Retronychia in children: A case series.

BACKGROUND: Retronychia is characterized by proximal ingrowing of the nail plate into the proximal nail fold. It is always associated with the presence of two or more overlapping nail plates under the proximal nail fold, clinical signs of chronic proximal paronychia refractory to antimicrobial treatment, and a yellowish nail that does not grow. It mainly affects young female adults, with less than 30 pediatric cases described in the literature so far. METHODS: Retrospective and observational study of patients between 0 and 18 years with a clinical and/or ultrasound diagnosis of retronychia attending a pediatric dermatology service between December 2020 and January 2022. RESULTS: We identified 9 patients with retronychia, 7 girls and 2 boys. In all cases, the hallux nails were affected with 5 unilateral and 4 bilateral cases. On physical examination we observed the following signs: thickened and opaque nail plate (one patient), yellowish nail plate (7 patients), double nail plate (6 patients), and erythema with edema, pain, and suppuration of the proximal nail fold (7 patients). Ultrasound was performed in 7 patients and specific findings of retronychia were found in 5 of them. All patients received topical treatment and were referred for the appropriate surgical treatment. To date, only one patient underwent nail avulsion, which was followed by complete recovery. CONCLUSIONS: Retronychia is underdiagnosed, particularly in the pediatric population. We present a series of 9 cases of retronychia in children, with clinical and ultrasonographic findings consistent with those of adults. We emphasize the importance of recognizing this entity, which will allow early and adequate treatment.

Long-term treatment with oral propranolol reduces relapses of infantile hemangiomas.

Oral propranolol (OP) has been shown to be effective in the treatment of complicated infantile hemangiomas (IHs), but optimal treatment duration to avoid relapses after stopping OP treatment has not been established. The objective of this study was to compare the frequency of relapses in long-term OP treatment with that of short-term OP treatment. This was a retrospective cohort study of 30 patients with complicated IHs who received treatment with OP. Patients were divided into two groups: OP treatment of 8 months or less and OP treatment of longer than 8 months. OP was started at 1 mg/kg/day in three doses every 8 hours for 1 week and increased to 1.5 to 4 mg/kg/day afterward. Ultrasound was used to objectively measure the response to treatment. Clinical and ultrasound assessment showed a decrease in IH size and resolution of complications in all patients (n = 30). In the short-term group (n = 10), nine patients (90%) relapsed after stopping treatment. In the long-term group (n = 20), the duration of treatment was 12 months in all patients, and only 1 patient out of the 20 treated (5%) showed relapse 2 months after finishing the full treatment (odds ratio = 18, 95% confidence interval 2.6, 123, p < 0.001. Twelve months of treatment of IH with OP is associated with a significantly lower rate of relapse than with shorter treatment.

Early propranolol treatment of infantile hemangiomas improves outcome.

BACKGROUND: Infantile hemangiomas (IH) are the most common soft tissue tumors of childhood. Although most of these tumors are not worrisome, some IH may be life or function-threatening, can lead to permanent disfigurement, or have associated structural congenital anomalies, requiring early recognition and referral to specialists for treatment consideration. Since 2008, oral propranolol has been widely considered to be the first-line treatment for IH. OBJECTIVES: To evaluate aesthetic and functional outcome in propranolol-treated infantile hemangiomas according to the age of treatment onset. METHODS: Retrospective, observational study of infantile hemangioma patients under 4 years of age at the time of diagnosis, treated with oral propranolol. Evaluated parameters included: pre and post-treatment morphologic/aesthetic aspects of the hemangioma, total resolution rate, degree of functional compromise of affected areas and its evolution. Two independent pediatric dermatologists evaluated all cases reviewing clinical data from medical records and comparing clinical photographs taken at initiation and at the end of treatment of each patient. Data were analyzed with STATA 13.0 program. RESULTS: The cohort included 138 patients, with a female predominance. The median age at therapy onset was 3 months. The morphological/aesthetic improvement rate was 99% (95% CI 96‒99), the total resolution rate was 48% (95% CI 44‒60) and the functional improvement rate reached 100%. When comparing total resolution outcome versus age when treatment started, the improvement was larger in younger patients (3.5 vs. 4.9 months, p = 0.01). When comparing the total resolution rate in those younger or older than 3 months at treatment initiation, the percentage of total resolution in the younger group was 57% vs. 40% in the older one (p = 0.05). STUDY LIMITATIONS: Retrospective design; patients photographs were the sole indicators used to measure regression rates. Visual assessment is subjective. CONCLUSION: The present results strongly suggest that early (before 3 months of age) initiation of treatment of infantile hemangiomas with propranolol results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution.

Atopic dermatitis in children and adolescents seen at a general hospital in the City of Buenos Aires. / Dermatitis atópica en niños y adolescentes asistidos en un hospital general de la Ciudad Autónoma de Buenos Aires.

Atopic dermatitis (AD) is an inflammatory skin disease highly prevalent in pediatrics as per international studies. There is scarce information on the epidemiological characteristics of AD in the Argentine pediatric population. The objective of this study was to describe the prevalence and clinical characteristics of AD in a population of Argentine children seen at the Department of Pediatrics of a general hospital. Observational, cross-sectional study. Five hundred patients were randomly included; their mean age was 10 years (SD: 5); 50% (250) were female. A total of 24 had AD. The overall prevalence was 5% (95% confidence interval: 3-7) and 3/24 were severe forms. The most frequent atopic comorbidity was asthma. The prevalence of AD in our population is similar to that of other countries. Our study provides new data on the epidemiological characteristics of AD in our region.

La dermatitis atópica (DA) es una enfermedad inflamatoria de la piel de alta prevalencia en pediatría, de acuerdo a estudios internacionales. Existe escasa información sobre las características epidemiológicas en la población pediátrica Argentina. El objetivo fue describir la prevalencia y características clínicas de la DA en una población de niños argentinos atendidos en el servicio de pediatría de un hospital general. Estudio observacional, de corte transversal. Se incluyeron 500 pacientes al azar, media de edad de 10 años (DE 5), el 50 % (250) de sexo femenino, de los cuales 24 presentaron DA. La prevalencia global fue del 5 % (IC95 % 3-7) y 3/24 fueron formas graves. La comorbilidad atópica más frecuente fue asma. La DA es una enfermedad con una prevalencia en nuestra población similar a la de otros países. Nuestro estudio aporta nuevos datos acerca de las características epidemiológicas de la dermatitis atópica en nuestra región.

Kaposiform hemangioendothelioma with Kasabach-Merritt phenomenon: successful treatment with embolization and vincristine in two newborns.

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor and has a high mortality in newborns when associated with Kasabach-Merritt syndrome (KMS). In two newborns with KHE and severe KMS refractory to medical treatment, emergency embolization led to clinical improvement in the acute neonatal setting by reducing tumor volume, increasing the platelet count, and improving other clotting parameters. Systemic vincristine treatment was added for further tumor control. Both patients remained symptom-free at long-term follow-up.

[Cutaneous manifestations of graft versus host disease in a population of pediatric and young adults patients]. / Manifestaciones cutáneas de la enfermedad injerto versus huésped en una población pediátrica y de adultos jóvenes.

Bone marrow transplant is a potentially curative therapy for several diseases, and allogeneic bone marrow transplant is the most commonly indicated type for leukemias. Graft versus host disease (GVHD) is the main complication of allogeneic bone marrow transplant. In both acute and chronic GVHD, the skin is the most frequently involved organ. The objective of this study was to analyze cutaneous manifestations of this disease. Retrospective and descriptive study that included 59 transplanted patients aged 0 to 20 years. In 50 cases allogeneic bone marrow transplant was performed. Twenty-five patients developed GVHD (17 acute disease and 8 chronic disease) and 24 of them had cutaneous involvement. According to the literature, skin compromise was the commonest clinical manifestation of GVHD. Main finding in acute GVHD in our series was the erythematous maculopapular rash, while in chronic GVHD they were sclerotic lesions resembling morphea.

El trasplante de médula ósea es una terapia potencialmente curativa para múltiples enfermedades; el alogénico es el más indicado en leucemias. La enfermedad injerto versus huésped (EIVH) constituye la principal complicación del trasplante de médula ósea alogénico. Tanto en la EIVH aguda como crónica, la piel es el órgano más frecuentemente comprometido. El objetivo fue analizar las manifestaciones cutáneas de esta entidad. Trabajo retrospectivo y descriptivo, que incluyó a 59 pacientes trasplantados de edades entre 0 y 20 años. En 50 casos, se realizó trasplante de médula ósea alogénico. Veinticinco pacientes desarrollaron EIVH (17, la forma aguda, y 8, la forma crónica), y 24 tuvieron compromiso cutáneo. En concordancia con lo comunicado se encontró que las manifestaciones cutáneas fueron la manifestación clínica más común de EIVH. El hallazgo principal en EIVH aguda en nuestra serie fue el rash eritematoso maculopapular y, en EIVH crónica, las lesiones escleróticas símil morfea.

Early propranolol treatment of infantile hemangiomas improves outcome

Abstract Background Infantile hemangiomas (IH) are the most common soft tissue tumors of childhood. Although most of these tumors are not worrisome, some IH may be life or function-threatening, can lead to permanent disfigurement, or have associated structural congenital anomalies, requiring early recognition and referral to specialists for treatment consideration. Since 2008, oral propranolol has been widely considered to be the first-line treatment for IH. Objectives To evaluate aesthetic and functional outcome in propranolol-treated infantile hemangiomas according to the age of treatment onset. Methods Retrospective, observational study of infantile hemangioma patients under 4 years of age at the time of diagnosis, treated with oral propranolol. Evaluated parameters included: pre and post-treatment morphologic/aesthetic aspects of the hemangioma, total resolution rate, degree of functional compromise of affected areas and its evolution. Two independent pediatric dermatologists evaluated all cases reviewing clinical data from medical records and comparing clinical photographs taken at initiation and at the end of treatment of each patient. Data were analyzed with STATA 13.0 program. Results The cohort included 138 patients, with a female predominance. The median age at therapy onset was 3 months. The morphological/aesthetic improvement rate was 99% (95% CI 96‒99), the total resolution rate was 48% (95% CI 44‒60) and the functional improvement rate reached 100%. When comparing total resolution outcome versus age when treatment started, the improvement was larger in younger patients (3.5 vs. 4.9 months, p = 0.01). When comparing the total resolution rate in those younger or older than 3 months at treatment initiation, the percentage of total resolution in the younger group was 57% vs. 40% in the older one (p = 0.05). Study limitations Retrospective design; patients photographs were the sole indicators used to measure regression rates. Visual assessment is subjective. Conclusion The present results strongly suggest that early (before 3 months of age) initiation of treatment of infantile hemangiomas with propranolol results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution.

Dermatitis atópica en niños y adolescentes asistidos en un hospital general de la Ciudad Autónoma de Buenos Aires / Atopic dermatitis in children and adolescents seen at a general hospital in the City of Buenos Aires

La dermatitis atópica (DA) es una enfermedad inflamatoria de la piel de alta prevalencia en pediatría, de acuerdo a estudios internacionales. Existe escasa información sobre las características epidemiológicas en la población pediátrica Argentina. El objetivo fue describir la prevalencia y características clínicas de la DA en una población de niños argentinos atendidos en el servicio de pediatría de un hospital general. Estudio observacional, de corte transversal. Se incluyeron 500 pacientes al azar, media de edad de 10 años (DE 5), el 50 % (250) de sexo femenino, de los cuales 24 presentaron DA. La prevalencia global fue del 5 % (IC95 % 3-7) y 3/24 fueron formas graves. La comorbilidad atópica más frecuente fue asma. La DA es una enfermedad con una prevalencia en nuestra población similar a la de otros países. Nuestro estudio aporta nuevos datos acerca de las características epidemiológicas de la dermatitis atópica en nuestra región

Atopic dermatitis (AD) is an inflammatory skin disease highly prevalent in pediatrics as per international studies. There is scarce information on the epidemiological characteristics of AD in the Argentine pediatric population. The objective of this study was to describe the prevalence and clinical characteristics of AD in a population of Argentine children seen at the Department of Pediatrics of a general hospital. Observational, cross-sectional study. Five hundred patients were randomly included; their mean age was 10 years (SD: 5); 50% (250) were female. A total of 24 had AD. The overall prevalence was 5% (95% confidence interval: 3­7) and 3/24 were severe forms. The most frequent atopic comorbidity was asthma. The prevalence of AD in our population is similar to that of other countries. Our study provides new data on the epidemiological characteristics of AD in our region.

Manifestaciones cutáneas de la enfermedad injerto versushuésped en una población pediátrica y de adultos jóvenes / Cutaneous manifestations of graft versus host disease in a population of pediatric and young adults patients

El trasplante de médula ósea es una terapia potencialmente curativa para múltiples enfermedades; el alogénico es el más indicado en leucemias. La enfermedad injerto versus huésped (EIVH) constituye la principal complicación del trasplante de médula ósea alogénico. Tanto en la EIVH aguda como crónica, la piel es el órgano más frecuentemente comprometido. El objetivo fue analizar las manifestaciones cutáneas de esta entidad. Trabajo retrospectivo y descriptivo, que incluyó a 59 pacientes trasplantados de edades entre 0 y 20 años. En 50 casos, se realizó trasplante de médula ósea alogénico. Veinticinco pacientes desarrollaron EIVH (17, la forma aguda, y 8, la forma crónica), y 24 tuvieron compromiso cutáneo. En concordancia con lo comunicado se encontró que las manifestaciones cutáneas fueron la manifestación clínica más común de EIVH. El hallazgo principal en EIVH aguda en nuestra serie fue el rash eritematoso maculopapular y, en EIVH crónica, las lesiones escleróticas símil morf

Bone marrow transplant is a potentially curative therapy for several diseases, and allogeneic bone marrow transplant is the most commonly indicated type for leukemias. Graft versus host disease (GVHD) is the main complication of allogeneic bone marrow transplant. In both acute and chronic GVHD, the skin is the most frequently involved organ. The objective of this study was to analyze cutaneous manifestations of this disease. Retrospective and descriptive study that included 59 transplanted patients aged 0 to 20 years. In 50 cases allogeneic bone marrow transplant was performed. Twenty-five patients developed GVHD (17 acute disease and 8 chronic disease) and 24 of them had cutaneous involvement. According to the literature, skin compromise was the commonest clinical manifestation of GVHD. Main finding in acute GVHD in our series was the erythematous maculopapular rash, while in chronic GVHD they were sclerotic lesions resembling morphe

[Skin and soft tissue infections in children: consensus on diagnosis and treatment]. / Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

[Infantile hemangiomas]. / Hemangiomas infantiles.

Infantile hemangiomas are the most common benign tumors of infancy. While most of them have an uncomplicated course, between 10 and 15% are at risk for complications, especially during the proliferative phase, and can cause impairment of vital functions or produce permanent cosmetic disfigurement. In this update we delineate the natural history of infantile hemangiomas, with special emphasis on identifying those that require special diagnostic evaluations and multidisciplinary and closer follow-up, reviewing the study and treatment indications and current treatment modalities.

[Toxic epidermal necrolysis associated with acute infection by Mycoplasma pneumoniae]. / Necrólisis epidérmica tóxica asociada a infección aguda por Mycoplasma pneumoniae.

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis represent different manifestations of the same spectrum of severe idiosyncratic cutaneous reactions to drugs and to a lesser extent are associated with infectous agents. Among these, Mycoplasma pneumoniae is one of the most frequent. We report the case of a female patient aged 5 years, with a toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection, which begins with a fever accompanied by a generalized rash with involvement of the mucous membranes. IgM serology for Mycoplasma pneumoniae was positive and initial biopsy was compatible with erythema multiforme major. The patient was treated with corticosteroids, intravenous immunoglobulin, plasmapheresis and strict care to prevent superinfection and sequels. After 31 days of hospitalization the patient was discharged from hospital.

[Onichocryptosis in pediatrics: conservative treatment and spiculectomy]. / Onicocriptosis en pediatría: tratamiento conservador y espiculotomía.

Onychocryptosis (onyx: nail and kriptos: hidden) is the main reason for consultation due to nail pain. It is secondary to the penetration of the lateral border of the nail plate into the lateral nail fold causing pain and inflammation in the surrounding tissue. Symptoms range from erythema, edema, and pain when pressure is applied on the nail fold, up to secondary infection and functional impotence. It is a mechanical onicopathy, almost exclusively of the first toe, which recognizes multiple causes. We present the therapeutic management in children by conservative measures and the spiculectomy.

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento: Parte 2: Celulitis, ectima y ectima gangrenoso, celulitis necrotizantes. Consideraciones finales / Skin and soft tissue infections in children: consensus on diagnosis and treatment

Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversia en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

Necrólisis epidérmica tóxica asociada a infección aguda por Mycoplasma pneumoniae / Toxic epidermal necrolysis associated with acute infection by Mycoplasma pneumoniae

El eritema multiforme, el síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica representan diferentes manifestaciones de un mismo espectro de graves reacciones cutáneas idiosincrásicas a fármacos y, en menor medida, están asociados a agentes infecciosos. De estos últimos, Mycoplasma pneumoniae es uno de los más frecuentes. Se presenta el caso de una niña de 5 años, con una necrólisis epidérmica tóxica asociada a infección aguda por Mycoplasma pneumoniae, que comenzó con un cuadro febril acompañado de un exantema generalizado y compromiso de todas las mucosas. Se obtuvo serología IgM positiva para Mycoplasma pneumoniae y una biopsia inicial compatible con eritema multiforme mayor. La paciente fue tratada con corticosteroides, gammaglobulina intravenosa, plasmaféresis y estrictos cuidados para la prevención de sobreinfección y posibles secuelas. Después de 31 días de internación fue dada de alta hospitalaria.

Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis represent different manifestations of the same spectrum of severe idiosyncratic cutaneous reactions to drugs and to a lesser extent are associated with infectous agents. Among these, Mycoplasma pneumoniae is one of the most frequent. We report the case of a female patient aged 5 years, with a toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection, which begins with a fever accompanied by a generalized rash with involvement of the mucous membranes. IgM serology for Mycoplasma pneumoniae was positive and initial biopsy was compatible with erythema multiforme major. The patient was treated with corticosteroids, intravenous immunoglobulin, plasmapheresis and strict care to prevent superinfection and sequels. After 31 days of hospitalization the patient was discharged from hospital.

Malformaciones vasculares: claves diagnósticas para el radiólogo / Vascular malformations: diagnostic clues for the radiologist

Las malformaciones vasculares son enfermedades raras ocasionadas por errores en el desarrollo embriológico de los vasos sanguíneos. Estas lesiones, junto con los tumores vasculares, constituyen las anomalías vasculares. En el caso de las malformaciones vasculares, éstas se denominan de acuerdo al vaso que conforma la lesión y se clasifican según las características del flujo en malformaciones de bajo o alto flujo. Si bien la mayor parte son diagnosticadas según criterios clínicos, algunas lesiones requieren de estudios complementarios tanto para el establecimiento de un correcto diagnóstico como para la evaluación de su extensión. La ecografía Doppler suele ser el estudio inicial para conocer las características hemodinámicas y contribuir al diagnóstico diferencial entre un tumor y una malformación vascular. La resonancia magnética (RM) es el mejor método para evaluar la extensión de las lesiones y su relación con estructuras adyacentes. El diagnóstico preciso del tipo de malformación vascular es importante por su pronóstico y tratamiento diferentes. La Radiología Intervencionista constituye uno de los pilares fundamentales en el manejo terapéutico. Es altamente recomendable un abordaje multidisciplinario dada la complejidad de estas lesiones, particularmente en la elección de las opciones terapéuticas y en el seguimiento clínico de los pacientes.

Vascular malformations: diagnostic clues for the radiologist. Vascular malformations are rare conditions resulting from the abnormal development of blood vessels. These lesions, together with vascular tumors, represent the vascular anomalies. Vascular malformations are named according to which type of vessel is affected and are classified into high- or low-flow malformations on the basis of flow characteristics. Most vascular malformations are diagnosed according to clinical criteria. However, some require imaging studies to confirm the diagnosis or assess its extension. Doppler ultrasound is the usual initial study for hemodynamic assessment and forits contribution to differential diagnosis between vascular tumors and malformations. Magnetic resonance imaging(MRI) is the best technique for evaluating the extent of the lesions and their relationship with adjacent structures. An accurate diagnosis of the type of vascular malformation is of importance because of the different prognosis and treatment. Interventional radiology is one of the cornerstones in the therapeutic management. A multidisciplinary approach is highly recommended given the complexity of these lesions, particularly for selecting therapeutic options and for the patient clinical follow-up.

Calcinosis cutis following trauma.

We report an 8-year-old boy who developed dystrophic calcinosis cutis that occurred following trauma. Multiple abrasions were observed in the inguinal folds after a soccer game. Subsequently, multiple papules with soft centers and white particles appeared in the same area. A biopsy specimen showed calcinosis cutis with transepidermal elimination of calcium. The causes of the underlying tissue damage associated with dystrophic calcinosis are discussed.