Catalina Matiz

Methylisothiazolinone: a case of perianal dermatitis caused by wet wipes and review of an emerging pediatric allergen.

Methylisothiazolinone (MI) is a preservative found in cosmetic, personal hygiene, and industrial products. It has been characterized as a moderate to strong sensitizer and is an emerging allergen in the pediatric population. We discuss a case of perianal dermatitis in a child caused by contact allergy to MI‐containing wet wipes.

Study of the Efficacy and Tolerability of 0.04% Tretinoin Microsphere Gel for Preadolescent Acne

OBJECTIVES: The goals were to assess the degree of improvement of facial acne after treatment with the 0.04% tretinoin microsphere gel (TMG) among patients 8 to 12 years of age and to assess tolerability and safety. METHODS: An open-label study was conducted with 40 patients 8 to 12 years of age (mean age: 10.7 years) with mild/moderate acne, defined on the basis of Evaluators Global Severity Score (EGSS) values between 2 and 3. Patients were treated with the 0.04% TMG for 12 weeks and were evaluated at baseline and weeks 3, 6, and 12. Primary end points were changes in EGSS and Alternative Evaluators Global Severity Score values; the secondary efficacy end point was the Investigators Global Evaluation of treatment responses at week 12. RESULTS: The mean EGSS value decreased significantly from baseline to week 12 (2.6 vs 2.1; P < .001), with 75% of cases being graded as almost clear or mild. The mean Alternative Evaluators Global Severity Score value decreased from 3.1 to 2.4 during the 12-week period (P < .001). The mean Investigators Global Evaluation score was 3.39 at week 12, indicating moderate improvement of acne. Treatment-associated adverse events were minimal, with mild skin irritation being most commonly recorded, generally in the first 3 weeks of therapy. CONCLUSIONS: The 0.04% TMG pump was effective and safe for the treatment of acne vulgaris in this 8- to 12-year-old population, and the treatment was generally well tolerated. Additional studies in this population are recommended, to confirm these results.

Pediatric Contact Dermatitis Registry Inaugural Case Data

BackgroundLittle is known about the epidemiology of allergic contact dermatitis (ACD) in US children. More widespread diagnostic confirmation through epicutaneous patch testing is needed. ObjectiveThe aim was to quantify patch test results from providers evaluating US children. MethodsThe study is a retrospective analysis of deidentified patch test results of children aged 18 years or younger, entered by participating providers in the Pediatric Contact Dermatitis Registry, during the first year of data collection (2015–2016). ResultsOne thousand one hundred forty-two cases from 34 US states, entered by 84 providers, were analyzed. Sixty-five percent of cases had one or more positive patch test (PPT), with 48% of cases having 1 or more relevant positive patch test (RPPT). The most common PPT allergens were nickel (22%), fragrance mix I (11%), cobalt (9.1%), balsam of Peru (8.4%), neomycin (7.2%), propylene glycol (6.8%), cocamidopropyl betaine (6.4%), bacitracin (6.2%), formaldehyde (5.7%), and gold (5.7%). ConclusionsThis US database provides multidisciplinary information on pediatric ACD, rates of PPT, and relevant RPPT reactions, validating the high rates of pediatric ACD previously reported in the literature. The registry database is the largest comprehensive collection of US-only pediatric patch test cases on which future research can be built. Continued collaboration between patients, health care providers, manufacturers, and policy makers is needed to decrease the most common allergens in pediatric consumer products.

Infant Clothing Snaps as a Potential Source of Nickel Exposure

Abstract:  Children’s clothes with metal snaps are a potential source of nickel exposure to consider in infants and very young children. Further more avoidance of this exposure may help prevent nickel sensitization.

Nickel Allergy—A Potential Cause of Razor Dermatitis

We discuss a case of razor‐associated dermatitis to highlight a potential source of nickel exposure in allergic patients.

A Slowly Enlarging Tumor on a Child's Leg

A 9-year-old boy from Mexico with no significant medical history presented for evaluation of a slowly enlarging, exophytic tumor on his right posterior lower leg. The lesion had appeared 5 years earlier, after a trauma to the area. The lesion was not pruritic or tender, but it had been intermittently bleeding. The mother reported the boy to be developing and ambulating normally. She denied he had any other skin lesions. Upon presentation, the tumor had received no treatment; no imaging studies were performed. A review of systems was negative for fever, weight loss, and pain. Physical examination revealed a large (6.5 cm 9 9 cm) malodorous, exophytic, verrucous, firm, nontender tumor on the posterior calf of the right lower leg (Fig. 1). What is the diagnosis?

An 8-month-old boy with purpuric skin lesions. Acute hemorrhagic edema of infancy.

A previously healthy 8-month-old Hispanic boy presented with a 5-day history of an erythematous, non-pruritic papular eruption on both legs. The eruption was initially diagnosed as impetigo by his primary care practitioner but progressed despite trimethoprim / sulfamethoxazole therapy, with extension to the face, trunk, and all extremities. When the patient subsequently developed a fever of 100.8° F, emesis, diarrhea, and upper respiratory symptoms, he was referred to the pediatric dermatology clinic for evaluation. Further questioning revealed a 3-day febrile illness 6 weeks prior to presentation that was treated with ceftriaxone. Review of systems failed to identify any hematuria, blood in stool, or abdominal pain, but the parents did report swelling of the extremities and face, as well as decreased oral intake. On examination, the infant was in no apparent distress, afebrile, and had mild rhinorrhea. His mucous membranes were unaffected, and no lymphadenopathy or hepatosplenomegaly was noted. Cutaneous exam revealed numerous edematous erythematous to violaceous plaques on the cheeks, arms, buttocks, and legs with minimal involvement of the trunk. Several lesions on the arms had a distinct cockade (rosette or iris-like) pattern. There were no vesicles, bullae, or necrosis. Edema of the bilateral lower extremities was noted. Laboratory work up revealed a normal complete blood count (CBC), comprehensive metabolic panel, creatinine, and urinalysis. Platelets were borderline elevated at 439 TH/μL (140-440 TH/μL), and erythrocyte sedimentation rate and C-reactive protein (CRP) were minimally elevated at 22 mm (0-15 mm) and 3.1 mg/dL (0.0-0.99 mg/dL), respectively.

Speckled lentiginous nevus: A rare presentation associated with motor neuropathy and muscular atrophy in a child

Speckled lentiginous nevus syndrome has been described in individuals with a speckled lentiginous nevus with rare associated neurologic deficits. Because speckled lentiginous nevus syndrome almost always affects adults, it is not typically considered when evaluating children. We present the first reported case of speckled lentiginous nevus syndrome presenting in a young child with muscle atrophy and motor deficits affecting muscles along the same distribution as the speckled lentiginous nevus.

Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate

Primary cutaneous aspergillosis is a rare but potentially life‐threatening disease. We present the case of a premature infant who developed primary cutaneous aspergillosis with Aspergillus niger at the site of a skin abrasion that had been treated with a purple‐colored cyanoacrylate product. The infection was treated successfully with gentle debridement of the cyanoacrylate product, followed by intravenous voriconazole and topical fluconazole. To our knowledge, this is the first reported case of primary cutaneous aspergillosis occurring at the site of cyanoacrylate‐based skin adhesive.

Contact Dermatitis in Atopic Dermatitis Children—Past, Present, and Future

Allergic contact dermatitis (ACD) used to be considered a rarity in children, but recently has been estimated to effect 4.4 million children in the USA alone, with a notable rise in investigative research in the field of pediatric ACD. Researchers have shown that patch testing is safe and effective in afflicted children and that those with atopic dermatitis (AD) have similar sensitization rates, although they have a higher sensitization to certain allergens, thought to be related to the inflammatory (IL-4) milieu. Patch testing assessment guidelines in children include five key considerations: if a patient’s dermatitis worsens, changes distribution, fails to improve with topical therapy, or immediately rebounds after removal of topical treatments; if a patient has a particular distribution of dermatitis; if a working patient has hand eczema that fails to improve with therapy; if the patient has AD that started in adolescence or adulthood with definitely no history of childhood eczema; and importantly, if a patient has severe or widespread atopic dermatitis that will require immunosuppressive systemic medication.