Lin Ma

Kaposiform hemangioendothelioma (KHE) is a rare borderline vascular tumor that occurs primarily during infancy and childhood. The tumor typically originates in the skin and exhibits invasive growth into deeper tissues, often manifesting as a firm, poorly defined purplish‐red mass. Cases of KHE involving visceral organs, including the bone, retroperitoneum, or mediastinum, have also been reported; however, their clinical features are often nonspecific, which may lead to delayed diagnosis. Importantly, these tumors are frequently associated with Kasabach–Merritt phenomenon, a consumptive coagulopathy that represents a major cause of mortality in KHE. Furthermore, tumor location, size, and clinical response to pharmacotherapy are closely associated with patient prognosis. Therefore, early recognition and timely treatment of KHE are essential. This article aims to review the epidemiology, etiology, clinical manifestations, diagnosis, and management of KHE.

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that affects approximately 10% to 20% of children, imposing substantial health and economic burdens. Although education for patients and caregivers is acknowledged as a crucial element in the management of AD, conventional approaches, such as workshops or in-person consultations, are often resource intensive and face challenges related to scalability, personalization, and relapse prevention. Digital tools present promising alternatives; however, empirical evidence supporting their effectiveness in young children is currently limited. Objective: This study aimed to evaluate whether a smartphone-based patient-caregiver educational program could reduce relapse rates in children aged 0 to 6 years with moderate-to-severe AD, compared with conventional outpatient consultation alone. Methods: In this multicenter, randomized, parallel-controlled trial, 615 children were enrolled across 12 tertiary pediatric dermatology centers in China and randomized (1:1) to receive either a smartphone-based digital education program with standard care (intervention group) or conventional face-to-face consultation only (control group). The 12-week digital program, delivered via the WeChat-based Skin Care E-Station platform, included structured multimedia modules, interactive educational materials, and a dynamic electronic action plan tailored to the child’s age and disease stage. The primary endpoint was the 12-week relapse rate after the acute treatment phase. The secondary endpoints included changes in disease severity (Scoring Atopic Dermatitis, Peak Pruritus Numerical Rating Scale, and Patient-Oriented Eczema Measure) and quality of life (Children’s Dermatology Life Quality Index or Infant’s Dermatitis Quality of Life Index and Dermatitis Family Impact) up to 52 weeks. Results: Among 615 randomized participants (mean age 3.3, SD 1.7 y; n=317, 51.5% male), relapse at 12 weeks occurred significantly less frequently in the digital education group than in the control group (16.6% vs 24.0%; relative risk 0.69, 95% CI 0.50‐0.96; P =.02). Kaplan-Meier analysis showed superior relapse-free survival over the first 100 days (hazard ratio 0.688, 95% CI 0.490‐0.966; P =.03). Differences in relapse rates beyond 12 weeks and in secondary outcomes were not statistically significant. Engagement tracking indicated high adherence to the intervention, with 58.0% of caregivers maintaining regular weekly use of the digital platform. Conclusions: A structured smartphone-based patient-caregiver educational intervention significantly reduced short-term relapse risk among young children with moderate-to-severe AD, likely through improved caregiver recognition and early management of disease flares. Although effects diminished beyond 12 weeks, this approach demonstrates that scalable digital education is a feasible and effective adjunct to standard care in pediatric AD. Future research should focus on sustaining engagement, optimizing long-term reinforcement, and assessing cost-effectiveness in diverse caregiver populations.

Purpose: We aimed to investigate alterations in the skin microbiome following treatment and discontinuation of dupilumab in children with atopic dermatitis (AD). Methods: In all, 24 pediatric AD patients and 10 pediatric health volunteers (HVs) were included. AD patients were treated with dupilumab for 16 weeks and following by a 12-week discontinuation. Cutaneous samples were collected from HVs, and AD patients at baseline and during dupilumab application period (Week 2, Week 4, Week 8, Week 12, and Week 16) and discontinuation period (Week 22 and Week 28) to conduct sequencing targeting the 16s rRNA V3-V4 regions. Clinical severity was assessed using the Eczema Area and Severity Index (EASI), Individual Signs Score (ISS), Children’s Dermatology Life Quality Index scores (CDLQI), Patient Oriented Eczema Measure (POEM), and peak pruritus Numerical Rating Scale (NRS itch). Results: Dupilumab treatment significantly improved AD characteristics, with reductions in EASI, ISS, CDLQI, POEM, and NRS itch scores (all P < 0.01). Concurrently, 16s rRNA sequencing indicated decline in Staphylococcus aureus abundance and increase in microbial diversity. These changes began to reverse upon treatment discontinuation, coinciding with a trend toward worsening EASI scores. Moreover, a dupilumab-responsive reduction in other bacterial genera such as Aggregatibacter, and Megasphaera were observed; and these alterations could be reversed after treatment cessation. Conclusion: We provided a dynamical pattern of skin bacterial community during and after dupilumab therapy in pediatric AD patients. Our findings suggest that the therapeutic action of dupilumab may extend to modulating a wider range of bacteria than previously recognized. The roles of our identified candidate microbial taxa require further investigation in larger and functional studies.

Background: Stapokibart is a novel anti-interleukin-4 receptor α (IL-4Rα) monoclonal antibody approved for the treatment of adults with moderate-to-severe atopic dermatitis (AD). Objectives: To assess the safety, efficacy, pharmacokinetics, pharmacodynamics and immunogenicity of stapokibart in children with moderate-to-severe AD. Methods: This was a multicentre open-label single-arm phase Ib/IIa trial (NCT06162507) involving 8 weeks of treatment and 8 weeks of follow-up. Children aged 6–11 years received subcutaneous stapokibart based on a bodyweight-tiered regimen (30–60 kg: 300 mg every 3 weeks for a total of three doses, including a 600-mg loading dose; 15–30 kg: 150 mg every 2 weeks for a total of four doses, including a 300-mg loading dose). Results: Twenty-five patients (13 weighing 30–60 kg; 12 weighing 15–30 kg) received stapokibart; 68% reported mild or moderate adverse events. At week 8, 54% (n = 7/13) of those weighing 30–60 kg and 75% (n = 9/12) of those weighing 15–30 kg achieved a ≥ 75% improvement from baseline in Eczema Area and Severity Index. Stapokibart concentrations increased rapidly following the first dose, climbed further with repeated dosing and gradually declined after treatment discontinuation. Stapokibart reduced inflammatory biomarkers in both groups. No treatment-related antidrug antibodies were detected. No new safety signals emerged. Conclusions: Stapokibart shows potential in improving disease outcomes and appears to be well tolerated in children aged 6–11 years with moderate-to-severe AD. Larger controlled studies are needed to confirm long-term benefits.

Background: Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease. The disruption of the epidermal barrier and the inflammatory response are the key factors for the occurrence and development of this disease. Artemisia annua extract (AAE), a widely used traditional Chinese medicine, exhibits anti-inflammatory properties that may benefit AD management. Objective: To evaluate the ability of AAE to inhibit inflammation and promote skin barrier repair in an AD-like three-dimensional (3D) epidermal equivalent model. Methods: Keratinocytes were treated with three AAE concentrations (0.1%, 0.3%, and 1%) to assess their cytotoxic effects using Cell Counting Kit-8. Methyl-β-cyclodextrin and interleukin (IL)-4, IL-13, and IL-25 were used to induce the AD-like model. The expression of skin structural proteins, inflammatory factors, and histopathological manifestations were compared among AAE-treated AD models, an untreated AD model, and normal control models. Results: Expression of the skin barrier proteins filaggrin (p < 0.0001, 95% CI: 0.7006 to 0.8265), loricrin (p < 0.0001, 95% CI: 0.2028 to 0.3031), and desmoglein-1 (p < 0.05, 95% CI: 0.0298 to 0.4227) was remarkably restored, whereas that of HAS3 (p < 0.05, 95% CI: 1.169 to 7.207), NELL2 (p < 0.0001, 95% CI: 5.787 to 6.978), TSLP (p < 0.01, 95% CI: 1.657 to 7.513), and IL-1α (p < 0.001, 95% CI: 19.33 to 63.35), IL-6 (p < 0.01, 95% CI: 2.474 to 13.78), and IL-8 (p < 0.0001, 95% CI: 36.55 to 55.63) was reduced significantly in 1% AAE concentration. AAE may exert its effects by inhibiting the over-activation of the MAPK pathway in an AD-like 3D epidermal model. Conclusion: 1% AAE inhibits inflammation and promotes skin barrier function in an AD-like 3D epidermal equivalent model. AAE which mainly includes Arteannuin B, Chlorogenic Acid, Chrysoplenol D, Scopolin, and Vitexicarpin is identified as the putative targets for AD therapy.

Background: Early-life gut microbiota and metabolism are increasingly linked to immune development and atopic diseases. However, predictive microbial and metabolic markers present during the neonatal period for later atopic dermatitis (AD) remain poorly defined. This study aimed to identify early-life gut microbiome and metabolite signatures associated with the development of AD by one year of age. Methods: We conducted a prospective birth cohort study in Beijing, China, enrolling 18 infants with fecal samples collected at 42 days of age. Infants were followed for one year and classified into AD (n = 6) or non-AD (n = 12) groups. Fecal samples underwent 16S rRNA gene sequencing and untargeted metabolomic profiling. Key microbial taxa, differential metabolites, and functional pathways were identified and integrated via multi-omics correlation analysis. Results: While overall microbial diversity was similar between groups, Staphylococcus was significantly less abundant in the AD group. Bifidobacterium and Lactobacillus showed strong correlations with lipid- and amino acid-related metabolites, including linoleic acid and N2-acetyl-L-ornithine. AD infants exhibited reduced levels of linoleic acid and choline phosphate. KEGG analysis revealed enrichment in linoleic acid metabolism, sphingolipid signaling, and AGE-RAGE signaling pathways. Integrated network analysis identified microbial–metabolite modules potentially involved in immune and barrier regulation. Conclusion: Multi-omics profiling of the infant gut at 42 days identified microbial and metabolic features associated with later AD development. These findings support the gut–skin axis and suggest potential early-life biomarkers for predicting AD risk and informing targeted prevention strategies.

This case series presents the demographic and clinical characteristics as well as laboratory results and treatment outcomes of young patients with eosinophilia and systemic symptoms.

Hemoporfin, a porphyrin derivative photosensitizer, has been approved for the treatment of port‐wine stain (PWS) in adults. However, its optimal dose for the pediatric population remains unclear. This study aimed to explore appropriate dosing for pediatric patients with PWS through population pharmacokinetics (PopPK) and exposure‐response (ER) analysis. Data from a prospective pilot study of hemoporfin photodynamic therapy in pediatric PWS patients, as well as a phase I study in healthy adult volunteers, were utilized for the analysis. The pharmacokinetics of hemoporfin in the pediatric population can be described by a three‐compartment model with linear elimination following allometric scaling rules. Simulations indicated that simply scaling down the approved adult dose of 5 mg/kg based on weight for the pediatric population, which is a common practice among clinicians, may lead to reduced drug exposure in pediatric patients. Mean C_max and AUC_0–30min in pediatric patients were 18.7% and 30.5% lower than those in adults, respectively. A positive relationship was identified between AUC_0–30min and the probability of investigators or patients giving high ratings for efficacy, suggesting that improved efficacy may be achieved with higher hemoporfin exposure. A series of dosing regimens were explored to match exposure in the pediatric population to that of the adult population. These findings may accelerate the development of pediatric indications for hemoporfin and help address the unmet medical needs of pediatric patients with PWS.