Consultant for Pediatricians Vol 8 No 6

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.

In their Photoclinic case of iron deficiency in a 4-year-old boy with pica (CONSULTANT FOR PEDIATRICIANS, March 2009, page 104), Drs Ron Shaoul and David Bader do a commendable job of describing pica and of documenting the child’s iron deficiency (Figure). However, I was surprised that the possibility of lead poisoning was not considered.

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.

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.

When young children have an irritant in their eyes, it can be very difficult to get them to open their eyes so that they can be irrigated. To reduce the stinging and make opening the eyes easier, try putting a drop of an ocular anesthetic in each medial canthus while the child is supine; be sure to wait for it to seep in.

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 5-month-old girl with progressively worsening generalized rash of 3 weeks’ duration. No obvious sensitivity, fever, recent infection, medication use, or known contact with irritant.

Tar on the feet and legs can be an unwelcome consequence of summer trips to the beach. Getting it off can be difficult, painful, and harmful to the underlying tissue. Tell parents they can make removal easier by gently rubbing a small amount of mayonnaise on the affected area.

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.