Pediatric Unit

Staff:

Arti Nanda
(Consultant) and Head of Unit

Rana El-Noon (Registrar)

Abdalla El-Arini (Registrar)

 

Some Diseases Photos from Pediatric Unit:

Epidermolysis Bullosa

Childhood Psoriasis

    Childhood Eczema

Childhood Alopecia Areata

 First Pediatric Dermatology Unit  in Kuwait was started in July 1992. We started with one clinic in a week and now we have established a full fledged Pediatric Dermatology Unit in our center and this unit was first of its kind in The Gulf States. The activities of the unit include:

1.                  General Pediatric Dermatology clinics (Since July 1992) - (4 to 5 in number) run through out the week to provide care to children with common skin ailments from our catchment area.

2.                Sick-kids clinic (Since January 2000) - once weekly to provide specialized tertiary care services to children with rare, and serious skin ailments referred from all over the Kuwait by various dermatologists, pediatricians and pediatric subspecialists.

3.       Genodermatoses  Once weekly to provide specialized diagnostic and  management care for such case. It is a unique specialty clinic in the region.

4.                  Teaching of Pediatric Dermatology to:

a.       Undergraduates (since 1993)

b.      Pediatric Postgraduates (Kuwait Board Pediatrics) (since 1994)

c.       Dermatology Postgraduates (Kuwait Board Dermatology) (since 2003)

5.                  Clinical & investigative research in collaboration with various International and National organizations.

During the last 17 years, significant observations have been made in the following fields of Pediatric Dermatology:

  1. Spectrum of Skin Diseases among Children in Kuwait: A prospective survey under which 10,000 consecutive new referrals to our general Pediatric Dermatology clinics were studied to understand the spectrum of Pediatric Dermatology problems in Kuwait.
  2. Childhood Psoriasis: Two large prospective clinicoepidemiological surveys and few investigative & therapeutic surveys on childhood psoriasis were conducted
  3. Alopecia Areata in Children: We studied the clinicoepidemiological features, associated thyroid abnormalities and HLA phenotyping of alopecia areata children from Kuwait.
  4. Dermatophytic Infections: In order to study the spectrum of dermatophytic infections in children in Kuwait, two large (one retrospective and one prospective) surveys were carried out.
  5.  Miscellaneous: We have also carried out prospective/ retrospective studies on some other important skin disorders including childhood lichen planus, linear IgA disease of childhood, pityriasis rosea, and diaper dermatitis.
  6. Sick-kids Clinic: Most of the referrals in this clinic are genodermatoses. Due to consanguinity being prevalent in this region, autosomal recessive disorders are more common.  Among other diseases, connective tissue diseases including SLE constitute a significant group. Our main concern in this clinic is to provide appropriate diagnosis and treatment to these children. Some of our interesting observations from this clinic have already been reported. We had collaborated with the various international genetic centers for identification of gene for lipoid proteinosis, infantile systemic hyalinosis, and cutis laxa/wrinkly skin syndrome. We are currently focusing on clinical care and genetic counseling of our patients with genetic skin disorders.

 CME Activities:

1.                  1st Pediatric Dermatology Symposium, held in Kuwait in Collaboration with International experts. (April 8-12, 2006)

2.                  2nd Pediatric Dermatology Symposium, held in Kuwait in Collaboration with International experts. (March 16-18, 2009)

3.                  1st Genodermatoses Symposium, held in Kuwait in Collaboration with International experts. (November 28-December 1, 2004)

Distinguished International Faculty Invited by the Ministry of Health/KIMS for CME Activities & Clinical Update of Pediatric Dermatology have included:  

1.                  Prof. Bernice Krafchick, Head of Pediatric Dermatology, Toranto University, Canada (2001)

2.                  Prof. John McGrath, Head of Genetic Skin Diseases, St. John?s Institute of Dermatology & Guy?s Hospital, London (2004, 2005, 2006)

3.                  Prof. Ahmed Teebi, Head of Genetics, Pediatric Department, Toranto University, Canada (2004)

4.                  Prof. David Atherton, Consultant Pediatric dermatologist, Great Ormond Street Hospital, London (2006)

5.                  Prof. Alain Taeib, Head of Pediatric Dermatology, Bordeaux, France (2006)

6.                  Prof. Rudolf Happle, Department of Dermatology, Philipp University of Marburg, Germany, (2009)

7.                  Prof. Ramon Grimalt, Ex-President, European Society of Pediatric Dermatology, University of Barcelona, Spain (2009)

8.                 Prof. Dott. Carlo Gelmetti, Director, Institute Di Scienze Dermatologiche, Dell University, Milan, Italy  (2009)

9.                  Prof. Daniel Hohl, Professor and Deputy Chairman,  Service de Dermatologie et V鮩r鯬ogie CHUV, H?al de Beaumont, Switzerland (2009)

10.              Dr. Alicia Mirada, Consultant Pediatrician and Neonatologist, Hospital Muta de Terrassa, Barcelona, Spain (2009)

 

Guidelines of Care of Epidermolysis Bullosa (EB) Cases in our Center:

Diagnosis of an EB Case:

A detailed clinical history, examination, and investigations are recorded for each case registered as EB in our Sick-kids clinic

  1. Clinical Data:

a.                   Birth history/antenatal history of mother

b.                  First appearance of blisters

c.                   Family history/pedigree/presence or absence of consanguinity

d.                  Presence/absence of scarring/milia/pigmentary abnormalities

e.                   Associated abnormalities: Mucosae/nails/teeth/hair/palms & soles/systemic

f.                    Photosensitivity

g.                   Sequlae

h.                   Developmental parameters

i.                     Appearance of new abnormal skin lesions

  1. Skin Biopsy:

a.                   Electron Microscopy

b.                  Immunofluorescence/immunohistochemical antigen mapping

  1. Routine Investigations:

a.                   Complete blood counts

b.                  Serum biochemistry

c.                   Skin swabs: culture & sensitivity

d.                  Urinalysis

e.                   Others as indicated

  1. Mutational Screening*: for responsible gene

 Final Diagnosis: (Classification adapted from – Fine J-D et al. J Am Acad Dermatol 2008; 58: 931-50)

a.                   EB-Simplex

                  Suprabasal

                  Basal

b.                  EB-Junctional

                  Herlitz

                  Others

c.                   EB-Dystrophic

                  Dominant

                  Recessive

d.                  Kindler’s Syndrome

 

Management: Treatment needs to be tailored according to EB subtype

  1. Skin care:

                  i. Avoidance of friction/trauma

      ii. Gentle skin handling

      iii. Appropriate clothing

      iv. Wound Care:

                  Antiseptic cleaning

                  Specialized wound dressings: Mepital/Mepiplex

 

  1. Antibiotics: Periodic use of topical/systemic antibiotics as indicated

 

  1. Nutritional supplements:

a.                   High protein diet

b.                  Proteins/multivitamins/iron/calcium/magnesium/zinc supplements as indicated

 

  1. Multidisciplinary Approach: Patient’s referral are arranged to different sub-specialties as indicated:

a.                   Dentist

b.                  Gastroenterologist

c.                   Plastic surgeon

d.                  Pediatrician

e.                   Dietician

f.                    Others as indicated

  1. Genetic Counseling:  Based on type of EB after the final diagnosis has been reached

 

For having more details about the observations made in Pediatric Dermatology Unit over the last 17 years, kindly refer to:

1.                  Reversade B, Escande-Beillard N, Dimopoulou A, Fischer B, Chng SC, Li Y, Shboul M, Tham PY, Kayserili H, Al-Gazali L, Shahwan M, Brancati F, Lee H, O'Connor BD, Schmidt-von Kegler M, Merriman B, Nelson SF, Masri A, Alkazaleh F, Guerra D, Ferrari P, Nanda A, et al. Mutations in PYCR1 cause cutis laxa with progeroid features. Nat Genet 2009; 41: 1016-21.

2.                  Nanda A. Autoimmune Diseases Associated with Neurofibromatosis Type 1 (NF1). Pediatr Dermatol 2008: 25: 392-3.

3.                  Nanda A, Alsaleh QA, Al-Sabah H, Marzouk EE, Salam AMA, Nanda M and Anim JT. Gerodermia osteodysplastica (GO)/ wrinkly skin syndrome (WSS): report of three cases and brief review of literature. Pediatr Dermatol 2008; 25:66-71.

4.                  Arita K, Nanda A, Wessagowit V, Akiyama M, Alsaleh QA, McGrath JA. A novel mutation in the VDR gene in hereditary vitamin D-resistant rickets.  Br J Dermatol 2008; 158: 168-171.

5.                  Nanda A, Nanda M, Dvorak R, Al-Sabah H, Alsaleh QA. Bullous pemphigoid (BP) in an infant complicated by tuberculous meningoencephalitis. Int J Dermatol 2007; 46: 964-966.

6.                  Nanda A, Dvorak R, Al-Sabah H, Alsaleh QA. Linear IgA bullous disease (LABD) of childhood: An experience from Kuwait. Pediatr Dermatol 2006; 23: 443-447.

7.                  Nanda A, Dvorak R, Al-Sabah H, Madda JP, Anim JT, Alsaleh QA. Association of linear IgA bullous disease (LABD) of childhood with Crohn?s disease. Int J Dermatol 2006; 45: 1184-1186.

8.                  Chuh A, Molinari N, Sciallis G, Harman M, Akdeniz S, Nanda A. Temporal case clustering in pityriasis rosea. A regression analysis on 1379 patients in Minnesota, Kuwait, and Diyarbakir, Turkey. Arch Dermatol 2005; 141: 767-771.

9.                  Alsaleh QA, Nanda A, Baker H, Al-Sabah H, Calonje E. Unilesional (segmental) mycosis fungoides presenting in childhood. Pediatr Dermatol 2004; 21: 558-560.

10.              Nanda A, Lionel J, Al-Tawari AA, Anim JT. What syndrome is this? Autosomal recessive type II cutis laxa (CL). Pediatr Dermatol 2004; 21: 167-170.

11.              Hasnks S, Adams S, Douglas J, Arbour L, Atherton D, Balci S, Bode H,  Campbell ME, Feingold M,  Keser G, Kleijer W, Mancini G, McGrath JA, Muntoni F, Nanda A, Futreal A, Rehman N. Mutations in capillary morphogenesis protein 2 cause juvenile hyaline fibromatosis and infantile systemic hyalinosis. Am J Hum Genet 2003; 73: 791-800

12.              Nanda A, Alsaleh QA, Al-Hasawi F, Al-Muzairai I. Thyroid function, autoantibodies, and HLA tissue typing in children with alopecia areata. Pediatr Dermatol 2002; 19: 486-491.

13.              Nanda A, Al-Fouzan AS, Al-Hasawi F. Alopecia areata in children: a clinical profile. Pediatr Dermatol 2002; 19: 482-485.

14.              Hamada T, McLean WH, Ramsay M, Ashton GH, Nanda A, et al. Lipoid Proteinosis maps to Iq21 and is caused by mutations in the extracellular matrix protein gene (ECM1). Hum Mol Genet 2002; 11: 833-840.

15.              Nanda A, Al-Saleh QA, Al-Sabah H, Ali AM, Anim JT. Lipoid proteinosis: report of four siblings and brief review of the literature. Pediatr Dermatol 2001; 18: 21-26.

16.              Mansoor Y, Nanda A, Al-Hasawi F, Alsaleh QA. Clinical and microbial spectrum of diaper dermatitis in Kuwait. Gulf J Dermatol 2001; 8: 23-27.

17.              Nanda A, Al-Ajmi H, Al-Sabah H, Al-Hasawi F, Alsaleh QA. Childhood lichen planus: a report of 23 cases. Pediatr Dermatol 2001; 18: 1-4.

18.              Nanda A, Al-Fouzan AS, El-Kashlan M, Al-Sweih N, Al-Muzairai I. Salient features and HLA markers of childhood psoriasis in Kuwait. Clin Exp Dermatol 2000; 25: 147-151.

19.              Nanda A, Al-Hasawi F, Alsaleh QA. A prospective survey of pediatric dermatology clinic in Kuwait: an analysis of 10, 000 cases. Pediatr Dermatol 1999; 16: 6-11.

20.              Alsaleh QA, Nanda A, Al-Hasawi F, Al-Sabah H, Bang RL. Trachyonychia caused by lichen planus: report of four cases. Kwt Med J 1999; 31: 387-390.

21.              Nanda A. Concomitance of psoriasis and atopic dermatitis. Dermatol 1995; 191: 72.

22.              Alsaleh QA, Nanda A, Al-Hasawi F, El-Kashlan M. Concurrent appearance of alopecia areata in siblings. Pediatr Dermatol 1995; 12: 285-286.

23.              Al-Fouzan AS, Nanda A. UVB phototherapy in childhood psoriasis. Pediatr Dermatol 1995; 12: 66.

24.              Al-Fouzan AS, Nanda A. A survey of childhood psoriasis in Kuwait. Pediatr Dermatol 1994; 11: 116-119.

25.              Alsaleh QA, Nanda A, El-Nabi HMMH,  Sakr MF. Familial inflammatory linear verrucous epidermal nevus (ILVEN). Int J Dermatol 1994; 33: 52-54.

26.              Al-Fouzan AS, Nanda A, Kubec K. Dermatophytoses of children in Kuwait: a prospective survey. Int J Dermatol 1993; 32: 798-801.

27.              Al-Fouzan AS, Nanda A. Dermatophytoses of children in Kuwait. Pediatr Dermatol 1992; 9: 127-130.

28.              Al-Fouzan AS, El-Naby HMMH, Nanda A. Congenital linear psoriasis. Pediatr Dermatol 1990; 7: 303-306.
   

Back