Susan B. Mallory

Atopic dermatitis: Clinical relevance of food hypersensitivity reactions

Forty-six patients with atopic dermatitis ranging from mild to severe were evaluated for food hypersensitivity with double-blind placebo-controlled food challenges. Twenty-eight (61%) patients had a positive prick skin reaction to one of the foods tested. Sixty-five food challenges were performed; 27 (42%) were interpreted as positive in 15 (33%) patients. Egg, milk, and peanut accounted for 78% of the positive reactions. As in previous studies, patients developed skin (96%), respiratory (52%), or gastrointestinal (30%) symptoms during the challenge. These studies indicate that children who have atopic dermatitis unresponsive to routine therapy or who continue to need daily treatment after several months would benefit from evaluation for food hypersensitivity.

Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts

BACKGROUND Contact immunotherapy has been shown to be effective for warts. Two previous studies on the use of squaric acid dibutylester (SADBE) for warts have reported widely divergent cure rates (10% and 60%). OBJECTIVE Our purpose was to determine the efficacy of SADBE in the treatment of recalcitrant warts. METHODS We treated 29 patients with SADBE for warts that were resistant to other therapies. The patient population had warts for a mean duration of 2.1 years. Patients were sensitized with 1% or 2% SADBE in acetone under occlusion, then treated with 0.5% to 5% SADBE applied to their warts every 2 to 4 weeks in the office. RESULTS Clearing of all warts was seen in 20 of 29 patients (69%), improvement in 3 patients (10%), and no change in 6 patients (21%). For the cured patients, mean duration of treatment was 4.2 months (range, 1 to 12 months) and mean number of treatments was 5.7 (range, 2 to 15). Adverse effects included acute contact dermatitis with 6 patients experiencing blisters and one experiencing hypopigmentation. CONCLUSION SADBE treatment is worth considering in patients with recalcitrant warts, especially in those who tolerate painful procedures poorly.

Azithromycin compared with cephalexin in the treatment of skin and skin structure infections

This randomized, third-party-blinded study compared short-course therapy of once-daily azithromycin (500 mg on day 1, followed by 250 mg/day on days 2-5) with cephalexin (500 mg twice daily for 10 days) in the treatment of patients with skin and skin structure infections. At 25 centers, a total of 361 patients were entered into the study and 148 were evaluable for efficacy. The main causative pathogens, Staphylococcus aureus and Streptococcus pyogenes, were responsible for approximately two thirds of the infections in the two treatment groups. Clinical cure and improvement rates for the two treatments were comparable; 99% with azithromycin and 96% with cephalexin. On completion of therapy, both treatments had eradicated approximately 98% of pathogens. In general, both agents were well-tolerated. The results of this study show that a 5-day course of once-daily treatment with azithromycin is as effective as a 10-day course of twice-daily treatment with cephalexin in the management of skin and skin structure infections.

Lymphangioma circumscriptum treated with pulsed dye laser

Lymphangioma circumscriptum is a lymphatic malformation that involves the skin and may extend to subcutaneous tissue and muscle. Treatment of these lesions is challenging. Surgical excision may be performed but recurrence is common. Herein we report a child with a symptomatic lymphangioma circumscriptum that was treated with pulsed dye laser with good results. For superficial lymphatic malformations containing blood, pulsed dye laser might be considered as a treatment option.

Linear IgA Bullous Dermatosis in a Neonate

Abstract: A newborn black boy had two facial blisters at birth that progressed to bullous lesions over the trunk, genitals, extremities, and oral and tracheal mucosa. A biopsy specimen demonstrated a subepidermal bulla with mixed eosinophilic and neutrophille, inflammatory infiltrate. Direct immunofluorescence showed linear IgA, IgG, and C3 depositions along the basement membrane zone, consistent with a diagnosis of childhood linear IgA bullous dermatosis (chronic bullous dermatosis of childhood). The skin disease was controlled with combined prednisone and dipsone. This is the youngest reported patient with the disease. Linear IgA bullous dermatosis should be considered in the differential diagnosis of blistering diseases of the newborn, and immunofluorescence should be performed on a skin biopsy specimen.

Cushing syndrome from percutaneous absorption of 1% hydrocortisone ointment in Netherton syndrome.

Abstract:  Netherton syndrome is a congenital skin disease associated with decreased skin barrier function and increased percutaneous absorption. We report an 11‐year‐old boy with Netherton syndrome who developed Cushing syndrome after application of 1% hydrocortisone ointment to his entire body for more than 1 year. This presentation illustrates that even low‐potency steroid ointments should be used with caution in Netherton syndrome and warns about the use of long‐term topical medications with potential systemic side effects when used in large quantities in any chronic skin disease.

A child with spider bite and glomerulonephritis: a diagnostic challenge

A previously healthy 7‐year‐old white boy presented to St. Louis Childrens Hospital with a 1‐day history of headache, malaise, temperature of 38.7 °C, and a progressively erythematous, tender calf with central dusky purpura. On the morning of admission, his mother noticed a 2‐mm crust on the patients right calf with a 3‐cm × 3‐cm area of surrounding erythema. No history of recent trauma or bite was obtained. He had suffered two episodes of nonbloody, nonbilious emesis during the last day. In addition, over the previous 12 h, he presented brown urine without dysuria. His mother and brother had suffered from gastroenteritis over the previous week without bloody diarrhea.

Neutrophilic Dermatoses in Two Children with Idiopathic Neutropenia: Association with Granulocyte Colony‐Stimulating Factor (G‐CSF) Therapy

Painful neutrophilic skin lesions were observed in two children receiving granulocyte colony‐stimulating factor (G‐CSF) for treatment of idiopathic neutropenia. A girl with cystic fibrosis and cyclic neutropenia developed an erythematous papular eruption without fever or neutrophilia 7 months after commencing therapy with G‐CSF. A skin biopsy specimen revealed microscopic, sterile, neutrophilic abscesses. A boy with chronic neutropenia and recurrent inflammatory skin lesions developed multiple erythematous nodules following administration of G‐CSF. A biopsy specimen showed neutrophilic panniculitis. We believe that these skin eruptions belong to a spectrum of neutrophilic dermatoses that can be induced or aggravated by G‐CSF therapy.

Neonatal Skin Disorders

Skin disorders are commonly seen in the neonatal period. A recent survey of neonates demonstrated that almost every neonate had some skin lesion. The most common skin findings are desquamation, Epsteins pearls, sebaceous hyperplasia, milia, toxic erythema, salmon patch, hypertrichosis, and Mongolian spot. In addition to these common cutaneous findings, other disorders may exist and are discussed in this article.

Waardenburg's Syndrome with Hirschsprung's Disease: A Neural Crest Defect

Abstract: Waardenburgs syndrome and Hirschsprungs disease are both conditions involving a defect of migrating neural crest cells and may be seen together. We report a patient with the combination of these two diseases and review the literature on the subject. Physicians should be aware that deafness can be associated with pigmentary anomalies.