Sarah Hill

Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement

Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a childs sleep, education, development and self‐esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short‐term hypothalamic‐pituitary‐adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.

Methotrexate for treatment of atopic dermatitis in children and adolescents

Low‐dose methotrexate is becoming established as a second‐line treatment for atopic eczema in the adult population, but there has been a paucity of data to support its use for this indication in the pediatric population.

Prevalence of Staphylococcus aureus and antibiotic resistance in children with atopic dermatitis: A New Zealand experience

Background/Objectives:  Children with atopic dermatitis often have infective exacerbations which are treated with antibiotics and/or antiseptics. The most common infective cause is Staphylococcus aureus with a worldwide trend towards antibiotic resistance. This prospective observational audit aimed primarily to establish the prevalence of S. aureus colonisation in New Zealand children with atopic dermatitis attending a specialised paediatric dermatology clinic. Secondary aims were to assess whether S. aureus colonisation correlated to clinical severity, the sensitivity patterns to antibiotics (in particular methicillin‐resistant S. aureus, and to identify any demographic or management risk factors.

Muscular hinge flaps: utility and technique in facial reconstructive surgery.

&NA; The authors have indicated no significant interest with commercial supporters.

Pseudochromhidrosis: Blue discolouration of the head and neck

A 57‐year‐old man is presented with blue pseudochromhidrosis affecting the face and neck following combination treatment with lansoprazole, a proton pump inhibitor, and ranitidine, a type two histamine receptor antagonist. The diagnosis was made on the basis of clinico‐histological features and growth of Malassezia furfur, and Bacillus species, not Bacillus cereus, in the absence of lipofuscin. The pseudochromhidrosis resolved on stopping both medications and did not recur on restarting only the proton pump inhibitor.

Surgical excision of skin cancer: the importance of training

Background  Skin cancers are the most common malignancy in New Zealand and their treatment imparts a huge burden on the healthcare system both in terms of the cost of surgical intervention and in treatment delivery (estimates are in excess of NZ

A collection of rare anomalies: multiple digital glomuvenous malformations, epidermal naevus, temporal alopecia, heterochromia and abdominal lipoblastoma

33 million per annum for the year 2000). Currently in New Zealand, skin cancers are excised by dermatologists, general practitioners (GPs), GPs with a special interest in skin surgery (GPSIs) and specialist surgeons with diverse training backgrounds including ear, nose and throat, ophthalmic and general surgeons. To date there is scant literature evaluating complete excision rates following surgical treatment of skin cancer between these vocational groups.

Childhood sarcoidosis presenting with extensive cutaneous lesions, bilateral hilar lymphadenopathy and severe hypercalcaemia

Glomuvenous malformations are a subtype of venous malformations, which present in infancy or childhood. We describe a teenage girl who presented with multiple digital glomuvenous malformations from birth. In addition, she had an epidermal naevus on the upper lip, an area of congenital alopecia of the scalp, heterochromia irides and an abdominal lipoblastoma. We are unaware of any reports of the association of multiple glomuvenous malformations with the other uncommon developmental anomalies seen in our patient, and a common link eludes us.

Effect of narrowband ultraviolet B phototherapy on melanocytic naevi

A 9‐year‐old boy with a history of atopic dermatitis presented with a 4‐month history of an asymptomatic papular eruption. This was predominantly perioral in distribution with lesser involvement of the neck, arms and trunk. Investigations revealed severe hypercalcaemia of 3.77 mmol/L (normal range 2.10–2.60) and bilateral hilar lymphadenopathy. The diagnosis of sarcoidosis was supported by granulomata in skin and lymph node biopsies on histopathological examination. Prednisolone (2 mg/kg/day) rapidly normalized serum calcium.

Parotid Fistula Complicating Surgical Excision of a Basal Cell Carcinoma: Successful Treatment with Botulinum Toxin Type A

Background  Melanocytic naevi have been observed to undergo morphological changes following exposure to narrowband ultraviolet (NB‐UV)B radiation.