Karmela Husar

Phototherapy in Pediatric Patients

Abstract: The treatment of children with psoriasis, atopic dermatitis (AD), pityriasis lichenoides, and scleroderma poses a therapeutic problem because all therapeutic options are associated with numerous side effects. Therefore ultraviolet A and B (UVA and UVB) phototherapy is presented as a possible alternative to some of these therapies, primarily topical and systemic corticosteroids, in children. Our results in treating children with phototherapy and psoralen plus UVA (PUVA) bath phototherapy over the past 5 years are reported. UVB therapy (TL01) was used in 20 psoriatic children (6 boys, 14 girls; ages 6–14 years) during the stage of disease exacerbation and in 9 children (3 boys, 6 girls; ages 8–16 years) with pityriasis lichenoides. Combined UVA/UVB phototherapy was applied in 21 AD children (7 boys, 14 girls; ages 4–15 years). Photochemotherapy with local application of a PUVA bath was used in six children (2 boys, 4 girls; ages 9–16 years) with circumscribed scleroderma and in one girl with systemic scleroderma. All children received short courses of phototherapy with either no maintenance or short maintenance. All three therapeutic protocols resulted in a certain degree of improvement in most of the study patients. None of the patients exhibited any early phototherapy side effects. We conclude that phototherapy and PUVA bath are valuable and safe therapeutic options for selected children who do not respond to other treatments.

Molluscum contagiosum from infancy to maturity

Molluscum contagiosum (MC) is a common cutaneous viral infection caused by a large DNA poxvirus that affects both children (1–5 years) and rarely, adults.1–3 MC clinically presents as waxy, dome-shaped umbilicated papules (Fig 1). The synonyms are epithelioma contagiosum and dimple warts.1 Descriptions of MC have been in the medical literature since 1817. In 1905, the viral nature of MC was discovered by Juliusberg.4 Molluscum contagiosum virus (MCV) is a large, double-stranded DNA orthopoxvirus of the family Poxviridae or an unclassified poxvirus.4–6 MCV is strictly epidermotropic (not scarring) and relatively large at 240–320 nm. MCV replicates in the cytoplasm of host epithelial cells, producing cytoplasmic inclusions, and may cause enlargement of infected cells.5,6 Transmissions are from person to person or autoinoculation. MC affects both sexes equally. The actual virus reservoir is not known. The incubation period is 2–8 weeks for year.5 The virus enters the skin directly via small epithelial defects or indirectly via clothing, towels, or handkerchiefs.7 MC in adults is most typically a sexually transmitted disease (STD), occurring in 10–20% of HIV-seropositive patients and in patients with immunosuppressive conditions. MC may be spread by “autoinoculation”— scratching or touching a lesion and transferring the virus from location to location. They are usually localized on the trunk, arms, and in the armpits. Genital area involvement is much more often seen in adults.

Mollusca contagiosa: from paediatric dermatology to sexually transmitted infection.

ZusammenfassungMollusca contagiosa (MC) sind eine häufig auftretende, durch das Molluscum-contagiosum-Virus verursachte Hautinfektion, sie kann Kinder und Erwachsene betreffen. Sie ist relativ häufig bei 1- bis 5-Jährigen und kann an fast allen Körperstellen auftreten. Bei Erwachsenen gelten MC als sexuell übertragbare Infektion (STI). Das Molluscum-contagiosum-Virus kann direkt von Mensch zu Mensch übertragen werden oder durch Autoinokulation. Bei Erwachsenen finden sich MC typischerweise in der Genitalregion. Extragenitaler Befall tritt häufiger auf unter Immunsuppression, besonders bei HIV-Infektion. Bei HIV-positiven Patienten können MC als Teil eines immunrekonstitutionellen inflammatorischen Syndroms (IRIS) verstanden werden. Bei Kindern sind vermutlich beide Geschlechter gleich häufig betroffen, bei Erwachsenen scheint die Prävalenz unter Männern höher zu sein. Hinsichtlich einer Behandlung bestehen zwar Kontroversen, sie kann aber sehr hilfreich sein bei der Prävention. Bisher gibt es keine kausale Therapie, die meisten Behandlungsoptionen sind mechanischer Art, andere sind nicht hinreichend evidenzbasiert. Besondere Beachtung sollte einem extragenitalen Befall bei Erwachsenen geschenkt werden, dann sollte ein HIV-Test empfohlen werden. Zur Prävention von Übertragung und Autoinokulation sollten sowohl Kinder als auch Erwachsene mit MC angehalten werden, Hautkontakt und Kratzen zu vermeiden. Erwachsene MC-Patienten sollten einem Screening auf andere sexuell übertragbare Infektionen unterzogen und entsprechend beraten werden.AbstractMolluscum contagiosum (MC) is a common cutaneous infection caused by the molluscipox virus (MCV) and can affect both children and adults. Molluscum contagiosum is relatively frequent in children aged 1-5 years old and can be localized almost anywhere on the body, but in adults it is regarded as a sexually transmitted infection (STI). MCV can be transmitted directly from person to person or by autoinoculation. MC in adults characteristically involves the genital area but extragenital appearance can be more typically seen in patients with immunosuppressive conditions, especially in HIV/AIDS. The onset of MC in HIV-positive individuals can be regarded as a part of the immune reconstitution inflammatory syndrome (IRIS). MC probably affects both sexes equally in children, whereas it seems that in adults the incidence is more prevalent in males. Therapy is controversial but may be considerably beneficial in preventing transmission or autoinoculation. At present there is no aetiological treatment of MC and most treatment options are mechanical sometimes causing discomfort or are not sufficiently evidence-based. Attention should be given to the extragenital site of involvement in adults and HIV testing should be recommended. Both children and adults with MC should be educated to avoid scratching and skin contact with others to prevent transmission and autoinoculation. Adult patients with MC should be carefully screened for other STIs and appropriately counseled.Molluscum contagiosum (MC) is a common cutaneous infection caused by the molluscipox virus (MCV) and can affect both children and adults. Molluscum contagiosum is relatively frequent in children aged 1-5 years old and can be localized almost anywhere on the body, but in adults it is regarded as a sexually transmitted infection (STI). MCV can be transmitted directly from person to person or by autoinoculation. MC in adults characteristically involves the genital area but extragenital appearance can be more typically seen in patients with immunosuppressive conditions, especially in HIV/AIDS. The onset of MC in HIV-positive individuals can be regarded as a part of the immune reconstitution inflammatory syndrome (IRIS). MC probably affects both sexes equally in children, whereas it seems that in adults the incidence is more prevalent in males. Therapy is controversial but may be considerably beneficial in preventing transmission or autoinoculation. At present there is no aetiological treatment of MC and most treatment options are mechanical sometimes causing discomfort or are not sufficiently evidence-based. Attention should be given to the extragenital site of involvement in adults and HIV testing should be recommended. Both children and adults with MC should be educated to avoid scratching and skin contact with others to prevent transmission and autoinoculation. Adult patients with MC should be carefully screened for other STIs and appropriately counseled.

Inflammatory epidermolysis bullosa acquisita in a 4-year-old girl.

This study presents a case of linear immunoglobulin A dermatosis‐like epidermolysis bullosa acquisita in a 4‐year‐old girl showing rapid, widespread and inflammatory skin lesions. The diagnosis was confirmed by histopathology, direct and indirect immunofluorescence, various immunoblotting analyses and enzyme‐linked immunosorbent assays. Despite the severe clinical manifestations, the disease was successfully controlled by combination therapy of oral prednisolone and dapsone.

Juvenile Onset Hypopigmented Mycosis Fungoides: A Case Series Of 3 Patients

Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Primary cutaneous lymphomas (PCLs) are exceedingly rare in children and adolescents, with mycosis fungoides (MF) being the most frequent PCL diagnosed in childhood. The incidence of MF is 6.4 per 1, 000, 000 per year in adults, but the occurrence in children and young adults is rare and has not been well established yet. Hypopigmented mycosis fungoides (HMF) is an atypical and rare subtype of MF characterized by solely hypopigmented patches or in combination with erythematous patches or plaques. There are no criteria that define a typical case of HMF. We present three cases of juvenileonset HMF at Department of Dermatology and Venereology, University Hospital Center Zagreb between November 2014 and January 2015. Patients were between 9 and 12 years old at the time of diagnosis. The diagnosis was reached based on clinical, histopathological and immunohistochemical correlation. All patients were investigated at the time of diagnosis with complete blood count, peripheral smear, ultrasonography of abdomen and pelvis, and chest X-ray. They were all without extracutaneous progression of disease. Narrowband UVB (311nm) phototherapy and/or potent topical steroids were used as a first- line treatment. HMF is rare in Caucasians and with only few cases described in children. Juvenile-onset MF is often misdiagnosed at early stages as benign condition. HMF may simulate atopic dermatitis, pityriasis alba, pityriasis lichenoides, tinea versicolor, vitiligo, postinflammatory hyperpigmentation or leprosy (Hansen? disease). Although HMF has good prognosis, it is a malignant skin lymphoma and should always be treated as such. Treatment modalities for juvenile MF are based on general strategies for adults according to disease stage.