Dermatology

A recent study by researchers at Dana-Farber Cancer Institute and Children's Hospital Boston has raised the possibility that scientists may be able to develop an effective means of protecting fair-skinned people from skin cancer caused by exposure to sunlight. The research involved "tanning" specially engineered red-haired, light-skinned mice by applying a cream that activated their skin cells' tanning mechanism. Although the tan-inducing compound used on the mice has not yet been tested in humans, the findings suggest that medicinally induced tanning likely can occur in people who do not normally tan well and are, therefore, deprived of a tan's protective qualities.

An adolescent girl complains of headaches and presents with lateral-gaze paralysis of the right eye. Can you solve this mystery?

Ten-day-old boy born vaginally at 37 weeks breech without complications. Has history of poor feeding with vomiting and has lost weight since birth. One episode of vomiting described as projectile. Ultrasonography ruled out pyloric stenosis but revealed bilateral hydronephrosis. Patient referred to the emergency department for further evaluation.

A 4-year-old boy was bitten on the right index finger by a goat at a petting zoo. The bite created 2 superficial 2-mm open wounds. One of the lesions developed into an indurated 8-mm nodule during the following week. A second nodule developed about 5 days later. The boy was seen by his physician 2 weeks after the bite wounds occurred. At that time, an 8-mm umbilicated nodule and a satellite papule were present.

A 9-year-old Hispanic boy, previously in good health, was admitted for evaluation of chronic right cervical adenopathy. The node had been present for about 6 weeks. The patient was initially taken to his primary medical doctor and given dicloxacillin, but there was no improvement. The patient reported no fever, sore throat, travel history, or animal exposure. He and his parents denied contact with any persons with tuberculosis. During the past year, the patient had undergone extensive dental work for excessive caries.

A 4-year-old girl presents with a highly pruritic rash. The day before, she had been playing outdoors at her grandmother's house. No pets were present, and the patient does not recall being stung or bitten by insects. There are bushes on the grandmother's property.

A 6-month-old infant was brought to the emergency department with a 2-day history of increasing redness and swelling of the cheek. Her primary care physician had been concerned about a possible facial abscess.

This 7-year-old boy was recently brought to my office having received a diagnosisof pemphigus foliaceus. His parents were seeking a second opinion.

A 14-year-old Hispanic boy presented with bilateral nodular lesions on the dorsal aspect of his tongue. He guessed that the lesions had been present for more than a year. They were not painful and had not changed in size or color.

The parents of this 4-month-old infant were concerned about an atrophic, 0.6-cm area on their son's parietal scalp that was surrounded by dark hair. The rest of the scalp was normal, and the child was otherwise healthy. Benjamin Barankin, MD, of Edmonton, Alberta, made the clinical diagnosis of the hair collar sign--growth of long, dark, coarse hair around a scalp lesion that may be a marker for underlying defects. The sign is sometimes found in association with aplasia cutis congenita, in which a portion of skin is absent--most commonly this manifests as a solitary round lesion on the scalp. These lesions may have healed at birth with a scar or they may remain eroded or ulcerated.

Allergies are not only becoming more prevalent but, in the case of food allergy, the natural course may be changing, according to Robert A. Wood, MD, professor of pediatrics and director of pediatric allergy and immunology at the Johns Hopkins University School of Medicine in Baltimore.

Before children get decked out as their favorite cartoon and television characters this Halloween, remind parents that peanuts and milk could be in the candy that young ones receive while trick-or-treating—a situation that could be life-threatening to those who have an allergy to one of these foods.

An 11-month-old boy breaks out in a rash when he eats. Is it a food allergy or something else?

A 9-year-old boy has developed an itchy vesicular rash on his left leg that has spread to his other leg and to both arms and hands. What is the diagnosis?

A 3-month-old infant was brought for evaluation after the sudden development of a tonic-clonic seizure that involved the left upper extremity. He had no history of fever, trauma, rash, refusal to suck, vomiting, diarrhea, upper respiratory tract infection symptoms, or bleeding. He was not taking any medications.

As our children are becoming fatter, diabetes is becoming more common. Diabetic ketoacidosis (DKA) can lead to cerebral edema, a complication unique to the pediatric population and a common cause of death in this young group.

Botulinum toxin type A has a role in managing spasticity and dystonia in pediatric patients. It can improve gait and upper extremity function when used appropriately.

Anorexia nervosa (AN) affects as many as 1 in 200 white adolescent girls. Mean onset of this disorder, which is characterized by dramatic weight loss, a disturbed perception of body shape, and an intense fear of weight gain, is between 13 and 14 years.

his 7-year-old boy presented with mental retardation and delayed gross motor milestones: he first sat up at 12 months, walked at 18 months, and ran at 2 years. His level of speech development was that of a 5-year-old; his IQ was 75.

Sixteen-year-old with a recurrent, painful, pruritic rash on right cheek and right eyelid. Current outbreak started 2 days earlier. The rash always appears in the same fashion and in the same location; it typically lasts a few days and resolves spontaneously.

If you are reading this editorial, you've already seen the 2 special supplements to Consultant For Pediatricians that came wrapped with our October issue. The editors of those special issues and I hope that you'll find information in the vaccine and dermatology supplements that you can put to good use in your practice. We hope you'll find the same in our regular issue.

Photoclinic: Incontinentia Pigmenti

Tuberculosis (TB) remains one the most important infectious diseases in the world. More than 8 million people are infected every year. The vast majority of infections--95%--occur in developing countries, where the disease accounts for 25% of avoidable adult deaths.

A 2-year-old boy was brought to the emergency department by his mother after he slipped and fell in the bathtub. The boy's father, who had been bathing the child when the injury occurred, reported that he had briefly turned his back while the child was attempting to drink from the hook-shaped faucet. The child had jerked his head upward when he fell, thus causing the sharp edge of the faucet tip to lodge in the soft floor of the mouth beneath the tongue. The father, in desperation, wrenched the faucet from its base and then was able to remove the tip from the child's mouth. During the removal process, the child reached up and also cut his finger on the sharp edge of the faucet.

This infant's mother noted the development of 2 reddish-pink firm papules on her son's forehead when he was about 1 month old. These are the only lesions present, and they are asymptomatic. The only change in the lesions has been their color, which is now yellow-orange.

It's long been suggested by research that adolescents who have ADHD are more likely—nearly four times so—to be involved in a motor vehicle accident than unaffected drivers in the same age group. Furthermore, young adults with ADHD have a significantly higher rate of traffic violations and license suspensions than patients without ADHD.

Researchers at Pennsylvania State University's College of Health and Human Development say that a program that utilizes a handbook to help parents talk to their children about skin-cancer risks may promote sun-safe behaviors in youngsters.

The latest products and technology for your patients and your practice.

Childhood melanoma is a challenging diagnosis even for a clinician who sees pigmented skin lesions every day. The authors share their international experience with you and describe what you need to know in your practice about the rare, but real, childhood melanoma.