Dermatology

A 7-week-old white boy presented to the emergency department (ED) with vomiting and weight loss. His parents brought him to the ED 3 weeks earlier after he had vomited for several days. Possible milk protein allergy was diagnosed at that visit, and a change from cow milk formula to an elemental formula was recommended. Vomiting subsequently increased in frequency. Nonbilious but forceful vomiting occurred with each feeding. The patient lost nearly 2 lb during the 3 weeks that followed the first ED visit.

An otherwise healthy 11-month-old infant hadhad an intermittent, nonpruritic rash for mostof his life. The lesions recurred mainly onthe extremities and trunk without a particulartrigger. Applications of 1% hydrocortisonecream were only partially beneficial. The joints and nailswere not affected. The patient’s maternal grandfather hadsevere psoriasis.

A white ring recently developed around this lesion on the upper back of a 15-year-old boy. Is there any reason for concern--and what clues would you use to suggest the need for a biopsy?

Photo Essay: The Butterfly Technique: A New Method of Inserting an Umbilical Vessel Catheter

Six-month-old girl with dysmorphic appearance referred for genetic evaluation. Child is a product of a fraternal twin pregnancy; born at 41 weeks gestational age. Mother, age 32, received no prenatal care. Paternal age, 41 years.

After an unsuccessful attempt to persuade pharmaceutical companies to fund further research on a head lice treatment he says he discovered and developed, dermatologist Dale Pearlman, MD, has revealed that the treatment is actually a brand-name over-the-counter skin cleanser.

Use this picture-packed review to discern the many faces of psoriasis, to distinguish the dermatologic disorder from other skin conditions, and to choose the best treatment option.

A newborn with multiple, dark, reddish-brown patches over the trunk, back, and forehead.

Purple and swollen skin becomes dark and thickened in a healthy 7-year-old girl.

A 5-year-old boy, who lives on a farm and routinely plays with his pet dogs, presented with these scaly, inflamed macules with a central clearingon the abdomen (A) and forehead.

An 18-year-old girl presented with an asymptomatic nodule on the posterior aspect of the right upper arm. The lesion had developed a month after an episode of chickenpox at 11 years of age and had slowly enlarged. The lesion was 7 mm in diameter; it was firm, rubbery, reddish brown, and nontender.

This lesion on the chest of a 6-week-old infant had developed over 2 days (A). It began as a small mass just below the right nipple. Initially, there was no tenderness or erythema; within 2 days, the lesion had begun to drain green-yellow and then white purulent exudate.

he parents of a 16-year-old girl report that during the past several months, she has exhibited behavioral changes, irritability, increased anger, depression, and anxiety. The girl had previously been healthy, and there has been no recent illness or trauma.

A 15-month-old girl presents for evaluation of macrocephaly and unusual facial features. Her prenatal and natal history are unremarkable. The child is now developing normally after mild gross motor delays during the first 6 months of life. Mild scoliosis was noted on a babygram taken at 8 months during an evaluation for possible nonaccidental trauma.

A 9-year-old girl presented with these lesions on her face and extremities. The lesions, which had developed within the past 24 hours, were warm to the touch and only mildly pruritic. The child feels unwell with nonspecific complaints of malaise and lack of energy. Before this eruption, she had been healthy and had not been taking any medications.

A 10-month-old girl with a mass on left side of neck. Swelling first noticed by mother when child was 7 months old. The infant is eating well, thriving, and otherwise healthy.

This year's roundup looks at innovations in wound care, hand sanitizers, otoscopy, and vision screening. It also considers helpful online resources?and takes a peek into a virtual time capsule of technology.

The mother of a 3-year-old boy has brought him to the clinic for you to evaluate thinning of his scalp hair over the past month. She reports that the hair loss is occurring "all over" his scalp and that she has not noticed him scratching his scalp or pulling his hair. He was hospitalized four months ago for a rotavirus infection.

This asymptomatic plaque on the left cheek of a 12-year-old girl was not respondingto a cream that her physician had prescribed when the rash began.

A3-year-old boy was at home with his cousinwho was preparing for a fishing trip when afishhook accidentally became lodged in thedistal part of the child’s right middle finger(A).

A2¹⁄₂-year-old child is hospitalized with a 1-monthhistory of worsening persistent cough. She was initiallytreated with a 5-day course of oral amoxicillin, andher symptoms abated somewhat. However, for the pastweek, she has experienced high fever (temperatures upto 38.3°C [101°F]) and chills associated with right-sidedpleuritic chest pain.

Photoclinic: Cutaneous Calcinosis in a Child With Tertiary Hyperparathyroidism

The rate of melanoma among children and young adults rose dramatically between 1973 and 2001, according to a study in a recent issue of the Journal of Clinical Oncology. "Between the years 1973 and 2001, the incidence of pediatric melanoma increased 2.9% per year and 46% per year of age," says John Strouse, MD, a pediatric oncologist and instructor in pediatrics at the Johns Hopkins University and author of the article.

Allergic diseases are the sixth leading cause of chronic disease in the United States and cost the health-care system more than $18 billion a year. But despite the seriousness suggested by these numbers, many people don't understand how deflating allergies can be to quality of life for patients and families, according to Mark Boguniewicz, MD, professor at Denver's National Jewish Medical and Research Center.

ABSTRACT: Hypothermia is not limited to the northern states: people also die of hypothermia in other areas with milder climates. Infants, young adolescent boys, and inadequately dressed teens who abuse alcohol or illicit drugs are at highest risk for death secondary to hypothermia. The mildly hypothermic patient may appear fatigued and display persistent shivering, ataxia, clumsiness, confusion, tachypnea, and tachycardia. The child with moderate hypothermia will not be shivering; declining mental status may cause the freezing patient to remove clothing. An irregular heartbeat is likely at this stage. Severe hypothermia is marked by apnea, stupor, and coma. In a frostbitten patient, rapid rewarming of the affected area in warm water for 15 to 30 minutes is the first step. Potent analgesia is often necessary. After thawing, the frostbitten part is kept dry, warm, and loosely covered. With an adequate dose of common sense, the vast majority of deaths from cold injury can be prevented.

A 2-year-old boy was brought for evaluation of a rash and fever of 2 days' duration. He had atopic dermatitis since 6 months of age that was partially controlled with low-potency topical corticosteroids and emollients. His father reported that recently the facial dermatitis had worsened, with increased redness, pain, and some skin breakdown. The child's medical history was otherwise unremarkable. His mother had a history of "cold sores."