Maureen Rogers

Childhood Psoriasis: A Clinical Review of 1262 Cases

Abstract: Our aim was to describe the types of psoriasis seen in a large series of patients presenting to a tertiary referral pediatric dermatology department using a classification system combining conventional terminology and additional categories based on the site and characteristics of the rash. A total of 1262 patients seen consecutively in the dermatology department of the Royal Alexandra Hospital for Children, Sydney, Australia, between 1981 and 1995 are described and classified according to the pattern of psoriasis at the time of presentation. Additional information recorded included family history, facial involvement, and history of a psoriatic type of diaper rash in infancy. The ages of the children ranged from 1 month to 15 years. There was an equal gender distribution and a high rate of positive family history at 71%. Twenty‐six percent of children had a history of a psoriatic diaper rash and facial involvement occurred in 38% of children. Plaque psoriasis was the most common type overall, affecting 430 patients (34%). Three hundred forty‐five children were less than 2 years of age, and this is the largest series of children with psoriasis in this age group presented to date. An entity defined by us as psoriatic diaper rash with dissemination was the most common type of psoriasis in the less than 2‐year age group, affecting 155 (45%) patients. This large series offers information on the manifestations of psoriasis in childhood, but is particularly useful in examining the previously less well‐described infant age group. The classification used is proposed as a practical way to describe psoriasis in children, particularly with respect to future descriptive studies.

Epidermal nevi and the epidermal nevus syndrome: A review of 131 cases

One hundred thirty-one patients with epidermal nevi are reviewed. The commonest site of involvement was the head and neck, and 13% of patients had widespread lesions. Ages of onset ranged from birth to 14 years. A spread beyond the original distribution was noted in 37% of patients. Many clinical patterns occurred, including eight cases of inflammatory linear verrucous epidermal nevus. A variety of other cutaneous abnormalities were found. Biopsies were performed in 41 cases. Three patients developed secondary tumors. One hundred nineteen of the patients were assessed for the presence of abnormalities in other organ systems. One or more abnormalities were demonstrated in 33% of patients, and in 5%, five or more abnormalities were detected. This study indicates that patients with epidermal nevi are at significant risk of having other abnormalities and warrant detailed initial assessment and close follow-up.

Vulvar disease in children: a clinical audit of 130 cases.

Abstract: We evaluated 130 prepubertal girls presenting with a vulvar complaint to determine the spectrum and frequency of conditions seen in this age group. Of the patients, 41 (33%) had atopic or irritant dermatitis, 23 (18%) had lichen sclerosus, 21 (17%) had psoriasis, 15 (12%) had vulvar lesions, most often hemangiomas and nevi, and 13 (10%) had streptococcal vulvovaginitis. Diagnoses less frequently seen were staphylococcal folliculitis (four patients), labial fusion (three patients), genital warts (two patients), molluscum contagiosum of the vulva only (one patient), vulvar bullous pemphigoid (two patients), scabies nodules (one patient), erythema annulare centrifugum (one patient), tinea (two patients), and vitiligo (one patient). We also encountered vulvar presentations of systemic diseases (varicella, staphylococcal scalded skin syndrome, and Henoch–Schönlein purpura, all one patient each). We did not see candidal vulvovaginitis in this age group nor did we encounter bacterial infection with pathogens other than Staphylococcus aureus and S. pyogenes.

Treatment of Childhood Vulvar Lichen Sclerosus with Potent Topical Corticosteroid

Abstract: Potent topical corticosteroid is recognized as the treatment of choice for vulvar lichen sclerosus in adults. A series of 11 children with vulvar lichen sclerosus were treated with the potent topical corticosteroid betamethasone dipropionate 0.05%, seven using an optimized vehicle preparation. There was an excellent response to therapy in all cases. No serious adverse effects or unwanted sequelae occurred. Eight of the 11 children experienced complete remission after 3 months of therapy. In these children no maintenance therapy has been necessary during follow‐up periods ranging from 3 to 18 months. Three children required maintenance therapy with a mild topical corticosteroid. We conclude that in children, as in adults, potent topical corticosteroid is a safe and effective treatment for vulvar lichen sclerosus.

Dermatological presentations of infantile myofibromatosis: A review of 27 cases

Twenty‐seven cases of infantile myofibromatosis presenting with dermatological manifestations were retrospectively reviewed. Approximately 80% were solitary lesions and 50% of these appeared on the head and neck. Around 60% were present at or soon after birth. Most lesions were dermal or subcutaneous, although some were intramuscular and intraosseous. The clinical appearance was non‐specific leading to frequent misdiagnosis. While most patients presented with nodules, atrophic depressed lesions and warty pedunculated lesions were also seen. Although 7% of lesions recurred after excision, spontaneous resolution was also documented.

Sonographic findings in a series of rapidly involuting congenital hemangiomas (RICH).

We report 10 patients with lesions consistent with the clinical entity of rapidly involuting congenital hemangioma (RICH). These are congenital vascular tumors bearing some resemblance to infantile hemangiomas, but with important clinical differences. The lesions in our patients were firm, red or purple plaques or tumors, sometimes with surface telangiectasia and almost all with a pale or blanched halo. They were fully developed at birth and underwent no further expansion. All promptly began to resolve and this progressed rapidly over the early months of life, with complete resolution, sometimes with residual atrophy, occurring at less than 1 year of age in most of the patients. Sonography was performed in all of our cases. A remarkably consistent picture was demonstrated. The lesions were uniformly hypoechoic and mostly confined to the subcutaneous fat. They were diffusely vascular, being traversed by multiple tubular vascular channels. Some of the channels were compressible, with a venous flow signal, while others demonstrated low resistant arterial flow. These features are consistent with recently described histopathologic findings in these rapidly involuting lesions. We feel that this entity can be reliably diagnosed in most cases with a consideration of the unique clinical features and with the use of noninvasive imaging studies.

Conditions masquerading as infantile haemangioma: Part 1

Infantile haemangiomas are among the most common growths during infancy. Their rapid growth during infancy and vascularity can easily cause confusion with other, less common growths. This article focuses on the myriad of diagnostic mimics of haemangiomas, including other vascular anomalies, benign growths, and malignancies.

Demodex infestation in a child with leukaemia: treatment with ivermectin and permethrin

Background  Demodex mites are almost ubiquitous on older adult skin but are infrequent in young children. In immunocompromised patients, demodicosis may be more frequent and severe, and systemic therapy may be needed to achieve clinical resolution.

Juvenile hyaline fibromatosis: an expanded clinicopathologic spectrum.

Abstract: A female infant had the typical cutaneous and soft tissue lesions of juvenile hyaline fibromatosis with the characteristic histologic and ultrastructural features of the disease. Her clinical course and autopsy findings strongly resembled those of infantile systemic hyalinosis, suggesting that the two conditions may be parts of a spectrum.

Inflammatory linear verrucous epidermal naevi: A review of 23 cases

Twenty‐three patients diagnosed with inflammatory linear verrucous epidermal naevi (ILVEN) over a 13 year period are reviewed retrospectively. These ILVEN showed a predilection for the buttock and legs and were usually unilateral. Onset of the lesions was usually within the first 6 months of life and extension beyond the original margins occurred in 26% of cases. Sixteen of the 23 patients were male. Ten patients had ILVEN predominantly involving the left side, 12 were on the right side and, in one case, the side involved was not recorded.