Dermatology

Certain exanthems show a predilection for the summer. The path to diagnosing these conditions, however, can be anything but clear. A new algorithm sheds some much needed light.

A healthy 2-year-old was noted to have "blueberry" spots on her legs and trunk at birth.

A 9-month-old white boy was brought to the emergency department (ED) after he had been crying inconsolably for 2 hours. The parents thought the crying was related to the child's left leg, which they felt "did not look right." Two weeks earlier, the boy had a similar episode of inconsolable crying, and a fracture of the right distal radius was diagnosed. The fracture was presumptively caused by entrapment of his arm in the crib railings.

A 4-year-old boy presented with a pustular rash on the radial aspect of the right wrist. The rash appeared about 4 days earlier as a group of vesicles on an erythematous base. The lesions caused mild discomfort.

I agree with Dr Kirk Barber's comments about treating molluscum contagiosum: that removal of the lesion's core is curative and that autoinoculation at the time of treatment is only a small concern. I have found, however, that it is not necessary to go through the trouble of removing the core.

This infant was brought to the emergency department after a week-long exacerbation of her atopic eczema. She had not received any therapy for her eczema or for these erosions.

These 2 swellings on the scalp of a 13-year-old boy had appeared about 8 months earlier and had slowly enlarged. The mother had massaged the lesions when they were small in an attempt to heal them. There was no history of local trauma (eg, from hair-cutting tools) and no pain or discharge from the lesions.

An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.

A 6-year-old girl is brought for evaluation of an asymptomatic indurated erythematous lesion that erupted on the metacarpophalangeal joint of one hand 2 weeks ago. The patient has no history of trauma or exposure and is otherwise healthy.

ABSTRACT: Dramatic progress has been made in our understanding of pediatric rheumatic disease. Various classification systems help identify juvenile idiopathic arthritis (JIA), which involves unique considerations that distinguish it from rheumatoid arthritis in adults. Vaccination issues are important for children with JIA. Renal involvement with systemic lupus erythematosus (SLE) is more common and more severe in children than in adults, but treatment of children who have SLE is similar to that of adults. Neonatal lupus erythematosus may occur in infants whose mothers have SLE. Juvenile dermatomyositis is associated with significant morbidity and mortality. Kawasaki disease is a common vasculitis of childhood, especially in infants and toddlers. Each of at least 8 major familial periodic fever clinical syndromes has specific distinguishing characteristics.

Pseudoporphyria (PP) is a photo-induced cutaneous bullous disease that resembles PCT and EPP. NSAIDs are thought to be the culprit in this condition.

Scant clothing, intense solar radiation, high heat and humidity, and burgeoning bug populations put children at risk for summertime dermatoses. The pediatric clinician must be able to distinguish innocent skin eruptions from potentially life-threatening disorders, and to counsel children and parents about skin protection during the summer.

Atopic dermatitis is much more than just "dry skin." It's important for patients and their families to receive proper health education, know about the different types of management options, and prepare for quality of life changes.

For about a week, a 4-year-old girl had a nonpruritic rash that initially appeared on her legs and arms. Lesions then spread to her face, hands, and buttocks; the trunk was spared. About 2 weeks earlier, the child had had a viral illness that lasted a few days; since then she had been healthy.

A healthy 4-year-old girl presented to the emergency department (ED) with suspected inflicted burns on the tongue. Initially, the patient had complained of a burning mouth to school staff. On direct questioning by the principal, the child said her mother had burned her tongue with a cigarette. School staff noted the lesions.

While playing on a brick walkway in her backyard, a 4-year-old girl stepped on a puss caterpillar and was stung. The ecchymosis exactly outlined the caterpillar's spines and remained visible for at least 3 months. The initial sting caused intense pain that lasted for more than an hour.

Henna and Hair DyeA 16-year-old Somali girl presented with a 30-day history of bilateral arm swelling and painful vesicular eruptions.Five days before presentation, she and her friends had used henna and black hair dye to “tattoo” their skin. Theothers did not experience similar signs or symptoms. This patient had used henna since childhood for decorativepurposes. However, outlining an intricate design with hair dye was new for her.This patient was hospitalized and treated for severe cosmetic dermatitis with systemic corticosteroids,diphenhydramine, and daily dry dressing changes. Ibuprofen was given to help relieve discomfort. Antibioticswere not ordered.The patient remained afebrile and was discharged on hospital day 2 with close follow-up and daily dressingchanges. She was advised to avoid contact with all hair-dye products.Case and photo courtesy of Jennifer A. Jewell, MD, and Lorraine L. McElwain, MD.

For several weeks, this 21/2-year-old boy has had erythematous annular lesions on the lower trunk and proximal lower extremities. He was treated for pityriasis rosea only to have the lesions recur when the topical corticosteroid was discontinued.

This 20-month-old patient with eczema has had a flare during the past week.

I enjoyed Drs Olivera and Lasser's recent "Case In Point" involving an 18-year-old with varicella-zoster virus (VZV) meningitis1 and found the case and illustrations informative and interesting.

A 6-year-old boy has a rash on his hands and feet that erupted shortly after he startedfirst grade. His parents are concerned that he may be allergic to something at school, such as chalk. He is otherwise healthy.

A 16 year old African American teenager complains of itchy bumps on the back of his neck for a 2-year period. What's the diagnosis?

Oral contraceptive (OC) pills are frequently prescribed for a variety of clinical purposes. These medications--which contain varying amounts of estrogen- and progestin-based compounds--essentially "override" a woman's innate hypothalamic-pituitary-ovarian axis and frequently help ameliorate the effects of a maturing reproductive system while preventing pregnancy.

This young girl is brought to your office with a rash that her mother thinks is triggered by sunlight. The mother is concerned because her own aunt has lupus erythematosus. The mother also reports that several children at her daughter's school have a similar eruption.

A 16-month-old Hispanic girl presented with a 2-day history of pain, redness, and swelling of the left side of her groin. Her mother first noticed the lesion after the child was seen limping and scratching the area. The mother thought her child had been bitten by an insect but did not witness any bite.