What's new in pediatric dermatology: update for the pediatrician.
OBJECTIVE
Common pediatric skin conditions such as infantile atopic dermatitis, vitiligo, hemangiomas of infancy, warts, and molluscum contagiosum do not always respond to standard therapy. In some settings pediatricians will use "off-label" medications if the benefit-to-risk ratio is favorable. This article reviews important literature from the past year related to "off-label" immune-based treatment of skin disease, using the topical immunomodulators tacrolimus, pimecrolimus, and imiquimod, as well as intravenous Ig.


RESULTS
The topical immunomodulators tacrolimus and pimecrolimus have been embraced by pediatricians as long awaited alternatives for treating atopic dermatitis in children 2 years of age and older. Their unique appeal as nonsteroidal topical agents with good safety profiles has led to their frequent use for unapproved indications. A number of recent publications detail their use in infantile atopic dermatitis in children as young as 3 months of age, as well as use in other conditions such as vitiligo. Imiquimod, another topical immunomodulator, approved for genital wart treatment in adults, has also been examined for "off-label" pediatric use in nongenital warts, molluscum contagiosum, hemangiomas of infancy, and basal cell carcinoma. Finally, "off-label" use of intravenous Ig has been evaluated for the life-threatening dermatoses Stevens-Johnson syndrome and toxic epidermal necrolysis.


CONCLUSIONS
In the absence of larger controlled trials, pediatricians must consider the cumulative weight of smaller studies with their personal experience when assessing any role for "off label" therapy. The recent literature reviewed herein will facilitate such assessments of the non-steroid topical immune modifiers tacrolimus, pimecrolimus, and imiquimod as well as intravenous immunoglobulin.
Department of Pediatrics, Children's Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington 98105, USA.
Robert
R
Sidbury
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000634:Aminoquinolines / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D003876:Dermatitis, Atopic / Q000188:drug therapy; D006391:Hemangioma / Q000188:drug therapy; D006801:Humans; D000077271:Imiquimod; D007136:Immunoglobulins / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008976:Molluscum Contagiosum / Q000188:drug therapy; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D012871:Skin Diseases / Q000188:drug therapy*; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014820:Vitiligo / Q000188:drug therapy; D014860:Warts / Q000188:drug therapy
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D007136:Immunoglobulins; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D000077271:Imiquimod; D016559:Tacrolimus