3234 randomized treatment (MTX, ADA 0.4, ADA 0.8) were any event 463.0, 362.8, 387.

2;
A study of cutaneous tuberculosis in children serious event 3.2, 4.0, 9.8. There were no serious infections.
Sumit Sethi, MBBS, MD, Maulana Azad Medical College and Associated Hospitals, Conclusion: In this pediatric population, efficacy was maintained through 52 weeks
New Delhi, India; Vijay Garg, MBBS, MD, Maulana Azad Medical College and of ADA treatment. Overall safety profile was similar for both ADA doses. No
Associated Hospitals, New Delhi, India; Rashmi Sarkar, MBBS, MD, Maulana Azad malignancies and no deaths related to study drug were reported.
Medical College and Associated Hospitals, New Delhi, India; Arvind Mishra,
MBBS, MD, Sanjay Gandhi Memorial Hospital, New Delhi, India AbbVie Inc participated in the study design; study research; collection, analysis
Background: Cutaneous tuberculosis is still highly prevalent in India and continues and interpretation of data; and writing, reviewing and approving of this
to be an important cause of morbidity in children. publication. All authors had access to the data, and participated in the
development and review.
Aim: The study the clinical spectrum of pediatric cutaneous tuberculosis and to
correlate them with Mantoux reactivity and BCG vaccination status.
Materials and methods: A prospective observational study was conducted on
patients attending an outpatient dermatology department of a tertiary care hospital
in Delhi to analyze the clinical pattern of cutaneous tuberculosis in paediatric
population. A detailed clinical examination, investigations, such as hemogram,
serology for HIV, Mantoux test, chest X-ray, cytology, and histopathology were
carried out in all children. They were treated with antitubercular therapy (directly
observed treatment short course-DOTS regimen), and the clinical response was
followed up.
Results: Twenty children (#16 years) out of a total of 55 patients seen with
cutaneous tuberculosis during a 1-year period, were included in this study. Of these,
8 (40%) had lupus vulgaris (LV), 7 (35%) had scrofuloderma (SD), 5 (25%) had lichen
scrofulosorum (LS), 3 (15%) had tubercular gumma and 1 (5%) had tuberculosis
verrucosa cutis (TBVC). Four (20%) patients concomitantly had more than one type
of skin tuberculosis. Affirmative clinicopathologic correlation was observed in all
the patients. Regional lymph nodes were involved in seven (35%) patients, 3 (15%)
patients had lung involvement while 1 (5%) each had involvement of GIT and bone.
No correlation was found between Mantoux reactivity and the extent of disease. Of
the 17 (85%) children in whom the data regarding vaccination status was available, 7
(35%) had been vaccinated and 10 (50%) had not. Among the vaccinated group no
child had disseminated disease. Three children in the nonvaccinated group had
disseminated disease. Family history of tuberculosis was positive in seven (35%)
patients. HIV test was negative by ELISA in all patients.
Conclusion: BCG vaccination at birth seems to provide protection against
disseminated disease in children. However, BCG coverage still remains poor in
migrant population from villages. The main source of childhood cutaneous
tuberculosis is infected household contacts and chemoprophylaxis needs to be
more widely adapted in Indian pediatric population. Due to immaturity of immune
system in children, systemic association is common and warrants a thorough look
for underlying focus.
Limitations: Small sample size.

Commercial support: None identified.

3258
Adalimumab long-term safety/efficacy results for pediatric patients with
chronic plaque psoriasis from a phase 3, randomized study
Kim Papp, K. Papp Clinical Research and Probity Medical Research, University of
Western Ontario, Waterloo, Ontario, Canada; Danielle Marcoux, CHU Sainte-
Justine Montreal, Montreal, Quebec, Canada; Ian Landells, Nexus Clinical
Research and Memorial University of Newfoundland, St. John’s,
Newfoundland, Canada; Lisa Weibel, University Children’s Hospital, Z€ urich,
Switzerland; Pierre-Dominique Ghislain, UCL St. Luc, Brussel, Belgium; Kristina
Unnebrink, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany;
David Williams, AbbVie Inc, North Chicago, IL, United States
Introduction: Results of long-term safety and efficacy of TNF-a—inhibitor adalimu-
mab (ADA) are reported for pediatric patients (pts) with severe chronic plaque
psoriasis who participated in the 52-week (wk) follow-up period (PerD) of this
phase 3 trial (NCT01251614).
Methods: This multisite international study included a 16-wk double-blind treatment
PerA, a 36-wk treatment withdrawal PerB, a 16-wk ADA double-blind retreatment
PerC, and a 52-week follow-up PerD conducted in parallel to the blinded periods. In
PerA, pts were randomized 1:1:1 to ADA 0.8 mg/kg every other week (eow); ADA 0.4
mg/kg eow; or MTX 0.1-0.4 mg/kg weekly. ADA pts received matching MTX
placebo; MTX pts received matching ADA placebo. Responders were pts achieving
$75% improvement in Psoriasis Area Severity Index (PASI75) and Physician’s Global
Assessment 0 or 1 (PGA 0/1). PerD participants included: (1) nonresponders at end
of PerA continued to PerD and received open-label (OL) ADA 0.8; (2) pts maintaining
disease control in PerB off treatment continued in PerD off treatment; (3)
responders at end of PerA who lost disease control in PerB, and at completion of
PerC, continued in PerD on respective blinded PerC treatment (ADA 0.8 if initially
randomized to MTX or ADA 0.8; ADA 0.4 if initially randomized to ADA0.4). All pts
could switch to OL ADA 0.8 in PerD.
Results: Of 114 enrolled pts, mean age was 13.0 years, range 5-18. All 108 pts who
entered PerD received ADA except 8 who entered off-treatment in PerB and
maintained disease control off-treatment in Per D. Treatment groups for efficacy are
defined by PerA dose/PerD dose: MTX (N ¼ 37)/ADA 0.8 (N ¼ 36); ADA 0.4 (N ¼
39)/0.4 (N ¼ 36); ADA 0.8 (N ¼ 38)/0.8 (N ¼ 36). PASI75 was achieved at wk16 PerA
by 32.4%, 43.6%, 57.9%, respectively; at wk16 PerD by 86.1%, 50.0%, 61.1%,
respectively; and at wk52 PerD by 86.1%, 47.2%, 72.2%, respectively. PGA 0/1 was
achieved at wk16 PerA by 40.5%, 41.0%, 60.5%, respectively; at wk16 PerD by
77.8%, 38.9%, 50.0%, respectively; and at wk52 PerD by 75.0%, 50.0%, 55.6%,
respectively. Treatment-emergent adverse events per 100 pt years in PerD by initial
3373
Body dysmorphic disorder and suicidal ideation in a 15-year-old girl who
witnessed sexual abuse
Dimitre Dimitrov, MD, The Royal London Hospital and Whipps Cross University
Hospital, Barts Health NHS Trust, London, UK, United Kingdom; Tanyo Tanev,
The Royal London Hospital and Whipps Cross University Hospital, Barts Health
NHS Trust, London, UK, United Kingdom; Ruth Taylor, MBChB, PhD, Barts and
the London School of Medicine and Dentistry; Queen Mary University of London,
London, UK, United Kingdom; Anthony Bewley, MBChB, MD, The Royal London
Hospital and Whipps Cross University Hospital, Barts Health NHS Trust, London,
UK, United Kingdom
A 15-year-old female patient attended our psychodermatology clinic with body
dysmorphic disorder, acne and a scar on her abdomen. During the consultation the
patient complained, her skin conditions had an enormously negative impact on her
life. She avoided social activities and isolated herself at home most of the time. She
was diagnosed with having depression and social anxiety disorder. She was also
suicidal. Her acne was treated with topical agents and a referral was made to child
mental health department. During the consultation with the psychiatrist became
clear that the patient had witnessed sexual abuse four years previously. At this time
her body dysmorphic disorder symptoms started. She was commenced on Sertraline
and referred to a counsellor for cognitive behavioral therapy. Her suicidal ideation
stopped and her depression settled with this and her dermatologic treatments. The
patient was referred as well to plastic surgeons for correction of her abdominal scar.
Research to date has indicated that childhood abuse in general is associated with
psychiatric disorders and suicidal ideations in later life. Research has examined the
unique association between body dysmorphic disorder and suicidal ideation on one
hand and childhood sexual abuse on the other. A study examining all form of child
abuse in body dysmorphic disorder patients found that 28.0% of participants (75
subjects) reported sexual abuse. Even more interesting was the severity of sexual
abuse was significantly associated with current body dysmorphic disorder severity.
Our case emphasizes the need for dermatology health care professionals to ask
about sexual abuse in childhood/early life, especially when a patient present with
body dysmorphic disorder and suicidal ideation. Dermatologists often shy away of
checking about sexual abuse and suicidal ideation in their patients. But body
dysmorphic disorder and social anxiety disorder are more commonly associated
with sexual abuse than dermatologists may realize.
Commercial support: None identified.

MAY 2016 J AM ACAD DERMATOL AB209