PeDRA

Pediatric Dermatology Research Alliance

Skin Tumors and Reactions to Cancer Therapies

Dilute bleach compresses to reduce the severity of radiation dermatitis in children with cancer

By

Principal Investigator

Amy Paller, MD

Overview

Many years ago, we were able to show that dilute bleach baths reduce the severity of pediatric atopic dermatitis. This simple and inexpensive technique is now standard-of-care and has benefitted children worldwide. T. Leung showed that this same concentration of bleach has a direct anti-inflammatory effect on keratinocytes and reduces radiation dermatitis severity in a mouse model. Radiation dermatitis remains an issue for children (and adults) treated with irradiation for cancer. We propose a double-blind study of bleach compresses vs. water to reduce the severity in cancer patients. This study will be a two-site study at Northwestern/Lurie Children’s (Paller, Vivar, Yun, etc) and Harvard/Boston’s Children’s (Huang). We envision starting the compressing 1-week before and continuing daily during the danger period (several weeks). We have joined forces with radiation oncologists at both sites already and hope to recruit approximately equal numbers of patients at both sites. Parallel studies in children and adults will be performed.

Status

Protocol development is underway.

This project received a 2019 PeDRA Study Support Grant to develop a power analysis and the statistical plan for analysis at the end of the study utilizing an in-house statistician at Northwestern University.

Patient education for children at risk for skin cancer

By

Principal Investigator:

Carrie Coughlin, MD – Washington University School of Medicine

Overview:

Though children are at risk for skin cancer and cutaneous complications of immunosuppressive therapy, there is a paucity of pediatric-specific educational materials.  Moreover, there are no materials produced by dermatologists and vetted by clinicians from multiple institutions to educate pediatric patients and their parents. 

In collaboration with the Society for Pediatric Dermatology and American Academy of Pediatrics, this project produced a general information sheet applicable to immunosuppressed/at risk children.  Additional educational materials for at-risk subgroups will be created in future, with the goal of partnering with research and clinical groups who are involved with these populations.  Over time, we aim to become the primary source for information about skin complications/care/screening.

Status:

An educational handout was published in Pediatric Dermatology in 2017. Work continues on additional educational materials

Melanoma and nonmelanoma skin cancer in children and young adults

By

Co-Principal Investigators:

Jen Huang, MD – Harvard Medical School and Larry Eichenfield, MD – UCSD

Overview:

This study is a collaboration of 10 major hospitals across the country with the unified goal of improving our understanding of skin cancer in children.  It is a multi-center retrospective case controlled study of all children < 20 years of age with the diagnosis of melanoma or nonmelanoma skin cancer (NMSC) over a 20 year period from 1995 to 2015.  We aimed to characterize the clinical and histopathologic features of melanoma and NMSC in children and to identify risk factors associated with development of these skin cancers, including exposure to chemotherapeutic agents, radiation therapy, immunosuppressive medications, and photosensitizing agents. 

The major goal of the study is to understand what risk factors are associated with development of melanoma and NMSC in children and young adults.  There have been no prior studies addressing this question.  By achieving our study goal, we hope to improve guidelines for skin cancer screening for children.

Status:

One publication in print – Huang, et al., 2019; (see publications page). Analysis is underway for additional publications.

This project received a 2019 PeDRA Study Support Grant to fund a biostatistician at Boston Chidren’s Hostpial to assist in the final stages of data analysis and provide support as abstracts and manuscripts are prepared.

Fatal Pediatric Melanoma Retrospective Study

By

Principal Investigator:

Elena Hawryluk, MD, PhD – Massachusetts General Hospital

Overview:

Pediatric dermatologists have a strong interest in better understanding pediatric nevi and characterizing melanoma; the diagnostic challenge of pediatric melanomas can delay diagnosis, lead to deeper and more advanced pediatric melanomas, and potentially result in worse outcomes. A coordinated effort among pediatric dermatologists to better understand and collectively describe the clinical features with which patients present to our specialty will allow us to educate and work constructively with colleagues in pediatrics, oncology, pediatric surgery, and adult dermatology, who manage melanoma more frequently. This retrospective study will allow us to describe clinical and histopathologic data associated with a fatal outcome, and ultimately promises to inform clinicians’ management and counseling strategies for melanoma patients and their families.

Status:

This study was funded as a 2017 PeDRA Pilot Grant. One publication in print – Bartenstein, et al., 2018; (see publications page). Additional sites have been added to gather more data and analysis is underway for additional publications.

This project received a 2019 PeDRA Study Support Grant to fund a biostatistician at Boston Chidren’s Hostpial to perform analysis on the additional data gathered, and provide support as abstracts and manuscripts are prepared.

Cutaneous Findings in Children Receiving MEK and BRAF Inhibitors

By

Principal Investigator:

Christina Boull, MD – University of Minnesota

Overview:

This is a multi-center retrospective chart review of pediatric patients who have received MEK inhibitors and/or BRAF inhibitors to better document and describe the associated cutaneous changes. The use of targeted therapies in the MAP kinase pathway for cancer treatment is increasing and it is essential to anticipate and prevent associated skin toxicities to prevent interruption of these cancer therapies.

Status:

Analyzing data.

Chronic Graft versus Host Disease

By

Principal Investigator:

Dominique Pichard, MD – National Institute of Arthritis and Musculoskeletal and Skin Diseases

Overview:

Chronic GVHD is a rare, but often debilitating, condition that occurs after stem cell transplant. The current diagnostic and management guidelines for cGVHD are based on data from adult patients. We recognize that there are likely differences in pediatric GVHD both in the range of morphologic presentation and in special considerations needed for treatment of pediatric patients.

Therefore, a survey created by members of the chronic graft versus host disease (cGVHD) subcommittee of STARC and transplant providers has been sent to members of the Society for Pediatric Dermatology and the Pediatric Bone Marrow & Transplant Consortium to better understand the current practices in the diagnosis and management of cutaneous cGVHD in the pediatric population.

Status:

Analyzing data.