Benjamin Barankin

Schamberg Disease in a 54-Year-Old Chinese Woman

Schamberg disease, also known as Schamberg purpura or progressive pigmentary purpura, is characterized by orange-brown or reddish-brown macules/patches with overlaying purpuric spots simulating “cayenne pepper”. We report a 54-year-old Chinese woman with Schamberg disease presenting with purpuric macules and patches of varying sizes on the ankles, legs, and knees. The lesions were nonblanchable and nonpalpable and asymptomatic. Close inspection of the lesions revealed pinpoint petechiae resembling grains of cayenne pepper superimposed on the reddishbrown macules/patches. To our knowledge, Schamberg disease has not been reported in the scientific literature in Chinese patients.

Bilateral Symmetrical Herpes Zoster in an Immunocompetent 15-Year-Old Adolescent Boy

Herpes zoster is uncommon in immunocompetent children. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare. We report a 15-year-old immunocompetent Chinese adolescent boy who developed bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature.

Physiological Striae Atrophicae of Adolescence with Involvement of the Upper Back

We report a 13-year-old boy with multiple purplish, atrophic, horizontal linear striae in the thoracic area. He reported a growth spurt in the preceding 12 months. His past health was unremarkable, and he took no medications. To our knowledge, physiological striae atrophicae of adolescence where idiopathic striae were restricted to the upper back have rarely been reported. Physiological striae atrophicae of adolescence may, on occasions, be mistaken for child abuse. It is important that child care professionals recognize this condition so that false accusations of child abuse will not be made.

Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management

BackgroundStaphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS.Data sourcesA PubMed search was completed in Clinical Queries using the key terms “Staphylococcal scalded skin syndrome” and “Ritter disease”.ResultsSSSS is caused by toxigenic strains of Staphylococcus aureus. Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation. The diagnosis is mainly clinical, based on the findings of tender erythroderma, bullae, and desquamation with a scalded appearance especially in friction zones, periorificial scabs/crusting, positive Nikolsky sign, and absence of mucosal involvement. Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin, oxacillin, or flucloxacillin is essential until cultures are available to guide therapy. Clarithromycin or cefuroxime may be used should the patient have penicillin allergy. If the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high, vancomycin should be used.ConclusionA high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.

Terra Firma-Forme Dermatosis

A 12-year-old girl with a history of alopecia areata and vitiligo presented with an asymptomatic brownish dirt-like lesion on the left postauricular skin of approximately 3 years of duration. The patient and her mother tried to clean the “dirt” with water and soap without success. There was no history of rapid weight gain. She had no history of an inflammatory dermatosis in the affected area. Physical examination revealed a dirt-like brownish plaque on the left postauricular skin (Figure 1). Rubbing of the lesion with a 70% isopropyl alcohol-soaked gauze pad and pressure resulted in complete disappearance of the lesion (Figure 2). A diagnosis of terra firma-forme dermatosis was, thus, confirmed. Terra firma-forme dermatosis is characterized by an asymptomatic brownish-black, dirt-like patch/plaque. Affected individuals often have normal hygiene habits. Characteristically, the lesion cannot be removed by conventional washing with soap and water but can be removed by wiping with isopropyl alcohol while applying some pressure. Terra firmaforme dermatosis is most frequently seen in prepubertal children and adolescents. It is believed that the condition results from delayed maturation of keratinocytes with incomplete development of keratin squames, and retention of keratinocytes and melanin within the epidermis. Sites of predilection include the neck, followed by the ankles and trunk. The main differential diagnoses are dermatosis neglecta and acanthosis nigricans. Dermatosis neglecta typically affects individuals of any age with neglected hygiene. The lesions can be removed with normal washing with soap and water as well as with alcohol swab or cotton ball. The lesion of acanthosis nigricans consists of dark, velvety thickening of the skin usually on the nape and sides of the neck. The condition is most commonly associated with obesity. The hyperpigmentation or “dirt” cannot be removed either by normal washing with soap and water or alcohol swab or cotton ball. ■

Visual Diagnosis: A Ring of Long, Dark, Coarse Hair on the Scalp of a 5-month-old Girl

1. Alexander K.C. Leung, MD* 2. Benjamin Barankin, MD† 1. *Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada 2. †Toronto Dermatology Centre, Toronto, Ontario, Canada A 5-month-old girl presents with an abnormal hair pattern on the scalp that was first noted at birth. The infant is born at term to a gravida 2, para 1 28-year-old mother after an uncomplicated pregnancy and a normal vaginal delivery. There is no history of maternal use of medication during pregnancy. The infant’s birthweight is 3,200 g, length is 20.2 in (51.2 cm), and head circumference is 13.9 in (35.4 cm), each approximately at the 50th percentile. The neonatal course is uneventful. Her developmental milestones are normal. The parents are healthy and nonconsanguineous. There is no family history of craniospinal disorder or other similar disorders. On …

An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.

Case 3: Recurrent Lesions on Palms of a 12-year-old Girl

1. Alexander K.C. Leung, MBBS* 2. Benjamin Barankin, MD† 1. *University of Calgary, Pediatrics, Calgary, Alberta, Canada 2. †Toronto Dermatology Centre, Toronto, Ontario, Canada A 12-year-old girl presents with a 1-year history of whitish papules and plaques on her palms after brief exposure to water, such as handwashing or taking a shower or bath. She is greatly bothered by the appearance and texture of her hands. She denies having similar lesions on her soles or other cutaneous areas when exposed to water. There is no family history of similar skin disorders or cystic fibrosis. The child has atopic dermatitis and asthma. She does not have allergic rhinitis, abnormal scalp hair, hyperhidrosis, or other skin or systemic disease. Of particular note, she has no history of chronic lung disease or gastrointestinal disease. She is not taking any medication and is otherwise healthy. Physical examination of the palms reveals normal findings. However, following immersion of the hands in water at room temperature for 5 minutes, numerous yellowish-white, nonscaling, smooth-surfaced, flat-topped papules, some of which have coalesced to form plaques, appear on both palms (Fig). After drying, the skin normalizes within 30 minutes. The dorsal surfaces of the hands and other body sites are unaffected with water immersion. The remainder of the examination is unremarkable. On specific examination, the girl has no sparse or thin hair. Figure. White, smooth-surfaced, flat-topped papules and plaques appear on both palms …

Physiological Striae Atrophicae of Adolescence with Involvement of the Axillae and Proximal Arms

We report a 16-year-old adolescent male with multiple violaceous, atrophic, vertical linear striae isolated to the axillae and proximal arms of approximately one-year duration. In the past two years, he indulged in heavy weight-lifting. He experienced a growth spurt over the past few years. The patient was otherwise in good health and was not on any medications. Physiological striae atrophicae of adolescence where the striae were restricted to the axillae and proximal arms have very rarely been reported.

Nevus Lipomatosus Superficialis on the Left Proximal Arm

We report a 58-year-old woman with a solitary type of nevus lipomatosus superficialis on the left proximal arm. To our knowledge, the occurrence of a solitary type of nevus lipomatosus superficialis on the arm has very rarely been reported. A perusal of the literature revealed but one case, to which we are going to add another one. Recognition of this clinical manifestation is important so that a proper diagnosis can be made.