Granulomatous periorificial dermatitis: a variant of granulomatous rosacea in children?

BACKGROUND: We report a case of granulomatous periorificial dermatitis (GPD). A 13-year-old Jamaican boy presented with pink to flesh-colored perioral and periocular papules that erupted during a summer visit to Jamaica. The child was initially diagnosed with sarcoidosis and treated with oral corticosteroids, but the eruption recurred 2 years later. He was referred to Dermatology. Biopsy of one of the facial papules revealed a dense granulomatous infiltrate with surrounding prominent lymphocytes. A diagnosis of GPD was made. OBJECTIVE AND CONCLUSION: Also known as facial Afro-Caribbean childhood eruption (FACE), GPD occurs in prepubertal children. It can be confused with sarcoidosis, infection, and granulomatous rosacea but contains lymphocytes around the granulomas and lacks the systemic involvement seen in sarcoidosis. Cultures are invariably negative. The histologic features of GPD and granulomatous rosacea can be identical, and certain treatments may exacerbate the condition, highlighting the importance of clinical correlation. The correct diagnosis is important to minimize treatment as GPD is ultimately self-limited.

Immune protective effect of a moisturizer with DNA repair ingredients.

Ultraviolet (UV) light damages DNA and impairs immune surveillance. The faulty repair of DNA after UV exposure is associated with immune suppression and facilitates photodamage that leads to photoaged skin and the growth of skin cancer. Sunscreens have been developed to filter UV light from entering the skin, but are not beneficial once DNA damage has occurred. Enhancing DNA repair after UV radiation may provide added advantage and prevent UV immunosuppression. This study was performed to determine whether a product with DNA repair ingredients prevents UV-induced suppression of contact hypersensitivity responses in vivo. Solar simulated radiation was delivered on skin with and without topical treatment with a moisturizer containing DNA repair enzymes (Advanced Night Repair Concentrate). Subjects were then sensitized to the hapten dinitrochlorobenzene, and the level of resultant contact hypersensitivity response was elicited 2 weeks later. Contact hypersensitivity response measured by skin fold thickness was significantly suppressed in untreated UV-irradiated subjects but not in subjects treated with DNA repair moisturizer after solar simulated radiation. Our results indicate that DNA repair ingredients significantly prevent UV-induced immune suppression.

Early melanoma detection: nonuniform dermoscopic features and growth.

BACKGROUND: Dermoscopy alone is not sufficient to detect all early melanomas. Total body photos reveal growth of melanomas but also reveal growth of melanocytic nevi. OBJECTIVE: We set out to determine whether a simplified algorithm on the basis of nonuniform dermoscopic features combined with growth noted from baseline total body photos targeted the early melanocytic neoplasms most likely to be malignant. METHODS: Lesions removed during follow-up of patients with total body photographs were reviewed and 169 melanocytic lesions were identified for which both gross clinical and dermoscopic photos were available. The images were evaluated separately by 3 academic dermatologists, without knowledge of the given pathologic diagnosis, for uniformity (consistent gradient of features from center to edge) and change (specifically, that which could indicate melanoma growth in normal skin or within a nevus). RESULTS: Using a minimum of 2 out of 3 agreement for uniformity and change, 12 of 16 melanomas (including all 5 superficially invasive tumors) were graded as nonuniform and changed. The 4 melanomas not included in this category were in situ. The predicted odds of melanoma for lesions scored as both nonuniform and changed was 4.06 (P >.0195). If 3 out of 3 agreement was used, the odds ratio increased to 6 (P >.0010). CONCLUSION: An algorithm on the basis of dermoscopic nonuniformity and change suggestive of growth as determined by total body photography segregates melanocytic neoplasms most likely to be malignant.