Dermatology

Identification of this disorder can be difficult because of the wide range of effects of prenatal alcohol exposure. Here: tips on how to recognize its clinical manifestations and neurodevelopmental features and behaviors.

A baby boy, aged 14 days, presented with a temperature of 38.2°C (100.8°F), a generalized maculopapular rash, and purulent otorrhea. He was treated with oral amoxicillin for 10 days. At age 25 days, he again presented-this time with erythema and edema of the umbilicus, thrush, and fever of 24 hours’ duration.

A discussion of three types of Genital Lesions: Sebaceous Gland Hyperplasia of the Penis, Varicocele, and Penile Dog Bite.

A 4-month-old girl is brought to your office by nervous parents who point out swelling of all the fingers of her right hand associated with tender, deep nodules on the proximal and middle phalanges.

The areas of hypopigmentation on this 4-month-old girl are sequelae of eczema. The rash had developed on the infant’s upper extremities in the bilateral antecubital and popliteal fossae at 1 month of age. Her cheeks were also affected, although only slightly. Her initial diet consisted of regular infant formula. This was switched to soy formula, which she vomited. She was then given a lactose-free formula, which she tolerated well.

A17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.

Three-month-old boy with multiple birthmarks and hypertrophic left arm. Infant was born at 38 weeks’ gestation to a 33-year-old gravida 2, para 1 after an uncomplicated pregnancy and normal spontaneous vaginal delivery. Birth weight, 3.45 kg; length, 53 cm. Both parents healthy, nonconsanguineous. No family history of growth abnormalities. Father had port-wine stains on nape and chest.

A 7-month-old boy with a history of severe atopic dermatitis and asthma was brought for evaluation of a generalized rash, fever, and irritability of 2 days’ duration. He had no respiratory symptoms. His medical history was significant for anorexia, without vomiting or diarrhea. He had a strong family history of allergy.

The lesions on this 10-year-old boy had developed during the past year. They were asymptomatic and appeared only on the anterior chest. The child's older brother had had similar lesions, also on the chest, for more than 10 years. The boys' mother was concerned that her younger son might experience the same "disfigurement" as her older son and wanted to prevent that from happening.

The mother of an 8-year-old boy sought medical care for her son, who had complained of a sore throat for 3 days. No fever, drooling, rash, rhinorrhea, cough, congestion, ear pain, neck stiffness, or dyspnea was reported. The boy had not been in contact with any ill persons, although his complaints coincided with a local outbreak of streptococcal pharyngitis.

During a newborn examination, you note a yellow streak on the foot of a healthy newborn.

The rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.

For 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.

A15-year-old girl was referred to a pediatric endocrinologist for evaluation of hyperthyroidism. Her primary concerns were intermittent increases in heart rate and appetite (with a weight gain of 7 kg within the past year), feeling hot at night even in winter, persistent lower extremity edema that had been present since age 4 years, and difficulty in concentrating. She denied having diarrhea, sweating, fatigue, breathing difficulties, hair loss, or changes in hair texture.

The mother of a 4-year-old boy noticed a rash on her son's left shoulder the day before. The otherwise healthy, asymptomatic boy plays outdoors daily in his hometown of West Virginia. Earlier in the week, he told his mother that he had felt a "scab" on his shoulder and had picked it off.

This young girl’s lesions have persisted for several months despite therapy with a multitude of over-the-counter products. The patient’s younger sister is affected as well.

A 9-year-old previously healthy boy presents to his pediatrician with acute onset of a nonproductive cough, left eye swelling without loss of visual acuity, persistent fever of 3 days’ duration, chills, headache, chest pain, vomiting, and left knee pain with inability to bear weight.

A discussion of three types of Genital Lesions: Concealed Penis, Balanoposthitis, and Scrotal Abscess.

Dr Robson reports on his time in 2 Haitian cities severely damaged by the January earthquake. He describes the significant challenges he faced and stresses the need for ongoing volunteer efforts.

An 18-year-old girl complains of having a peculiar brown patch on her right anterior thigh for 3 weeks. She admits to having a laptop on ther right thigh for a few hours each day.

A 10-month-old boy with an asymptomatic rash is brought to your office by his mother. The rash, which began on the legs and spread to the arms, face, and buttocks, has been present for 3 days. Other than rhinorrhea and nasal congestion for the past 3 to 5 days, the infant has been well, although fussier than usual, especially at night. His appetite is normal. The rash has persisted despite the application of bacitracin, petroleum jelly, and cortisone. He has had no sick contacts with a similar rash or illness. His immunizations are up-to-date.

An otherwise healthy 5-year-old girl presented with 2 papillary lesions just below the left lower outer lip. Five months earlier, she had had a common wart on the dorsal side of the web space between her left thumb and index finger. This wart was treated with electrocautery desiccation and curettage. The pictured lesions appeared after the wart on the left hand had been removed.

I’ve weaned my 2-year-old off the bottle. Now how can I get her to break the thumb-sucking habit?

At his first well-child visit after a family move, an 8-year-old boy was noted to have bilateral erythematous plaques on the surfaces of his hands and feet. Mother reported that the condition had been present since he was 2 or 3 months old. Patient’s father and other male relatives on the paternal side (uncles, grandfather, great-grandfather) were similarly affected. No other associated symptoms, such as hyperhidrosis, reported. The child did not have a history of eczema, asthma, or food allergies; however, he did have a history of allergic rhinitis and occasional pruritus.

The mother of this 11-month-old Somalian girl expressed concern about a light-colored patch over her daughter’s right brow. She was worried that the infant had vitiligo.

Vascular birthmarks are very common in newborns, and some varieties affect up to 50% of babies.

A 15-year-old girl is desperate for you to treat brown bumps on her chest, neck and trunk that have increased in number over the last 8 years.

An 18-year-old boy presented with a several-month history of an intermittent, very pruritic rash on his back that did not improve with topical corticosteroids. Physical examination revealed grouped erythematous papules with a few scattered small vesicles on his posterior neck and bilateral posterior shoulders at the location where his backpack frequently rubbed.

A healthy term infant born via normal vaginal delivery was noted at birth to have numerous small vesicles involving most of his face and upper chest. He was transferred to the neonatal ICU for suspicion of disseminated herpes simplex. On examination, the infant had small, 1- to 2-mm, superficial, clear vesicles that were confluent on the forehead, eyelids, nose, cheeks, neck, and upper back. A Tzanck test was negative for multinucleated giant cells.

After completing training in pediatrics, dermatology, and pediatric dermatology, I am convinced that the art of medicine, especially as practiced in the field of pediatric dermatology, consists largely of an ability to use pattern recognition to separate the usual from the rare.