Cosmetic procedures in children.

PURPOSE OF REVIEW: Cosmetic procedures are being performed with increased frequency in the United States and worldwide. Many of these procedures are being performed on children for aesthetic reasons and for the management of dermatological conditions such as psoriasis and vitiligo. This review serves as an overview of selected cosmetic procedures with pediatric applications. RECENT FINDINGS: Recent developments in laser technology have improved our ability to treat a large number of pediatric cutaneous disorders. The vast majority of these technologies were first developed for aesthetic dermatology in adults. Collagen-stimulatory agents such as poly-L-lactic acid were first approved for lipoatrophy associated with human immunodeficiency virus. Poly-L-lactic acid and dermal fillers have potential therapeutic applications in children with atrophic disorders such as lipoatrophy and morphea. Injection of botulinum toxin is very successful in the treatment of hyperhidrosis in adults and can be utilized to improve quality of life in children with hyperhidrosis. SUMMARY: The field of cosmetic dermatology is evolving quickly, with limited safety and efficacy studies in the pediatric age group. Children may benefit from thoughtful application of these technologies.

Spitz nevi arising in speckled lentiginous nevus: clinical, histologic, and molecular evaluation of two cases.

Spitz nevi are small dome-shaped nodules that sometimes arise in areas of preexisting hyperpigmentation, such as a speckled lentiginous nevus (nevus spilus), where they present a diagnostic dilemma. We report clinical, histopathological, and molecular findings of two cases of multiple Spitz nevi arising in a speckled lentiginous nevus. We used immunohistochemistry to assess expression of Ki-67, epidermal growth factor receptor, vascular endothelial growth factor, and RelA in two cases of Spitz nevi arising in a speckled lentiginous nevus. We observed rare staining for the proliferative marker Ki-67, but positive staining for the growth and antiapoptotic factors epidermal growth factor receptor, vascular endothelial growth factor, and RelA. Characterization of the molecular phenotype of Spitz nevi arising in speckled lentiginous nevi may provide a useful adjunct to long-term monitoring in this rare but difficult clinical presentation.

Acrodermatitis due to nutritional deficiency.

PURPOSE OF REVIEW: Nutritional deficiency is prevalent in developing countries but should also be considered in developed countries in the setting of genetic or acquired disease states. The skin is commonly involved and is often one of the first organs affected in nutritional deficiency, providing a key to the diagnosis. This article will review the most common nutritional deficiencies causing a periorificial and/or acrodermatitis: zinc deficiency, biotin deficiency, kwashiorkor, and essential fatty acid deficiency. RECENT FINDINGS: Whereas older literature has focused on the relationship among nutritional deficiency, malnutrition and poverty, recent research has identified additional patient populations that are at risk for developing nutritional deficiencies. These populations include premature infants, patients with long-term total parenteral nutrition, Crohn's disease, cystic fibrosis, intestinal bypass procedures, chronic alcoholics, anorexia nervosa, and restrictive diets. Recent studies have also focused on further understanding the genetic basis of inherited nutritional deficiencies such as acrodermatitis enteropathica. SUMMARY: Skin manifestations can lead a provider to the diagnosis of a nutritional deficiency. In a child with a periorificial or acral dermatitis, the diagnosis of zinc, biotin, protein, or essential fatty acid deficiency should be considered, especially if accompanied by systemic signs of failure to thrive.

Ichthyotic-appearing skin changes associated with childhood morphea, systemic sclerosis, and systemic lupus erythematosus/scleroderma overlap.

Ichthyotic-appearing skin changes have been associated with autoimmune disorders, including systemic lupus erythematosus and systemic sclerosis in adults. We report three children with ichthyotic-appearing skin changes that may be an early feature reflecting underlying dermal sclerosis. Detection of these subtle skin changes may be predictive of more widespread cutaneous involvement, ultimately prompting earlier treatment.

Multiple granular cell tumors in a child with Noonan syndrome.

Granular cell tumors are benign neurally derived neoplasms, involving cutaneous and subcutaneous tissues; and typically occur as solitary lesions. Multiple granular cell tumors occur in 10% of affected individuals, but are in children. Children with underlying somatic and genetic syndromes, including neurofibromatosis and Noonan syndrome, appear to be at higher risk of developing multiple granular cell tumors. Skin biopsy assists in diagnosis, since granular cell tumors have a similar appearance to other cutaneous nodules. Painful or rapidly growing granular cell tumors should be excised and asymptomatic non-growing granular cell tumors may be observed. Children with multiple granular cell tumors should have a complete physical examination to rule out an underlying genetic syndrome.

Acute lymphocytic leukemia presenting as an isolated scalp nodule in an infant.

We describe the presentation and management of a patient referred for a presumed benign scalp lesion in infancy. The subcutaneous nodule was ultimately diagnosed as the first manifestation of acute lymphoblastic leukemia. We review leukemia cutis with special emphasis on the differential diagnosis of scalp nodules in infancy that may be encountered by the plastic surgeon.

An enlarging tender nodule on the finger of a 4-year-old boy: an unusual presentation of infantile myofibromatosis.

Infantile myofibromatosis is a benign neoplasm most commonly seen in the neonatal period through infancy. We report a case of a 4-year-old boy who had a nodule on his left index finger. Biopsy specimen showed features of infantile myofibromatosis (solitary type). Unusual features of this case included location and the concept of an infantile myofibromatosis/infantile hemangiopericytoma continuum.

Acute retroviral syndrome.

The acute retroviral syndrome (ARS), also known as primary HIV infection, acute HIV infection, and HIV seroconversion syndrome, is the earliest clinical manifestation of HIV infection. Early detection of HIV allows for medical and behavioral interventions critical to the management of HIV. This article reviews the clinical features and current management of individuals with ARS.

Methotrexate-induced bullous acral erythema in a child.

Chemotherapy induced acral erythema (CIAE) is an uncommon and dramatic reaction to high-dose chemotherapy. It is characterized by symmetrical, well-demarcated, painful erythema of the palms and soles which may progress to bullae formation and desquamation. Prompt recognition and discrimination from more serious conditions such as graft-vs-host disease or toxic epidermal necrolysis is essential. This paper describes the case of a 12-year-old boy who developed CIAE after high-dose methotrexate treatment and discusses the important clinical, histopathological, and therapeutic features of this condition.