Christine Labrèze

Nail matrix arrest in the course of hand, foot and mouth disease

Abstract. Onychomadesis describes complete nail shedding from the proximal portion; it is consecutive to a nail matrix arrest and can affect both fingernails and toenails. It is a rare disorder in children. Except for serious generalised diseases or inherited forms, most cases are considered to be idiopathic. Few reports in literature concern common triggering phenomena. We present four patients in whom the same benign viral condition in childhood appeared as a stressful event preceding onychomadesis. In each case, spontaneous complete healing of the nails was achieved within a few weeks. Conclusion: onychomadesis and/or onycholysis is a newly recognised complication in the course of viral infections presenting clinically as hand, foot and mouth disease, and because of mild forms, is probably underestimated.

Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin.

Crusted scabies is mainly observed in children with immunosuppression or mental illness. Treatment is very difficult, and relapse is frequent after topical scabicidal therapy. We describe a case of crusted scabies, induced by long-term application of a topical corticosteroid, relapsing after topical treatment and dramatically improved by ivermectin. We suggest that ivermectin is a safe and effective alternative therapy for the treatment of severe Sarcoptes scabiei infestation in children unresponsive to conventional treatment.

INFANTILE PERIANAL PYRAMIDAL PROTRUSION: A MARKER OF CONSTIPATION?

To the Editors: We read with interest the article by Paller et al. “Pulmonary Hemorrhage: An Often Fatal Complication of Henoch-Schonlein Purpura” (1). We have previously published a similar report of pulmonary hemorrhage as a complication of Henoch-Schonlein purpura (2). Our patient, a 14-year-old girl, presented with abdominal pain, melena, arthritis, generalized edema, diffuse proliferative glomerulonephritis, and palpable purpura and had lifethreatening pulmonary hemorrhage requiring intensive care unit admission. While a skin biopsy specimen showed vasculitis with positive IgA staining, pulmonary pathology of a lung biopsy specimen showed acute vasculitis with IgM and C3 staining. The patient responded well to ICU supportive care, peritoneal dialysis, and pulse methylprednisolone. Our patient’s case was not included in the literature summary presumably because it was published as a case of ‘‘anaphylactoid purpura.” Our article also referenced two other pediatric cases not included in the Paller et al. article (3,4). Additionally, since our publication there has been another case report of a 15-year-old boy with pulmonary hemorrhage complicating HSP (5) . We concur with Paller et al. on the importance of physician knowledge of pulmonary hemorrhage with Henoch-Schonlein purpura and of the severe morbidity and mortality of this fairly rare complication.

Percutaneous Cryoablation of Symptomatic Localized Venous Malformations: Preliminary Short-term Results

Short-term outcomes after percutaneous image-guided cryoablation of symptomatic venous malformations in four consecutive patients (mean age, 42.5 y) are reported. Two patients had local recurrences after previous treatment. Mean preoperative pain was estimated on a visual analog scale at 5 (range, 3-7). Cryoablation was performed in a single session under general anesthesia. Postoperative pain and superficial edema disappeared within 2 weeks. No pain was subsequently reported, and magnetic resonance imaging demonstrated a significant volume decrease at 3 months (75%; P = .01) and at 6 months (95%; P = .01). Percutaneous cryoablation shows promising local control in patients with symptomatic venous malformations.

Necrotic ulcerated lesion in a young boy caused by cowpox virus infection.

The case presented here points towards the fact that skin lesion observed with a cowpox virus is a rare event but should be considered more as the number of cases has increased in the last years. Cowpox virus (CPXV) belongs to the Poxviridae family. The transmission of CPXV to humans is caused by wild rodents or mostly by domestic animals and pet rats. In humans, CPXV is responsible for localized skin lesions regularly accompanied by lymphadenopathy. The lesions remain localized but self-inoculation from the primary lesions could occur. Then physicians have to be vigilant concerning bandages. In this case report, a necrotic and ulcerated lesion of a CPXV infection in a young boy is reported. The CPXV was possibly transmitted by wild rodents. The importance of performing the diagnosis is also pointed out. Virus information was obtained from phylogenetic analyses showing that the CPXV isolate was distinct from outbreaks of human cowpox which occurred in 2009 in France and Germany but was close to the CPXV Brighton Red strain. For several years, cases of viral zoonosis caused by CPXV have increased and physicians should be made aware that people could be infected without history of direct contact with animals.

Management of congenital nevi at a dermatologic surgical paediatric outpatient clinic: consequences of an audit survey 1990-1997.

Background: Since 1987 we have run a Dermatologic Surgical Paediatric Outpatient Clinic (DSPOC) within the Children’s Hospital in Bordeaux. Objective: We analyse the consequences of an audit survey concerning the management of patients with congenital nevi (CN) seen at this clinic. Methods: We reviewed the cases of 192 children examined and photographed at the DSPOC during the period January 1990–December 1997. Patients were contacted for a reassessment of their status. The management options chosen at the DSPOC were reviewed as well as the satisfaction of the patients or parents of young children. Results: Of 192 children prerecruited, 56 girls and 52 boys could be included in the survey. They were mostly European whites and 67% were <6 months of age at the first DSPOC visit. 65/108 (61%) had been operated following the first DSPOC visit. The mean follow-up based on the 1997–1998 survey was 33 months (8 months to 10 years). The size of the nevus, independently of location, influenced decision for early surgery. Another important factor was the estimated disfigurement risk (15% of decisions) mostly related to CN of the face. There was a significant risk of pigmentary recurrence around the scar in children operated before the age of 2, but long-term follow-up indicated a spontaneously regressive course. Conclusions: Nevus recurrence in cases operated early suggests a time-dependent phenomenon in nevogenesis. Early counselling is important. Early surgery seems associated with a better scar quality. Explanations concerning risks and outcome are best given with the cooperation of a surgeon and a dermatologist.

Exogenous Inflammatory Acne due to Combined Application of Cosmetic and Facial Rubbing

Background: Exogenous acne refers to acneiform lesions due to external factors such as cosmetic agents, exposure to various oils, skin rubbing or friction or chloracne, now better called metabolizing acquired dioxin-induced skin hamartoma (MADISH). Here we report a new form of severe inflammatory exogenous acne due to the association of two factors: facial friction with cosmetic agents. Observations: A 15-, 17- and 19-year-old female presented at the department with severe inflammatory acne. In all cases, the face had been strongly rubbed in a compulsory manner in the previous weeks with cosmetic agents. The disease has not responded to various conventional acne treatments and was well controlled by a combination of oral corticosteroids and low-dose isotretinoin. Conclusion: Because cosmetic face friction as a cosmetic care becomes more and more fashionable, dermatologists should be aware of this severe clinical condition, which can occur in patients without a personal history of acne.

Aluminium sensitization in a French paediatric patch test population

Persistent itching subcutaneous nodules at the injection sites of aluminium-adsorbed vaccines are increasingly described in children and are associated with contact allergy to aluminium, in 77% to 100% of cases, according to different studies. In general, aluminium is considered to be a rare allergen, given its wide usage and the relative scarcity of contact dermatitis cases. However, the prevalence of contact sensitization to aluminium in children is not well known. The objective of this study was to determine the prevalence of contact sensitization to aluminium in a paediatric population consulting for patch testing in a French paediatric dermatology department, and to study the association of the sensitization with persistent itching nodules.