Amrinder J. Kanwar

Urticaria in Children

Abstract: The etiologic factors responsible for urticaria were analyzed in 44 children seen In the Urticaria Clinic, a referral center of the Dermatology Department. Of these, 23 were girls and 21 boys. Nine (20.5%) had acute urticaria and 25 (79.5%) were diagnosed as having chronic urticaria. A definitive etiology factor was identified in 1B (40%) patients. Of these, 15 had physical urticarias; in 2 foods and in 1 drug was incriminated. Probable ettologlc factors were identified in 19 (43%) patients, in 5 (11.3%) of whom more than one factor was Identified. In 11 (25%) children, it was not possible to establish the cause. Our study suggests that etiologic factors of urticaria are more readily identifiable in children than in adults.

Kikuchi Disease with Facial Rash and Erythema Multiforme

Kikuchi disease, or histiocytic necrotizing lymphadenitis, is a benign illness characterized by fever and cervical lymphadenopathy predominantly in young women. It has a self‐limiting course. Skin changes occur in about one‐third of patients and are of a nonspecific nature. A case of Kikuchi disease with cutaneous involvement in the guise of erythema multiforme and a facial rash is reported. The differential diagnosis with systemic lupus erythematosus and Rowell syndrome is discussed.

Scrofuloderma with Multiple Organ Involvement in a 5‐Year‐Old Child

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis seen in children in developing countries. We report a 5‐year‐old child with cutaneous tuberculosis with involvement of lymph nodes, lungs, and the musculoskeletal and central nervous systems, which was not clinically obvious. Antituberculous treatment led to marked clinical improvement. The importance of a thorough search for internal organ involvement in patients presenting with cutaneous tuberculosis is emphasized.

Lichen scrofulosorum: a rare manifestation of a common disease.

Tuberculids develop as hypersensitive immunologic reactions in the skin to an occult internal focus of tuberculosis. These eruptive lesions are due to hematogenous dissemination of bacilli in a host with a high degree of immunity against Mycobacterium tuberculosis. Although rare, these specific lesions are important diagnostic markers of tuberculosis. Lichen scrofulosorum is one of the recognized tuberculids, usually seen in children and young adults. We report three children with lichen scrofulosorum; in two children it developed during treatment of tuberculosis. The appearance of lichen scrofulosorum after initiation of treatment due to a probable increase in cell‐mediated immunity is emphasized.

Cutis laxa in seven members of a north-Indian family.

Abstract: Congenital cutis laxa, characterized by cutaneous laxity and loose skin, may be autosomal dominant or autosomal recessive. The autosomal dominant variety is usually not associated with any systemic defects and has a good prognosis. We report an unusual family in which seven members were affected by the autosomal dominant variant of this disorder. We suggest that close monitoring of the cardiorespiratory systems may be worthwhile to detect any systemic complications, although these complications are rare in the autosomal dominant variant of cutis laxa.

Familial acanthosis nigricans

A 15‐year‐old girl (Case 1), presented with thickening and hyperpigmentation of the skin over the dorsa of both hands and feet, and the periorbital area. Hyperpigmentation at the above sites was noticed 6 months after birth; gradually the skin became thickened over the years. Her 39‐year‐old mother (Case 2) also had similar skin lesions since infancy. On enquiry, the girls one brother (27 years old), maternal uncle (55 years old), and maternal grandfather (77 years old) were found to have similar skin lesions (Fig. 1).

Fixed Drug Eruption on the Tongue of a 4-Year-Old Boy

Abstract: A 4‐year‐old boy had a rare fixed drug eruption due to amoxicillin and confined to the tongue. Avoidance of the drug resuJted in complete clearance within three months.

Nevus Depigmentosus Associated with Hemihypertrophy of the Limhs

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Infraorbital Crease and Atopic Dermatitis

Abstract: The usefulness of a prominent infraorbital skin crease as a marker of atopic dermatitis (AD) was examined in 500 consecutive school children 3 to 11 years of age, Infraorbital crease was recorded by two trained observers according to a strict protocol, and AD was determined by an independent dermatologist who was blinded to the study design. A prominent Infraorbital crease was present in only 4 of 20 (20%) children with AD, compared with 171 of 480 (35,6%) children who did not have AD (p,05), While infraorbital crease may be of some use in diagnosin individual cases of AD in a hospital setting, it appears to be less useful in population‐based studies because of Its poor validity and repeatability.

NODULAR PRURIGO IN A CHILD

neuromeningeal relapse ofthe hemopathy. Reapplication of systetnic polychemotherapy led to neuromeningea! remission with dramatic improvement iB DM signs. Ten months later a meduUar relapse was observed, though no recurrence of DM signs. The patient failed to respotid to chemotherapy and died three years after beginning hemopathy. The criteria proposed by Bohan (1) for diagnosing DM were met in our patient. Moreover, our clinical and especially histologic findings for occlusive vasculitis were characteristic of childhood DM (2). Cases of DM associated with malignancy are generally observed in the adult population (3). To our knowledge, only one pediatric case of DM in the context of acute leukemia has been reported (4). In this 5-year-old boy DM signs occurred three months after diagnosis of acute leukemia. As in our patient, facial edema and weakness were the prominent features ofthe disease. Various factors may be implicated in the origin of DM in patients with neoplasia, and it would appear that a direct relationship between the diseases exists. Of particular interest are those cases in which DM enters into remission after initiation of cancer therapy or may relapse with neoplastic progression. Immunologic disorders are frequently associated with collagen disease. The relative impairment of cell-mediated and humoral immunity in patients with malignancy might be a causative risk factor of DM. Infection also plays a role in the onset of DM. Disseminated enterovirus (echovirus) infection in patients with deficient antibody-mediated immunity (e.g., agammaglobulinemia) may cause a DM-like syndrome (5-6). Finally, the occurrence of DM in patients with malignant hemopathy suggests a pathogenetic cause ofthe disease.