Elizabeth Alvarez Connelly

Prevention of chemotherapy-induced alopecia in rodent models.

Alopecia (hair loss) is experienced by thousands of cancer patients every year. Substantial-to-severe alopecia is induced by anthracyclines (e.g., adriamycin), taxanes (e.g., taxol), alkylating compounds (e.g., cyclophosphamide), and the topisomerase inhibitor etoposide, agents that are widely used in the treatment of leukemias and breast, lung, ovarian, and bladder cancers. Currently, no treatment appears to be generally effective in reliably preventing this secondary effect of chemotherapy. We observed in experiments using different rodent models that localized administration of heat or subcutaneous/intradermal injection of geldanamycin or 17-(allylamino)-17-demethoxygeldanamycin induced a stress protein response in hair follicles and effectively prevented alopecia from adriamycin, cyclophosphamide, taxol, and etoposide. Model tumor therapy experiments support the presumption that such localized hair-saving treatment does not negatively affect chemotherapy efficacy.

Early localized morphea mimicking an acquired port-wine stain

Port-wine stains (PWS) and morphea are distinct conditions that are easily recognized and diagnosed in pediatric patients. Rarely, early localized morphea may mimic an acquired PWS. We present 4 such cases, in two of which the initial clinical impression of acquired PWS was thought to be confirmed by histopathology. A diagnosis of morphea was made approximately 6 months to 3 years after the onset of the acquired PWS. Clinicians should be aware that an apparent acquired PWS may be an early manifestation of localized morphea and continue to monitor these lesions.

S100-Negative Indeterminate Cell Histiocytosis in an African American Child Responsive to Narrowband Ultraviolet B

Abstract:  Indeterminate cell histiocytosis is a rare cutaneous disease characterized by the presence of dendritic cells that lack Birbeck granules and immunophenotypically shares features of both Langerhans cells and macrophages. We describe a case of a 4‐year‐old African American boy affected by a disseminated, exclusively mucocutaneous form of indeterminate cell histiocytosis. The eruption was successfully treated with narrowband ultraviolet B. The peculiar negativity of the Langerhans cell marker S100 is also discussed.

Distraction Anesthesia for Pediatric Dermatology Procedures

Minor dermatologic surgery procedures performed on pediatric patients pose significant challenges not apparent in adult patients. Most pediatric patients are frightened when they enter the doctor’s office, especially if they are expecting a painful procedure. Studies have shown that it is imperative to provide a workflow that is tailored to the child’s needs, such as providing a comfortable ambiance and having an understanding of child development appropriate for a particular age group (1,2). The power of the child’s mind is remarkable; therefore, it is advantageous to integrate distraction techniques while performing a painful procedure. These techniques are beneficial for dermatologists in order to perform minor surgical procedures on children more efficiently. We report a method of distraction anesthesia unique to pediatric patients. We feel our guidelines for distraction anesthesia can minimize pain and psychologic trauma, decrease the time of the average pediatric procedure by avoiding unnecessary steps such as bargaining or using further restraints, lower medical costs, and ultimately circumvent risky side effects by evading general anesthesia. These simple surgical pearls will provide effective perioperative pain therapy for minor, out-patient surgical dermatologic procedures on children.

Addison's disease, diffuse skin, and mucosal hyperpigmenation with subtle "flu-like" symptoms--a report of two cases.

Abstract:  Addison’s disease, or chronic adrenocortical insufficiency, is the overproduction of adrenocorticotropic hormone by the pituitary gland as a compensatory mechanism for decreased cortisol production by the adrenal glands. Classically, patients affected with Addison’s disease develop weakness, anorexia, electrolyte imbalances: decreased sodium and chloride with increased serum potassium resulting in hypotension, and hyperpigmentation of the skin and mucous membranes. Herein this case report, we focus on the subtle findings of diffuse hyperpigmentation and intermittent but repetitive “flu‐like” symptoms in two patients to correctly identify the diagnosis of Addison’s disease effectively and efficiently.

A rare presentation of squamous cell carcinoma in a patient with PIBIDS-type trichothiodystrophy.

Abstract:  The clinical presentation of trichothiodystrophy type F includes photosensitivity, ichthyosis, brittle hair, intellectual impairment, decreased fertility, and short stature, often referred to as the PIBIDS syndrome. While many of these patients demonstrate features also found in xeroderma pigmentosum patients, including similar nucleotide excision repair gene defects and photosensitivity, PIBIDS patients rarely demonstrate cutaneous malignancies. This case report demonstrates the rare presentation of squamous cell carcinoma developing in a PIBIDS patient.

Systematized Contact Dermatitis and Montelukast in an Atopic Boy

Abstract:  Upon ingestion, the artificial sweetener, aspartame is metabolized to formaldehyde in the body and has been reportedly associated with systemic contact dermatitis in patients exquisitely sensitive to formaldehyde. We present a case of a 9‐year‐old Caucasian boy with a history of mild atopic dermatitis that experienced severe systematized dermatitis after being started on montelukast chewable tablets containing aspartame. Patch testing revealed multiple chemical sensitivities which included a positive reaction to formaldehyde. Notably, resolution of his systemic dermatitis only occurred with discontinuation of the montelukast chewables.

Excision and grafting of palmoplantar keratoderma.

Palmoplantar keratodermas may present to the clinician with an extremely broad series of clinical findings. Management has also taken on a wide variety of medical and surgical modalities. The literature seems to provide evidence that optimum management consists of surgical excision with skin grafting. It is believed that this will eliminate all of the underlying tissue and associated skin appendages, which are believed to be the source of this abnormal skin entity. We present a case of a patient in which tangential excision with delayed split-thickness skin grafting was performed after initial application of an acellular dermal matrix (Integra). Unfortunately, there was nearly immediate recurrence of this disease, and we, therefore, suggest a more aggressive approach to the initial excision.

Fever and rash in a child: When to worry?

The differential diagnosis of a fever and rash presenting in a pediatric patient is quite extensive. This article is not all-inclusive but is meant to aid in the diagnosis to differentiate serious, life-threatening eruptions from more benign common rashes.

Isolated systematized nevus flammeus

Nevus flammeus (NF), also known as port wine stain, can occur in isolation or in the context of complex syndromes, such as Sturge–Weber–Klippel–Trenaunay syndrome, Proteus syndrome, and phacomatosis cesioflammea. Nevus flammeus can also be associated with other cutaneous birthmarks, such as cutis marmorata telangiectatica congenita, café au lait spots, multiple congenital melanocytic nevi, nevus depigmentosus, nevus sebaceous, Becker nevus, and various combinations of these. When it occurs in isolation, NF appears most frequently as a lateralized segmental lesion on the face, whereas when it is associated with other birthmarks or syndromes, it often features a checkerboard pattern. We report two cases of isolated extensive NF presenting with widespread lesions arranged in a checkerboard pattern and with a reticulate appearance.