Lichen Striatus on the Arm of a 7-Year-Old GirlOctober 5th 2009
These hypopigmented, mildly pruritic lesions on the right arm of a 7-year-old African American girl appeared several weeks ago. She had no other lesions and was otherwise healthy. The diagnosis on the basis of the clinical presentation was lichen striatus.
Henoch-Schönlein Purpura in an 18-Year-Old BoyOctober 2nd 2009
This palpable, nontender, nonblanching rash had developed on the elbows of an 18-year-old boy and spread to the ankles and feet. The rash was accompanied by moderate abdominal pain associated with episodes of nonbloody emesis that did not change with eating or bowel movements. Diffuse joint pain developed the day after the rash appeared.
Intensely itchy, hyperpigmented macules developed on the shoulders and upper arms of a 16-year-old boy 2 weeks after he completed his eighth cycle of chemotherapy with bleomycin, etoposide, and cisplatin, following an orchiectomy for a stage IV germ cell tumor of the left testis. During the next 3 days, the lesions evolved into a papulopustular rash that spread to the upper chest, abdomen, and neck.
Should this boy’s parents be concerned about the possibility of malignanttransformation in their son’s skin lesion?October 1st 2009
The skin lesion pictured here is noted in a 12-year-old boy. His parents state that it developed when he was 1 year of age and that it has been growing with him ever since, with the number of “speckles” seen throughout the light brown background gradually increasing.
Unusual Lesions-Abuse or Accidental Injury?October 1st 2009
Because of the presence of unusual skin findings, a 3-year-old African American girl was evaluated for possible child abuse. The father, the primary guardian, reported that his daughter had returned home from her mother's residence 2 days before-a day earlier than planned. According to the father, the child was crying and had skin lesions, which initially appeared white and then darkened over the course of the next day or two.
Bone Pain, Bruising, and Epistaxisin a Young BoyOctober 1st 2009
A 5-year-old boy was brought for evaluation of ongoing thrombocytopenia before undergoing adenotonsillectomy for obstructive sleep apnea. The child had been given a diagnosis of "growing pains" after frequent evaluation for leg pain over the past 2 years.
Two-Year-Old Boy With Recalcitrant “Diaper Rash”October 1st 2009
A 2-year-old boy brought for pediatric dermatology consultation because of the "worst diaper rash in the world." Mother reported that the rash had been present for a year and was asymptomatic. She had been using topical barrier creams, corticosteroids, and antifungals to treat the area. Child had also received a course of oral antibiotics. Occasional improvement of rash noted but never complete resolution. Patient had no other medical problems. Family history noncontributory.
Southern Tick–Associated Rash IllnessSeptember 23rd 2009
In early summer, an 8-year-old boy from rural central Virginia was brought for evaluation of a rash on his buttock. He had noticed the rash that morning, when it became pruritic. The father had removed a tick from the area about 10 days earlier. The child denied fever, headache, vomiting, fatigue, arthralgia, myalgia, and other symptoms.
Recommended Vitamin D Intake in Children: Reasons for the Recent IncreaseSeptember 22nd 2009
The American Academy of Pediatrics (AAP) recently doubled the amount of vitamin D that it recommends all infants, children, and adolescents receive each day-from 200 to 400 IU. Also new is the academy's recommendation that vitamin D supplementation begin as soon after birth as possible. Supplementation is recommended in infants who do not receive 400 IU per day from formula.
Erythematous pustules and papules with some coalescence developed on the anterior trunk and to a lesser degree on the face and extremities of a newborn boy the day after birth. The baby was born at full term after an uncomplicated pregnancy and delivery.
Persistent Ankle Mass in an Otherwise Healthy 9-Year-Old GirlAugust 31st 2009
An apparently healthy 9-year-old girl noted to have left ankle mass during well-child checkup. Her last well-child visit was 3 years earlier. Medical history unremarkable. She denied fevers, weight loss, night sweats, and chills. No family history of bone deformities or growth disturbances.
Rashes and Fever in Children: Sorting Out the Potentially Dangerous, Part 3August 26th 2009
Few clinical scenarios engender as much anxiety as the sudden onset of rash and fever in a child. However, the diagnostic possibilities can be quickly narrowed-and the likelihood of potentially serious disease can be assessed-with a triage system that involves classifying the presenting symptoms into 1 of 3 groups.
Diagnostic Challenges Associated With Pediatric Tuberculosis: 2 CasesAugust 23rd 2009
A 10-week-old white baby girl with a history of difficulty in breathing presented with stridor, tachypnea, wheezing, and increased work of breathing.
Episodic right-sided facial flushing was noted in a 2-month-old girl born at full term via forceps-assisted vaginal delivery. The erythema appeared within minutes of latching onto her mother’s breast and resolved within 5 to 10 minutes after breastfeeding. The episodes of flushing had begun a week before the clinic visit; there were no collateral symptoms of anaphylaxis. Because food allergy was suspected, the mother had eliminated all dairy products from her diet.
Pityriasis Lichenoides Et Varioliformis Acuta in a 7-Year-Old BoyJuly 27th 2009
A 7-year-old boy was brought for evaluation of a nonpruritic, nonpainful, evolving polymorphic rash that began on the torso and spread to the extremities, face, palms, and soles over a 2-week period. He had been otherwise healthy and had no history of constitutional symptoms.
Circumscribed erythematous lesions developed on the back and abdomen of this 19-month-old boy. The rash was mildly pruritic. The parents gave the child 1 dose of diphenhydramine, and the rash resolved after an hour. About 12 hours later, new lesions developed on the face, neck, and upper back. The child was given the same treatment and the symptoms resolved. The following morning, widespread lesions were noted on the child's face, neck, trunk, and extremities.
Does this yellow-brown plaque on a young girl's cheek require removal?July 1st 2009
The parents of this 6-year-old girl expressed concern about a yellow-brown arciform plaque on their daughter's cheek that has been present since birth. Although it has remained stable throughout her early childhood, her parents wonder whether it may become cancerous later on. Would you recommend removing the lesion?
Juvenile Plantar Dermatosis: Readers’ RemediesJune 2nd 2009
In his Dermclinic case in the March 2009 issue of CONSULTANT FOR PEDIATRICIANS (page 77), Dr Kirk Barber discusses juvenile plantar dermatosis (JPD). A very simple treatment for this condition is the use of a home foot spa, in which wax is melted and the foot immersed according to the directions included with the device. Following the wax immersion procedure, the patient should apply a good lotion. JPD can be remedied or at least controlled with this treatment.
Traction Alopecia From Atopic DermatitisJune 2nd 2009
A 5-month-old Asian boy was brought for evaluation of hair loss and a red, scaly rash on the scalp and body. The rash had not responded to hydrocortisone 2.5% ointment. There was a family history of asthma, food allergies, and allergic rhinitis. His mother had Hashimoto thyroiditis.
Managing Asthma in Children, Part 2: Achieving and Maintaining ControlJune 2nd 2009
Asthma exacerbations continue to cause a significant number of emergency care visits and hospitalizations among children.1 In “Managing Asthma in Children, Part 1” (CONSULTANT FOR PEDIATRICIANS, May 2009, page 168), we reviewed the epidemiology, risk factors, and diagnosis of asthma in children. We also discussed how to make an initial assessment of asthma severity. In Part 2, we review the key components of treatment.
This white patch in the medial periorbital area of a 15-year-old girl had been present for several months. It was asymptomatic. The patient denied having had an injury to the area. Results of a potassium hydroxide preparation of a skin smear and fungus culture were negative. She had no history of other hypopigmented lesions and was otherwise healthy. There was no family history of vitiligo or autoimmune disease.
Why Does Facial Rash Flare When Treatment Stops?June 2nd 2009
An itchy rash developed around the nose in this 8-year-old boy. At first it responded to the application of a midstrength corticosteroid cream. However, the rash returned promptly after the cream was stopped and then spread to the perioral area. It is no longer responding to treatment with the topical corticosteroid that initially was effective.
A 14-year-old girl with systemic lupus erythematosus (SLE) was evaluated for worsening left leg pain of 1 week’s duration. A month earlier, she had presented with left knee arthritis and a vasculitic rash; the antinuclear antibody titer was positive. In addition, she had leukopenia, myositis, hypocomplementemia, and mild proteinuria.