P6915Infantile hemangioma and risk factors: A literature review

Cecile Meni, MD, Dermatologyst, Boulogne Billancourt, France; Charles-RemyTaieb, MD, MBA, Pierre Fabre, Boulogne Billancourt, France; Jean-JacquesVoisard, MD, Pierre Fabre Dermatology, Lavaur, France

Background: Infantile hemangioma (IH) is the most common benign vascular tumorin children. Its evolution typically involves 3 periods: rapid growth, plateau phaseand slow involution. Several risk factors have been identified. The aim is to carry outa literature review in order to assess risk factors involved in IH.

Methods: Systematic literature review carried out using the Pubmed database. Themost relevant keywords were searched (eg, ‘‘IH/strawberry hemangioma and riskfactors,’’ ‘‘epidemiology/prevalence and IH’’). The search was subsequently ex-tended to other terms (eg, ‘‘strawberry nevi/hemangioma and natural history,’’‘‘hemangioma and prospective study’’). Only prospective, retrospective studiesincluding a minimum of 300 patients were used. Studies specifically relating toPHACE syndrome or to the risk of hepatic hemangioma were not selected.

Results: A total of 14 studies were found: 8 relating to risk factors in general and 6 toa particular risk factor. Female, premature children (\37 weeks amenorrhea), lowbirth weight (\2500 g) and a family history of vascular lesions are risk factors thathave been significantly proven in a large proportion of the studies. The female:maleratio varies from between 5:1 in an Australian study to 1.4:1 in premature babies. Inmost of the studies, the sex ratio tended to decrease in premature infants. Low birthweight is systematically present. One study even showed that the lower the birthweight, the higher the incidence of IH. Caucasian origin, advanced maternal age,multiple gestations, previous history of placenta praevia and preeclampsia are riskfactors commonly but not systematically found. Chorionic villus sampling wasidentified as risk factor (compared to amniocentesis) however this result was foundfor transcervical but not for the transabdominal procedure. One study makes thecase for a link between IH and retinopathy of prematurity and another betweenerythropoietin treatment in preterm infants and IH. Consumption of alcohol ortobacco by parents was not identified as risk factors.

Conclusion: Many risk factors have been identified. Advancedmaternal age,multiplegestation, history of placenta praevia or preeclampsia during pregnancy areprobably confounding factors. A chinese study found different risk factors (lowerlevel of education in parents, manual labor by the mother). A cohort study iscurrently under way in France and should be able to confirm or refute thesehypotheses.

APRIL 20

ponsored by Pierre Fabre Dermatology.

100% is s

P6910Infantile hemangioma: Epidemiology update

Cecile Meni, MD, Dermatologyst, Boulogne Billancourt, France; Charles-RemyTaieb, MD, MBA, PFSA, Boulogne Billancourt, France; Jean-Jacques Voisard, MD,PFD, Lavaur, France

Background: Infantile hemangioma (IH) is the most common benign vascular tumorin children. Its incidence has been estimated at around 3 and 10%. However, it hasnot been subject to many studies. The aim is to carry out a systematic review of theliterature investigating this incidence. Materials and methods: Systematic literaturereview carried out using the Pubmed database. The most relevant keywords weresearched (eg, ‘‘epidemiology/prevalence and IH,’’ ‘‘strawberry nevi/hemangiomaand natural history’’). The search was subsequently extended to other terms (eg, ‘‘IHand demography,’’ ‘‘birthmarks in infants,’’ ‘‘neonatal skin survey’’). Only prospec-tive, retrospective studies including a minimum of 500 patients were used.

Results: 12 studies relating to newborn babies aged \2 weeks old, 5 relating toinfants and children of over 2 weeks, 3 relating to premature or low birth weightbabies were found. 12 of these studies, published between 1954 and 1995, werereported in 2008 in a literature review which found a variable incidence between0.7% and 2.6%, and 3.5% and 8.5% for the first 2 groups respectively. Our reviewfound more recent prospective studies, particularly one carried out in theNetherlands on children aged between 0 and 16 months, it found an incidence of9.9%. Another in Australia on infants aged 0 to 6weeks found an incidence of 2.6%. 3studies on new-borns aged less than one week old found incidences varyingbetween 0.2% and 0.9%. Finally, 2 studies including prematurely born babies and1 on babies with a low birth weight found incidences of 4.3%, 12.7% and 11.1%respectively.

Conclusion: The data previously gathered probably underestimated the incidence.Studies dating from the 50s to 70s are based on an out-of-date definition of IH, and itis therefore probable that the same studies carried out in a contemporary contextwould not include the same patients. However, a large part of the studies includednewborns, who, according to natural history of IH, should have a lower incidencethan that calculated for children aged up to one year. The Dutch study confirmed thepreviously calculated incidences and seems to agree on an incidence between 4%and 10%. It appears that other studies of this type are necessary to corroborate thesefindings. Prematurity and low birthweight are identified as risk factors, which servesto explain the elevated figures in these populations. A study is currently under wayin Italy.

ponsored by Pierre Fabre Dermatology.

100% is s

13

P6339Management of cutaneous abscess by dermatologists

Jason Chouake, Albert Einstein College of Medicine, Bronx, NY, United States;Adam Friedman, MD, Albert Einstein College of Medicine, Bronx, NY, UnitedStates; Josh Nosanchuk, MD, Albert Einstein College of Medicine, Bronx, NY,United States

Cutaneous abscesses are often uncomplicated at the time of initial presentation.However, these infections can worsen quickly when appropriate management andtreatment are not instituted. There is currently no data detailing the degree to whichdermatologists follow CDC guidelines in the treatment of abscesses, which dictatesthat I+D constitutes primary therapy for uncomplicated abscesses. Additionally,previous studies surveying the treatment of abscesses did not evaluate how lesionlocation impacted the physician’s course of action, and were limited to specificpatient populations. A national email survey of a random sample of 502 dermatol-ogists was conducted fromMay-June 2012. The instrument was designed to evaluateawareness, experience, and preparedness of respondents for abscess treatment, aswell as the treatment practices of uncomplicated abscesses in different clinicalscenarios. The response rate was 65% (503 eligible surveys of the 770 in the eligiblesampling frame). The main practice affiliation of respondents was distributedbetween solo (20%), group (33%), university health system or academic (32%), andmulti-specialty practices (13%). The main practice setting of respondents wasdivided between urban (49%), suburban (42%), and rural (9%). Most respondents(86%) were aware or somewhat aware of the CDC recommendations for thetreatment of skin and soft tissue infections. Only 0.4% reported that no one in theirpractice was capable of performing incision and drainage (I+D) of an uncomplicatedabscess. Only 18% culture abscesses\50% of the time, which is inconsistent withCDC guidelines. For facial abscesses, respondents are less likely to incorporate I+Dinto their initial treatment for all pediatric and adolescent patients (52% and 79% (P\ .001), respectively), when compared to adult and geriatric patients (88.5%; P\.01). For abscesses on the trunk and extremities, respondents are less likely to I+Dinfants and toddlers (I+D performed in 79%, P \ .01), compared to adolescents,adults and the elderly (I+D performed in 87%, P\.01). Although most dermatol-ogists are prepared to manage uncomplicated abscesses, this survey identifies gapsin clinical standards of care, highlighting the need for standardized clinicalguidelines based on regional sensitivities. A comprehensive clinical guideline couldnot only improve abscess management, but also decrease barriers related to suchcare.

cial support: None identified.

Commer

P6402Skin and climate

Nicola Balato, MD, Department of Dermatology, University of Naples Federico II,Naples, Italy; Anna Balato, MD, PhD, Department of Dermatology, University ofNaples Federico II, Naples, Italy; Cataldo Patruno, MD, PhD, Department ofDermatology, University of Naples Federico II, Naples, Italy; Fabio Ayala, MD,Department of Dermatology, University of Naples Federico II, Naples, Italy;Guido Barone, Department of Chemistry, University of Naples Federico II,Naples, Italy; Matteo Megna, MD, Department of Dermatology, University ofNaples Federico II, Naples, Italy

Some human activities by means of use of fossil fuel and land consumption areleading to an accumulation of greenhouse gases in the atmosphere, contributing toglobal climate change. Indeed, many authors have reported on the current trendtoward global warming (temperature will probably increase by 28C by the end of2100), changes in precipitations, atmospheric humidity changes, global rise inextreme climatic events, and rising in sea levels. Changing climate also explainsshifts in the distribution and behavior of insect, bird, and plant species. The impactof these changes on human activity are matters of debate. Climate change couldaffect social, economic, and health systems. However, few studies focus onrelationship with human skin. The skin is the most exposed organ to environment;therefore cutaneous diseases are inclined to have a high sensitivity to climate.Moreover, influences of climate change on skin diseases is wide and complex; infact, numerous factors might contribute to modify the frequency and clinical patternof many dermatoses. Global warming, deforestation and changes in precipitationhave been linked to variations in the geographical distribution of vectors of someinfectious diseases (malaria, leishmaniasis, lyme disease, etc) by changing theirspread. Warm and humid environment encourage, the colonization of the skin bybacteria and fungi. Extreme events such as floods can also lead to skin infectionscaused by atypical bacteria and to an increasing incidence of infestations, scabies,and papular urticaria. On the other hand, decreased stratospheric ozone layer andconsequently the increases in UV radiation are related to photocarcinogenesis,leading to increased incidence of skin cancer: it is estimated that for each 1%reduction in the thickness of the ozone layer the incidence of melanoma willincrease between 1% and 2%.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB95