Skin cancer risk is elevated in solid organ transplant recipients (OTRs). Studies of skin cancer awareness and sun-protection behaviors in pediatric transplant recipients (pOTRs) have not been reported. We measured effects over time of a multimodal educational intervention on knowledge of sun-protection practices and skin cancer risk, engagement in sun-protection behaviors, and self-efficacy and perceived barriers to photoprotection in pOTRs, their guardians, and a comparison group of children and guardians. Knowledge about skin cancer risk increased in pOTRs and their guardians (P ≤ .01) and frequency of pOTRs’ sun-protection behaviors reported by pOTRs and their guardians also improved.

Oral and topical β-blockers are used to treat infantile hemangiomas (IHs). Although a recent consensus report provided guidelines for the treatment of IH with propranolol, there are no standard guidelines for the use of topical timolol. The objectives of this study were to determine the current use of oral propranolol and topical timolol by pediatric dermatologists in an outpatient setting and to compare current propranolol use with published propranolol consensus guidelines. An electronic survey was sent to pediatric dermatologists in May and June 2013. One hundred forty-nine pediatric dermatologists responded to the survey, a 79% response rate. Of the respondents, 96% prescribed oral propranolol, but 75% did not follow consensus guidelines exactly; recommended history, physical examination, initial dose, and frequency varied. The dose of propranolol was usually titrated up to goal dose as recommended (89%). Fifty-six percent monitored vital signs in patients after the initial dose and 49% continued to monitor vital signs in their clinic after each dose escalation, which did not meet consensus guideline recommendations. Ninety-one percent reported using topical timolol for the treatment of IH and 66% responded they had used topical timolol in conjunction with oral propranolol to treat IH. The most common indication was superficial hemangiomas (97%). Most practitioners (74%) did not routinely monitor heart rate or blood pressure in infants treated with topical timolol. This study highlights the variability in prescribing and monitoring practices of physicians using propranolol for the treatment of IHs and demonstrates that topical timolol is commonly used alone and in conjunction with oral propranolol to treat IHs.

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A woman in her 40s presented with a 6-month history of intermittent fevers, malaise, polyarthralgias, sore throat, and a pruritic exanthem on her trunk, scalp, and extremities. A previous biopsy was nonspecific. She had no significant medical history.Physical examination revealed erythematous, mildly scaly plaques in a shawl distribution ( Figure, A) and hyperpigmented, erythematous, excoriated papules in a linear arrangement on her back (Figure, B) and lower extremities. Laboratory studies showed leukocytosis (27 900/uL, 95% neutrophils) and increased levels of C-reactive protein (344 mg/L) and ferritin (63 000 ng/mL). Antinuclear antibody titer was 1:80. Findings for rheumatoid factor and antineutrophil cytoplasmic antibodies were negative, as were those for Lyme disease, rickettsial disease, cytomegalovirus, Bartonella, rapid plasma reagin, human immunodeficiency virus, and hepatitis. Serum and urine protein electrophoresis findings were also negative, and chest, abdomen, and pelvic computed tomography showed nonspecific hilar lymphadenopathy. A punch biopsy specimen from the back was obtained (Figure, C).

Primary hyperhidrosis is a common disorder affecting children and adolescents, and it can have a significant negative psychosocial effect. Treatment for pediatric hyperhidrosis tends to be limited by low efficacy, low adherence, and poor tolerance. Oral glycopyrrolate is emerging as a potential second-line treatment option, but experience with safety, efficacy, and dosing is especially limited in children. We present an institutional review of 12 children with severe, refractory hyperhidrosis treated with oral glycopyrrolate; 11 (92%) noted improvement and 9 (75%) would recommend oral glycopyrrolate to their friends. No significant side effects were noted. Our retrospective analysis suggests that oral glycopyrrolate is safe and effective in children with hyperhidrosis.