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Cutaneous Legionella infection is rare and primarily seen in immunosuppressed patients. Herein, we present a case of cutaneous and pulmonary legionellosis presenting with fever and erythematous subcutaneous nodules in a neonate with severe combined immunodeficiency. This case underscores the importance of considering this diagnosis and highlights the use of modern testing modalities to promptly diagnose and treat infections in immunocompromised patients.
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Sepsis is a leading cause of death in preterm neonates. The increased susceptibility to sepsis is due to prolonged hospitalization, the need for invasive procedures, and immaturity of innate and adaptive immunity. Chlorhexidine gluconate is a popular topical disinfectant that was not recommended for use in preterm neonates until 2012. Thus, there are few studies assessing the role of chlorhexidine gluconate in antisepsis for preterm neonates. A better understanding of the safety and efficacy of chlorhexidine gluconate as an antiseptic agent for preterm neonates is the first step in establishing best practice guidelines for this population.
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OBJECTIVES: To assess the management and outcomes of afebrile infants who received a pediatric dermatology consultation for pustules and/or vesicles. METHODS: Medical records were reviewed for all infants 60 days of age or younger who received a pediatric dermatology consult across 6 academic institutions between September 1, 2013 and August 31, 2019 to identify those infants with pustules and/or vesicles. RESULTS: Of the 879 consults, 183 afebrile infants presented with pustules and/or vesicles. No cerebrospinal fluid cultures or blood cultures were positive for bacteria. No concordant positive urine cultures were identified in infants with cutaneous infection. Nine infants were diagnosed with herpes simplex virus (HSV). Five preterm infants were diagnosed with angioinvasive fungal infections. CONCLUSIONS: No serious bacterial infections attributable to a skin source were identified, yet 53% of these infants received parenteral antibiotics. HSV was diagnosed in 7% of this cohort, 77.8% (7/9) of whom were term infants and 22.2% (2 of 9) of whom were preterm. Angioinvasive fungal infection was diagnosed in 3%, all of whom (100%, 5 of 5) were extremely preterm at <28 weeks gestational age. These findings suggest that in full-term afebrile infants ≤60 days, the likelihood of a life-threatening etiology of isolated pustules or vesicles is low once HSV infection is excluded. In preterm infants with pustules and/or vesicles, a high index of suspicion must be maintained, and broad infectious evaluation is recommended. HSV testing is recommended for all infants with vesicles, grouped pustules and/or punched-out erosions.
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Herpes Simple , Humanos , Recién Nacido , Lactante , Masculino , Femenino , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Estudios Retrospectivos , Recien Nacido Prematuro , Antibacterianos/uso terapéutico , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , DermatologíaRESUMEN
Dermatologic concerns are common in the general pediatrician's practice. Herein, we review the most commonly encountered cutaneous bacterial, viral, and superficial fungal infections in the pediatric population. We describe clinical presentation, pathogenesis, and current treatments. The goal of this guide is to increase pediatricians' comfort in diagnosing and managing common skin infections, as well as determining when a dermatology referral may be necessary. [Pediatr Ann. 2024;53(4):e138-e145.].
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Medicina Familiar y Comunitaria , Piel , Humanos , Niño , PediatrasRESUMEN
Pyoderma gangrenosum is a rare neutrophilic dermatosis characterized by painful skin ulcers with necrotic, undermined margins. In severe cases, particularly in pediatric patients, work-up for an associated autoimmune, inflammatory, malignant, or genetic disorder should be considered based on the clinical presentation. We report a unique case of pediatric pyoderma gangrenosum with a leukemoid reaction, secondary to an autosomal recessive leukocyte adhesion deficiency type 1.
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Reacción Leucemoide , Síndrome de Deficiencia de Adhesión del Leucocito , Piodermia Gangrenosa , Úlcera Cutánea , Humanos , Niño , Piodermia Gangrenosa/complicaciones , Piodermia Gangrenosa/diagnóstico , Síndrome de Deficiencia de Adhesión del Leucocito/complicaciones , Síndrome de Deficiencia de Adhesión del Leucocito/diagnóstico , Síndrome de Deficiencia de Adhesión del Leucocito/genética , Reacción Leucemoide/complicacionesRESUMEN
Background: Atopic dermatitis (AD) is a chronic, inflammatory skin disease commonly onset during infancy. Objective: We examine the association between pre-and postnatal antibiotic exposure and the development of AD. Methods: A retrospective, observational study analyzed 4106 infants at the University of Florida from June 2011 to April 2017. Results: Antibiotic exposure during the first year of life was associated with a lower risk of AD. The association was strongest for exposure during the first month of life. There were no significant differences in the rates of AD in infants with or without exposure to antibiotics in months 2 through 12, when examined by month. Antibiotic exposure during week 2 of life was associated with lower risk of AD, with weeks 1, 3, and 4 demonstrating a similar trend. Limitations: Retrospective data collection from a single center, use of electronic medical record, patient compliance with prescribed medication, and variable follow-up. Conclusions: Early life exposures, such as antibiotics, may lead to long-term changes in immunity. Murine models of atopic dermatitis demonstrate a "critical window" for the development of immune tolerance to cutaneous microbes. Our findings suggest that there may also be a "critical window" for immune tolerance in human infants, influenced by antibiotic exposure.
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A female twin presented at birth with a collodion membrane on the hands and feet. After the membrane resolved over the first months of life, she was initially diagnosed with acral self-healing collodion membrane. However, she subsequently developed brown well-defined geometric scales on the trunk and extremities, consistent with ichthyosis. Genetic testing showed a heterozygous pathogenic variant in ELOVL4, a gene associated with syndromic ichthyosis with developmental delay, seizures, and spasticity. Although acral collodion membrane is considered to be a benign variant of the more generalized collodion, usually described as "self-healing," it may be the initial presentation of more diffuse ichthyosis.
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Ictiosis Lamelar , Ictiosis , Recién Nacido , Humanos , Femenino , Colodión , Ictiosis Lamelar/diagnóstico , Ictiosis Lamelar/genética , Ictiosis/genética , Heterocigoto , Mano/patología , Proteínas del Ojo/genética , Proteínas de la Membrana/genéticaRESUMEN
Lack of standardized dermatoscopy training limits confidence and accuracy. We assessed the effect of a dermatoscopy lecture series on the diagnostic accuracy of dermatology residents' biopsies. Additionally, we evaluated resident comfort with and knowledge of dermatoscopy before and after the curriculum. Twelve dermatology residents were enrolled in a 5-month dedicated dermatoscopy curriculum. To assess knowledge of and comfort with dermatoscopy, residents were given a 50-question assessment and 21-question survey before and after the curriculum. Change in diagnostic accuracy was assessed by comparing the suspected clinical diagnosis to the final histopathologic diagnosis of lesions biopsied by residents before and after the course. Upon completion of the curriculum, residents felt significantly more comfortable performing dermatoscopy (P = .002) and using dermatoscopy to identify melanocytic nevi (P = .037) and melanomas (invasive and in situ) (P = .012). Postgraduate year 2 residents also showed significantly improved diagnostic accuracy after the training course (odds ratio, 1.33; 95% confidence interval, 1.06-1.67; P = .013). Our study was limited by a small sample size of 12 residents from a single academic institution. A formal dermatoscopy course can effectively improve dermatology residents' knowledge, confidence, and diagnostic accuracy when using dermatoscopy.
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Dermatología , Internado y Residencia , Melanoma , Nevo Pigmentado , Neoplasias Cutáneas , Humanos , Nevo Pigmentado/diagnóstico por imagen , Nevo Pigmentado/patología , Melanoma/diagnóstico por imagen , Melanoma/patología , Curriculum , Competencia Clínica , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Estudios de Casos y ControlesRESUMEN
Neonatal sepsis is a major cause of morbidity and mortality in preterm infants. Preterm and very low birth weight infants are particularly susceptible to sepsis due to their immature skin barrier, naive immune system, exposure to broad-spectrum antibiotics, and insertion of medical devices. Neonatal intestinal dysbiosis has been linked to neonatal sepsis; however, the cutaneous microbiome likely plays a role as well, as common sepsis pathogens also dominate the skin flora. This review summarizes our current understanding of the infant skin microbiome and common causative pathogens in neonatal sepsis, as well as the relationship between the two. A better understanding of the role of the skin microbiome in the pathogenesis of neonatal sepsis may guide future prophylaxis and treatment.
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Microbiota , Sepsis Neonatal , Sepsis , Lactante , Recién Nacido , Humanos , Recien Nacido Prematuro , DisbiosisRESUMEN
The human microbiome encompasses the microorganisms that live in and on the body. During the prenatal and infantile periods, foundations for the cutaneous and gut microbiomes are being established and refined concurrently with the development of immune function. Herein, we review the relevance of the microbiome to 5 conditions commonly encountered in pediatric dermatology: acne, alopecia areata, atopic dermatitis, psoriasis, and seborrheic dermatitis. Understanding the role microbes play in these conditions may establish the groundwork for future therapeutic interventions.
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Alopecia Areata , Dermatitis Atópica , Microbiota , Enfermedades de la Piel , Niño , Humanos , PielRESUMEN
BACKGROUND: Atopic dermatitis (AD) is a common pediatric skin condition with significant morbidity. It is unclear what factors contribute to racial differences in disease prevalence. METHODS: A single-site, retrospective cohort study of infants born from June 1, 2011, to April 30, 2017, was performed. RESULTS: Of the 4016 infants included, 39.2% (n = 1574) were Black, 38.5% (n = 1543) White (non-Hispanic), 7.1% (n = 286) Hispanic, 5.3% (n = 213) Asian, 6.5% (n = 262) "other" race, 3.4% (n = 135) multiracial, and 0.1% (n = 3) not reported. Prevalence of AD differed by race, with 37.0% (n = 583) of Black, 25.8% (n = 55) of Asian, 24.1% (n = 69) of Hispanic, 23.0% (n = 31) of multiracial, 19.1% (n = 50) of "other" race, and 17.9% (n = 276) of White patients diagnosed (P < 0.0001). Delivery mode, NICU stay, and gestational age were all significantly associated with race. In modeling AD with logistic regression, race was significantly associated with the development of AD (P < 0.0001, OR Black = 2.6 [2.2-3.2], OR Asian = 1.6 [1.1-2.2], OR Hispanic = 1.4 [1.0-1.9], OR multiracial 1.4 [0.91-2.2], OR "other" 0.97 [0.67-1.4], and OR White 1.0). CONCLUSIONS: Racial differences in rates of AD arise early in life. Diagnosis is associated with race rather than delivery mode, insurance type, and gestational age. Further investigation into these disparities and interventions to mitigate them should focus on infancy and early childhood.
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Dermatitis Atópica , Niño , Preescolar , Dermatitis Atópica/epidemiología , Etnicidad , Edad Gestacional , Hispánicos o Latinos , Humanos , Lactante , Estudios RetrospectivosRESUMEN
OBJECTIVE: Infancy and early childhood are crucial periods in the development of the human microbiome and shape the trajectory of microbial colonization, immune system development, and systemic disease. We review the development of the skin and gut microbiomes, their connection to the immune system, and their relevance to common pediatric pathologies. FINDINGS: Beginning after birth, and likely even in utero, colonization of the skin and the gut occur in parallel, influenced by external factors. This colonization, in turn, dictates maturation of the immune system and contributes to conditions from atopic dermatitis to sepsis. Emerging literature is identifying links between the gut and skin microbiomes. CONCLUSION: The gut and skin microbiomes are associated with pediatric disease states. Immune and microbial plasticity make this unique period an ideal target for intervention. Investigating the purposeful manipulation of the pediatric microbiome may lead to novel treatment and prevention strategies.
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Dermatitis Atópica , Microbioma Gastrointestinal , Microbiota , Niño , Preescolar , Humanos , PielRESUMEN
Reactive angioendotheliomatosis (RAE) is an uncommon, benign, antiproliferative condition associated with systemic diseases that may cause occlusion or inflammation of the vascular lumina. A link between antiphospholipid syndrome (APS) and RAE has been reported a few times in the literature. Herein, we present a unique case of RAE diagnosed in a patient with primary APS who was well-managed on warfarin and rituximab with no recent thrombotic events. As RAE can precede or follow a diagnosis of APS, the presence of the condition indicates a need to workup for APS and to ensure those with the condition are adequately anticoagulated. However, as demonstrated in this case, the condition can still occur in patients who are adequately anticoagulated.
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Síndrome Antifosfolípido/complicaciones , Hemangioendotelioma/complicaciones , Neoplasias Cutáneas/complicaciones , Anticoagulantes/uso terapéutico , Hemangioendotelioma/tratamiento farmacológico , Hemangioendotelioma/patología , Humanos , Masculino , Persona de Mediana Edad , Rituximab/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Warfarina/uso terapéuticoRESUMEN
Introduction The National Resident Matching Program (NRMP) requires all Match participants to adhere to a strict code of conduct known as the Match Participation Agreement, yet Match violations continue to occur. We sought to determine how interview experiences, including Match violations, impact applicants' perceptions and rankings of residency programs. Methods An electronic survey was sent to all accredited medical school Deans of Student Affairs and Association of American Medical Colleges Student Representatives for distribution to fourth-year medical students. Questions assessed pressures that residency programs placed on applicants during interview season and their impact on applicants. Both quantitative and qualitative data were collected. Results Of the 433 included respondents, 31.2% (n = 135) reported breaches of the NRMP Match Participation Agreement. Of those, 63% (n = 85) had a negative perception of the violating programs, and 37.8% (n = 51) were less likely to rank those programs highly. Violations included asking applicants about the locations of their other interviews (60.3%, n = 261), pressuring applicants to reveal their ranking (24.0%, n = 104), explicitly requesting applicants to reveal their ranking (6.5%, n = 28), asking applicants to provide a commitment before Match day (3.9%, n = 17), and other behavior that was felt to ignore the spirit of the Match (16.4%, n = 71). Implying that applicants would match into a program if they ranked it highly (37.2%, n = 161) was received positively by 65.2% (n = 105) of applicants experiencing this breach, with 42.2% (n = 68) ranking the program more highly. Three major themes impacting applicants' impressions of residency programs emerged from the qualitative data: interview experience, professionalism, and post-interview communication (PIC). Respondents overwhelmingly agreed that PIC should either be eliminated or that programs should set clear expectations for PIC. Conclusions Match violations continue to occur, despite the NRMP Match Participation Agreement. With the notable exception of communication implying that applicants would match into a program, applicants overwhelmingly view programs that commit these violations negatively and often rank these programs lower as a result.
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BACKGROUND/OBJECTIVES: Premature infants have lower rates of atopic dermatitis (AD) compared with full-term infants, though little is known about the factors contributing to this association. We explored the infant and environmental factors that may contribute to the association between prematurity and atopic dermatitis, including mode of delivery, birthweight, gestation, and duration of stay in the neonatal intensive care unit (NICU). METHODS: This was a single-center retrospective study. Independent samples t tests or chi-square tests were used to compare groups on continuous and categorical variables, respectively. Logistic regression then examined the association of the predictor variables with AD. RESULTS: Four thousand sixteen mother-infant dyads were included. Infants had a higher risk of developing AD if they were delivered vaginally (P = .013), did not stay in the NICU (P < .001), had a longer gestation (P = .001), or had a higher birthweight (P = .002). In modeling atopic dermatitis with the predictor variables, only NICU length of stay remained significantly associated with a lower risk of AD (P = .004). CONCLUSION: Infants had a lower risk of developing AD if they had a longer stay in the NICU.
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Dermatitis Atópica , Unidades de Cuidado Intensivo Neonatal , Dermatitis Atópica/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Tiempo de Internación , Estudios RetrospectivosRESUMEN
BACKGROUND/OBJECTIVE: The h-index is a measure of research achievement. Individuals with similar h-indices should be equivalent in terms of scientific impact. However, this value is inherently biased toward fields with higher visibility and readership. To utilize the power of h-indices in predicting future research success and as a benchmark for academic advancement, niche fields like pediatric dermatology must be examined independently. METHODS: Publicly available data were examined. A list of current pediatric dermatologists were obtained from the Society for Pediatric Dermatology's member directory. The following demographic information was obtained: fellowship certification year, PhD status, prior pediatric residency training, state/region, practice setting, academic appointment, number of publications, and h-index. Descriptive and analytic statistics were calculated. RESULTS: A total of 317 pediatric dermatologists were included. Practice setting distribution was as follows: 54.3% academic, 32.5% non-academic, and 13.3% combined. H-index differed significantly based on pediatric dermatology certification year (P < .001), increasing as time from certification increased. Those in academics had higher h-indices than those in both non-academic and combined practice settings (P < .001 and .007, respectively). Professors (25.0) had higher h-indices than associate professors (11.0), who had higher h-indices than assistant professors (4.4) (P < .001). CONCLUSIONS: H-index increased with increasing academic rank and was highest among those working in academics. For pediatric dermatologists considering application for promotion, the h-index for each level can serve as a useful benchmark to guide decision-making.
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Dermatólogos , Dermatología , Bibliometría , Niño , Eficiencia , Docentes Médicos , Humanos , Estados UnidosRESUMEN
Androgenetic alopecia (AGA) is common and associated with significant psychosocial distress. Treatment options are needed for patients that do not adequately respond to first line treatments of finasteride or minoxidil. Topical ketoconazole has been proposed as a promising treatment. The goal of this systematic review was to evaluate the efficacy of topical ketoconazole in the treatment of AGA. A systematic literature search was conducted within the MEDLINE database using the key terms "ketoconazole" and "alopecia." Forty-seven papers were screened for inclusion, of which nine were assessed for eligibility. Seven articles were included in the qualitative synthesis, including two animal studies (total of 40 participants) and five human studies (total of 318 participants). Murine studies demonstrated a significant increase in mean ratio of hair regrowth to denuded area in the ketoconazole treatment groups compared to controls. Human studies reported increased hair shaft diameter following ketoconazole use. One study reported a significant increase in pilary index (percent anagen phase × diameter) following treatment. Studies also demonstrated clinical improvement of AGA based on photographic assessment and subjective evaluation. Topical ketoconazole is a promising adjunctive or alternative therapy in the treatment of AGA. Randomized controlled trials are needed.
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Alopecia/tratamiento farmacológico , Cabello/crecimiento & desarrollo , Cetoconazol/administración & dosificación , Administración Tópica , Animales , Humanos , Ratones , Resultado del TratamientoRESUMEN
Recent focus on the neonatal intestinal microbiome has advanced our knowledge of the complex interplay between the intestinal barrier, the developing immune system, and commensal and pathogenic organisms. Despite the parallel role of the infant skin in serving as both a barrier and an interface for priming the immune system, large gaps exist in our understanding of the infantile cutaneous microbiome. The skin microbiome changes and matures throughout infancy, becoming more diverse and developing the site specificity known to exist in adults. Delivery method initially determines the composition of the cutaneous microbiome, though this impact appears transient. Cutaneous microbes play a critical role in immune system development, particularly during the neonatal period, and microbes and immune cells have closely intertwined, reciprocal effects. The unique structure of newborn skin influences cutaneous microbial colonization and the development of dermatologic pathology. The development of the infantile skin barrier and cutaneous microbiome contributes to future skin pathology. Atopic dermatitis flares and seborrheic dermatitis have been linked to dysbiosis, while erythema toxicum neonatorum is an immune response to the establishment of normal bacterial skin flora. Physicians who care for infants should be aware of the impact of the infantile skin microbiome and its role in the development of pathology. A better understanding of the origin and evolution of the skin microbiome will lead to more effective prevention and treatment of pediatric skin disease.