Dermatology

Medicine is at least as much art as science. Often things are not clear-cut, but rather appear in shades of gray. We offer the following list of terminology for those who don't mind thinking in terms of black or white.

A healthy, 3-year-old African-American girl is brought to your office for evaluation of hair loss. The child does not have a history of recent infection or medication use. She has not had any hair styling treatments and has not been subject to trauma or application of heat to the hair. What's the diagnosis?

Your doctor has just told you that you have an infection with human papillomavirus (HPV). Most teens have a lot of questions about warts and HPV. This guide will help answer some of those questions.

A 5-year-old girl is brought for evaluation of an asymptomatic inflamed streak on one leg that has been present for several weeks. She is otherwise healthy and takes no medications.

Several asymptomatic, erythematous papules and plaques had appeared on the hands of an otherwise healthy 11-year-old girl. The personal and family medical histories were noncontributory. A punch biopsy from the largest lesion on the palm confirmed the clinical diagnosis of localized granuloma annulare, a self-limited inflammation of the dermis

The "A" in the title stands for acrodermatitis enteropathica, an uncommon underlying cause of diaper dermatitis (DD). The "Pee," the colloquial term for urine, is probably the most common irritant (along with feces) that contributes to the breakdown of skin in the diaper area.

The prevalence and incidence of sinus infection, or sinusitis, is increasing and has been estimated to affect 31 million persons in the United States each year. It is one of the most common reasons why patients seek a physician's care. If left untreated, sinusitis can cause significant physical symptoms and can negatively affect quality of life by substantially impairing the daily functioning of sufferers. For children, this can mean learning difficulties at school and for adults, a loss of efficiency at work.

A healthy 16-year-old girl was bothered by a patch of white hair on her forehead; she also had a few white plaques on her abdomen, which had been present since birth. Her maternal great grandmother and maternal grandfather, as well as her mother, had a similar pattern of white hair.

Adolescents are at high risk for HPV infection because they tend to become involved with multiple simultaneous sexual partners rather than forming monogamous relationships.

Seven-year-old boy with red, nonpruritic rash that appeared first on the cheeks and then spread to the trunk, extremities, and buttocks. No history of respiratory, GI, or other symptoms in the several weeks before the onset of the rash. Patient is otherwise healthy.

What's causing a 7-month-old boy to be hospitalized for failure to thrive, recurrent wheezing, and bilateral infiltrates refractory to antibiotics?

What's causing a 7-month-old boy to be hospitalized for failure to thrive, recurrent wheezing, and bilateral infiltrates refractory to antibiotics?

What's the cause for an asymptomatic plaque that has been growing slowly on a boy's nose?

Early attention to maternal diet and infant nutrition may help prevent allergy and food intolerance in high-risk infants who are unable to be completely breastfed, according to recent data and speakers at a dinner symposium Sunday evening. Speakers Peyton Eggleston, MD, professor of pediatrics at Johns Hopkins University School of Medicine; Mark Boguniewicz, MD, National Jewish Medical and Research Center and University of Colorado School of Medicine; and John A. Kerner, MD, Stanford University School of Medicine, discussed the rising prevalence of allergic disease worldwide and the key factors shaping the trend, the progression of atopic disease in genetically predisposed children, the factors associated with risk of developing allergic disease, and the evidence for a role of diet in preventing allergic disease in young children.

The mother of this 3-year-old boy noticed that his smile was asymmetric when he awoke that morning. He had been seen 3 days previously for left ear discomfort, sore throat, and a low-grade fever. Otitis media was diagnosed, and amoxicillin was prescribed. The child has an unremarkable history and is otherwise healthy. He has been acting normally and tolerating food and liquids without difficulty.

The parents of a 7-year-old girl, who had fallen off her bicycle and hit her left forehead 2 weeks earlier, brought their daughter to the emergency department after she began having increasingly severe headaches. She had been healthy before her fall and had no history of other trauma or meningitis. She had no neurologic deficits on presentation. Examination of the fundus revealed no papilledema.

For several weeks, a 6-year-old girl has had a worsening mildly pruritic rash on the trunk. She has a history of seasonal allergies. The family has had a cat and a dog in the house for a number of years.

The patient, a 14-year-old boy, comes to see you the same day he was bitten by a dog. In the examination room, you find him seated comfortably in the chair with his right hand and arm bandaged.

A 7-year-old boy presented with an asymptomatic cystic lesion on the lateral aspect of the left ankle of 4 months' duration. There was no history of trauma. The mass fluctuated in size: it was smaller when the child was recumbent and larger when the child was upright.

A 9-year-old girl was hospitalized because of a painful, vesicular rash on her genitals, groin, and buttocks. There was also concern about possible genital herpes infection in a minor.

This 13-year-old boy plays basketball for his school team. His mother brings him to your office and asks you about her son's toenail that has changed appearance and now looks like his father's great toenail. The father has psoriasis.

In a trend that pediatricians should note carefully in their management of children with atopic dermatitis (eczema), dermatologists likely will exercise more caution in prescribing the topical calcineurin inhibitors (TCIs) Elidel cream (pimecrolimus, Novartis) and Protopic ointment (tacrolimus, Astellas Pharma) in response to the Food and Drug Administration's decision to add "black box" warnings to these drugs' labels, an expert pediatric dermatologist told the publication Dermatology Times recently.

A child's long-lasting cough is vexing for parents. One route to finding the cause is to, first, rule out serial viral illness and, then, piece together characteristics of the cough with findings from the history.

Most cases of HSV-2 infection are spread through sexual transmission. An infected person can have virus in his or her saliva, semen, or vaginal secretions. When a seronegative partner comes in sexual contact with these secretions, the virus can enter the body through mucosal surfaces (such as the vagina, anus, or mouth) or micro-abrasions on the skin (eg, the penile shaft, scrotum, thighs, or perineum).

The patient, a 13-year-old girl, was concerned about the development of a very itchy, painful, papular rash on her hands and feet. She had been previously well and had no history of illness other than a minor upper respiratory tract infection 2 weeks earlier. The distribution of lesions and the severe pruritus initially suggested scabies, which was treated with 5% permethrin cream. The rash did not improve with applications of this medication, however, and the patient returned the following day for care. She had no oral lesions but complained of mildly painful, nonswollen joints.

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

The parents of a 3-week-old infant are concerned about the numerous small, erythematous papules and pustules on his cheeks. All the lesions were at a similar stage in development. The pregnancy was uneventful.

These pinpoint pustules, some with excoriations, and surrounding erythema appeared on the posterior trunk (A) and outer arms (B) of a 15-year-old boy after he had wrapped his upper body in a wool blanket. These lesions were occasionally pruritic, especially on the arms, where most of the excoriations were noted.

Your doctor has just told you that you have a herpes simplex virus infection (herpes). Most teens have a lot of questions about herpes. This guide will help answer some of them for you.

A 9-year-old girl presents with multiple hyperpigmented lesions, some of which have been present since birth (Figure 1). The lesions have increased in size and number. There is no history of seizures. Her 40-year-old mother has multiple skin nodules (Figure 2).