Dermatology

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.

A boy with a history of skin eruption, intermittent fever, and generalized weakness now has red bumps on the bony prominences of his hands, elbows, and knees. What's the diagnosis?

An 8-year-old Hispanic child with no significant medical history presented to our pediatric clinic after 2 episodes of vomiting, diarrhea, and abdominal pain. Symptoms had begun earlier the same morning; the child and his parents described the vomitus as "yellowish" and diarrhea "watery." There was no associated fever.

Photo Essay: A Collage of Infectious Diseases in Children Perichondritis Periorbital Cellulitis Bacterial Conjunctivitis Roseola Infantum (Exanthem Subitum) Tinea Corporis ("Ringworm")

Steven, a 13-year-old boy, experienced his first headache at age 7 years. The frequency, intensity, and duration of his headaches have been increasing over the past 6 months. Steven now experiences 7 to 10 headaches each month that last up to 8 hours. The headaches are associated with mild nausea, light and sound sensitivity, dizziness, fatigue, occasional abdominal discomfort, and difficulty in concentrating. Last year, he had a vomiting episode because of a headache. The pain is usually more prominent in the forehead and does not favor either side of the head. The headaches usually begin in the morning before he leaves for school. As a result, Steven has missed nearly 25% of his school days this semester; his parents are considering home tutoring for "sick children who are unable to attend school."

Musculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial. Staphylococcus aureus is the most common organism in children in all age cat-egories. Others include group A Streptococcus, Neisseria meningitidis in purpura fulminans, Streptococcus pneumoniae, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and Borrelia burgdorferi.

I enjoyed reading the article "Diaper Dermatitis" in your June issue. To the many treatments discussed, I would offer 2 additional management points. First, persistent and/or recurrent diaper rash is more common when children older than 12 months continue to drink from the bottle. Excess fluid intake leads to soppy diapers and often, sloppy stools. When the cup replaces the bottle, diapers and firmer stools ensue--and accompanying rashes disappear.

For several weeks, an 18-year-old man has been bothered by itchy ears. He has seasonal allergies that are well controlled with oral antihistamines. He has not been exposed to contactants and has not used any nutritional supplements or new shampoos or conditioners. He works out at a gym 5 days a week.

The parents of a 4-year-old girl are concerned because she has experienced hair loss for several weeks. The child is otherwise healthy and active, has no known disorders, and takes no medications.

A 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.

Two children--one with a history of infection, the other with a history of an allergic reaction--were noted to have postinflammatory hyperpigmentation.

Seven-month-old boy with hyperpigmented lesions on his legs. Lesions first noted at 4 months of age. His 32-year-old father and 58-year-old grandfather had similar lesions on their legs.

Speaking at the American Academy of Dermatology Summer Meeting in July in San Diego, James Q. Del Rosso, DO, advised physicians not to overlook the possibility of truncal involvement in patients who come in for treatment of facial acne vulgaris.

What's causing this newborn's feeding problems?

A 3-year-old girl develops a red, dry, flaky rash over her body, and a dried, yellow crust around her eyes. What's the diagnosis?

Right lower leg pain prompted a 15-year-old boy to seek medical attention. An hour earlier, he had fallen on the leg during a football game and on standing had heard a "pop." No gross abnormality was noted. Jack-Ky Wang, MD, and Laurie Meng, PA-C, of Palos Heights, Ill, report that radiographs revealed a transversing pathologic fracture through an expansile lytic lesion of the right fibula.

Chest pain in children evokes anxiety in patients and their parents--and prompts frequent visits to the pediatrician's office, urgent care facility, or emergency department (ED). In a prospective study, Selbst and colleagues reported that chest pain accounted for 6 in 1000 visits to an urban pediatric ED.