Dermatology

There is increasing evidence that the inflammatory nature of psoriasis is associated with an increase in comorbid conditions, such as obesity and cardiovascular disease, and that people with psoriasis have a shortened life expectancy.

A discussion of two types of Genital Lesions: Smegma and Torsion of the Testis.

Hemangiomas are the most common tumors seen in infants. Despite their rapid growth early in life, often the only action required of the physician is to reassure the parents that such tumors usually involute spontaneously during childhood.

A 7-month-old male infant was brought to the emergency department (ED) by his biological mother, who reported noticing dried blood on the baby's penis and in his mouth. For several hours prior, he had been in the care of her boyfriend. On physical examination, there were severe ecchymoses and petechiae on the penile glans and shaft (Figure 1), ecchymoses on the right side of the soft palate, a laceration of the lingular frenulum, and a 2-cm bruise with dried blood over the right lip.

A 7-year-old boy presented to his primary care pediatrician with a 24-hour history of vomiting, abdominal pain, and low-grade fever. The child appeared stable. A viral illness was diagnosed. The child was sent home, and his parents were advised to give him adequate fluids as well as acetaminophen as needed for fever.

Sixteen-year-old African American girl with pruritic, painful lesions on both thighs that progressively worsened over 2 weeks and later spread to the trunk and upper and lower extremities.

A 3-month-old boy was brought to the pediatrician with a 2-day history of "moaning," lethargy, and difficulty in latching on for breast-feeding. The infant had not had a wet diaper for the past 24 hours, and his last bowel movement was more than 48 hours ago.

A healthy 16-year-old presents with a raised, two-year-old scar-like lesion on his scalp which has caused hair loss.

An overview of disorders related to allergic symptoms in the pediatric patient, such as rhinitis, otitis media, asthma, and atopic dermatitis, as well as guidence regarding when to refer to an allergist.

Match the following clinical characteristics with the photographs of Cases 1 and 2. Then read the brief descriptions that follow on pages 314 and 315 to see how well you did.

This fairly common phenomenon, also known as Mongolian spots, affects more than 90% of African Americans, 80% of Asians, 46% of Hispanics, and fewer than 10% of Caucasians.1 The bluish gray or slate-colored areas occur most frequently on the lower back and buttocks and less frequently on the posterior thighs, legs, back, and shoulders. The face is rarely affected. The skin coloration is believed to be caused by melanocyte migration arrest from the neural crest to the epidermis.

African American girl born at 36 weeks' gestation to 24-year-old primigravida via spontaneous vaginal delivery at a community hospital. Apgar scores, 7 at 1 minute and 9 at 5 minutes. Grossly normal placenta, with a 3-vessel cord. On the second day of life, infant required several minutes of blow-by oxygen for a desaturation event and subsequent transfer to a level III neonatal ICU for further monitoring.

A previously healthy 14-year-old girl presented with retrosternal chest pain, odynophagia, and dysphagia of 10 days' duration. Her medical history was unremarkable. Results of an ECG and a chest radiograph were normal. An upper GI series revealed an abnormality at the level of the mid esophagus. She was treated with lansoprazole and sucralfate for a week; however, her symptoms persisted and perhaps worsened slightly. She lost 2.3 kg (5 lb) during her illness and was referred to a pediatric gastroenterologist.

Twenty-two-month-old girl seen in the emergency department (ED) after several hours of abdominal pain associated with non-bloody, non-bilious emesis. Over past 2 months, has had 7 or 8 similar episodes of abdominal pain followed by emesis 1 to 2 hours later.

Five weeks after returning from a school trip to the Amazon in Peru, a 16-year-old boy presentedwith 2 persistent “bug bites” on the lateral left calf. He had sustained multiple bug bites duringhis trip, all of which had resolved spontaneously except for the 2 on his lower leg.

The mother of a 3-day-old is concerned that the light spots on her daughter's right flank may be linked to seizures and mental retardation.

Links to useful Web sites about neonatal dermatologic conditions.

An infected insect bite was initially diagnosed, and a course of oral trimethoprim/sulfamethoxazole was started. Eight days later, the patient returned with worsening symptoms and a "white thing poking in and out" of one of the lesions (A). He was advised to occlude the lesion with petroleum jelly and an adhesive bandage. The next day, the patient brought in the "creature" that had emerged from the lesion. It was subsequently identified as a larva of the human botfly, Dermatobia hominis. A second larva emerged from the other lesion 1 week later.

ABSTRACT: Practicing pediatricians make many clinical decisions each day in the courseof patient care. For each decision, risks and benefits must be weighed. It is important,therefore, to be able to understand different measures of increased or decreased risk.It is also important to be able to talk with patients and their parents about risk. Thisreview of various ways of expressing risk is offered with the goal of making it easierfor pediatricians to incorporate measures of risk into clinical decision making.

The parents of an 8-year-old boy seek evaluation of a red patch on their son's shoulder. The asymptomatic spot erupted 2 weeks earlier. The patient has seasonal allergies and frequently plays with his dog.

There was no drainage from the lesion. Two more small papules were noted on the buttocks. Physical findings were otherwise unremarkable.

The infant's father and sister had similar toe deformities. Radiographs of the feet revealed no bone abnormalities. The patient was referred to a pediatric orthopedist to reassure the mother.

In this infant, microscopic examination of a potassium hydroxide preparation of scalp scrapings revealed Trichophyton tonsurans, which is the most common causative organism in North America.

A Food and Drug Administration (FDA) advisory panel has come out in favor of a request by Amgen Inc. to broaden the use of Enbrel to include moderate to severe child psoriasis.

The Food and Drug Administration has begun a safety review of four tumor necrosis factor (TNF) inhibitors, after receiving over reports of cancer caused in children who were taking them.

The mother of a 6-week-old infant is concerned about a generalized, scaly eruption evident over the past 10 days.

Ten-month-old girl with swelling of the left knee of 7 weeks' duration. Unable to bear weight on the left leg for the past 2 weeks. No fever or history of trauma to the area. Infant has good appetite for breast milk and formula, but possible malaise.

This tender lesion on the right cheek of a 4-year-old white girl had appeared shortly after her birth. It had subsequently enlarged for about 3 years before stabilizing. Physical examination revealed an erythematous arcuate plaque with a slightly thickened border that extended from the right oral commissure onto the right cheek. There was no family history of similar lesions, and the child was otherwise healthy.

ABSTRACT: Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes and those with early or undifferentiated rash. The morphology of lesions among children with symptoms of serious illness offers clues to the underlying cause. Purpura or ecchymoses in a well-appearing child may not be associated with serious illness; a large percentage of children who present with fever and purpura have Henoch-Schönlein purpura. Kawasaki disease typically manifests with blanching rash and fever. Vesicular or bullous lesions and fever are the hallmark of erythema multiforme, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Umbilicated papules and pustules are the sine qua non of molluscum contagiosum and varicella.

Scleroderma may present at any age and can be localized or systemic. Localized scleroderma affects the skin, subcutaneous fascia, and occasionally muscle and bone. Systemic scleroderma is characterized by chronic disease with both skin changes and visceral abnormalities. Rarely, localized scleroderma may progress to systemic disease; however, screening for this form is unnecessary in patients who have no systemic symptoms.1-5