Dermatology

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A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration (A). Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.

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THE CASE: A 3-year-old boy is brought to the office by his mother. The previous evening, she had noticed a single large red spot on the back of his thigh. This morning, his whole body was covered with a similar rash, and he had a temperature of 38.8°C (102°F). The mother administered 1 dose of acetaminophen at home for the fever; the rash was asymptomatic.

A 9-week-old Caucasian infant is brought to the primary care physician for evaluation of purpura and petechiae. His parents noted the bruising the previous night, which grew progressively worse throughout the next day. The lesions seemed to appear "out of the blue" without apparent cause, including trauma.

An 8-year-old boy seen at a gastroenterology clinic after "accidentally" swallowing 2 coins 4 days earlier. Had difficulty in breathing shortly after swallowing the coins and was taken to emergency department. X-ray films at that time demonstrated coins in his esophagus. Patient was immediately transferred to a tertiary care facility. Repeated x-rays showed the coins in his stomach. Patient was sent home with instructions to follow up with his pediatrician in 1 to 2 days.

This has been an exciting year for medical office technology. Improvements in otoscopy, hemoglobin analyzers, tissue adhesives, and topical skin preps top the list of innovations.

The news this week from the floor of the commercial Exhibit Hall of AAP 2004 National Conference and Exhibition is that the most common allergic reaction has a cure. More than 55 million Americans develop allergic contact dermatitis from exposure to poison oak, poison ivy, or poison sumac (Toxicodendron species) every year. According to a report by researchers at St. Luke's Hospital & Health Network in Bethlehem, Pa., relief with the new soap product of alcohol solubles and anionic surfactants is just 30 seconds away.

Food can keep infants free of allergic disease. The right nutritional choices during the first four to six months of life can mean the difference between a healthy childhood and a progression of atopic disease that can lead to asthma.

With dietary vitamins having potent immunomodulating effects in vitro and in animal models, investigators were led to examine whether vitamin supplementation during infancy affects the risk of asthma and allergic disease in early childhood.