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IMPORTANCEOral propranolol is widely considered to be first-line therapy for complicated infantile hemangioma, but its use in patients with PHACE (posterior fossa malformations, hemangioma, arterial anomalies, cardiac defects, eye anomalies) syndrome has been debated owing to concerns that the cardiovascular effects of the drug may increase the risk for arterial ischemic stroke.OBJECTIVE To assess the incidence of adverse events among patients with PHACE syndrome receiving oral propranolol for infantile hemangioma. DESIGN, SETTING, AND PARTICIPANTSThis multicenter retrospective cohort study assessed the incidence of adverse events among 76 patients with PHACE syndrome receiving oral propranolol for infantile hemangioma at 11 tertiary care, academic pediatric dermatology practices. Medical records from January 1, 2010, through April 25, 2017, were reviewed.EXPOSURES Patients received oral propranolol, 0.3 mg/kg/dose or more. MAIN OUTCOMES AND MEASURESThe main outcome was the rate and severity of adverse events occurring throughout the course of treatment with oral propranolol, as documented in the medical records. Adverse events were graded from 1 to 5 using a scale derived from the Common Terminology Criteria for Adverse Events and were considered to be serious if they were grade 3 or higher.RESULTS A total of 76 patients (59 girls and 17 boys; median age at propranolol initiation, 56 days [range, 0-396 days]) met the inclusion criteria. There were no reports of serious adverse events (ie, stroke, transient ischemic attack, or cardiovascular events) during treatment with oral propranolol. A total of 46 nonserious adverse events were reported among 29 patients (38.2%); the most commonly reported nonserious adverse events were sleep disturbances and minor gastrointestinal tract and respiratory tract symptoms. In a comparison with 726 infants who received oral propranolol for hemangioma but did not meet criteria for PHACE syndrome, there was no significant difference in the rate of serious adverse events experienced during treatment (0 of 76 patients with PHACE syndrome and 3 of 726 patients without PHACE syndrome [0.4%]).CONCLUSIONS AND RELEVANCE This study found that oral propranolol was used to treat infantile hemangioma in 76 patients with PHACE syndrome and that no serious adverse events were experienced. These data provide support for the safety of oral propranolol in this patient population.

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We assess women's perceptions of health risks in relation to quality of life concerns, with attention to variables viewed as central to maintaining or improving health and well-being. In this paper, we specifically underscore how a life-threatening disease-malaria-is experienced and bio-cyclically understood and managed in relation to seasonal hunger, food insecurities, and livelihood vulnerabilities. The study, conducted June-July 2013, draws on field data and interviews with 60 women farmers of the Luhya community along the Yala River in Kakamega County, Western Province, Kenya. Major findings suggest the following: (1) women's perceived desired quality of life is shaped by priorities for children's education, nutrition, food security, and economic security in their rural communities; (2) malaria emerged as a challenging household health problem that curtails livelihood opportunities for most study participants; and (3) local understandings of malaria transmission, particularly how and when female mosquitoes become infected with malaria-causing protozoans, was low, but malaria symptoms were relatively well-understood. The interest and motivation to institute new malaria risk reduction practices at the community level are explored, including attention to building upon the Luhya tradition of oral storytelling in order to promote actions to eliminate malaria. This analysis of local narratives of health risks illustrates these points and demonstrates how women's constructions of health risks and well-being provide a basis for developing interventions targeting income generation and microloan opportunities that could support Kenyan women in their intersecting approaches to malaria, securing nutritious diets, and enhancing the local health environment.

Punch biopsies from the scalp may bleed profusely and can be difficult to suture because of surrounding hair. 1 Shaving the scalp around the biopsy site is cosmetically impractical. SOLUTIONA piece of an absorbable gelatin foam sponge is cut to a width equal to 1.5 to 2 times the biopsy specimen width. The sponge is inserted immediately after the specimen is removed, and no cautery or sutures are required (Fig 1; Supplementary Video 1, available online at www.jaad.org). When there is brisk or arterial bleeding, the wider diameter of gelatin foam is preferable, and gentle pressure is applied until the dressing expands. Hemostatic mesh can be used in place of gelatin foam when bleeding is brisk. The senior author has used both Fig 1. Scalp biopsy site packed with gelatin foam.