Dermatology

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

Results of a complete blood cell count (CBC), measurements of electrolyte concentrations, and urinalysis were normal. A rapid streptococcal test result was negative. The C-reactive protein level was elevated at 3.3 mg/L (normal, less than 1 mg/L); the erythrocyte sedimentation rate was 58 mm/h (normal, 4 to 20 mm/h).

Vital signs were normal. Soft tissue swelling of the left foot and ankle was nonsignificant; there was no obvious deformity. Point tenderness was marked over the medial malleolus and over the shaft of the fifth metatarsal distally. The remaining physical findings were normal.

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.

A rock-hard lump on a boy's left great toe that has caused progressive nail distortion and previously diagnosed as a keloid may need a new diagnosis.

In children, most causes ofitching are the result of skin disease,not underlying systemic illness. The mostcommon dermatological causes of pruritusare atopic and contact dermatitis,urticaria, miliaria rubra, infections, insectbites or infestations, xerosis, and aquagenicpruritus. A careful history andphysical examination usually reveal thediagnosis. The location, chronicity, timeof occurrence, and nature of the itchingoffer important diagnostic clues, as doprecipitating factors, associated symptoms,drug use, exposure to infectious diseasesor pets, psychosocial history, past health,and family history. Treatment of the underlyingcause of itching should beaddressed whenever possible. Symptomatictreatment is essential to breakthe itch-scratch cycle.

This teenager had been taking penicillin for a sore throat about 2 weeks before this rash developed. Her pediatrician thought that the rash was a drug reaction and had her discontinue the medication. Nevertheless, the rash persisted for more than a month after therapy was stopped.

Ultrasonography showed a large multiseptated cystic mass in the posterior part of the left side of the neck. No obvious vascular flow evident within the mass (Figures 3 and 4).