Karen Wiss

Diaper Dye Dermatitis

Diaper dermatitis is a common problem in outpatient pediatric office settings. Although most diaper rashes represent a form of contact dermatitis in response to irritants in the diaper environment, other rashes may be the result of an allergen in the diaper. On the basis of clinical examination results for 5 patients and patch testing results for 2 patients, we suspect that the patients demonstrated allergic contact dermatitis in response to the various blue, pink, and green dyes in diapers. Although topically administered corticosteroids are useful in the treatment regimen, the preferred treatment for allergic contact dermatitis in the diaper area is the use of dye-free diapers for allergen avoidance. Patch testing may also be valuable in identifying the allergen, because allergen avoidance is the key to prevention of recurrent disease.

An unusual pustular eruption in an infant with Down syndrome and a congenital leukemoid reaction

Congenital leukemia and leukemoid reactions may be indistinguishable on clinical and histologic grounds and are highly associated with trisomy 21. This report characterizes a specific vesiculopustular skin eruption in an infant with Down syndrome and a congenital leukemoid reaction. On the first day of life an unusual vesiculopustular eruption developed, starting in areas of cutaneous trauma. A biopsy revealed immature myeloid cells in an epidermal spongiotic vesiculopustule and in a perivascular distribution, suggestive of leukemia cutis. As the peripheral blood smear normalized, the eruption cleared. Myelodysplasia subsequently developed and evolved into acute myelogenous leukemia. This is the first detailed report of a specific skin infiltrate caused by the immature cells of a leukemoid reaction. Skin infiltration by immature myeloid cells during a congenital leukemoid reaction may portend an aggressive course of the myeloproliferative disorder.

An update on diaper dermatitis

Diaper dermatitis leads to approximately 20% of all childhood dermatology visits. There have been several technologic advances in diaper design the last several years; however, due to the unique environment of the diaper area, many children continue to suffer from a variety of dermatologic conditions of this region. Common causes include allergic contact dermatitis, irritant contact dermatitis, infection, and psoriasis. Treatments include allergen avoidance, barrier protection, parent education, and topical therapies.

Comparison of once- and twice-daily naftifine cream regimens with twice-daily clotrimazole in the treatment of tinea pedis

1. Steere AC, Malawista SE, Bartcnhagen NR, et al. The clinical spectrum and treatment of Lyme disease. Yale J Bioi Med 1984;57:453-61. 2. Berger BW. Erythema chronicum migrans of Lyme disease. Arch DermatoI1984;120:1017-21. 3. Kramer N, Rickert RR, Brodkin RH, et al. Septal panniculitis as a manifestation of Lyme disease. Am J Med 1986; 81:149-52. 4. Eichenfield AR, Goldsmith DP, Benach JL, et al. Childhood Lyme arthritis: experience in endemic area. J Pediatr 1986;109:753-8. 5. Russell H, Sampson JS, Schmid GP, et al. Enzyme-linked immunosorbent assay and indirect immunofluorescence assay for Lyme disease. ] Infect Dis 1984;149:465-70. 6. Duffy J, Mertz LE, Wobig GH, et al. Diagnosing Lyme disease: the contribution of serologic testing. Mayo Clin Proc 1988;63: 1116-21. 7. Gammon WR. Urticarial vasculitis. Dermatol Clin 1985; 3:97-105. 8. Monroe EW, Schulz CI, Maize JC, et al. Vasculitis in chronic urticaria: an immunopathologic study. J Invest DcrmatoI1981;76:103-7. 9. Midgard R, Hofstad R. Unusual manifestations of nervous system Borrelia burgdorferi infection. Arch Neurol J987; 44:781-3. 10. Camponovo F, Meier C. Neuropathy of vasculitic origin in a case of Garin-Boujadoux-Bannwarth syndrome with positive Borrelia antibody response. J Ncurol 1986;233: 69-72.

Lumps and bumps in neonates and infants

ABSTRACT:  There are many developmental abnormalities that may appear in the neonate and in infants when critical steps in embryogenesis fail. These steps are often not fatal but can lead to signifi‐cant morbidity for those patients affected. A logical approach is needed in addressing both the diagnostic and therapeutic issues that arise when caring for these patients, as various lesions will warrant an observational approach, and others may require imaging studies or definitive surgical intervention. Additionally, there are other “lumps and bumps” that are seen in the neonatal and infantile age groups that include malignancies and cutaneous neoplasms with associated systemic sequelae.

Chromoblastomycosis Can Mimic Keratoacanthoma

A 59‐year‐old white man presented to the Dermatology Clinic at the University of Texas Medical Branch with ti verrucous nodule on the right forearm. The patient was a retired woodworker. He had polytiiyositis with pulmonary fibrosis for 5 years. Prednisone and mcthotrexate were required to control his disease.

Doing the math: A simple approach to topical timolol dosing for infantile hemangiomas

Topical timolol maleate has recently gained popularity as a treatment for superficial infantile hemangiomas, but calculating a safe dose of timolol can be time consuming, which may limit the medications use in fast‐paced clinical environments. This report offers a simplified calculation of the maximum daily safe dosage as 1 drop of medication per kilogram of body weight.

Pityrosporum Folliculitis: A Retrospective Review of 110 Cases

Background Pityrosporum folliculitis is an under‐recognized eruption of the face and upper portion of the trunk that may be confused with, or occur simultaneously with, acne vulgaris. Objective We sought to characterize risk factors for Pityrosporum folliculitis, its clinical presentation, and its response to treatment. Methods A retrospective chart review was performed on all patients age 0 to 21 years seen at our facility from 2010 to 2015 with Pityrosporum folliculitis confirmed by a potassium hydroxide preparation. Results Of 110 qualifying patients, more than 75% had acne that had recently been treated with antibiotics, and when recorded, 65% reported pruritus. Clinical examination demonstrated numerous 1‐ to 2‐mm monomorphic papules and pustules that were typically on the forehead extending into the hairline and on the upper portion of the back. The most common treatment was ketoconazole shampoo, which led to improvement or resolution in most cases. Some patients required oral azole antifungals. Limitations This study was retrospective and relied on providers describing and interpreting the clinical findings and potassium hydroxide preparations. No standard grading system was used. Conclusion Unlike classic acne vulgaris, Pityrosporum folliculitis was more common after antibiotic use. It presented as fine monomorphic, pruritic papules and pustules along the hairline and on the upper portion of the back, and it improved with topical or oral azole antifungal therapy.

Noonan syndrome with loose anagen hair associated with trichorrhexis nodosa and trichoptilosis

We report a case of Noonan syndrome with loose anagen hair (NS/LAH), a rare variant of Noonan syndrome, with associated trichorrhexis nodosa and trichoptilosis. The SHOC2 mutation may be responsible for these additional hair shaft defects, revealing the importance of microscopic examination of hairs in these patients.

Clinicopathologic challenge. Disseminated fusariosis.

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