Dermatology

Sleep is an important, yet frequently underestimated component of adolescent health. Adequate sleep is essential for achieving maximal cognitive abilities as well as for maintaining the energy needed to meet the demands of a busy adolescent’s schedule. Lack of quality sleep can result in attention problems, cognitive dulling, various somatic complaints (such as headaches and abdominal pain), and mood disturbances.

A 3-year-old girl was with her family on vacation in Cancun, Mexico, when blisters developed on the fingers of both her hands. The family returned home early and sought immediate medical attention.

A 4-month-old boy was transferred to our center from a community care hospital because of persistent fever (temperature up to 39.4°C [103°F]) of 5 days’ duration. He also had decreased activity, increased irritability, occasional vomiting after feedings, and a few episodes of loose stool.

Case: The parents of this 5-month-old boy are concerned about recurring eruptions of blisters on the infant’s hands and feet. What question could you ask the parents that might quickly define the condition for you?

Hypertrichosis refers to the increased growth of vellus or other hair at inappropriatelocations beyond the normal variation for a patient’s reference group.1 The affectedareas have a greater number of hair follicles than is normal for the body site.1 The condition is unrelated to androgen excess and unaccompanied by virilism or menstrual abnormalities.

A 17-year-old teenager has developed fuzzy pale rings around several moles over the summer, the moles were present for years,possibly since birth. There is a family history of skin cancer.

The most common chronic medical problem that we pediatricians treat is asthma. We do our best to manage our patients' asthma by prescribing controller medications, providing asthma action plans, and guiding families through acute exacerbations. We often ask about possible environmental triggers, such as tobacco smoke and cockroaches, and we advise patients to reduce their exposure to those triggers.

Measurement of body mass index (BMI) is an effective way to screen for obesity and is an important part of the routine health evaluation of all children. A fasting blood sugar test is recommended for obese children 10 years and older who have a BMI above the 85th percentile for their age and sex and 2 high-risk criteria for diabetes (eg, positive family history or signs of insulin resistance). Patients with a BMI at the 85th percentile or higher also require screening for other comorbidities. Such screening includes measurement of waist circumference, blood pressure, lipid levels (specifically, levels of high- and lowdensity lipoprotein cholesterol and triglycerides, as well as total cholesterol), and liver transaminase levels.

A 13-year-old boy was brought to the emergency department (ED) with a generalized itchy rash of 2 days' duration. For the past 3 days, he had dry, itchy eyes with a purulent discharge (Figure 1) and nonbilious emesis 2 or 3 times per day, with some blood streaks in the vomitus on the third day of illness.

The parents of this 8-year-old girl have brought her for evaluation of areas of loss of pigment on her face. They are worried that these might represent the beginnings of vitiligo.

A previously healthy 15-year-old girl presents with right-sided chest pain that began a few hours earlier during Spanish class. The pain is nonradiating; it is alleviated by leaning forward and exacerbated by sitting still. Shortly after its onset, the patient had taken acetaminophen, which provided temporary relief. However, when she returned home from school, the pain resumed. She denies fever, shortness of breath, nausea, vomiting, and cough.

Four-month-old Hispanic boy brought for evaluation because of hypopigmented patches on his skin and a history of seizures. Infant was the product of an uncomplicated pregnancy; born at 40 weeks' gestation to a 16-year-old gravida 1, para 1 mother who received appropriate prenatal care. At birth, he had multiple hypopigmented patches on his face, torso, and extremities. At age 2 months, he was hospitalized for new-onset seizures.

An afebrile baby presents with disseminated pustules on the trunk, face, and extremities.

A 17-month-old girl awoke with drooling, cough, respiratory distress, and a muffled cry and was brought to the emergency department. She had no nausea, vomiting, or diarrhea and no history of choking, aspiration, or airway problems.

An 8-year-old girl is brought to the emergency department by her mother with a complaint of 5 days of worsening constipation and rectal bleeding. For the past week, the girl has had small stools 3 or 4 times a day and crampy abdominal pain. Yesterday, her stools were streaked with a small amount of blood. The mother notes that her daughter spends up to an hour in the bathroom with each bowel movement. In addition, the mother remarks that the girl has a rash in the rectal area and along the inner thighs.

An 11-year-old girl presented with a swelling on the left side of the chin of 1 month's duration; in the past 24 hours, following a bite by an unidentified insect, the swelling had rapidly enlarged and become painful (A). She was otherwise healthy and had no significant medical or family history.

Numerous brown macules were sparsely distributed over the torso, head, and extremities of an African American newborn. The infant also had a mongolian spot on the buttocks. The baby's mother, a great aunt on the father's side, and the great aunt's daughter and grandson had similar brown macules at birth. All family members were healthy.

A 4-month-old infant is brought in due to raised hyperpigmented lesions around his shins.

For 2 days, a 17-year-old boy had a widespread pruritic eruption that involved the trunk and extremities but spared most of the face. Many of the lesions were annular, and they would appear and resolve within 1 day. The patient denied shortness of breath, difficulty in swallowing, and periorbital swelling.

Practicing pediatricians commonlytalk with patients and parentsabout medical risks. Examples of suchrisks include those of a newborn havinga genetic disease, of a complication of anillness developing, and of a patient experiencingan adverse effect from a medicationor vaccine. Different ways of expressingand communicating risk mayhelp patients and parents understand themagnitude of a risk and make informed,thoughtful decisions about their medicalcare. It is important to be aware of theinfluence personal experience and concernshave on how risk is perceived andto recognize how the choice of a particularway of framing a risk may inadvertentlycommunicate a clinician's personalbiases in a situation.

For the past few weeks, a 10-year-old boy had a pruritic abdominal rash that had not responded to over-the-counter topical medications. The rash had appeared around the time he started wearing a new belt (shown). The child was otherwise healthy. There was a family history of asthma.

In the newborn nursery, pediatricians commonly encounter infants born to mothers who were receiving selective serotonin reuptake inhibitors (SSRIs) for depression during pregnancy. Earlier studies suggested a number of potential effects of maternal SSRI use on the newborn; these included jitteriness, agitation, diarrhea, hypoglycemia, vomiting, hypothermia, respiratory distress, seizures, feeding difficulties, increased or decreased tone, low birth weight, and small size for gestational age.1

It is estimated that 12% of clinical methicillin-resistant Staphylococcus aureus (MRSA) infections are now community- associated.1 To combat the rising incidence of such infections, last month the CDC launched a new national campaign.

A previously healthy 16-month-old boy was hospitalized because of vomiting of 10 days' duration, fever of 4 days' duration (temperature up to 38.6°C [101.4°F]), and watery diarrhea. He also had had a maculopapular rash, which resolved the day before presentation. Family history was unremarkable.

The cause was pilonidal sinus disease. The term pilonidal is derived from the Latin words "pilus," meaning "hair," and "nidus," meaning "nest." Pilonidal sinus disease is more common in males than in females and typically appears during adolescence. About 1% of all males and 0.1% of all females have an asymptomatic pilonidal sinus with potential for disease.1 The suspected overall incidence is about 1 in 5000. The disease seems to be most prevalent in those with stiff, dark or auburn hair, although it has been observed in all races.2

Parents are understandably concerned about vaccines and autism, a relationship publicized by lawsuits, alternative therapies, and claims of government cover-up.

A healthy 10-year-old girl has had a red, white, and blue lump on her thigh since birth.

Many factors can be considered in attempting to establish the cause of a skin disorder. These include the color, morphology, and location of the lesions; associated symptoms, such as itching and fever; and exposure to drugs or to other children who have a rash. Linearity of the lesions may also suggest the diagnosis.

In addition to syringohydromelia and meningocele, the MRI of the spine showed a fluid-filled mllerian duct remnant that extended from the base of the bladder to the posterior superior aspect of the prostate gland. The margins of the fluid collection in the remnant are smoothly bound by a hypointense structure that represents a discrete tissue wall. A mllerian duct remnant can be confused with free fluid in the cul-de-sac posterior to the bladder.

A 4-year-old boy was brought to the hospital because of fever (temperature of 39.4°C [103°F]) and a bright, salmon-pink rash on the palms and soles that was associated with peeling (A and B). His symptoms had been present for 2 days. During that time, he also had redness of the eyes, fatigue, and anorexia.