Howard B. Pride

Consensus conference on pediatric atopic dermatitis

C urrent information identifying risk factors for cutaneous diseases such as atopic dermatitis in childhood is limited. Cutaneous disease prevention programs and health promotion strategies in children and adolescents have not been addressed in a concerted way by government agencies or relevant medical societies. Disease-based interventions often emphasize adult disease, but many diseases may be prevented or minimized by intervention during childhood years. Research may be more effectively coordinated and carried out with the establishment of consensus on how best to diagnose and treat diseases such as atopic dermatitis (AD) in children and identify the most critical issues related to this condition. A consensus conference was convened by the American Academy of Dermatology on January 1921, 2001 to (1) define the core dermatologic issues related to AD in children and adolescents that can influence their dermatologic health over a lifetime and (2) prioritize future research efforts on epidemiology, pathogenesis, prevention, and management of AD. The following focus questions were addressed and responses/recommendations were developed:

Penile squamous cell carcinoma arising from balanitis xerotica obliterans

Squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe an 83-year-old man in whom metastatic penile squamous cell carcinoma developed after 18 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Twenty-nail dystrophy and vitiligo: A rare association

The term twenty-nail dystrophy (TND) of childhood has evolved since its initial description in 1977. TND has also been reported in adults, and many clinical as well as histopathologic associations have been described. We describe the third case of a rare association of TND with vitiligo in a 10-year-old girl.

Ecchymoses and Edema in a 4‐Month‐Old Boy

A 4-month-old, healthy boy developed white papules on his cheeks and forehead that became ecchymotic. This occurred in association with mild rhinorrhea three weeks after a diphtheria-pertussis-tctanus immunization. Otitis media was diagnosed and treatment was started with oral amoxicillin-clavulinic acid after a single intramuscular injection of ccftriaxone. The purpuric edema progressed to involve the cheeks, ears, and extremities (Fig. 1). The buttocks were spared. Despite the childs impressive cutaneous fmd-

What's new in pediatric dermatology?: Part II. Treatment

The field of pediatric dermatology has been rich in new developments. Part II of this continuing medical education article will focus on new therapeutic modalities for several entities encountered in pediatric dermatology. The treatment of atopic dermatitis, exciting advances in the use of propranolol and other beta-blockers for the use of infantile hemangiomas, the use of rapamycin for vascular anomalies, the use of biologics in children, the central nervous system risks of general anesthesia in young children, side effects in the use of isotretinoin, the treatment of tinea capitis, treatment of herpes simplex infections, and the use of technologies such as texting and social media in medicine will be discussed.

What's new in pediatric dermatology?: part I. Diagnosis and pathogenesis.

The field of pediatric dermatology has been rich in new developments. Part I of this continuing medical education article will focus on new diagnoses and new insights into the etiology and pathogenesis of pediatric skin disorders. Insights into the pathogenesis of atopic dermatitis, new forms of contact dermatitis, recently recognized mimickers of port wine stains, associations with infantile hemangiomas, the concept of genetic diseases being classified by common pathways (RASopathies), newly recognized genetic discoveries in mosaic disorders, the recognition of cystic fibrosis being associated with aquagenic wrinkling of the palms, new forms of epidermolysis bullosa, and genital ulcers in non-sexually active adolescent girls will be discussed.

Recurring Diffuse Annular Erythematous Plaques in a Newborn

A newborn female infant presented with an asymptomatic eruption that first began on her fifth day of life. The lesions developed over a 24-hour period, lasted for approximately 3 to 6 weeks before spontaneously resolving, and recurred several days later. When the patient was treated with prednisone by her primary physician for an upper respiratory tract infection, her lesions quickly cleared, only to recur a few days after stopping treatment with the medication. The infant was otherwise healthy with normal growth and development, and no household contacts were experiencing any eruptions or pruritus. Skin examination revealed discrete, annular, erythematous plaques with raised borders and central clearing on the infant’s chest, arms, and neck (Figure, A). At follow-up, it was found that the previous lesions had resolved completely without scarring or residual hyperpigmentation, and new lesions of variable size had developed on her scalp, neck, arms, vulva, and trunk (Figure, B). Results of a complete blood cell count with differential, peripheral smear, complete metabolic panel, and assays for C-reactive protein, antinuclear antibody, anti–double-stranded DNA antibody, anti-SSA, and anti-SSB autoantibodies were all normal. A punch biopsy was performed of a representative lesion of her left medial arm (Figure, C and D).

Secondary syphilis and suspected child abuse

A 38-year-old Hispanic woman presented with a widespread papulosquamous eruption with accentuation on the palms and soles (Fig 1, A). Travel history was remarkable for a recent trip to her native country (Dominican Republic). Her 13-year-old son, who accompanied her on the trip, developed a similar rash after their return (Fig 1, B). In addition, the patient noted that her boyfriend, whom she was visiting in the Dominican Republic, had a rash when she arrived. The rapid plasma reagin (RPR) test produced negative findings whereas the skin biopsy specimen from the patient’s foot showed a psoriasiform lichenoid dermatitis teeming with spirochetes highlighted by a Steiner stain. After discussion with the laboratory about the RPR results, serial dilutions proved positive (prozone effect). At follow-up 4 days later, the son was evaluated for his rash. As expected, the patient’s fluorescent treponemal antibody absorption (FTA-ABS) test result was positive, but the son’s test finding was only minimally reactive.

Novel MBTPS2 Missense Mutation in the N-Terminus Transmembrane Domain in a Patient with Ichthyosis Follicularis, Alopecia, and Photophobia Syndrome

Ichthyosis follicularis, alopecia, and photophobia (IFAP) syndrome is an X‐linked dominant condition characterized by the triad of ichthyosis follicularis, alopecia, and photophobia caused by mutations in the MBTPS2 gene. Herein we describe a proband with IFAP syndrome with mild cutaneous manifestations and a novel MBTPS2 mutation in the N‐terminal transmembrane domain.

The histopathology of terra firma‐forme dermatosis: author's response

To the Editor, We appreciate the comments of Drs Berk and Mutizuwa regarding our report and find their hypothesis intriguing, but we believe that terra firma-forme dermatosis and confluent and reticulated papillomatosis (CARP) are separate entities that share some clinical and histopathological features. Terra firma-forme dermatosis in its most classical presentation favors concavities, is especially common in the post-auricular region, and truly looks ‘dirty’. We are unaware of reported resolution with any form of medical therapy, including oral minocycline. When wiped with alcohol, a site of involvement by terra firma-forme dermatosis leaves essentially normal skin.1 In contrast, CARP has a female predilection and is more common in dark-skinned individuals and favors the chest, upper abdomen and axillae. There are several systemic therapies that seem to be effective, but minocycline is the classic one.2 CARP looks improved after wiping with alcohol (as does acanthosis nigricans), but normal skin is not the consequence of wiping.3 Any papillomatous skin condition can trap debris and sebum and thus should improve with alcohol wipes. Another case of terra firma-forme dermatosis was recently biopsied at our institution. During the evaluation of this patient, a biopsy was taken prior to rubbing with alcohol and then again immediately after wiping with alcohol (Fig. 1). Both biopsies showed a similar papillated epidermal architecture; however, the post-alcohol treated sections demonstrated a thicker and more compact lamellar stratum corneum that lacked loose orthohyperkeratotic superficial layers identified in the pre-alcohol sections Fig. 1. Terra firma-forme dermatosis before and after removal with isopropyl alcohol.