Did you know that children with psoriasis may be eligible for the BADBIR study?
Since October 2015, BADBIR has been accepting enrolment of paediatric patients with psoriasis.
As these patients are being exposed to immunosuppressive therapy on a comparatively immature immune system, it is important that the long term safety is evaluated. In addition, there is potentially a high lifetime exposure to these therapies which may place them at a higher risk than adults.
Currently BADBIR’s recruitment total for participants is only around 30 registrations across the whole of the U.K. and Ireland with just 16 centres contributing. We understand that it is possible that you are not necessarily managing these patients in your clinics but please could you liaise with colleagues to explore the feasibility of registering these eligible patients.
Full details of the eligibility criteria for paediatric patients on BADBIR can be found at http://www.badbir.org/Clinicians/Eligibility/
If you require any assistance or advice please contact the BADBIR study team at firstname.lastname@example.org or on 0161 306 1896.
‘We are delighted to announce the launch of the Lichen Sclerosus Priority Setting Partnership!
Do you have unanswered questions about lichen sclerosus? The Lichen Sclerosus Priority Setting Partnership is an opportunity to influence future research for lichen sclerosus in women, men and children. We are asking people with experience of lichen sclerosus, as a patient, parent, carer, partner or health professionals involved in the care of people with lichen sclerosus, to complete a short survey and give us your views. The survey is open throughout September 2017 and it will take no longer than 10 minutes to complete. This survey is part of an initiative between the University of Nottingham, The British Society for the Study of Vulval Disease and the James Lind Alliance.
Prevalence of Headlice in Children
A single centre trial is currently being conducted in the paediatric outpatient department at the John Radcliffe Hospital in Oxford. The study uses an anonymised questionnaire and aims to determine the prevalence of headlice in all children attending the outpatient department. The study also aims to highlight whether there is an associated link between prevalence and increased social media use. The questionnaire also addresses the currently identified confounding factors for headlice ; family size, socioeconomic status and hair length. For further information, please contact Dr Tess McPherson at email@example.com.
Vitiligo is a skin condition which causes white patches to develop on the skin. Although the condition does not cause any physical symptoms, it can have a considerable impact on quality of life and psychological wellbeing.
There is still a lot of uncertainty regarding the best treatments for the condition. Most of the clinical trials of treatments for vitiligo have been very small and it is difficult to know which treatments work best.
The HI-Light Vitiligo Trial aims to provide information on the effectiveness of topical corticosteroid (mometasone furoate 0.1% ointment) versus (i) home-based narrowband UVB (NB-UVB) light, delivered using a hand-held unit and (ii) the combination of topical corticosteroid and home-based NB-UVB light therapy, in the management of early and limited vitiligo in children and adults. The trial will also assess whether and improvement in the vitiligo is maintained once the intervention is stopped, and it will compare the cost-effectiveness of the treatments.
This is a multi-centre (recruiting across 16 UK sites); 3-arm (participants are allocated to one of three possible treatment groups); placebo-controlled (participants will use a light unit and ointment, up to one of which may be a placebo); double-blind (participants and investigators will be unaware of which treatments the participants are using); randomised (participants are allocated to treatment groups at random) trial.
Recruitment to the trial commenced in July 2015 and will continue to the autumn of 2016. We are seeking to recruit a total of 440 participants into the trial, each of whom will participate in the trial for a total of 21 months (9 months of treatment and 12 months of follow-up). Participants must be aged 5 years and above, with vitiligo affecting up to 10% of the total area of their skin, and the vitiligo must have appeared or changed within the last 12 months.
To find out more or to express an interest in participating in the trial, please click on this link: http://www.nottingham.ac.uk/research/groups/cebd/projects/2vitiligo/vitiligo-maintrial.aspx
The HI-Light Vitiligo trial is funded by the National Institute for Health Research’s HTA Programme (project number 12/24/02) to inform NHS care.
The trial is being co-ordinated through the Nottingham Clinical Trials Unit. The trial sponsor is the University of Nottingham.
The views and opinions expressed herein are those of the HI-Light Vitiligo Trial Management team and do not necessarily reflect those of National Institute for Health Research’s HTA Programme, NIHR, NHS or the Department of Health.
‘SKINS’ – a qualitative project for Healthtalk on young people and skin conditions
‘SKINS: an online resource for young people with common skin conditions (acne, alopecia, eczema, psoriasis)’ is a qualitative research project being undertaken the Health Experiences Research Group at the University of Oxford. The project involves conducting semi-structured interviews with young people aged 12-24 years old, who live in England and have (or have previously had) acne, alopecia, eczema or psoriasis. The research will help us find out what is important to young people faced with skin conditions and identify how best to offer information and support. To date, we have completed 97 interviews and are in the process of compiling analysed material for www.healthtalk.org. This award-winning website links video and audio clips of patients’ experiences with evidence-based information about the illness and treatment options. The website is run by the DIPEx charity and allows visitors to watch, listen to and read people’s accounts of their experiences of health and illness. In addition to building a valuable resource for supporting young people with skin conditions, the research will be used in the training and teaching of medical students and other healthcare professionals. The new skin condition sections on www.healthtalk.org will be reviewed in Autumn 2016, and launched soon after.
International study shows that propranolol is a safe and effective treatment for complicated infantile haemangiomas:
An infantile haemangioma is a harmless overgrowth of blood vessels in the skin. When infantile haemangiomas are superficial, then they often look a bit like a strawberry, hence the alternative term ‘strawberry naevus’. They are common and affect about 1 in 20 babies. Typically, a small red mark is present at birth or develops in the first weeks of life. This often rapidly increases in size over a number of months. Usually after 6-9 months the increase in size slows, and the haemangioma then shrinks over several years.
Around 20% of infantile haemangiomas need medical attention due to complications, for instance bleeding, ulceration or if they interfere with feeding or the development of normal vision.
Propranolol (a type of drug called a beta-blocker) given by mouth is now the first choice when haemangiomas cause complications. The study led by Dr Carsten Flohr from the Paediatric Dermatology Department at St John’s Institute of Dermatology, Guy’s & St Thomas’ NHS Foundation Trust, examined data from 1097 patients across eight European countries who had treatment of an infantile haemangioma with oral propranolol to see why treatment was started, whether it was effective and also whether the treatment caused any side effects. The three main indications for treatment were because the tumour was near the eye and threatened vision’ (29.3%), risk of cosmetic disfigurement on the face (21.1%) and ulceration and bleeding (20.6%). Treatment response was overall excellent and side effects were rare and usually mild.
Phototherapy (ultraviolet light treatment) in children with moderate to severe eczema
Phototherapy (light treatment) in the form of narrowband ultraviolet B is effective for controlling moderate to severe eczema
Eczema commonly affects children and it is associated with a marked disturbance in their quality of life including constant itch and sleep disturbance. Caring for a child with severe eczema can have as much impact on a family as caring for a child with type 1 diabetes. A treatment option for children with moderate to severe eczema includes phototherapy (light treatment) but little has been done previously to see how effective it is.
In Newcastle upon Tyne we studied children aged 3-16 years who needed phototherapy for their moderate or severe eczema. The severity of their eczema was scored using standard measures which included looking at quality of life, how itchy/scratchy they felt and sleep disturbance. The eczema was scored before treatment, during treatment and at the end of the treatment course (treatments are given twice weekly for 12 weeks). It was also scored 3 and 6 months after treatment to see how quickly the eczema came back. These children’s scores were compared to a control group. The control group was made up of children who were prescribed phototherapy for their moderate or severe eczema, but who chose not to have treatment for whatever reason (which varied from parents’ anxiety about skin cancer risk, phobia of the cabinet, to travelling difficulties). Children in the control group also had their eczema scored at baseline and 12 weeks. In both groups topical treatment in the form of creams and ointments was optimised and continued, including emollients, steroids or tacrolimus (the latter not used at the same time as phototherapy).
Thirty-four children in the phototherapy group were compared to 26 in the control group. The average age was 9 years. Overall, there was a 63% decrease (or improvement) in scores in the children in the phototherapy group compared with a deterioration of 14% in the control group. The difference in scores between the two groups was statistically significant. Subjective and quality of life scores also showed significant difference between the phototherapy group and controls at the end of treatment (P< 0.0001 for all). The average scores were still significantly lower than at baseline 3 and 6 months after finishing phototherapy. Overall, phototherapy resulted in considerable reduction in total disease activity in children with moderate to severe atopic eczema as compared to a control group.
(This study was supported by a small grant from the British Skin Foundation)
Darné, S., Leech, S.N. and Taylor, A.E.M. (2014), Narrowband ultraviolet B phototherapy in children with moderate-to-severe eczema: a comparative cohort study. British Journal of Dermatology, 170: 150–156. doi: 10.1111/bjd.12580