Dermatology

An itchy eruption puts a damper on a girl’s Hawaiian vacation. How might you help her avoid a similar experience on her next trip to the tropics?

An 11-year-old girl presents to the clinic with a lesion under the tongue of 3 weeks' duration. She complains of a "mass sensation" while eating and speaking but has no difficulty with swallowing.

A 10-month-old breast-feeding boy was taken to the emergency department (ED) with a temperature of 40°C (104°F). Because he was on day 7 of treatment with amoxicillin for a previously diagnosed ear infection, unresolved otitis media was diagnosed.

One week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent. She was afebrile. Worsening eczema with secondary infection was diagnosed. Treatment with oral clindamycin was prescribed. At follow-up, the lesions had worsened. The child had multiple excoriated papules, some of which had coalesced into plaques. She also had two 5-mm vesicles on her right shoulder. Eczema herpeticum was diagnosed clinically. Culture of the vesicles later grew herpes simplex virus (HSV).

The mother of this 4-year-old boy is concerned about a small drop of fluid that she noticed on her son’s neck at the dinner table the night before.

An adolescent girl seeks medical advice for managing recurrent nodules on her ear lobes. The diagnosis is keloids.

These hypopigmented, mildly pruritic lesions on the right arm of a 7-year-old African American girl appeared several weeks ago. She had no other lesions and was otherwise healthy. The diagnosis on the basis of the clinical presentation was lichen striatus.

This palpable, nontender, nonblanching rash had developed on the elbows of an 18-year-old boy and spread to the ankles and feet. The rash was accompanied by moderate abdominal pain associated with episodes of nonbloody emesis that did not change with eating or bowel movements. Diffuse joint pain developed the day after the rash appeared.

Intensely itchy, hyperpigmented macules developed on the shoulders and upper arms of a 16-year-old boy 2 weeks after he completed his eighth cycle of chemotherapy with bleomycin, etoposide, and cisplatin, following an orchiectomy for a stage IV germ cell tumor of the left testis. During the next 3 days, the lesions evolved into a papulopustular rash that spread to the upper chest, abdomen, and neck.

A 12-month-old awakens with asymptomatic juicy red papular eruptions on her cheeks. It is diagnosed as Gianotti-Crosti Syndrome.

The skin lesion pictured here is noted in a 12-year-old boy. His parents state that it developed when he was 1 year of age and that it has been growing with him ever since, with the number of “speckles” seen throughout the light brown background gradually increasing.

Because of the presence of unusual skin findings, a 3-year-old African American girl was evaluated for possible child abuse. The father, the primary guardian, reported that his daughter had returned home from her mother's residence 2 days before-a day earlier than planned. According to the father, the child was crying and had skin lesions, which initially appeared white and then darkened over the course of the next day or two.

A 5-year-old boy was brought for evaluation of ongoing thrombocytopenia before undergoing adenotonsillectomy for obstructive sleep apnea. The child had been given a diagnosis of "growing pains" after frequent evaluation for leg pain over the past 2 years.

A 2-year-old boy brought for pediatric dermatology consultation because of the "worst diaper rash in the world." Mother reported that the rash had been present for a year and was asymptomatic. She had been using topical barrier creams, corticosteroids, and antifungals to treat the area. Child had also received a course of oral antibiotics. Occasional improvement of rash noted but never complete resolution. Patient had no other medical problems. Family history noncontributory.

In early summer, an 8-year-old boy from rural central Virginia was brought for evaluation of a rash on his buttock. He had noticed the rash that morning, when it became pruritic. The father had removed a tick from the area about 10 days earlier. The child denied fever, headache, vomiting, fatigue, arthralgia, myalgia, and other symptoms.

The American Academy of Pediatrics (AAP) recently doubled the amount of vitamin D that it recommends all infants, children, and adolescents receive each day-from 200 to 400 IU. Also new is the academy's recommendation that vitamin D supplementation begin as soon after birth as possible. Supplementation is recommended in infants who do not receive 400 IU per day from formula.

An 18-year-old girl presented for evaluation of several pink, crusted papules with surrounding hyperpigmentation and a larger pink, crusted nodule with purulent drainage on her inferior right knee

The parents of this 8-year-old boy consult you about the warts on their son’s hands. During the examination, you discover multiple sharply defined light brown flat papules on the child’s forehead.

Three profiles of a magical waste basket, a reusable breastpump, and a t-shirt that helps prevent food allergies.

Teen with painful papules and plaques is diagnosed with Sweet's Syndrome

The ninth in a year-long series of commentary reviewing topics published in Contemporary Pediatrics 25 years ago. This month's article reviews the causes and management of hirsutism in adolescent girls.

Purpuric pustules can present diagnostic challenges. However, the ability to correctly identify these lesions can be of crucial-even lifesaving-importance in caring for ill children.

Erythematous pustules and papules with some coalescence developed on the anterior trunk and to a lesser degree on the face and extremities of a newborn boy the day after birth. The baby was born at full term after an uncomplicated pregnancy and delivery.

An apparently healthy 9-year-old girl noted to have left ankle mass during well-child checkup. Her last well-child visit was 3 years earlier. Medical history unremarkable. She denied fevers, weight loss, night sweats, and chills. No family history of bone deformities or growth disturbances.

Few clinical scenarios engender as much anxiety as the sudden onset of rash and fever in a child. However, the diagnostic possibilities can be quickly narrowed-and the likelihood of potentially serious disease can be assessed-with a triage system that involves classifying the presenting symptoms into 1 of 3 groups.

A 10-week-old white baby girl with a history of difficulty in breathing presented with stridor, tachypnea, wheezing, and increased work of breathing.

A child is born with congenital melanocytic nevi.

A 3-year-old boy with white patches on the trunk first noticed shortly after birth.

A 17-year-old girl presented for evaluation of right hip pain. Several months earlier she had incurred a twisting injury to her hip when she landed from a jump while dancing.

Episodic right-sided facial flushing was noted in a 2-month-old girl born at full term via forceps-assisted vaginal delivery. The erythema appeared within minutes of latching onto her mother’s breast and resolved within 5 to 10 minutes after breastfeeding. The episodes of flushing had begun a week before the clinic visit; there were no collateral symptoms of anaphylaxis. Because food allergy was suspected, the mother had eliminated all dairy products from her diet.