Ingrid Polcari

Panniculitis in childhood.

Panniculitis refers to disorders with inflammation of the subcutaneous fat. Such inflammation can be primary or can be a reaction pattern induced by a systemic process. Some types of panniculitis are seen more commonly or exclusively in children. These include erythema nodosum, subcutaneous fat necrosis of the newborn, sclerema neonatorum, poststeroid panniculitis, and cold panniculitis. The most typical clinical finding is tender, erythematous subcutaneous nodules. Clinical clues can aid in the diagnosis of the panniculitides, but pathology is often necessary to confirm the diagnosis. In general, the pediatric panniculitides are treated with supportive care and management of any underlying disorders, but certain types such as infectious panniculitis and malignancy‐related panniculitis require more specific therapies.

Local Vaccine Site Reactions and Contact Allergy to Aluminum

Abstract:  Childhood vaccines are a routine part of pediatric care in the United States; clinicians must be able to recognize and interpret associated localized adverse reactions. Redness and induration at the site of injection are commonly reported and are considered to be the result of local inflammation or hematoma formation, although other atypical reactions can occur. We report the case of a 6‐month‐old infant who developed subcutaneous nodules at the sites of his 4‐ and 6‐month Pentacel (DTaP/Hib/IPV, diphtheria, tetanus, acellular pertussis, Haemophilus b conjugate, and inactivated poliovirus vaccine) and 6‐month Prevnar (heptavalent pneumococcal vaccine) injections. Infectious disease and immunodeficiency examinations were unremarkable. Aluminum contact allergy was considered, and contact allergy testing confirmed sensitivity to aluminum. Although rare, aluminum contact allergy after routine immunization can occur and should be considered in the differential diagnosis of persistent subcutaneous nodules after vaccination.

Headaches as a Presenting Symptom of Linear Morphea en Coup de Sabre

Linear morphea en coup de sabre (ECDS) is a form of localized scleroderma that predominantly affects the pediatric population, with a median age of 10 years at presentation. The existence of neurologic findings in association with ECDS has been well described in the literature. Here we describe 4 patients with ECDS who presented with headaches, which were typical migraines in 3 of the patients. The headaches preceded the onset of cutaneous findings by at least 6 months. Our patients’ cases emphasize both the importance of recognizing headaches as a harbinger of ECDS and the necessity of performing thorough cutaneous examination in patients with unexplained headaches or other neurologic disease.

Observational study of free public sunscreen dispenser use at a major US outdoor event

(BPO). Each received the standard Mohs beveled incision a few millimeters beyond the visual tumor margin that continued along a horizontal plane and resulted in a thin disc of excised tissue. Seventy-one percent of non-CWNMSCs were cleared in 1 stage, and 24% were cleared in 2 stages. In contradistinction, 33% of CWBCCs were cleared in 1 stage. Moreover, 33% of CWBCCs required

Morphology-Based Diagnosis of Acneiform Eruptions.

3 stages compared to 5% of non-CWNMSCs. These differences were statistically significant. Postoperative defects also revealed statistically significant differences. Sixty-three percent of non-CWNMSCs left wounds \2 cm in diameter compared to 14% of CWBCCs. Forty-eight percent of CWBCCs had defects[3 cm compared to 11% of non-CWNMSCs. The central facial location (90%) in CWBCCs adds to the impact. In the literature, the aggressive BCC—a composite term including, like CWBCCs, infiltrative, morpheaform, and micronodular histologic subtypes—has an incidence of 20% to 30% of all BCCs. In this study, CWBCCs accounted for 2% of NMSCs, 2.8% of BCCs, and 9% to 14% of aggressive BCCs. This study describes the candle wax sign, a visual clue associated with a subtle niche of aggressive BCCs. Awareness of this clinical finding can avert the diagnostic delay, extensive surgery, and significant aesthetic damage associated with CWBCC treatment.

Novel nickel contact dermatitis in a patient taking isotretinoin.

Acne is the most common skin disease. Distinguishing between true acne vulgaris and the various acneiform eruptions is important yet sometimes challenging. Given the common nature of acne and acneiform eruptions, the pediatrician must be aware of these lesion patterns and possess the skills to effectively evaluate the pediatric presentation of these eruptions. This article discusses several of the most common acneiform eruptions, including neonatal acne and cephalic pustulosis, periorificial dermatitis (perioral dermatitis), facial angiofibromas, iatrogenic acneiform drug eruptions, and childhood rosacea.

Penile Myofibroma Occurring in a Dorsal Hood Prepuce

There are many reports about contact dermatitis to nickel and side effects of isotretinoin, but the development of contact dermatitis to a previously tolerated allergen while taking isotretinoin is not well described. We report the case of a 19‐year‐old man who developed a new nickel allergy during isotretinoin treatment. We theorize that thinning of the stratum corneum by this medication allows for greater antigen presentation and thus sensitization to contact allergens.

Methotrexate treatment in a case of juvenile pityriasis rubra pilaris

Dorsal hood prepuce is a common congenital anomaly of the penis. Neoplasms of the prepuce are very rarely seen in children. We present an interesting case of a penile myofibroma encountered during circumcision of a dorsal hood foreskin in an 8-month-old infant.

Skin lesions in a 5-year-old boy with recent unusual course of pneumonia

An 8‐year‐old boy who was initially diagnosed with plaque psoriasis failed management with topical therapies and skin biopsy confirmed the suspected diagnosis of juvenile pityriasis rubra pilaris (PRP). Pityriasis rubra pilaris is a rare inflammatory disorder of the skin characterized by follicular keratotic papules coalescing into plaques, along with palmoplantar keratoderma. Treatment modalities include topical and systemic therapies, although previous studies have not shown much benefit with methotrexate in children. We present a case in which methotrexate led to significant improvement of the skin findings in a child with type IV juvenile pityriasis rubra pilaris.

Characteristics and Skin Cancer Risk Behaviors of Adult Sunless Tanners in the United States

A 5-year-old boy presented to the dermatology clinic with a 3-week history of skin lesions that had been treated with cephalexin and sulfamethoxazole/trimethoprim without improvement. Examination showed pink nodules with yellow crusting on the face, right elbow (Figures 1 and 2), and left calf. His parents reported that he was previously healthy with the exception of a recent hospitalization 2 months earlier for pneumonia. Further history revealed that he required intensive care and multiple intravenous antibiotics and ultimately improved after a chest tube was inserted. A biopsy of the skin lesion of the left calf was obtained for tissue culture and pathologic analysis (Figure 3). Careful review of exposures revealed that 2 months before his hospitalization, he had been in northern Minnesota and spent some time outside playing at a construction site with excavated soil.