Philippa Dickison

A Prospective Study of Infantile Hemangiomas with a Focus on Incidence and Risk Factors

Abstract:u2002 Infantile hemangiomas (IHs) are the most common tumor of infancy and have been estimated to occur in 4% of infants. Only two previous incidence studies of IH in a healthy population have been published, and both of these were performed in the first week of life. The objective was to identify the incidence of IH in an Australian neonatal population and characterize the risk factors. All women who presented to the postnatal ward in a 200‐bed maternity hospital were asked to complete a questionnaire. Details of maternal history and birth details were recorded. Two follow‐up emails 3 and 6u2003weeks after discharge were sent to all mothers who consented, asking if their baby had developed an IH. Babies reported to have an IH were seen in clinic to confirm the diagnosis. Details were collected from 1,034 mothers of 1,065 babies; 28 (2.6%) of the infants developed IH. Babies that developed IH were more likely to be female (pu2003<u20030.001), have a low birth weight (pu2003=u20030.020), be born at a gestational age of <37u2003weeks (pu2003=u20030.005), and be conceived through in vitro fertilization (IVF) (pu2003=u20030.001) than those who did not. The incidence of IH at 6u2003weeks of life was 2.6%.:u2002 Infantile hemangiomas (IHs) are the most common tumor of infancy and have been estimated to occur in 4% of infants. Only two previous incidence studies of IH in a healthy population have been published, and both of these were performed in the first week of life. The objective was to identify the incidence of IH in an Australian neonatal population and characterize the risk factors. All women who presented to the postnatal ward in a 200-bed maternity hospital were asked to complete a questionnaire. Details of maternal history and birth details were recorded. Two follow-up emails 3 and 6xa0weeks after discharge were sent to all mothers who consented, asking if their baby had developed an IH. Babies reported to have an IH were seen in clinic to confirm the diagnosis. Details were collected from 1,034 mothers of 1,065 babies; 28 (2.6%) of the infants developed IH. Babies that developed IH were more likely to be female (pxa0<xa00.001), have a low birth weight (pxa0=xa00.020), be born at a gestational age of <37xa0weeks (pxa0=xa00.005), and be conceived through in vitro fertilization (IVF) (pxa0=xa00.001) than those who did not. The incidence of IH at 6xa0weeks of life was 2.6%.

Beware what lies beneath: a case of a gigantic cutaneous squamous cell carcinoma

H. Marzo-Ortega and D. McGonagle Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre and Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; and Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Via Potito Petrone snc, 85100 Potenza, Italy E-mail: g.abignano@hotmail.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 16 June 2018

Itching for nail fashion: chronic urticaria and chronic hand dermatitis secondary to acrylate and methacrylate allergy in gel nail varnish

Allergic contact dermatitis (ACD) secondary to acrylates and methacrylates is a well‐ described occurrence, particularly in those who wear or handle gel nail varnish. Management involves avoidance of the identified allergen. The cause of chronic urticaria (CI) is often not identified, and CU is not known to be associated with acrylates or methacrylates. We report a case of a 50‐year‐old woman who initially presented with hand dermatitis exacerbated by gel nail varnish on a background of CU. Avoiding all nail varnishes because of her ACD also resulted in improvement of her CU. To our knowledge, this is the first documented case of CU secondary to the acrylates and methacrylates found in nail cosmetics.

Biting down on the truth: A case of a delayed hypersensitivity reaction to lidocaine

nised, with conditions such as blister beetle dermatitis, paederus dermatitis (rove beetles – Paederus spp.), erucism (caterpillars), and lepidopterism (moths and butterflies). However, there seem to be no reports in the literature on adverse reactions due to contact with S. australis or with any other fulgoroid (planthopper) species. Caterpillars and occasionally moths have evolved defence mechanisms including irritating hairs, spines, venoms and toxins that may cause adverse health effects in humans. The adults of S. australis do not have spines so the exact mechanism of causing itch is unclear. Nymphs of many fulgoroids produce wax from special glands; these are hydrophobic and help conceal the insects. Adult female S. australis also produce wax but there are no reports of these being toxic. An irritant plant chemical, extracted by the planthopper may be responsible, although it may just be the pressure of the legs of many insects, hopping off human skin, that caused the symptoms.

Apathy in a sunburnt country: Understanding the skin cancer and sun protection knowledge and practises of Australian doctors

finding of the earliest lesion showed that part of the epidermis was necrotic, but most aggregates of neoplastic basaloid cells were not affected (Fig. 2d). In a partial progressed lesion, the histopathology showed that part of the epidermis was necrotic. The neoplastic aggregates were shrunken with a dense infiltrate of lymphocytic cells (Fig. 2e). The histopathology of the most progressed lesion showed a complete loss of both the epidermis and the neoplastic cells (Fig. 2f). There was no relapse after resection of the tumour. Therapeutic options depend on the histopathological subtype, as nonsurgical treatments can be alternative choices for treating sBCC. Therefore, clinical and dermoscopic assessments before deciding on the therapy are important. The dermoscopic feature of multiple small erosions is the most significant of the dermoscopic features of BCC that differentiates sBCC from other histopathological subtypes (odds ratio 7.8). In our patient, erosions and ulcerations due to epidermal necrosis developed above the aggregates of neoplastic cells histopathologically. Initially, necrosis is confined to the epidermis. In the progressed lesion, the whole epidermis becomes necrotic and tumour nests are shrunken, and eventually both the epidermis and tumour nests are completely necrotic. This chronological histopathological process may contribute to the formation of the multiple small erosions (Fig. 2d–f). Ulcerations due to necrosis of both the epidermis and tumour nests may also reflect the thinness of the tumour. From those dermoscopic and histopathological correlations, we substantiated the relevance of dermoscopic features of the multiple small erosions in the diagnosis of sBCC.

Nickel hypersensitivity following closure of atrial septal defect: A case report and review of the literature

We present an unusual case where symptoms of headache and chest pain persisted for 3 years following the implantation of a septal occluder device for an atrial septal defect despite endothelialisation of the device. The patient was found to have nickel hypersensitivity on patch testing. Following the removal of the device the patient had complete resolution of headaches and chest pain up to 10 months post‐explantation.

Itching for answers: Prevalence and severity of pruritus in psoriasis

Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents.

Mycobacterium abscessus infection following penetrations through wetsuits

Mycobacterium abscessus is a rapidly growing mycobacterium which is reportedly increasing in prevalence. Infection of the skin and soft tissue with M. abscessus is rare but typically associated with trauma. We present two cases of M. abscessus infection linked by penetration through wetsuits.

Fungal kerion of the vulva

A 19-year-old woman presented to an outer metropolitan hospital with increasing vulval discomfort. She stated that a small area of inflammation had developed on her left labia majorum 2 weeks previously. Despite this, she had continued to shave her pubic area. Inflammation and swelling had increased rapidly over 4 days prior to presentation. She was otherwise well with no relevant past medical history. In the emergency department, the patient was noted to have a vulval rash but no vaginitis. Genital swabs were collected for sexually transmitted infections and bacterial swabs were taken from the labia majora. The patient was admitted under the gynaecology team with a provisional diagnosis of bacterial cellulitis and she was commenced on i.v. flucloxacillin. A dermatology examination was requested and it revealed a severe erythematous eroded and oedematous eruption of both labia majora extending to the mons pubis and lower abdomen. The swelling was boggy on palpation and there was copious purulent exudate. Follicular pustules were noted within the inflamed plaque and inferiorly (Fig. 1a). A provisional diagnosis of fungal kerion was made. On further questioning it was established that the woman’s partner had a long history of a groin rash not being actively managed, but clinically diagnosed as tinea cruris. Swabs were negative for sexually transmitted infections and bacteria. A punch biopsy and fungal scrapings were collected. The patient was commenced on a 4-week course of oral terbinafine 250 mg daily and antibiotics were ceased. The biopsy and scraping demonstrated fungal elements and Tinea mentagrophytes was cultured. The patient was discharged home after 3 days and was advised to stop shaving her vulval area and that her partner should seek treatment for his tinea cruris. At follow-up 2 weeks after presentation, the erythema, exudate and swelling had reduced considerably (Fig. 1b). There have been several reported cases of vulval kerion. 5 T. mentagrophytes was identified most commonly as the causative organism. There has been one previous case series and one case report for sexually transmitted T. mentagrophytes. All the patients were immunocompetent. Many of the patients shaved their pubic hair prior to infection, which is known to be a risk factor for Majocchi granulomas on the legs, as it facilitates infection of the dermis.

Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause

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