Dermatology

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A 3-month-old infant presented with a 4-week history of a symmetric skin eruption on her face, axillae, distal extremities, and external genitalia. The infant was otherwise healthy, although colicky since birth. She was exclusively breast-fed and had a good appetite. Voiding and stooling patterns were normal. Her growth was appropriate for age.

An 8-year-old boy whose family had recently immigrated from Southeast Asia was brought to the emergency department (ED) with a well-demarcated, pruritic rash that had appeared on his face 6 weeks earlier. At that time, the patient's primary care physician had diagnosed Fifth disease. As the rash spread to the child's arms and back, atopic dermatitis was considered. The week before presentation in the ED, the rash had become more inflamed and pruritic and was accompanied by fevers.

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.

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 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.

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.

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.

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.