RESUMO
Reflectance confocal microscopy is an innovative imaging modality, which noninvasively provides an optical image to aid in the diagnosis of skin lesions. While performing a skin biopsy for histopathologic analysis is the gold standard to definitively diagnose skin disease, this may prove to be more difficult in the pediatric population. This will occasionally necessitate sedation or general anesthesia as an approach, which carries a number of different risks. Reflectance confocal microscopy is an exciting new avenue in the support of diagnosing skin pathology, with the goal of improving pediatric patient tolerance and experience when examining epidermal and superficial dermal skin lesions. This review discusses the utility of reflectance confocal microscopy for pediatric dermatology patients pertaining to melanocytic and non-melanocytic skin neoplasms and inflammatory and infectious skin diseases in children.
Assuntos
Dermatologia , Criança , Humanos , Microscopia ConfocalRESUMO
BACKGROUND/OBJECTIVES: Congenital hemangiomas (CH) are a group of benign vascular tumors that are present at birth and exhibit variable involution during infancy. Congenital hemangiomas that do not involute are typically solitary patch or plaque-type tumors that grow proportionally with somatic growth. We report a case series of 9 patients with persistent CH, which exhibited uncommon features including segmental involvement, recurrent or severe pain, or growth via volumetric increase in size or apparent increased extent of anatomic involvement over time. METHODS: Via retrospective chart review, we included patients with persistent CH and atypical presentations. Available data regarding clinical characteristics, natural history, histopathology, imaging, and genetic tests were collected. RESULTS: Data on 9 patients were collected, including 7 noninvoluting CH and 2 partially involuting CH. Three of the 9 cases had segmental distribution, 6 had apparent growth or clinical evolution, and 4 were symptomatic with pain. One also had marked localized intravascular coagulopathy. CONCLUSIONS: Ongoing or recurrent pain and large extent of anatomic involvement can be features of CH, albeit uncommon ones, and can pose both diagnostic and management challenges. Tissue genomic studies can offer a novel tool for CH diagnosis.
Assuntos
Hemangioma/congênito , Neoplasias Cutâneas/congênito , Neoplasias Vasculares/congênito , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Diagnóstico por Imagem , Feminino , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Lactente , Masculino , Medição da Dor , Fenótipo , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/terapiaRESUMO
Currently there exist few reported cases where lasers are used successfully to treat glomuvenous malformations in adolescents. In the two cases described here, we provide evidence that the long-pulsed neodymium-doped yttrium aluminum garnet laser is an effective and safe alternative treatment for these lesions. Our case series is unique because it focuses on adolescents, the population that most often seeks treatment for this dermatologic condition.
Assuntos
Tumor Glômico/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Paraganglioma Extrassuprarrenal/cirurgia , Adolescente , Criança , Estética , Feminino , Seguimentos , Tumor Glômico/diagnóstico , Humanos , Paraganglioma Extrassuprarrenal/diagnóstico , Doenças Raras , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Mastocytosis is a relatively common disorder characterized by mast cell collections in the skin and other organ systems. Affected children are more likely than adults to have limited cutaneous disease. We report two patients with localized vulvar mastocytosis in the absence of other cutaneous findings and review previous reports of vulvar involvement in cutaneous mastocytosis.
Assuntos
Mastocitose Cutânea/patologia , Vulva/patologia , Vulvite/patologia , Biópsia , Criança , Pré-Escolar , Feminino , HumanosRESUMO
A 2-year-old African American, Hispanic boy presented with well-defined, violaceous, annular dermal plaques without scale over the upper extremities, face, lower extremities, and buttocks. The clinical presentation and laboratory studies were consistent with a diagnosis of subacute cutaneous lupus erythematous (SCLE). SCLE presenting in childhood is exceedingly rare, with only eight cases previously reported. It is important to clinically differentiate SCLE from other eruptions more common to children, such as atopic dermatitis, urticarial drug eruptions, and psoriasis vulgaris, because progression to systemic lupus erythematous (SLE) may occur. SLE needs to be closely followed. We present the first case (to our knowledge) of SCLE in a child of African American or Hispanic descent and provide a table of other documented pediatric presentations of SCLE for comparison.
Assuntos
Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/patologia , Pele/patologia , Biópsia , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Índice de Gravidade de DoençaAssuntos
Técnica Direta de Fluorescência para Anticorpo , Dermatose Linear Bolhosa por IgA/diagnóstico , Dermatose Linear Bolhosa por IgA/patologia , Biópsia , Dapsona/uso terapêutico , Diagnóstico Diferencial , Humanos , Imunoglobulina A/análise , Imunossupressores/uso terapêutico , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Masculino , Prednisona/uso terapêutico , Pele/imunologia , Pele/patologia , Adulto JovemAssuntos
Dermatofibrossarcoma/patologia , Hipertricose/patologia , Neoplasias Cutâneas/patologia , Dermatofibrossarcoma/congênito , Dermatofibrossarcoma/metabolismo , Feminino , Humanos , Hipertricose/congênito , Hipertricose/metabolismo , Lactente , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/metabolismoRESUMO
Langerhans cell histiocytosis (LCH) is a clonal proliferation of bone marrow derived antigen-presenting cells that can involve a spectrum of cutaneous findings, with or without internal organ involvement. Neonatal LCH almost always presents with skin findings, usually petechial papules and/or erosions in a seborrheic distribution, with or without extracutaneous involvement. Previously described as varying entities, LCH is now considered a single disease process demonstrating a spectrum of clinical findings. We report a unique case of neonatal LCH presenting with a "blueberry muffin" rash in conjunction with a large soft tissue tumor.
Assuntos
Exantema/etiologia , Hematopoese Extramedular , Histiocitose de Células de Langerhans/diagnóstico , Pele/patologia , Biópsia , Calcinose/diagnóstico , Calcinose/patologia , Quimioterapia Combinada , Exantema/fisiopatologia , Histiocitose de Células de Langerhans/tratamento farmacológico , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/fisiopatologia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Pele/fisiopatologia , Coxa da Perna , Vimblastina/administração & dosagem , Vimblastina/uso terapêuticoRESUMO
Skin disease is highly prevalent in the United States, and it has been well-documented that patients with skin disease experience financial, psychological, social, and quality-of-life (QoL) burdens beyond those of the general population. Pediatric patients and their caregivers are particularly vulnerable to the burden of skin disease. Over the past decade disease-specific indices for QoL measurement in pediatric dermatology have been developed. Most of this research has focused on acne, atopic dermatitis, hemangiomas, ichythosis, psoriasis, and vitiligo. This article provides an overview of QoL assessment in pediatric dermatology for these six conditions.
Assuntos
Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Dermatopatias/psicologia , Adolescente , Fatores Etários , Atitude Frente a Saúde , Cuidadores/psicologia , Criança , Pré-Escolar , Dermatologia , Humanos , Lactente , Fatores Socioeconômicos , Inquéritos e QuestionáriosAssuntos
Síndromes Neurocutâneas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , LactenteRESUMO
We describe an 11-month-old boy with an unusually large presternal mass present since birth. The large size, fluctuant properties, transillumination, compressibility, and imaging of this lesion were characteristic of a lymphatic malformation. Although four treatments with sclerotherapy markedly reduced its size, it was not until definitive treatment with surgical excision and the final pathology report that we arrived at the ultimate diagnosis of dermoid cyst. Dermoid cysts, although appearing along embryologic lines of closure, are rarely presternal. They are usually small, thick walled, and filled with sebaceous or keratinous fluid, which typically allows for clinical diagnosis, and show characteristic features on magnetic resonance imaging (MRI) and ultrasound. However, this case illustrates that dermoid cysts can appear in somewhat atypical locations, and imaging is not always diagnostic, so dermoid cyst should remain a part of the differential diagnosis for any lesion presenting midsternally, regardless of the size and imaging characteristics.
Assuntos
Cisto Dermoide/diagnóstico , Anormalidades Linfáticas/diagnóstico , Escleroterapia/métodos , Neoplasias Cutâneas/diagnóstico , Biópsia por Agulha , Cisto Dermoide/congênito , Cisto Dermoide/tratamento farmacológico , Diagnóstico Diferencial , Seguimentos , Humanos , Imuno-Histoquímica , Lactente , Imageamento por Ressonância Magnética/métodos , Masculino , Medição de Risco , Neoplasias Cutâneas/congênito , Neoplasias Cutâneas/tratamento farmacológico , Esterno , Parede Torácica/patologia , Resultado do TratamentoRESUMO
Perioral ulcerated hemangiomas in infants can present a therapeutic challenge to clinicians, especially when associated with severe pain and difficulty feeding. Topical and oral pain medications can be beneficial, but feeding difficulties may still occur while awaiting healing of the ulceration with the use of systemic or topical agents. We present a case of an infant with an ulcerated lip hemangioma treated with an over-the-counter topical sealant in combination with systemic corticosteroid therapy who showed dramatic improvement in pain and tolerance to feeding, resulting in healing of the ulceration.
Assuntos
Carboximetilcelulose Sódica/análogos & derivados , Hemangioma/patologia , Manejo da Dor/métodos , Dor/tratamento farmacológico , Neoplasias Cutâneas/patologia , Úlcera Cutânea/patologia , Anti-Inflamatórios/uso terapêutico , Carboximetilcelulose Sódica/uso terapêutico , Quimioterapia Combinada , Feminino , Hemangioma/complicações , Hemangioma/tratamento farmacológico , Humanos , Lactente , Lábio/patologia , Dor/etiologia , Prednisolona/uso terapêutico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/etiologiaRESUMO
Port-wine stains (PWS) and morphea are distinct conditions that are easily recognized and diagnosed in pediatric patients. Rarely, early localized morphea may mimic an acquired PWS. We present 4 such cases, in two of which the initial clinical impression of acquired PWS was thought to be confirmed by histopathology. A diagnosis of morphea was made approximately 6 months to 3 years after the onset of the acquired PWS. Clinicians should be aware that an apparent acquired PWS may be an early manifestation of localized morphea and continue to monitor these lesions.