Valerie B. Lyon

Serum 25-hydroxyvitamin D concentration does not correlate with atopic dermatitis severity

BACKGROUND An inverse correlation between serum 25-hydroxyvitamin D concentration and atopic dermatitis (AD) severity has been suggested. OBJECTIVE To determine if a statistically significant relationship exists between serum 25-hydroxyvitamin D concentration and AD severity. METHODS A cross-sectional study was conducted of patients with AD who were 1 to 18 years of age. An objective Severity Scoring of Atopic Dermatitis (SCORAD) and a serum 25-hydroxyvitamin D concentration were measured for each subject. Statistical analysis was performed using appropriate univariate tests and multivariable models. RESULTS Ninety-four of 97 enrolled subjects were included in the analysis. Vitamin D deficiency (25-hydroxyvitamin D <20 ng/mL) was present in 37 subjects (39%), insufficiency (25-hydroxyvitamin D 21-29 ng/mL) in 33 (35%), and sufficiency (25-hydroxyvitamin D ≥30 ng/mL) in 24 (26%). The correlation between 25-hydroxyvitamin D concentration and SCORAD was not significant (r = -0.001; P = .99). A multivariate model showed that a lower serum 25-hydroxyvitamin D concentration was significantly associated with age 3 years or older (P < .0001), black race (P < .0001), and winter season (P = .0084). LIMITATIONS Limitations of this study include the inability to control for natural sunlight exposure, vitamin D intake, and AD treatment; in addition, only a single time point was captured. CONCLUSIONS Serum 25-hydroxyvitamin D concentration is not significantly correlated with AD severity in our pediatric population.

Store-and-forward teledermatology versus in-person visits: A comparison in pediatric teledermatology clinic

BACKGROUND The role of teledermatology in the diagnosis of pediatric skin conditions has not been studied exclusively. OBJECTIVE To determine the ability of a pediatric dermatologist to correctly diagnose rashes by history and digital images. METHODS Consecutive, new referrals to the pediatric dermatology clinic with a rash were enrolled in the study. A history, demographic data, and digital photographs were obtained from each patient. The data were reviewed by a pediatric dermatologist who made a preliminary diagnosis. The child was then seen in person and a final diagnosis was made. Concordance and kappa values were calculated. Cases of diagnostic disagreement were analyzed for their effect on management. RESULTS One hundred thirty-five patients were enrolled. Diagnostic concordance was 82% (95% confidence interval [CI], 73%-88%), and the kappa value was 0.80. Clinically relevant disagreement occurred in 12% of cases. LIMITATIONS The study was performed at a single site, theoretically limiting generalizability. CONCLUSION Teledermatology appears to have a useful role in the care of children with rashes.

One‐Year Experience with Candida Antigen Immunotherapy for Warts and Molluscum

Abstract:  Molluscum contagiosum and warts are two very common viral‐induced diseases of childhood. We report our 1‐year experience with intralesional candida antigen therapy for both warts and molluscum contagiosum. A retrospective chart review was performed and a total of 217 patients were identified. Follow‐up was obtained either through clinic visits or telephone interviews for 25/47 molluscum patients and 55/170 wart patients. Of the molluscum patients with follow‐up, 14/25 (56%) had complete resolution, 7/25 (28%) had partial clearing, and 4/25 (16%) had no improvement. For the wart patients with follow‐up, 48/55 (87%) had complete resolution, 3/55 (6%) had partial clearing, and 4/55 (7%) had no improvement. It is important to note that our clearance rate may be overestimated, as many patients were also treated concurrently with liquid nitrogen or other therapies. All wart and molluscum patients experienced some discomfort at the time of injection, but no serious side effects were reported. Our experience suggests intralesional candida antigen may represent a treatment option for warts and molluscum contagiosum that is safe and effective.

Congenital Melanocytic Nevi

The relative risk for melanoma arising within a congenital nevus is related to the size of the lesion. The timing of and clinical presentation of development of melanoma is also related to the size of the lesion. Medical decisions are individualized taking into account the perceived risk of malignancy, psychosocial impact, and anticipated treatment outcome. In this article, the common features of congenital nevi are discussed as well as the potential individual variations and their impact on treatment recommendations.

Demographic and clinical characteristics of cutaneous lupus erythematosus at a paediatric dermatology referral centre.

Paediatric cutaneous lupus erythematosus (CLE) is uncommon and inadequately described in the literature. Similar to adults, children with CLE develop LE‐specific and/or LE‐nonspecific skin findings. Similarities and differences in demographics and clinical course between paediatric and adult CLE have not been sufficiently described.

Cutaneous and Disseminated Blastomycosis: A Pediatric Case Series

Abstract:  Blastomycosis is a rare fungal infection that most often initially infects the lungs and can progress to disseminated involvement of the skin, bones, and central nervous system (CNS). Pediatric blastomycosis constitutes a small portion of total cases, but delay in diagnosis may result in significant morbidity. Seventeen pediatric cases of blastomycosis were identified at Children’s Hospital of Wisconsin from 1999 to 2009 through retrospective chart review; 53% had evidence of dissemination (bone, skin, or CNS) confirmed by culture. Six cases presented with cutaneous lesions, and five of these were found to have other systemic involvement. These five nonimmunosuppressed cases of primary pulmonary disease with cutaneous involvement plus dissemination to bone or the CNS are reported in detail. The diagnosis of blastomycosis in children is often delayed, and dissemination by the time of diagnosis may be more common than in adults. Cutaneous dissemination may occur in immunocompetent children, may indicate underlying systemic involvement, and can be more readily identified than symptoms of bony or neurologic involvement. These reported cases indicate the importance of dermatologists recognizing and investigating all potentially involved organ systems when a patient presents with characteristic skin lesions with or without a history of respiratory illness.

Approach to procedures in neonates.

ABSTRACT:  Physical constraints and metabolic differences in neonates require that special attention is given to performing procedures in this patient group. Neonates have a thinner dermis and a greater surface‐to‐weight ratio, allowing for easier invasion through the skin barrier. The enzymes for metabolism of agents and defense against organisms inside the body are not fully developed in infants. Very premature neonates also have less circulating albumin, making the effective concentration of circulating agent even greater. The infant is prone to unanticipated movement during procedures, such as rolling on the procedure table. The neonatal period is the most common time period for malformations to become manifest on the skin, and invasion of some of these lesions can produce morbidity. These and other factors affect the choice of the type of procedure used, the timing for intervention, and the approach to intervention in this age group. This article reviews the important considerations for approaching procedures and offers suggestions for safe and effective methods of reliably producing the intended outcome.

Necrotic facial papules in an adolescent: C2 deficiency with eventual development of lupus erythematosus.

Abstract: A 14‐year‐old girl was admitted to the hospital because of persistent throat pain, fever, fatigue, 25 pound weight loss, and leukopenia. On physical examination she was thin, ill‐appearing, and had necrotic papules on the face and palpable cervical lymph nodes. Presumptive differential diagnosis included occult malignancy and infection. Numerous investigative procedures failed to elucidate a source. Vasculitis was eventually appreciated after repeat skin biopsy. Numerous serologic studies were performed and were notable for a very low level of the second component of complement without direct evidence of lupus erythematosus (LE) or other autoimmune conditions. A diagnosis of C2 deficiency‐associated vasculitis was made. She was treated with high‐dose prednisone and cyclophosphamide with resolution of her symptoms. Two years later she returned with marked malar erythema. Antinuclear and Smith antibodies were then detected and a diagnosis of LE was made. She was treated with hydroxychloroquine and sun‐avoidance measures with clearance of the malar rash.

Toddler Wrap for Abdominal Biopsy or Excision

Abstract:  Young children, especially toddlers, are anxious and uncooperative during skin procedures. Wrapping a sheet or blanket around the child is an effective way to restrain the child to maintain a sterile field. The wrap can be used for skin biopsies and small excisions on the midsection of the body, arms, and legs.

Stepwise Approach to Topical Therapy for Atopic Dermatitis

assessment of skin lesions and an appropriate knowledge base of medications are required. Lesions must be assessed for duration of presence and response to medication. In addition to selecting medications for duration and response to treatment, selection should be tailored according to body sites of application. Patients will benefit from efficacious therapy that is customized to meet their individual needs and will thereby experience better disease control, improved satisfaction, and quality of life. Children with atopic dermatitis often present to primary care clinics before dermatology offices. The principles and pathway presented here will aid the general practitioner in treating mild to moderately severe atopic dermatitis in children. In the pathway, response of the dermatitis to the chosen therapy is used to guide subsequent care in a stepwise fashion for long-term disease management.