Minimizing the pain of office procedures in children.

Office practitioners are often required to perform painful procedures on children. A wide variety of techniques that minimize the physical and psychologic trauma of the procedure are reviewed. Various methods of accomplishing some common procedures are evaluated.

Pulsed dye laser therapy for infants and children.

Pulsed dye laser therapy has revolutionized the treatment of benign vascular neoplasms of the skin. Treatment is safe and generally effective in children of all ages. Because of the pain associated with the treatment, special techniques are discussed that may minimize the physical and psychological traumas associated with treatment.

Pain management for dermatologic procedures in children.

Simple explanations provided to children and their parents before a dermatologic procedure is attempted will decrease the time it takes to perform the procedure and make it a less difficult experience for all concerned. The dermatologist should always consider the availability of less painful but effective methods when treating children.

Perianal pseudoverrucous papules and nodules in children.

BACKGROUND: Pseudoverrucous papules and nodules were originally described as a reaction to irritation in association with urostomies. These changes have not been described as occurring on the perianal skin or around colostomies. OBSERVATIONS: Five children had remarkably similar-appearing papules and nodules of the perianal and suprapubic skin. The rash consisted of more than a dozen 2- to 8-mm shiny, smooth, red, moist, flat-topped, round lesions. This peculiar and striking reaction appears to be the result of encopresis or urinary incontinence. Biopsy specimens reveal reactive acanthosis or psoriasiform spongiotic dermatitis. The lesions regress when the irritating factor is removed. CONCLUSIONS: Recognition of this entity is important because pseudoverrucous papules and nodules may mimic more serious dermatoses and unnecessary workup may be initiated. Although this reaction involving perianal skin has not been reported previously, we believe it is not uncommon.

Congenital self-healing reticulohistiocytosis. A new entity in the differential diagnosis of neonatal papulovesicular eruptions.

A case of congenital self-healing reticulohistiocytosis is described. The case is different from those previously described because papulovesicles, rather than the papulonodules that are usually characteristic of this disease, predominated. All lesions regressed within 2 months of presentation, and at 2-year follow-up, the patient continues to develop normally without recurrence of the eruption or progression to internal organ involvement. Electron microscopic examination revealed numerous Langerhans' granules admixed with myelinlike laminated dense granules characteristic of this disease. The unique physical presentation in this case, as well as the criteria used to differentiate this disorder from the more malignant forms of histiocytosis and other childhood papulovesicular eruptions, is emphasized.

Use of oral and topical agents for acne in pregnancy.

Dermatologists frequently are consulted by a pregnant patient or a woman of childbearing age who desires acne therapy. Because there are no published studies in which women took acne medications throughout pregnancy, information about safety must be obtained indirectly from studies in which the agents were taken for another indication during some portion of pregnancy. Oral tetracycline is associated with maternal liver toxicity and deciduous tooth staining in the infant, and tetracycline occasionally has been associated with other congenital anomalies. Maternal isotretinoin ingestion is associated with major craniofacial and cardiac deformities, as well as other congenital anomalies. Erythromycin, however, appears to be safe. Topical acne medications never have been implicated as a cause of fetal deformities in human beings. Dermatologists should be aware of potential toxic and teratogenic effects of acne medicines before prescribing them to women of childbearing age. Prompt reporting of adverse effects is encouraged.