Acute Genital Ulceration After Severe Acute Respiratory Syndrome Coronavirus 2 Vaccination and Infection.

Reactive, nonsexually related acute genital ulceration, also known as Lipschütz ulcer, is a nonsexually related ulceration involving the vulva, most commonly affecting girls and adolescent women in response to infection. Herein, we describe 3 female patients with acute genital ulceration occurring after severe acute respiratory syndrome coronavirus 2 vaccination or natural infection.

Pediatric morphea state-of-the-art literature review: Reframing morphea as a systemic disease.

Pediatric morphea is an inflammatory, fibrosing dermatologic disorder. Although morphea may be localized to the skin and subcutaneous tissues, differentiating it from systemic sclerosis, there is increasing evidence that morphea is a manifestation of a systemic inflammatory process, with the potential to involve many organ systems. Given the potential risk for irreversible sequelae, pediatric morphea should be treated early and aggressively. Long-term disease monitoring is essential.

Genital vitiligo in children: Factors associated with generalized, non-segmental vitiligo.

BACKGROUND/OBJECTIVES: It remains uncertain as to whether genital vitiligo of childhood is segmental or a forme fruste of non-segmental disease. This type of vitiligo is sometimes termed figure-of-eight disease due to female predominance and perineal and perianal hypopigmentation or depigmentation around two orifices, the anal and vaginal introitus. The objective of this series was to categorize the features of genital-limited vitiligo of childhood including comorbidities, family history, and long-term course. METHODS: IRB-approved retrospective chart review of vitiligo cases. RESULTS: Eight cases of vitiligo that began in childhood in the genital area were identified, including clinical course and comorbidities. Involvement of the contiguous skin, including inner thighs, buttocks, and scrotum, was noted in all males. In females, only 1 patient had other sites of vitiligo, which was a solitary lesion on the chest. Therapeutic response to topical corticosteroids for perianal skin was seen in five of six children and topical calcineurin inhibitors with or without calcipotriene in four out of four patients. CONCLUSIONS: Segmental disease limited to the genitalia was more common in females than males, suggesting that perhaps intervention and work-up for comorbid autoimmune diseases may be required for males with genital-limited vitiligo at onset, but may be deferred in females and added if observation of spread is noted. Differentiation from lichen sclerosus et atrophicus may require biopsy.

Vitamin and Mineral Deficiencies in Patients With Telogen Effluvium: A Retrospective Cross-Sectional Study.

Telogen effluvium is one of the most common forms of non-scarring alopecia for which patients present to a dermatologist. It is a challenging disorder to treat and study, primarily owing to its multifactorial etiology which includes both physiologic and non-physiologic factors. Nutritional deficiency has been purported to contribute to hair shedding, and a patient's clinical history usually aids in directing laboratory evaluation. Many prior studies have either supported or failed to find a correlation between telogen effluvium and deficiencies in vitamins and minerals, in particular, vitamin D, ferritin, vitamin B12, folate, and zinc. We performed a retrospective cross-sectional study of patients with telogen effluvium in the greater Pittsburgh, Pennsylvania area, and measured the rates of these deficiencies. Our results demonstrate that the prevalence of vitamin D, ferritin, and zinc deficiencies is non-trivial and therefore justifies including these laboratory studies in initial clinical evaluation.

J Drugs Dermatol. 2016;15(10):1235-1237.

Association between Eosinophilic Esophagitis and Esophageal Food Impaction in the Pediatric Population.

Objectives (1) To describe the presentation, management, and outcomes associated with pediatric esophageal food impaction (EFI) at a single tertiary care institution. (2) To identify the key clinical features of pediatric EFI that are associated with a diagnosis of eosinophilic esophagitis (EoE). Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods Thirty-five children <18 years of age presenting with EFI between November 1, 2006, and October 31, 2013, were included. Presenting symptoms, medical history, biopsy results, endoscopic findings, and underlying etiology were examined. Fisher exact test, t tests, and logistic regression were used to compare between patients with and without EoE. Results Thirty-five patients had isolated EFI and were included in the study. EoE accounted for 74% (n = 26) of pediatric EFI, with the remaining cases being attributed to neurologic impairment (n = 5, 15%), prior surgeries (n = 1, 3%), reflux esophagitis (n = 1, 3%), or unknown etiologies (n = 2, 6%). EFI was the initial manifestation of EoE in 81% (n = 21) of patients. The most common presenting symptoms were dysphagia (n = 34), choking (n = 26), and vomiting (n = 23). Linear furrowing was the only endoscopic finding that was significantly associated with EoE ( P < .001). Conclusion Most esophageal food impactions in the pediatric population are associated with an underlying diagnosis of EoE and are often the initial manifestation of the disease. EoE must be considered in all pediatric patients with EFI; esophageal biopsies should be strongly considered in these patients at the time of endoscopic management of the EFI.

Predictors of Foreign Body Aspiration in Children.

OBJECTIVES: To examine the sensitivity and specificity of history, physical examination, and radiologic studies as predictors of foreign body aspiration in children. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: Medical records were reviewed for 102 children who presented to our institution from 2006 to 2013 with suspected foreign body aspiration and who underwent endoscopy. Data included symptoms, physical examination, radiologic, and endoscopy findings. Descriptive statistics, sensitivity and specificity, and univariate and multivariable analyses were performed. RESULTS: A total of 102 patients were included (62% male). The mean age was 3.3 years (SD, 3.7). A foreign body was identified on endoscopy in 69 cases (68%). The most common presenting symptoms were cough (88%), choking/gagging (67%), and wheezing (57%). Decreased breath sounds and wheezing on examination were independently associated with increased odds of foreign body. The most common abnormal radiographic finding was air trapping (33%). The most frequent items retrieved were fragments of seeds and nuts (49%). There were no serious complications related to endoscopy. The sensitivity and specificity of any finding on history, physical examination, and imaging were 100% and 3%, 90% and 33%, 61% and 77%, respectively. Having a positive history, examination, and chest radiograph combined was 46% sensitive and 79% specific. CONCLUSIONS: Patients with airway foreign bodies have varied presentations. The presence of any radiologic finding suggests that endoscopy should be performed, as a foreign body is probable. The absence of any history or physical examination finding was associated with a low likelihood of a foreign body.

Diagnosis of Pediatric Foreign Body Ingestion: Clinical Presentation, Physical Examination, and Radiologic Findings.

OBJECTIVES: (1) To describe clinical and radiologic findings in patients with esophageal foreign bodies. (2) To examine the sensitivity and specificity of history, physical examination, and radiologic studies in children with suspected foreign body ingestion. METHODS: A retrospective cohort study was performed evaluating all children who underwent esophagoscopy for suspected foreign body ingestion at our institution from 2006 to 2013. RESULTS: Five hundred forty-three patients were included (54% male). Average age was 4.7 years (SD = 4.1 years). Foreign bodies were identified on esophagoscopy in 497 cases (92%). Ingestion was witnessed in 23% of cases. Most common presenting symptoms were choking/gagging (49%), vomiting (47%), and dysphagia/odynophagia (42%). Most patients with foreign bodies had a normal exam (76%). Most foreign bodies were radiopaque (83%). In 59% of patients with normal chest radiographs, a foreign body was present. Sensitivity and specificity of 1 or more findings on history, physical examination, and imaging were 99% and 0%, 21% and 76%, and 83% and 100%, respectively. CONCLUSIONS: Most patients with esophageal foreign bodies are symptomatic. Although many patients will have a normal physical examination, an abnormal exam should increase suspicion for a foreign body. Most esophageal foreign bodies are radiopaque, but a normal chest radiograph cannot rule out a foreign body.

Rats preexposed to MDMA display attenuated responses to its aversive effects in the absence of persistent monoamine depletions.

RATIONALE: The abuse potential of a given drug may be mediated by both its rewarding and aversive effects, the latter of which are often far less characterized. OBJECTIVES: Using the conditioned taste-aversion (CTA) preparation, the present experiments examined changes in the aversive effects of the commonly used recreational drug MDMA following repeated drug exposures. METHODS: Experiment 1 used three varying doses of MDMA (1.0, 1.8, and 3.2 mg/kg) to determine a dose that produced taste aversions of intermediate strength. Experiments 2 and 3 characterized the effects of repeated preexposures to MDMA (1.8 or 3.2 mg/kg) on taste aversions induced by MDMA (1.8 mg/kg). Additionally, levels of several monoamines and metabolites were analyzed in frontal cortex and caudate-putamen from subjects in Experiment 3 to assess for persistent monoamine depletions. RESULTS: MDMA induced dose-dependent taste aversions. Preexposure to MDMA (at both doses) resulted in an attenuation of MDMA-induced taste aversions. These effects were not likely due to persistent monoamine depletions, as subjects preexposed to the higher MDMA dose did not differ from controls in levels of monoamines or metabolites in either brain region examined. CONCLUSIONS: Prior MDMA experience weakened the ability of MDMA to induce taste aversions. This attenuation of MDMA's aversive effects may occur with low doses that do not persistently alter monoamine levels.