Publications by authors named "Lucia Z Diaz"

18 Publications

  • Page 1 of 1

Depigmented patches in a child.

JAAD Case Rep 2021 Apr 2;10:8-10. Epub 2021 Feb 2.

Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas.

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http://dx.doi.org/10.1016/j.jdcr.2021.01.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935687PMC
April 2021

Ulcerated plaques on the hands.

Pediatr Dermatol 2021 Jan;38(1):e7-e9

Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.

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http://dx.doi.org/10.1111/pde.14432DOI Listing
January 2021

Hidradenitis Suppurativa in the Pediatric Population: An International, Multicenter, Retrospective, Cross-sectional Study of 481 Pediatric Patients.

JAMA Dermatol 2021 Feb 24. Epub 2021 Feb 24.

Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada.

Importance: Hidradenitis suppurativa (HS) in pediatric patients has been understudied. Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition.

Objective: To describe the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with HS.

Design, Setting, And Participants: International, multicenter, retrospective medical record review of pediatric patients (aged 1-18 years) with a clinical diagnosis of HS carried out in 10 dermatology clinics across the US, Canada, Israel, Australia, and Italy from January 1996 to January 2017.

Main Outcomes And Measures: Patient demographics, clinical features, severity, associated comorbidities, and treatments in pediatric patients with HS.

Results: This cross-sectional study included 481 patients diagnosed with HS. Overall, 386 (80%) were girls. The mean (SD) age of disease onset was 12.5 (2.9) years, and the mean (SD) age at diagnosis was 14.4 (3.5) years. Family history of HS was present in 111 of 271 (41%) patients. First signs/symptoms reported at disease onset were cyst/abscess in 229 of 481 (48%), pain/tenderness in 118 of 481 (25%), and papules/pustules in 117 of 481 (24%). At initial dermatologic assessment, 233 of 481 (48%) patients already had evidence of skin scarring. Disease severity (Hurley staging) was documented in 288 of 481 (60%) patients (47% stage 1, 45% stage 2 and 8% stage 3). Comorbid conditions were reported in 406 of 481 (85%) patients, the most common being obesity (263/406 [65%]) and acne vulgaris (118/406 [29%]). Complications occurred in 378 of 481 (79%) patients, the most common of which were scars or contractures (301/378 [80%]).

Conclusions And Relevance: The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS. Pediatric patients with HS are likely to present with other comorbidities. Prospective observational and interventional studies are needed to better understand clinical course and optimal treatments for pediatric HS.
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http://dx.doi.org/10.1001/jamadermatol.2020.5435DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905696PMC
February 2021

Quality of life in hidradenitis suppurativa: A cross-sectional study of a pediatric population.

J Am Acad Dermatol 2021 Mar 1;84(3):829-830. Epub 2020 Oct 1.

Department of Medicine, Division of Dermatology, University of Texas at Austin-Dell Medical School, Austin, Texas; Department of Pediatrics, University of Texas at Austin-Dell Medical School, Austin, Texas.

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http://dx.doi.org/10.1016/j.jaad.2020.09.072DOI Listing
March 2021

Visual Diagnosis: Eosinophilia as a Clue to the Diagnosis of Infantile Bullous Pemphigoid.

Pediatr Rev 2020 Sep;41(9):e34-e36

Department of Internal Medicine (Dermatology) and.

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http://dx.doi.org/10.1542/pir.2018-0115DOI Listing
September 2020

Off-label use of dupilumab for pediatric patients with atopic dermatitis: A multicenter retrospective review.

J Am Acad Dermatol 2020 Feb 10;82(2):407-411. Epub 2019 Oct 10.

Saint Louis University, Department of Dermatology, St. Louis, Missouri.

Background: Atopic dermatitis (AD) is a common, chronic type 2 inflammatory skin disease, typically starting in infancy, with increased risk for subsequent extracutaneous atopic morbidities. Dupilumab is the first biologic agent targeting type 2 inflammation approved by the U.S. Food and Drug Administration (USFDA); it was licensed in 2017 for adults with moderate to severe AD and 2 years later for adolescents. Systemic treatment for pediatric AD remains a significant unmet medical need.

Objective: To analyze off-label use of dupilumab in children with AD.

Methods: Multicenter retrospective review that evaluated children who were prescribed dupilumab for moderate to severe AD.

Results: One hundred eleven of 124 patients (89.5%) gained access to dupilumab after a mean of 9 weeks. The dosing range was 4 to 15.5 mg/kg for the loading dose and 2.0 to 15.3 mg/kg every other week for maintenance. The range was widest for 6- to 11-year-olds and was related to use of either full or half of adult dosing. Associated morbidities, treatment response, and adverse events were comparable to those in previous adolescent and adult trials.

Limitations: The retrospective design of the study limited uniform data collection.

Conclusion: Access to dupilumab was achievable for the majority of children after a mean 9-week delay because of insurance payment denial. This review supports dupilumab response and tolerability in children. Optimal dosing for patients younger than 12 years has not been defined. Availability of the drug in 2 different concentrations is an important safety issue.
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http://dx.doi.org/10.1016/j.jaad.2019.10.010DOI Listing
February 2020

Pediatric trichotillomania: Review of management.

Pediatr Dermatol 2019 Nov 6;36(6):803-807. Epub 2019 Oct 6.

Dell Children's Medical Center, Austin, Texas.

Trichotillomania can present in childhood, with many families seeking initial evaluation by a dermatologist for hair loss. Prompt and accurate diagnosis by dermatologists is crucial, as children can suffer from academic or social impairments as well as mental health sequelae. Children are especially vulnerable to lasting psychological distress from appearance-related bullying. This article reviews the psychosocial impacts of pediatric trichotillomania and the current interventions studied in this population. Included are studies evaluating behavioral therapies as well as pharmacologic options. This review highlights the importance of early and appropriate identification, intervention, and the need for more treatment studies in the pediatric population.
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http://dx.doi.org/10.1111/pde.13954DOI Listing
November 2019

Efficacy and patient opinion of wet-wrap dressings using 0.1% triamcinolone acetonide ointment vs cream in the treatment of pediatric atopic dermatitis: A randomized split-body control study.

Pediatr Dermatol 2019 Jul 14;36(4):437-441. Epub 2019 Apr 14.

Dell Children's Medical Center, Austin, Texas.

Background: Wet wraps can be an effective means of improving atopic dermatitis (AD). Little research has been done regarding the comparative efficacy of topical steroid vehicles and patient preference.

Objective: This study aimed to compare the efficacy of 0.1% triamcinolone acetonide ointment vs cream used with wet wraps in pediatric patients with AD and to explore patient preference/opinion.

Methods: We performed a small, randomized, investigator-blind prospective study of 39 pediatric patients experiencing symmetric, bilateral AD flares. Patients were instructed to apply a topical steroid cream to one extremity and apply the same topical steroid in an ointment vehicle to the other extremity using the wet-wrap technique once or twice daily for 3 to 5 consecutive days. Patients were evaluated at a follow-up visit.

Results: Comparison of the change in Investigator's Global Assessment scores disclosed no significant difference between efficacy ratings of cream (mean difference = 0.72) and ointment (mean difference = 0.59) when used with wet wraps (P = 0.22). Although patients found the ointment more difficult to apply, they were more likely to prefer ointments for future prescriptions (P < 0.01).

Conclusion: Patient preference of corticosteroid vehicle is what should ultimately drive treatment. In this small study, we found no difference in efficacy between triamcinolone acetonide wet wraps with cream vs ointment. Dermatologists should select the vehicle of the patient's choice as it may increase satisfaction with treatment.
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http://dx.doi.org/10.1111/pde.13830DOI Listing
July 2019

Management of a neonate with diffuse cutaneous mastocytosis: Case report and literature review.

Pediatr Dermatol 2019 Jul 3;36(4):486-489. Epub 2019 Mar 3.

Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin, Austin, Texas.

Mastocytosis is an accumulation of clonal mast cells within tissues, commonly caused by mutations in the KIT proto-oncogene. This report describes the management of a neonate with diffuse cutaneous mastocytosis (DCM) caused by a rare activating KIT mutation, specifically internal tandem duplication of the Ala502Tyr503 pair on exon 9, and reviews current data regarding work-up of DCM in pediatric patients.
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http://dx.doi.org/10.1111/pde.13801DOI Listing
July 2019

Use of psychologic strategies to reduce pain and anxiety related to dermatology procedures.

Pediatr Dermatol 2019 May 10;36(3):416-417. Epub 2019 Feb 10.

Dell Children's Medical Center, Austin, Texas.

The fear of painful procedures is at an increased incidence within the pediatric population. This can be an extremely challenging obstacle in dermatology where injections, blood draws, and cryotherapy are often required during the care of patients. Psychologic techniques based on cognitive behavioral therapy (CBT) can be implemented leading up to and while performing these procedures to help reduce patient anxiety.
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http://dx.doi.org/10.1111/pde.13739DOI Listing
May 2019

A New Dark Skin Lesion in a 3-Year-Old Undergoing Induction Therapy for Acute Lymphoblastic Leukemia.

JAMA Oncol 2018 11;4(11):1607-1608

Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin.

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http://dx.doi.org/10.1001/jamaoncol.2018.2086DOI Listing
November 2018

Caring for Pediatric Patients With Epidermolysis Bullosa in the Emergency Department.

Pediatr Emerg Care 2019 Aug;35(8):579-584

Department of Internal Medicine (Dermatology), Dell Medical School at The University of Texas at Austin.

Epidermolysis bullosa (EB) refers to a heterogeneous group of genetic disorders characterized by epithelial fragility. We provide guidelines for management of pediatric patients with EB in the emergency department based on a review of literature, as well as insights from our own experiences caring for patients with EB. The purpose of the guidelines proposed is prevention of avoidable iatrogenic trauma to the skin and mucosa of patients with EB who are presenting to the emergency department for a variety of reasons.
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http://dx.doi.org/10.1097/PEC.0000000000001500DOI Listing
August 2019

Hyper-immunoglobulin D syndrome with novel mutations in an afebrile infant.

Pediatr Dermatol 2018 Jul 30;35(4):482-485. Epub 2018 Mar 30.

Department of Medicine, Dell Medical School, University of Texas, Austin, TX, USA.

Hyper-immunoglobulin D syndrome is a rare autosomal-recessive autoinflammatory syndrome in which a mevalonate kinase deficiency results due to mutations of the mevalonate kinase gene. We report a case of an Asian male infant who was found to have hyper-immunoglobulin D syndrome in the absence of fever. His skin manifestations included cephalic pustulosis as well recurrent transient and fixed pink plaques and nodules on the face and extremities. Subsequent examination revealed hyper-immunoglobulin D syndrome with two novel allelic mutations in the mevalonate kinase gene: c.895G > A (p.D299N) and c.1168C > T (p.Q390). It is important for dermatologists to recognize the varied cutaneous presentations of hyper-immunoglobulin D syndrome because rapid diagnosis and treatment can significantly affect outcomes.
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http://dx.doi.org/10.1111/pde.13488DOI Listing
July 2018

Dermatofibrosarcoma protuberans in pediatric patients: A diagnostic and management challenge.

JAAD Case Rep 2018 Mar 16;4(2):155-158. Epub 2018 Jan 16.

Department of Pediatrics and Medicine, Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, Texas.

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http://dx.doi.org/10.1016/j.jdcr.2017.09.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789519PMC
March 2018

Adams-Oliver Syndrome Type 2 in Association with Compound Heterozygous DOCK6 Mutations.

Pediatr Dermatol 2017 Sep;34(5):e249-e253

Dell Medical School, Dell Children's Medical Center, University of Texas at Austin, Austin, Texas.

Adams-Oliver syndrome (AOS) is a multiple congenital anomaly syndrome characterized by aplasia cutis congenita (ACC) and transverse terminal limb defects (TTLDs). We present a case of type 2 autosomal recessive AOS associated with heterozygous mutations in the dedicator of cytokinesis 6 (DOCK6) gene, with characteristic findings of ACC, TTLD, intracerebral periventricular calcifications, and polymicrogyria.
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http://dx.doi.org/10.1111/pde.13239DOI Listing
September 2017

Incontinentia Pigmenti.

J Pediatr 2016 Sep 24;176:218-218.e1. Epub 2016 Jun 24.

Dell Medical School at The University of Texas at Austin, Austin, Texas; Dell Children's Medical Center of Central, Austin, Texas.

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http://dx.doi.org/10.1016/j.jpeds.2016.05.081DOI Listing
September 2016

Complications of ichthyosis beyond the skin.

Dermatol Ther 2013 Jan-Feb;26(1):39-45

Department of Dermatology, University of Texas Health Science Center-Houston, Houston, TX 78723, USA.

Although ichthyoses are noted for their skin features, like many dermatologic conditions, patients are often impacted in ways beyond the skin. Much has been described in recent years regarding quality of life and skin disorders. This is certainly the case for ichthyosis. For neonates or others with diffuse involvement of their skin, nutritional needs are often exceeding normal requirements. These can often result in growth abnormalities. Lastly, with specific subtypes of ichthyosis, compromise of tissues around the eyes and ears can be of concern to some patients. Certainly, some forms of ichthyosis are routinely complicated by such findings. It is important for practitioners caring for individuals with ichthyosis to have these issues in mind.
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http://dx.doi.org/10.1111/j.1529-8019.2012.01517.xDOI Listing
August 2013