Tinea versicolor in a premature infant.

Tinea versicolor (TV) is a fungal skin infection that classically affects adolescents and young adults. Occasionally, it may be seen on the face of infants. We report an unusual case of widespread cutaneous TV in a premature infant.

Acute onset traction-associated ulceration and alopecia.

Traction alopecia is a protracted form of hair loss resulting from persistent tension on the hair follicle . We report a case of a 9-year-old African American girl who presented with extensive scalp ulceration and alopecia 11 days after placement of a synthetic hair braid. Over a period of months, with consistent wound care and low-tension hairstyling, most of the hair regrew. We propose that the ulceration and hair loss in this case represents an acute variant of traction alopecia due to pressure-induced ischemia and necrosis.

Differentiating skin-limited and multisystem Langerhans cell histiocytosis.

OBJECTIVE: To identify features associated with multisystem involvement and therapeutic failure in patients with skin Langerhans cell histiocytosis (LCH). STUDY DESIGN: We reviewed medical records of 71 consecutive patients with LCH with skin involvement evaluated at Texas Children's Hospital and analyzed clinical features, laboratory results, and the presence of circulating cells with the BRAF-V600E mutation with respect to initial staging and clinical outcomes. RESULTS: Skin disease in patients older than 18 months of age at diagnosis was associated with the presence of multisystem disease (OR, 9.65; 95% CI, 1.17-79.4). Forty percent of patients referred for presumed skin-limited LCH had underlying multisystem involvement, one-half of these with risk-organ involvement. Patients with skin-limited LCH had a 3-year progression-free survival of 89% after initial therapy, and none developed multisystem disease. Patients with skin/multisystem involvement had a 3-year progression-free survival of 44% with vinblastine/prednisone therapy, and risk-organ involvement did not correlate with failure to achieve nonactive disease. Circulating cells with BRAF-V600E were detected at higher frequency in patients with multisystem involvement (8 of 11 skin/multisystem vs 1 of 13 skin-limited; P = .002). CONCLUSION: Skin-limited LCH necessitates infrequent therapeutic intervention and has a lower risk of progression relative to skin plus multisystem LCH. The less-aggressive clinical course and lack of circulating cells with the BRAF-V600E mutation in skin-limited LCH suggest a different mechanism of disease origin compared with multisystem or risk-organ disease.

Idiopathic eruptive macular pigmentation involving the distal extremities: a case report.

Idiopathic eruptive macular pigmentation is a disorder of pigmentation found in children and adolescents. It typically manifests as nonconfluent tan to brown macules involving the neck, trunk, and proximal extremities. We report the case of a 6-year-old girl with an atypical presentation involving the distal extremities. Histopathology confirmed the subtle increase in pigmentation of the basal layer of the epidermis. Treatments are largely ineffective. The condition is generally self-limited over months to years, thus treatment is unnecessary.

Periungual Bowen's disease in a 4-year-old girl.

Bowen's disease (BD), or cutaneous squamous cell carcinoma (SCC) in situ, is rare in children. BD usually occurs in Caucasian adults on sun-exposed areas and may progress to invasive cutaneous SCC. Most cases of periungual BD have been linked to human papillomavirus infection. We report an immunocompetent child with periungual BD.

Concurrent hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum in a 16-year-old boy.

We report the case of a 16-year-old boy who presented to our clinic with concomitant hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum. Recent reports describe the co-occurrence of pyoderma gangrenosum, acne, and hidradenitis suppurativa. This case further expands the spectrum of concomitant pyoderma gangrenosum and dissecting cellulitis of the scalp.

Cutaneous manifestations of malignancy.

PURPOSE OF REVIEW: Many types of cancer can cause lesions to appear on the skin. Cutaneous manifestations may be primary or secondary to an underlying malignancy. Skin lesions may appear prior to the onset of systemic malignancy or they may occur concurrently or following an established diagnosis. The purpose of this review is to educate medical providers about several types of pediatric malignancies that can present with cutaneous findings. The primary focus of this review will be cutaneous features of leukemias, lymphomas, neuroblastoma, some sarcomas, and Langerhans cell histiocytosis. RECENT FINDINGS: A wide range of cutaneous manifestations have been reported in systemic malignancies of children. In addition to providing a description of more typical features of skin lesions associated with these conditions, this review will summarize a few recent case reports of pediatric malignancies with unusual cutaneous presentations. SUMMARY: Systemic malignancy can present with a variety of cutaneous manifestations. Given that accurate, prompt diagnosis of malignancy can have tremendous prognostic significance, it is imperative that clinicians are familiar with features of skin lesions that may be seen in this setting.

Beta-blockers as therapy for infantile hemangiomas.

Infantile hemangiomas (IH) are common benign vascular tumors seen in children. Although the majority will improve spontaneously without treatment, a small subset will require therapy due to a variety of complications. Less than a decade ago, propranolol replaced corticosteroids as first-line treatment for most IH and it has proven to be a relatively safe, effective therapy. After initiation of propranolol, most hemangiomas show evidence of significant improvement relatively rapidly, often within days. Although propranolol is generally felt to have a more limited side-effect profile than systemic corticosteroids, its use has been infrequently associated with adverse events, including sleep disturbances, acrocyanosis, hypotension, bradycardia, respiratory events, and hypoglycemia. Rarely, hypoglycemic seizures have been reported, usually occurring in the setting of prolonged fasting.