top five most common contact allergens. “MI is in everything, including things you would think would be hypoallergenic,” she said. She recommended looking at ingredient labels with a keen eye when making testing decisions.
Despite MI’s status as a frequent culprit, it’s not an allergen that appears on common test kits, Dr. Warshaw pointed out. For example, it’s absent from one of the most commonly used test kits, the Thin-Layer Rapid Use Epicutaneous Patch (T.R.U.E. test).
The T.R.U.E. test, said Dr. Warshaw, has reasonable sensitivity – it can detect 71% of relevant positive patch tests (RPPTs) in children. However, she added, a recent study showed that about 23% of children reacted to a supplemental allergen. “That’s significant. One quarter of these individuals only reacted to a preservative … or a sunscreen, or an acrylate. These aren’t on the T.R.U.E. test.”
Decyl glucoside is another frequent culprit that is not included in commercial patch test kits. “It’s really an important emerging allergen,” said Dr. Warshaw, noting that it commonly cross-reacts with coco and lauryl glucoside, frequently found in fragrance-free products. “It’s always humbling when we find the allergen in the product we’ve recommended to our patients.”
Other important allergens not on the T.R.U.E. test include propolis, tocopherol, oxybenzone, and many surfactants and botanicals.
In order to avoid a confounding reaction to aluminum, Dr. Warshaw recommends testing using plastic-backed test chambers, such as IQ chambers, rather than Finn chambers, which are aluminum backed.
When working with families to track down allergens in the pediatric population, Dr. Warshaw adjusts her approach from what she would use for adults.
“What do I do differently in kids? First of all, I set expectations for children and parents,” she said. Some of the most frequent parental questions deal with food allergies, so she allots time to explain the rationale for not testing for food allergens when allergic contact dermatitis is suspected.
For many patients, “I try and frame that there is probably baseline eczema, and our goal is to try to figure out if there is an allergy in addition to that that is contributing to the flares,” she said. She makes sure to convey that “all it takes is one exposure every 3 weeks; that will keep this reaction going.”
However, she’s judicious in interpreting equivocal results. “I feel a responsibility not to label children with an allergy” if results are unclear. Finally, providing enough time is key, said Dr. Warshaw, who allots an hour for reviewing final testing results.
The take-home points? It’s worthwhile to patch test children, since over half of children will have at least one RPPT. Also, contact dermatitis can be an overlay on preexisting allergic dermatitis, so patch testing can still be helpful for these children. Supplemental allergens are important in patch testing, “especially in children with a negative test to a screening series,” Dr. Warshaw said.
She recommended accessing the Contact Allergen Management Program (CAMP) database, found on the American Contact Dermatitis Society website. The list is a searchable database that generates a list of “safe” products that don’t contain a given allergen. This resource is available for society members, but a member’s access code can be shared among faculty members at academic institutions, she said. Patients can also be given unique codes that will give them access for life, so they can use the CAMP database on a computer or via a smartphone app.
Dr. Warshaw reported no relevant financial disclosures.
On Twitter @karioakes
MINNEAPOLIS – When it comes to allergic contact dermatitis in children, the answer is sometimes hiding in plain sight. Cleansers, moisturizers, shampoos, detergents – all can contain ingredients that provoke significant reactions, yet many of these ingredients are not on the most common testing panels.
Erin Warshaw, MD, professor of dermatology at the University of Minnesota, reviewed common but often unsuspected causes of allergic dermatitis in the pediatric population at the annual meeting of the Society for Pediatric Dermatology.
Even some hypoallergenic and frequently recommended products can contain preservatives and other ingredients that provoke allergic reactions, according to Dr. Warshaw. A chief culprit is methylisothiazolinone (MI), a preservative that came into common use as formaldehyde has been gradually phased out.
“If there’s anything I could emphasize from this talk, it’s MI, MI, MI. This is the major epidemic of our time in the contact dermatitis world,” Dr. Warshaw said. Upcoming publications, she added, will place MI in the top five most common contact allergens. “MI is in everything, including things you would think would be hypoallergenic,” she said. She recommended looking at ingredient labels with a keen eye when making testing decisions.
Despite MI’s status as a frequent culprit, it’s not an allergen that appears on common test kits, Dr. Warshaw pointed out. For example, it’s absent from one of the most commonly used test kits, the Thin-Layer Rapid Use Epicutaneous Patch (T.R.U.E. test).
The T.R.U.E. test, said Dr. Warshaw, has reasonable sensitivity – it can detect 71% of relevant positive patch tests (RPPTs) in children. However, she added, a recent study showed that about 23% of children reacted to a supplemental allergen. “That’s significant. One quarter of these individuals only reacted to a preservative … or a sunscreen, or an acrylate. These aren’t on the T.R.U.E. test.”
Decyl glucoside is another frequent culprit that is not included in commercial patch test kits. “It’s really an important emerging allergen,” said Dr. Warshaw, noting that it commonly cross-reacts with coco and lauryl glucoside, frequently found in fragrance-free products. “It’s always humbling when we find the allergen in the product we’ve recommended to our patients.”
Other important allergens not on the T.R.U.E. test include propolis, tocopherol, oxybenzone, and many surfactants and botanicals.
In order to avoid a confounding reaction to aluminum, Dr. Warshaw recommends testing using plastic-backed test chambers, such as IQ chambers, rather than Finn chambers, which are aluminum backed.
When working with families to track down allergens in the pediatric population, Dr. Warshaw adjusts her approach from what she would use for adults.
“What do I do differently in kids? First of all, I set expectations for children and parents,” she said. Some of the most frequent parental questions deal with food allergies, so she allots time to explain the rationale for not testing for food allergens when allergic contact dermatitis is suspected.
For many patients, “I try and frame that there is probably baseline eczema, and our goal is to try to figure out if there is an allergy in addition to that that is contributing to the flares,” she said. She makes sure to convey that “all it takes is one exposure every 3 weeks; that will keep this reaction going.”
However, she’s judicious in interpreting equivocal results. “I feel a responsibility not to label children with an allergy” if results are unclear. Finally, providing enough time is key, said Dr. Warshaw, who allots an hour for reviewing final testing results.
The take-home points? It’s worthwhile to patch test children, since over half of children will have at least one RPPT. Also, contact dermatitis can be an overlay on preexisting allergic dermatitis, so patch testing can still be helpful for these children. Supplemental allergens are important in patch testing, “especially in children with a negative test to a screening series,” Dr. Warshaw said.
She recommended accessing the Contact Allergen Management Program (CAMP) database, found on the American Contact Dermatitis Society website. The list is a searchable database that generates a list of “safe” products that don’t contain a given allergen. This resource is available for society members, but a member’s access code can be shared among faculty members at academic institutions, she said. Patients can also be given unique codes that will give them access for life, so they can use the CAMP database on a computer or via a smartphone app.
Dr. Warshaw reported no relevant financial disclosures.
On Twitter @karioakes
EXPERT ANALYSIS FROM THE SPD ANNUAL MEETING
PHM16: Pediatric Hospital Medicine Leaders Kick Off 2016 Conference
Speaker: Lisa Zaoutis, MD, Pediatric Residency Program Director at the Children’s Hospital of Philadelphia.
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, comprised of hospitalists, PHM program leaders, and advanced care practitioners, gathered to educate and inspire one another in the the care of hospitalized children.
Dr. Lisa Zaoutis, director of the pediatric residency program at Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to, “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into PHM and negative experiences that often drive behavior, she started with the beginning, the evolution of our brains.
“We are wired toward the negative,” stated Dr. Zaoutis. “We are Teflon for positive experiences and Velcro for negative experiences.” In addition, negative experiences are more likely to be stored in our memories. “It’s easy to park negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists lead to anxiety responses that are faster, more robust, and triggered more easily.
But all is not lost, asserted Dr. Zaoutis, as our brains are more plastic than previously known. The “neural Darwinism,” of our brains, as Dr. Zaoutis states, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience dependent neuroplasticity. For example, stated Dr. Zaoutis, London taxi drivers have thicker white matter in their hippocampus as a result of the effect of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways:
The lesson for pediatric hospitalists, stated Dr. Zaoutis, is that you can shape your brain for greater joy. “Consciously choose activities,” said Dr. Zaoutis, that counter our evolutionary negativity bias. How is this done?
1. Have a positive experience (you can create one or retrieve a prior one);
2. Enrich it and install it by dwelling on it for at least 15-30 seconds; and
3. Absorb it into your body, which my require somatisizing it – Dr. Zaoutis presses her hand into her chest to aid in this.
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your signout with the best thing that happened to you in the week. Most importantly, start with observing yourself.
Speaker: Lisa Zaoutis, MD, Pediatric Residency Program Director at the Children’s Hospital of Philadelphia.
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, comprised of hospitalists, PHM program leaders, and advanced care practitioners, gathered to educate and inspire one another in the the care of hospitalized children.
Dr. Lisa Zaoutis, director of the pediatric residency program at Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to, “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into PHM and negative experiences that often drive behavior, she started with the beginning, the evolution of our brains.
“We are wired toward the negative,” stated Dr. Zaoutis. “We are Teflon for positive experiences and Velcro for negative experiences.” In addition, negative experiences are more likely to be stored in our memories. “It’s easy to park negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists lead to anxiety responses that are faster, more robust, and triggered more easily.
But all is not lost, asserted Dr. Zaoutis, as our brains are more plastic than previously known. The “neural Darwinism,” of our brains, as Dr. Zaoutis states, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience dependent neuroplasticity. For example, stated Dr. Zaoutis, London taxi drivers have thicker white matter in their hippocampus as a result of the effect of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways:
The lesson for pediatric hospitalists, stated Dr. Zaoutis, is that you can shape your brain for greater joy. “Consciously choose activities,” said Dr. Zaoutis, that counter our evolutionary negativity bias. How is this done?
1. Have a positive experience (you can create one or retrieve a prior one);
2. Enrich it and install it by dwelling on it for at least 15-30 seconds; and
3. Absorb it into your body, which my require somatisizing it – Dr. Zaoutis presses her hand into her chest to aid in this.
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your signout with the best thing that happened to you in the week. Most importantly, start with observing yourself.
Speaker: Lisa Zaoutis, MD, Pediatric Residency Program Director at the Children’s Hospital of Philadelphia.
Amid the skyscrapers of the Windy City, Pediatric Hospital Medicine (PHM) 2016 swept into town, bringing with it the denizens of pediatric hospitalist programs across the country. Some 1,150 attendees, comprised of hospitalists, PHM program leaders, and advanced care practitioners, gathered to educate and inspire one another in the the care of hospitalized children.
Dr. Lisa Zaoutis, director of the pediatric residency program at Children’s Hospital of Philadelphia, kicked off the conference with the opening plenary. Initially titled “North Star and Space,” she quickly changed the title to, “Changing Our Minds.” Touching on the disconnect between positive experiences that bring physicians into PHM and negative experiences that often drive behavior, she started with the beginning, the evolution of our brains.
“We are wired toward the negative,” stated Dr. Zaoutis. “We are Teflon for positive experiences and Velcro for negative experiences.” In addition, negative experiences are more likely to be stored in our memories. “It’s easy to park negative experiences.”
Delving deeper into neuroanatomy, Dr. Zaoutis spoke of “amygdala hijack,” where chronic stress inherent to the professional lives of pediatric hospitalists lead to anxiety responses that are faster, more robust, and triggered more easily.
But all is not lost, asserted Dr. Zaoutis, as our brains are more plastic than previously known. The “neural Darwinism,” of our brains, as Dr. Zaoutis states, leads to epigenetic intracellular changes, more sensitive synapses, improved blood flow, and even new cells as a result of experience dependent neuroplasticity. For example, stated Dr. Zaoutis, London taxi drivers have thicker white matter in their hippocampus as a result of the effect of learning London city streets, and mindfulness meditators have thicker gray matter in regions that control attention and self-insight.
Key Takeaways:
The lesson for pediatric hospitalists, stated Dr. Zaoutis, is that you can shape your brain for greater joy. “Consciously choose activities,” said Dr. Zaoutis, that counter our evolutionary negativity bias. How is this done?
1. Have a positive experience (you can create one or retrieve a prior one);
2. Enrich it and install it by dwelling on it for at least 15-30 seconds; and
3. Absorb it into your body, which my require somatisizing it – Dr. Zaoutis presses her hand into her chest to aid in this.
Further, spread this to your group by the old medical training technique of “see one, do one, teach one.” See if you can start your signout with the best thing that happened to you in the week. Most importantly, start with observing yourself.
Possible Downside to Cloth Diapers: Bullous Diaper Dermatitis
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
AT THE SPD ANNUAL MEETING
Possible downside to cloth diapers: bullous diaper dermatitis
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
On Twitter @karioakes
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
On Twitter @karioakes
MINNEAPOLIS – A small study of cloth diaper–wearing toddlers with unusual vesiculobullous and erosive lesions found that the rashes fully resolved with aggressive barrier cream application and a switch to disposable diapers.
The four patients had previously received aggressive work-ups, including biopsy in some cases; all had received systemic antibiotics. Katya L. Harfmann, MD, a pediatric dermatologist at Nationwide Children’s Hospital in Columbus, Ohio, was the lead author in a poster presentation at the annual meeting of the Society for Pediatric Dermatology.
The toddlers, aged 17 months to 2 years, had diaper dermatitis of several weeks’ to several months’ duration, with a presentation of vesicles, bullae, and erosions. All of the children had been placed in cloth diapers since birth. The patients, three of them male, had undergone work-ups that included bacterial culture for three patients, herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for three patients, and blood work for two patients. HSV cultures and viral cultures were each performed on one patient. With the exception of one bacterial culture returning methicillin-sensitive Staphylococcus aureus (MSSA), all results were negative.
Two patients underwent biopsies. One biopsy was reported as “spongiform dermatitis,” while the other was read as a “nonspecific ulcer.”
A variety of treatments had been tried for the children. All of the children had received systemic antibiotics; two received systemic antivirals as well. Two patients each received topical steroids and topical antibacterials, and one patient also received topical dapsone. Many treatments were given “in repetitive courses, without improvement in the lesions,” wrote Dr. Harfmann and her coauthor.
The families were advised to switch to exclusive use of disposable diapers and to begin frequent use of a zinc oxide–based thick diaper paste. For all patients, the diaper dermatitis completely resolved within as little as 2 weeks.
The medical literature documents an increased risk of diaper dermatitis with cloth diaper use. “Despite this knowledge in the medical community, nearly half of cloth diaper–using parents select cloth diapers with the assumption that diaper rash is less frequent with their usage,” the researchers noted.
They pointed out that bullae in the diaper region are often thought to be associated with such infectious conditions as impetigo and herpes simplex infection, and can also be associated with immunobullous disorders. Diaper changes are less frequent in older children, though, giving the opportunity for prolonged contact with the irritating chemicals in feces and urine. This prolonged contact, exacerbated by the moister environment of a cloth diaper, may account for the unusual, severe presentation seen in these cases.
Also, the three boys had vesicular lesions on their testicles and penis. “It is possible that the thinner skin in these areas has a lower irritation threshold or that the redundancy of skin often seen on the penile shaft leads to trapping of irritants with extended diaper use,” they wrote.
“An empiric trial of disposable diapers exclusively with aggressive barrier cream application for several weeks may eliminate the need for more invasive procedures and laboratory tests,” wrote Dr. Harfmann and her coauthor.
They reported no conflicts of interest.
On Twitter @karioakes
AT THE SPD ANNUAL MEETING
Key clinical point: A distinct, vesiculobullous form of diaper dermatitis may be associated with cloth diaper use in toddlers.
Major finding: Disposable diapers and barrier protection resolved vesiculobullous lesions in cloth diaper–wearing toddlers.
Data source: A case series of four children with extensive negative work-ups for erosive and vesiculobullous eruptions.
Disclosures: The study investigators reported no disclosures.
Psychotropic drug use more likely with ASD diagnosis at older age
Older age at the time of autism spectrum disorder diagnosis was associated with a higher likelihood of psychotropic medication in children aged 6-11, according to Katharine Zuckerman, MD, and her associates.
The mean age at diagnosis for the 722 children included in the study was 4.4 years, with a mean diagnostic delay of 2.2 years. The adjusted odds ratio for psychotropic drug use in children who were diagnosed with autism spectrum disorder (ASD) after the age of 4 was 3.09, compared with children diagnosed before the age of 4. Children diagnosed at a later age were less likely to receive behavioral intervention (BI) therapy (adjusted odds ratio = 0.44), complementary and alternative medicine (aOR = 0.63), and school-based therapy (aOR = 0.38).
Children who experienced at least 2 years of delay before diagnosis were also significantly more likely to use psychotropic drugs (aOR = 1.77), and less likely to receive BI therapy (aOR = 0.54) and school-based therapy (aOR = 0.59). However, a delay of at least 2 years was associated with a greater chance of receiving complementary and alternative medicine (aOR = 2.81).
“Results suggest that if long-term ASD therapy use is a priority, payers and policymakers may need to proactively accelerate diagnosis by incentivizing screening or enhancing case management of children at high risk of diagnostic delays. From a population standpoint, as children receive earlier ASD diagnoses, payers may expect changes in service use patterns toward more therapy use and less pharmacology,” the investigators wrote.
Find the full study online in Psychiatric Services (doi:10.1176/appi.ps.201500549).
Older age at the time of autism spectrum disorder diagnosis was associated with a higher likelihood of psychotropic medication in children aged 6-11, according to Katharine Zuckerman, MD, and her associates.
The mean age at diagnosis for the 722 children included in the study was 4.4 years, with a mean diagnostic delay of 2.2 years. The adjusted odds ratio for psychotropic drug use in children who were diagnosed with autism spectrum disorder (ASD) after the age of 4 was 3.09, compared with children diagnosed before the age of 4. Children diagnosed at a later age were less likely to receive behavioral intervention (BI) therapy (adjusted odds ratio = 0.44), complementary and alternative medicine (aOR = 0.63), and school-based therapy (aOR = 0.38).
Children who experienced at least 2 years of delay before diagnosis were also significantly more likely to use psychotropic drugs (aOR = 1.77), and less likely to receive BI therapy (aOR = 0.54) and school-based therapy (aOR = 0.59). However, a delay of at least 2 years was associated with a greater chance of receiving complementary and alternative medicine (aOR = 2.81).
“Results suggest that if long-term ASD therapy use is a priority, payers and policymakers may need to proactively accelerate diagnosis by incentivizing screening or enhancing case management of children at high risk of diagnostic delays. From a population standpoint, as children receive earlier ASD diagnoses, payers may expect changes in service use patterns toward more therapy use and less pharmacology,” the investigators wrote.
Find the full study online in Psychiatric Services (doi:10.1176/appi.ps.201500549).
Older age at the time of autism spectrum disorder diagnosis was associated with a higher likelihood of psychotropic medication in children aged 6-11, according to Katharine Zuckerman, MD, and her associates.
The mean age at diagnosis for the 722 children included in the study was 4.4 years, with a mean diagnostic delay of 2.2 years. The adjusted odds ratio for psychotropic drug use in children who were diagnosed with autism spectrum disorder (ASD) after the age of 4 was 3.09, compared with children diagnosed before the age of 4. Children diagnosed at a later age were less likely to receive behavioral intervention (BI) therapy (adjusted odds ratio = 0.44), complementary and alternative medicine (aOR = 0.63), and school-based therapy (aOR = 0.38).
Children who experienced at least 2 years of delay before diagnosis were also significantly more likely to use psychotropic drugs (aOR = 1.77), and less likely to receive BI therapy (aOR = 0.54) and school-based therapy (aOR = 0.59). However, a delay of at least 2 years was associated with a greater chance of receiving complementary and alternative medicine (aOR = 2.81).
“Results suggest that if long-term ASD therapy use is a priority, payers and policymakers may need to proactively accelerate diagnosis by incentivizing screening or enhancing case management of children at high risk of diagnostic delays. From a population standpoint, as children receive earlier ASD diagnoses, payers may expect changes in service use patterns toward more therapy use and less pharmacology,” the investigators wrote.
Find the full study online in Psychiatric Services (doi:10.1176/appi.ps.201500549).
FROM PSYCHIATRIC SERVICES
Many pediatric trials go unfinished, unpublished
Photo by Logan Tuttle
Clinical trials in children too often go uncompleted or unpublished, according to a pair of researchers.
The duo evaluated nearly 560 pediatric trials and found that 19% were discontinued early. Of the trials that were completed, 30% remained unpublished several years later.
Industry-sponsored trials were more likely to be completed than trials sponsored by academic institutions. However, completed trials sponsored by industry were less likely to be published than trials sponsored by academia.
“Our findings are in line with previously published studies focusing on adult trials, which may speak to how commonplace discontinuation and non-publication are in medical research in general,” said study author Natalie Pica, MD, PhD, of Boston Children’s Hospital in Massachusetts.
She and Florence Bourgeois, MD, also of Boston Children’s Hospital, reported these findings in Pediatrics.
The researchers tracked 559 randomized, controlled pediatric trials registered on ClinicalTrials.gov from 2008 to 2010 and whose final status (completed or discontinued) was confirmed by the end of 2012.
The pair then searched for related peer-reviewed articles published through September 1, 2015. When no publication could be found, the researchers inquired with study investigators and sponsors via email.
Of the 559 trials, 104 (19%) were discontinued early. Two-thirds of these had enrolled participants.
Of the 455 completed trials, 136 (30%) remained unpublished after an average of 58 months post-completion. However, 42 of these (31%) did have results posted on ClinicalTrials.gov.
Of the 104 discontinued trials, 39% were sponsored by industry, and 55% were sponsored by academic institutions. (The rest were funded by other sources.)
Two years after trial completion, academia-sponsored trials accounted for 30% of unpublished trials, and industry-sponsored trials accounted for 63%.
Three years after trial completion, academia-sponsored trials accounted for 23% of unpublished trials, and industry-sponsored trials accounted for 70%.
In a multivariate analysis, the likelihood of non-publication was more than doubled for industry-sponsored trials 2 years after completion (odds ratio=2.21) and more than tripled 3 years after completion (odds ratio=3.12).
Overall, more than 8000 children were enrolled in trials that were never completed, and more than 69,000 children were enrolled in completed trials that were never published.
“This is the first study to look systematically at discontinuation and nonpublication of interventional pediatric clinical trials,” Dr Bourgeois said.
“A number of legislative initiatives have been implemented to increase the study of interventions in children. Now, we need to make sure that the proper resources are in place to ensure that information gleaned from these studies reaches the scientific community.”
One proposed initiative cited by Drs Bourgeois and Pica is RIAT (Restoring Invisible and Abandoned Trials), which is supported by some high-profile journals. RIAT invites researchers with unpublished trials to either commit to publish within a year or provide public access to their data.
“It’s hard to reanalyze others’ data,” Dr Pica noted, “but this may be a useful mechanism to make sure that findings from completed trials are disseminated in the medical literature.” 
Photo by Logan Tuttle
Clinical trials in children too often go uncompleted or unpublished, according to a pair of researchers.
The duo evaluated nearly 560 pediatric trials and found that 19% were discontinued early. Of the trials that were completed, 30% remained unpublished several years later.
Industry-sponsored trials were more likely to be completed than trials sponsored by academic institutions. However, completed trials sponsored by industry were less likely to be published than trials sponsored by academia.
“Our findings are in line with previously published studies focusing on adult trials, which may speak to how commonplace discontinuation and non-publication are in medical research in general,” said study author Natalie Pica, MD, PhD, of Boston Children’s Hospital in Massachusetts.
She and Florence Bourgeois, MD, also of Boston Children’s Hospital, reported these findings in Pediatrics.
The researchers tracked 559 randomized, controlled pediatric trials registered on ClinicalTrials.gov from 2008 to 2010 and whose final status (completed or discontinued) was confirmed by the end of 2012.
The pair then searched for related peer-reviewed articles published through September 1, 2015. When no publication could be found, the researchers inquired with study investigators and sponsors via email.
Of the 559 trials, 104 (19%) were discontinued early. Two-thirds of these had enrolled participants.
Of the 455 completed trials, 136 (30%) remained unpublished after an average of 58 months post-completion. However, 42 of these (31%) did have results posted on ClinicalTrials.gov.
Of the 104 discontinued trials, 39% were sponsored by industry, and 55% were sponsored by academic institutions. (The rest were funded by other sources.)
Two years after trial completion, academia-sponsored trials accounted for 30% of unpublished trials, and industry-sponsored trials accounted for 63%.
Three years after trial completion, academia-sponsored trials accounted for 23% of unpublished trials, and industry-sponsored trials accounted for 70%.
In a multivariate analysis, the likelihood of non-publication was more than doubled for industry-sponsored trials 2 years after completion (odds ratio=2.21) and more than tripled 3 years after completion (odds ratio=3.12).
Overall, more than 8000 children were enrolled in trials that were never completed, and more than 69,000 children were enrolled in completed trials that were never published.
“This is the first study to look systematically at discontinuation and nonpublication of interventional pediatric clinical trials,” Dr Bourgeois said.
“A number of legislative initiatives have been implemented to increase the study of interventions in children. Now, we need to make sure that the proper resources are in place to ensure that information gleaned from these studies reaches the scientific community.”
One proposed initiative cited by Drs Bourgeois and Pica is RIAT (Restoring Invisible and Abandoned Trials), which is supported by some high-profile journals. RIAT invites researchers with unpublished trials to either commit to publish within a year or provide public access to their data.
“It’s hard to reanalyze others’ data,” Dr Pica noted, “but this may be a useful mechanism to make sure that findings from completed trials are disseminated in the medical literature.”
Photo by Logan Tuttle
Clinical trials in children too often go uncompleted or unpublished, according to a pair of researchers.
The duo evaluated nearly 560 pediatric trials and found that 19% were discontinued early. Of the trials that were completed, 30% remained unpublished several years later.
Industry-sponsored trials were more likely to be completed than trials sponsored by academic institutions. However, completed trials sponsored by industry were less likely to be published than trials sponsored by academia.
“Our findings are in line with previously published studies focusing on adult trials, which may speak to how commonplace discontinuation and non-publication are in medical research in general,” said study author Natalie Pica, MD, PhD, of Boston Children’s Hospital in Massachusetts.
She and Florence Bourgeois, MD, also of Boston Children’s Hospital, reported these findings in Pediatrics.
The researchers tracked 559 randomized, controlled pediatric trials registered on ClinicalTrials.gov from 2008 to 2010 and whose final status (completed or discontinued) was confirmed by the end of 2012.
The pair then searched for related peer-reviewed articles published through September 1, 2015. When no publication could be found, the researchers inquired with study investigators and sponsors via email.
Of the 559 trials, 104 (19%) were discontinued early. Two-thirds of these had enrolled participants.
Of the 455 completed trials, 136 (30%) remained unpublished after an average of 58 months post-completion. However, 42 of these (31%) did have results posted on ClinicalTrials.gov.
Of the 104 discontinued trials, 39% were sponsored by industry, and 55% were sponsored by academic institutions. (The rest were funded by other sources.)
Two years after trial completion, academia-sponsored trials accounted for 30% of unpublished trials, and industry-sponsored trials accounted for 63%.
Three years after trial completion, academia-sponsored trials accounted for 23% of unpublished trials, and industry-sponsored trials accounted for 70%.
In a multivariate analysis, the likelihood of non-publication was more than doubled for industry-sponsored trials 2 years after completion (odds ratio=2.21) and more than tripled 3 years after completion (odds ratio=3.12).
Overall, more than 8000 children were enrolled in trials that were never completed, and more than 69,000 children were enrolled in completed trials that were never published.
“This is the first study to look systematically at discontinuation and nonpublication of interventional pediatric clinical trials,” Dr Bourgeois said.
“A number of legislative initiatives have been implemented to increase the study of interventions in children. Now, we need to make sure that the proper resources are in place to ensure that information gleaned from these studies reaches the scientific community.”
One proposed initiative cited by Drs Bourgeois and Pica is RIAT (Restoring Invisible and Abandoned Trials), which is supported by some high-profile journals. RIAT invites researchers with unpublished trials to either commit to publish within a year or provide public access to their data.
“It’s hard to reanalyze others’ data,” Dr Pica noted, “but this may be a useful mechanism to make sure that findings from completed trials are disseminated in the medical literature.”
Combo MenC vaccine loses effectiveness after 5 years
A majority of children were not protected from Neisseria meningitidis serogroup C 5 years after receiving a combined Haemophilus influenzae type b–N. meningitidis serogroup C–tetanus toxoid conjugate vaccine or other MenC combination vaccines, according to Dr. Juan Carlos Tejedor of Hospital Universitario de Móstoles, Madrid, and his associates.
A total of 530 children approximately 6 years old were included in the study. Participants received vaccinations at 2, 4, and 6 months, and received a booster vaccination at 11-18 months. Patients were separated into four groups, receiving either Hib–MenC plus a 10-valent pneumococcal nontypeable H. influenzae protein D conjugate vaccine (PHiD-CV), Hib–MenC plus 7-valent cross-reacting material 197 (CRM197) conjugate vaccine (7vCRM), MenC plus CRM, or MenC plus tetanus toxoid vaccinations. MenC antibody titers were measured with a serum bactericidal antibody assay using rabbit complement (in other words, rabbit SBA [rSBA]).
The rate of seropositivity for rSBA–MenC titers ranged from 24% to 40%. All groups maintained a seropositivity rate of at least 98.5% for anti-Hib polyribosylribitol phosphate antibodies, and at least 72.8% of children maintained seropositivity for hepatitis B.
“The low MenC titers at 5 years after vaccination suggested that individuals may no longer be protected or contribute to herd immunity,” the investigators noted.
Find the full study in Clinical and Vaccine Immunology (2016 Jul. doi: 10. 1128/CVI.00057-16).
A majority of children were not protected from Neisseria meningitidis serogroup C 5 years after receiving a combined Haemophilus influenzae type b–N. meningitidis serogroup C–tetanus toxoid conjugate vaccine or other MenC combination vaccines, according to Dr. Juan Carlos Tejedor of Hospital Universitario de Móstoles, Madrid, and his associates.
A total of 530 children approximately 6 years old were included in the study. Participants received vaccinations at 2, 4, and 6 months, and received a booster vaccination at 11-18 months. Patients were separated into four groups, receiving either Hib–MenC plus a 10-valent pneumococcal nontypeable H. influenzae protein D conjugate vaccine (PHiD-CV), Hib–MenC plus 7-valent cross-reacting material 197 (CRM197) conjugate vaccine (7vCRM), MenC plus CRM, or MenC plus tetanus toxoid vaccinations. MenC antibody titers were measured with a serum bactericidal antibody assay using rabbit complement (in other words, rabbit SBA [rSBA]).
The rate of seropositivity for rSBA–MenC titers ranged from 24% to 40%. All groups maintained a seropositivity rate of at least 98.5% for anti-Hib polyribosylribitol phosphate antibodies, and at least 72.8% of children maintained seropositivity for hepatitis B.
“The low MenC titers at 5 years after vaccination suggested that individuals may no longer be protected or contribute to herd immunity,” the investigators noted.
Find the full study in Clinical and Vaccine Immunology (2016 Jul. doi: 10. 1128/CVI.00057-16).
A majority of children were not protected from Neisseria meningitidis serogroup C 5 years after receiving a combined Haemophilus influenzae type b–N. meningitidis serogroup C–tetanus toxoid conjugate vaccine or other MenC combination vaccines, according to Dr. Juan Carlos Tejedor of Hospital Universitario de Móstoles, Madrid, and his associates.
A total of 530 children approximately 6 years old were included in the study. Participants received vaccinations at 2, 4, and 6 months, and received a booster vaccination at 11-18 months. Patients were separated into four groups, receiving either Hib–MenC plus a 10-valent pneumococcal nontypeable H. influenzae protein D conjugate vaccine (PHiD-CV), Hib–MenC plus 7-valent cross-reacting material 197 (CRM197) conjugate vaccine (7vCRM), MenC plus CRM, or MenC plus tetanus toxoid vaccinations. MenC antibody titers were measured with a serum bactericidal antibody assay using rabbit complement (in other words, rabbit SBA [rSBA]).
The rate of seropositivity for rSBA–MenC titers ranged from 24% to 40%. All groups maintained a seropositivity rate of at least 98.5% for anti-Hib polyribosylribitol phosphate antibodies, and at least 72.8% of children maintained seropositivity for hepatitis B.
“The low MenC titers at 5 years after vaccination suggested that individuals may no longer be protected or contribute to herd immunity,” the investigators noted.
Find the full study in Clinical and Vaccine Immunology (2016 Jul. doi: 10. 1128/CVI.00057-16).
FROM CLINICAL AND VACCINE IMMUNOLOGY
LABA achieves better asthma control when combined with FDC inhaler
Long-acting beta-2 agonists achieve better asthma control when added to inhaled corticosteroids in a fixed-dose combination, compared with use of a LABA as a separate inhaler, according to Steve Turner, MD, and his associates.
At baseline, 35% of children in the FDC ICS (fixed-dose combination inhaled corticosteroids)/LABA cohort and in the separate ICS+LABA cohort had achieved overall asthma control. After 2 years, 43% of children in the FDC ICS/LABA cohort had achieved overall asthma control, compared with 37% of children in the separate ICS+LABA cohort. The adjusted odds ratio for overall asthma control in the separate ICS+LABA cohort was 0.77.
The adjusted relative risk of acute respiratory events for the separate ICS+LABA cohort was 1.21, compared with the FDC ICS/LABA cohort, and the aRR for severe exacerbations was 1.31 for the separate ICS+LABA cohort. More children in the separate ICS+LABA cohort were treated with antibiotics; however, the incidence of thrush was higher in the FDC ICS/LABA cohort.
“This small effect may be partly explained by improvement in all outcomes in both groups as the children became older. An additional factor may be that adherence was relatively poor for all participants (22%-33%), and poor adherence is associated with poor control. This may have led to the decision to step up and also to a relatively disappointing response to treatment,” the investigators wrote.
Find the full study in the Journal of Allergy and Clinical Immunology (doi:10.1016/j.jaip.2016.06.009).
Long-acting beta-2 agonists achieve better asthma control when added to inhaled corticosteroids in a fixed-dose combination, compared with use of a LABA as a separate inhaler, according to Steve Turner, MD, and his associates.
At baseline, 35% of children in the FDC ICS (fixed-dose combination inhaled corticosteroids)/LABA cohort and in the separate ICS+LABA cohort had achieved overall asthma control. After 2 years, 43% of children in the FDC ICS/LABA cohort had achieved overall asthma control, compared with 37% of children in the separate ICS+LABA cohort. The adjusted odds ratio for overall asthma control in the separate ICS+LABA cohort was 0.77.
The adjusted relative risk of acute respiratory events for the separate ICS+LABA cohort was 1.21, compared with the FDC ICS/LABA cohort, and the aRR for severe exacerbations was 1.31 for the separate ICS+LABA cohort. More children in the separate ICS+LABA cohort were treated with antibiotics; however, the incidence of thrush was higher in the FDC ICS/LABA cohort.
“This small effect may be partly explained by improvement in all outcomes in both groups as the children became older. An additional factor may be that adherence was relatively poor for all participants (22%-33%), and poor adherence is associated with poor control. This may have led to the decision to step up and also to a relatively disappointing response to treatment,” the investigators wrote.
Find the full study in the Journal of Allergy and Clinical Immunology (doi:10.1016/j.jaip.2016.06.009).
Long-acting beta-2 agonists achieve better asthma control when added to inhaled corticosteroids in a fixed-dose combination, compared with use of a LABA as a separate inhaler, according to Steve Turner, MD, and his associates.
At baseline, 35% of children in the FDC ICS (fixed-dose combination inhaled corticosteroids)/LABA cohort and in the separate ICS+LABA cohort had achieved overall asthma control. After 2 years, 43% of children in the FDC ICS/LABA cohort had achieved overall asthma control, compared with 37% of children in the separate ICS+LABA cohort. The adjusted odds ratio for overall asthma control in the separate ICS+LABA cohort was 0.77.
The adjusted relative risk of acute respiratory events for the separate ICS+LABA cohort was 1.21, compared with the FDC ICS/LABA cohort, and the aRR for severe exacerbations was 1.31 for the separate ICS+LABA cohort. More children in the separate ICS+LABA cohort were treated with antibiotics; however, the incidence of thrush was higher in the FDC ICS/LABA cohort.
“This small effect may be partly explained by improvement in all outcomes in both groups as the children became older. An additional factor may be that adherence was relatively poor for all participants (22%-33%), and poor adherence is associated with poor control. This may have led to the decision to step up and also to a relatively disappointing response to treatment,” the investigators wrote.
Find the full study in the Journal of Allergy and Clinical Immunology (doi:10.1016/j.jaip.2016.06.009).
FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Serum vitamin D levels, atopy not significantly linked
SCOTTSDALE, ARIZ. – Serum vitamin D level was not significantly associated with atopic dermatitis or disease severity in a single-center study of more than 600 children and adolescents.
However, “we did observe a strong correlation between average serum vitamin D levels and skin type, as well as body mass index,” said Kavita Darji, a medical student at Saint Louis (Mo.) University, who presented the findings in a poster at the annual meeting of the Society for Investigative Dermatology. Those findings challenge the logic of following universal definitions of vitamin D deficiency, especially given the phenotypic heterogeneity of patients in the United States, she added in an interview.
Serum vitamin D testing is one of most common laboratory assays in this country, but clinicians still debate the risks and benefits of supplementing children and adolescents who test below the Endocrine Society’s threshold for sufficiency (30.0 ng/mL).
To identify factors affecting vitamin D levels, Ms. Darji and her associates reviewed electronic medical charts for patients under age 22 years at Saint Louis University medical centers between 2009 and 2014. The cohort of 655 patients was primarily white (64%) or black (29%), and was nearly equally balanced by gender; their average age was 10 years. The researchers analyzed only the first vitamin D serum measurement for each patient, and defined deficiency as a level under 20 ng/mL, insufficiency as a level between 20 and 29.9 ng/mL, and sufficiency as a level of at least 30 ng/mL.
Serum vitamin D levels were slightly lower among atopic patients, compared with those without atopy, but the difference did not reach statistical significance (about 25 ng/mL vs. about 38 ng/mL; P greater than .05). “We also did not find an association between AD severity and vitamin D level,” Ms. Darji reported. Instead, race and body mass index were the most significant predictors of vitamin D deficiency, probably because these factors directly affect cutaneous photo-induced vitamin D synthesis and the sequestration of fat-soluble vitamins in adipose tissue, she said.
Using the standard definitions, more than 50% of black patients were vitamin D deficient, while less than 30% had sufficient vitamin D levels. In contrast, about 25% of white patients were vitamin D deficient, while nearly 40% had sufficient vitamin D levels (P less than .0001 for proportions of deficiency by race). Furthermore, only about 10% of obese children (those who exceeded the 99th percentile of BMI for age) had sufficient vitamin D levels, compared with more than 40% of underweight children and about 30% of normal-weight children (P less than .00001).
Since vitamin D deficiency was more common among black and obese patients, “maybe they could benefit from a different cut-off value than the standard 30 ng per mL that we used,” Ms. Darji said. “The question is, do they really require these supplements? It may be beneficial to look at the unique characteristics of each patient before supplementing, because the risks of supplementation are considerable in terms of bone health and cardiovascular disease.”
Vitamin D levels did not vary significantly by gender or by month or season measured, Ms. Darji noted. She reported no funding sources and had no disclosures.
SCOTTSDALE, ARIZ. – Serum vitamin D level was not significantly associated with atopic dermatitis or disease severity in a single-center study of more than 600 children and adolescents.
However, “we did observe a strong correlation between average serum vitamin D levels and skin type, as well as body mass index,” said Kavita Darji, a medical student at Saint Louis (Mo.) University, who presented the findings in a poster at the annual meeting of the Society for Investigative Dermatology. Those findings challenge the logic of following universal definitions of vitamin D deficiency, especially given the phenotypic heterogeneity of patients in the United States, she added in an interview.
Serum vitamin D testing is one of most common laboratory assays in this country, but clinicians still debate the risks and benefits of supplementing children and adolescents who test below the Endocrine Society’s threshold for sufficiency (30.0 ng/mL).
To identify factors affecting vitamin D levels, Ms. Darji and her associates reviewed electronic medical charts for patients under age 22 years at Saint Louis University medical centers between 2009 and 2014. The cohort of 655 patients was primarily white (64%) or black (29%), and was nearly equally balanced by gender; their average age was 10 years. The researchers analyzed only the first vitamin D serum measurement for each patient, and defined deficiency as a level under 20 ng/mL, insufficiency as a level between 20 and 29.9 ng/mL, and sufficiency as a level of at least 30 ng/mL.
Serum vitamin D levels were slightly lower among atopic patients, compared with those without atopy, but the difference did not reach statistical significance (about 25 ng/mL vs. about 38 ng/mL; P greater than .05). “We also did not find an association between AD severity and vitamin D level,” Ms. Darji reported. Instead, race and body mass index were the most significant predictors of vitamin D deficiency, probably because these factors directly affect cutaneous photo-induced vitamin D synthesis and the sequestration of fat-soluble vitamins in adipose tissue, she said.
Using the standard definitions, more than 50% of black patients were vitamin D deficient, while less than 30% had sufficient vitamin D levels. In contrast, about 25% of white patients were vitamin D deficient, while nearly 40% had sufficient vitamin D levels (P less than .0001 for proportions of deficiency by race). Furthermore, only about 10% of obese children (those who exceeded the 99th percentile of BMI for age) had sufficient vitamin D levels, compared with more than 40% of underweight children and about 30% of normal-weight children (P less than .00001).
Since vitamin D deficiency was more common among black and obese patients, “maybe they could benefit from a different cut-off value than the standard 30 ng per mL that we used,” Ms. Darji said. “The question is, do they really require these supplements? It may be beneficial to look at the unique characteristics of each patient before supplementing, because the risks of supplementation are considerable in terms of bone health and cardiovascular disease.”
Vitamin D levels did not vary significantly by gender or by month or season measured, Ms. Darji noted. She reported no funding sources and had no disclosures.
SCOTTSDALE, ARIZ. – Serum vitamin D level was not significantly associated with atopic dermatitis or disease severity in a single-center study of more than 600 children and adolescents.
However, “we did observe a strong correlation between average serum vitamin D levels and skin type, as well as body mass index,” said Kavita Darji, a medical student at Saint Louis (Mo.) University, who presented the findings in a poster at the annual meeting of the Society for Investigative Dermatology. Those findings challenge the logic of following universal definitions of vitamin D deficiency, especially given the phenotypic heterogeneity of patients in the United States, she added in an interview.
Serum vitamin D testing is one of most common laboratory assays in this country, but clinicians still debate the risks and benefits of supplementing children and adolescents who test below the Endocrine Society’s threshold for sufficiency (30.0 ng/mL).
To identify factors affecting vitamin D levels, Ms. Darji and her associates reviewed electronic medical charts for patients under age 22 years at Saint Louis University medical centers between 2009 and 2014. The cohort of 655 patients was primarily white (64%) or black (29%), and was nearly equally balanced by gender; their average age was 10 years. The researchers analyzed only the first vitamin D serum measurement for each patient, and defined deficiency as a level under 20 ng/mL, insufficiency as a level between 20 and 29.9 ng/mL, and sufficiency as a level of at least 30 ng/mL.
Serum vitamin D levels were slightly lower among atopic patients, compared with those without atopy, but the difference did not reach statistical significance (about 25 ng/mL vs. about 38 ng/mL; P greater than .05). “We also did not find an association between AD severity and vitamin D level,” Ms. Darji reported. Instead, race and body mass index were the most significant predictors of vitamin D deficiency, probably because these factors directly affect cutaneous photo-induced vitamin D synthesis and the sequestration of fat-soluble vitamins in adipose tissue, she said.
Using the standard definitions, more than 50% of black patients were vitamin D deficient, while less than 30% had sufficient vitamin D levels. In contrast, about 25% of white patients were vitamin D deficient, while nearly 40% had sufficient vitamin D levels (P less than .0001 for proportions of deficiency by race). Furthermore, only about 10% of obese children (those who exceeded the 99th percentile of BMI for age) had sufficient vitamin D levels, compared with more than 40% of underweight children and about 30% of normal-weight children (P less than .00001).
Since vitamin D deficiency was more common among black and obese patients, “maybe they could benefit from a different cut-off value than the standard 30 ng per mL that we used,” Ms. Darji said. “The question is, do they really require these supplements? It may be beneficial to look at the unique characteristics of each patient before supplementing, because the risks of supplementation are considerable in terms of bone health and cardiovascular disease.”
Vitamin D levels did not vary significantly by gender or by month or season measured, Ms. Darji noted. She reported no funding sources and had no disclosures.
AT THE 2016 SID ANNUAL MEETING
Key clinical point: Serum vitamin D was not a significant marker for pediatric atopic dermatitis or disease severity.
Major finding: The average serum vitamin D level was lower among patients with atopic dermatitis than healthy children, but the difference did not reach statistical significance.
Data source: A single-center retrospective review of electronic medical records from 655 patients aged 21 years and younger (average age, 10 years).
Disclosures: Ms. Darji reported no funding sources and had no disclosures.
