Dermatology

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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.

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.

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.

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.

For several months, a 12-year-old boy has been bothered by intermittent pruritus of the feet. He is very active in sports all year, and his feet tend to perspire heavily. He has a family history of seasonal allergies. He says that the rash worsened after he used an over-the-counter hydrocortisone cream.

A 6-month-old infant was brought for evaluation of an "atypical mole" on the chest that her parents and referring physician feared might be skin cancer. The parents reported that the lesion had been present since shortly after birth and had become red and inflamed after minor trauma on a few occasions and once had blistered.

Attention deficit hyperactivity disorder (ADHD) is very common. In the United States, between 6% and 10% of children and adolescents are affected, as are 4% of adults.1 Children in other countries also have ADHD, although rates of comorbid disorders may vary from those found in the United States.2