Psychiatric Comorbidities in Pediatric Trichotillomania: A Multicenter Cohort Study.

BACKGROUND: Trichotillomania (TTM) significantly increases the risk of psychiatric comorbidities. Sparse research in pediatric populations necessitates larger studies to assess these risks. This study investigates the risk of developing psychiatric comorbidities in pediatric TTM patients. METHODS: This case-control study assessed pediatric patients (< 18 years old) with TTM diagnosed between May 18, 2013, and January 1, 2024, using US-based data from the TriNetX global research network. TTM patients (ICD-10 diagnostic category F63.3) aged 18 years or younger at diagnosis and control patients (ICD-10 code Z00.129) matched for age, sex, race, and ethnicity were assessed. Propensity score matching yielded 16,590 patients in each cohort. The analysis assessed subsequent diagnoses of ADHD, conduct disorders, tic disorders, obsessive-compulsive disorder, anxiety disorders, dissociative, stress-related, and somatoform disorders, mood disorders, and suicide attempts compared to controls. RESULTS: TTM patients under 18 years exhibited significantly greater risks of subsequent diagnoses for ADHD (OR: 2.002; CI 1.841-2.178; p < 0.001), conduct disorders (OR: 3.668; 3.2-3.668; p < 0.0001), tic disorders (OR: 2.247; 1.826-2.765; p < 0.0001), obsessive-compulsive disorder (OR: 11.047; 8.822-13.832; p < 0.0001), anxiety disorders (OR: 3.583; 3.387-3.7; p < 0.0001), dissociative, stress-related, and somatoform disorders (OR: 6.179; 3.935-9.701; p < 0.0001), mood disorders (OR: 2.476; 2.288-2.68; p < 0.0001), and suicide attempts (OR: 1.81; 1.121-2.924; p = 0.0139) compared to controls. TTM patients had the greatest risk of psychiatric diagnosis 1 year postindex event. CONCLUSIONS: Pediatric TTM patients have higher psychiatric comorbidity risks, necessitating timely intervention and comprehensive management. Dermatologists can facilitate access to behavioral and pharmacological care, enhancing patient outcomes.

Limb body wall complex in a 28-week fetus and impact of cultural beliefs on maternal outcomes: A case report.

The limb body wall complex is a rare congenital disorder that is marked by various anomalies such as thoracoschisis, gastroschisis, limb defects and exencephaly. These defects are not compatible with life and result in spontaneous abortion or stillbirth. It is important to diagnose the anomalies on time and counsel the patients extensively to make the right decision. In this case report, we present a woman in her early twenties pregnant with a fetus with multiple anomalies including ectopia cordis, gastroschisis, meningomyelocele, kyphoscoliosis and congenital talipes equinovarus diagnosed as limb body wall complex at 18 weeks of gestation. Despite extensive counselling by the consultant, the couple decided to continue the pregnancy due to cultural beliefs which ultimately affected the maternal health. The fetus was spontaneously delivered at 28 weeks when the mother came to the hospital with ruptured membranes and the fetus was pronounced dead at birth. The co-occurrence of all these anomalies poses a challenge in diagnosis and management. Extensive counselling is required for the patient to make the appropriate decision for better outcomes. Cultural beliefs can play a major role in the decision-making of the patients and their families which can have a significant effect on maternal outcomes.

Sunscreen Label Marketing Towards Pediatric Populations: Guidance for Navigating Sunscreen Choice.

INTRODUCTION:  Sunscreen marketing to specific demographics is largely unregulated. Marketing specifically targeting pediatric populations has the potential to drive consumer behavior. The American Academy of Pediatrics (AAP) and American Academy of Dermatology (AAD) provide recommendations for sunscreen use in children over the age of six months. This study sought to determine if sunscreen products marketed toward pediatric populations align with healthcare guidelines. MATERIALS AND METHODS: Sunscreens available in major retail outlets in the Philadelphia area were cataloged and reviewed for marketing targeting specific demographics such as "baby", "babies", "children", "kids", "sports", and "active". The products were reviewed for sun protection factor (SPF), broad-spectrum ultraviolet (UV) protection, water resistance, active UV filters, and application method.  Results: Of 410 sunscreens cataloged, 27 were marketed towards "baby" or "babies", 44 towards "children" or "kids", and 71 towards "sports" or "active". All of the sunscreen products reviewed targeting the pediatric population offered water resistance for up to 80 minutes and broad-spectrum UV coverage. Sunscreens targeting "baby" or "babies" aligned most closely with AAP guidelines for sunscreen use in pediatric populations, with 92.6% offering an SPF between 15 to 50 and no products including oxybenzone as a UV filter. However, sunscreens targeting "children", "kids", "sports", and "active" bore a close resemblance to the overall sunscreen profile for all demographics but with a higher percentage of products containing oxybenzone. Oxybenzone was found in 11.4% of "children" and "kids" products and 16.9% of "sports" and "active" sunscreen products, compared to 7.6% of all sunscreen products available, and was also found in most sunscreen products with an SPF of 70 or higher. CONCLUSION:  Sunscreen products marketed towards "baby" and "babies" tend to align closely with guidelines for sunscreen use in the pediatric population for children over six months of age; however, those with brand marketing towards "children", "kids", "sports", and "active" do not. Limiting recommendations for a sunscreen product with an SPF of 30 to 50 targeting this demographic, however, sufficiently meets guidelines set forth by the AAP and AAD.

Assessment of UV Protection for Children's Summer Clothing.

INTRODUCTION:  Excess ultraviolet (UV) radiation exposure during childhood poses a particular long-term risk of developing skin cancer later in life however recent studies have called attention to the absorption of chemical sunscreen ingredients into the bloodstream with unclear significance. This has led to recommendations to consider sun protection in the form of clothing to reduce the need for sunscreen products. METHODS:  Ten brands of routine summer clothing not labeled as sun protective from five distributors marketed for children were identified with varying price ranges. Summer clothing items consisting of T-shirts and tops were evaluated for fiber composition, cost, and UPF testing was performed to determine UVA and UVB transmittance.  Results: Around 88.2% of blended textile compositions compared to 60% of 100% cotton textiles offered adequate UV protection with an Ultraviolet Protection Factor (UPF) greater than 15. 58% of blended fabrics compared to 50% of cotton textiles offered a UPF greater than 30. There was no correlation between brand and cost with UPF values.  Conclusions: In the absence of regulations for testing and labeling of all children's garments for UV protection, guidelines for the pediatric population for choosing clothing for the summer should reflect the information available to consumers that is easy to understand and more likely to result in higher UPF values. Based on fiber composition, blended textiles are more likely to have adequate UV protection compared to 100% cotton or 100% polyester.

Availability of Adequate Photoprotection for Skin of Color.

INTRODUCTION: The impact of ultraviolet (UV) light on the skin is well-established to have both immediate and delayed effects with increasing awareness of the impact of visible light (VL) on the skin with regard to photoaging and dyspigmentation. The effects of VL disproportionately impact the skin of color with regard to discoloration of the skin leading to guidelines for photoprotection that include the use of iron oxides in sunscreen products that impart a tint. METHODS: Commercially available sunscreen products found in the suncare and sun protection displays at local stores, pharmacies, and grocery stores were cataloged, and ingredients were reviewed for the presence of iron oxides. RESULTS: Of the 410 commercially available sunscreen products cataloged, 1.7% of facial sunscreen products available offered iron oxides, and 0.5% of non-lip products offered shade matching. CONCLUSION: With only 1.7% of commercially available facial sunscreen products offering iron oxides in addition to traditional broad-spectrum UV protection, there is a clear gap in the market for iron oxide-containing sunscreen products to meet the photoprotection needs for the skin of color.

The Impact of Routine Laundering on Ultraviolet Protection Factor (UPF) Values for Commercially Available Sun-Protective Clothing.

Background Ultraviolet (UV) radiation has potentially harmful effects on the skin. Sunscreen products have historically focused on blocking UV-B radiation to prevent sunburns while efforts to block UV-A radiation have been lacking. UV protective clothing, rated by ultraviolet protection factor (UPF) values, has gained popularity as an alternative form of UV protection, offering a physical barrier against UV rays. However, concerns arise regarding the disclosure and sustainability of UV-protective textiles, as companies often do not disclose the methods used to achieve UV protection. The addition of chemical sunscreen additives to textiles raises questions about their potential release during laundering and their impact on sustained UV protection and environmental health. Further research is needed to understand the risks and benefits of these practices. Methods Seven garments from commercially available sun-protective brand names claiming UV protection were tested for UPF values. The garments were washed separately using cold water in commercially available detergent in cold water followed by drying on a low setting. UPF measurements were obtained at baseline and at intervals of 10 wash cycles until 50 wash cycles were completed. Results Two brands (Brands A and D) experienced a significant decrease in UPF value (70% to 78%) by the completion of 50 washes. Brand A disclosed the use of a nano-zinc additive in their garments while Brand D did not disclose the means of achieving UV protection. In comparison, five brands (Brands B, C, E, F, G) maintained relatively stable UPF values throughout the 50 washes. The comparison between Brand A and Brand G, who disclosed their UV protection methods, showed that Brand A gradually decreased in UPF value throughout the washes while Brand G remained stable. Conclusion The findings suggest that textile compositions with UV finishes may lose their UPF effectiveness during laundering by loss of the finish used over time or the textile integrity could be affected. This raises questions about the necessity of adding these UV finishes if there are fabrics that can maintain their UPF values without them.

An Overview of Ultraviolet-Protective Clothing.

Protection from harmful ultraviolet radiation (UVR) can be achieved in a multitude of ways: sunscreen, chemical laundering additives, regular clothing, and photoprotective clothing. While sunscreen remains a popular sun-protective method, research has shown that its long-term use can lead to serious neurological, endocrine, and developmental consequences. Chemical laundering additives have been marketed as a means to absorb or reflect UVR, but data on its efficacy tests are not currently available, and skin contact with these chemicals may prove to be harmful. All clothing, regular or sun-protective, confers sun protection through dyes, weave patterns, and textile materials. However, photoprotective clothing is generally rated as more protective on the ultraviolent protection factor (UPF) scale and garment protection factor (GPF) scale. A combination of photoprotective clothing and sunscreen use over non-covered body areas is likely to be the optimal way for sun protection with minimal risk. However, further research on the topic is needed to gain deeper insights into it.

Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers.

BACKGROUND: The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery. OBJECTIVE: The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection. METHODS: Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC. RESULTS: A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03). CONCLUSION: Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.

Skin cancers of the hand and upper extremity.

Skin cancers represent the most common primary malignancies of the hand. They typically present as painless lesions on areas of high sun exposure, such as the dorsum of the hand and upper extremity. The most common malignancy is squamous cell carcinoma, followed by basal cell carcinoma and melanoma. The key to successful treatment is early and accurate diagnosis and treatment. Unlike open biopsies, which are indicated for deep soft tissue and bone lesions, biopsies for skin cancer can be performed under local anesthesia in the office setting in the form of shave or punch biopsies. A number of nonsurgical treatment options are available for treatment. However, when surgical excision is indicated, appropriate margin resections are dictated by the grade and stage of the malignancy.

Two novel TP63 mutations associated with the ankyloblepharon, ectodermal defects, and cleft lip and palate syndrome: a skin fragility phenotype.

BACKGROUND: Ankyloblepharon, ectodermal defects, and cleft lip and palate (AEC) syndrome is a rare autosomal dominant disorder caused by mutations in the sterile alpha motif region of TP63, a homologue of the tumor suppressor TP53. Recent structure-function studies have identified complexities in the genotype-phenotype correlation of the p63 syndromes. OBSERVATIONS: We report 2 sporadic cases of AEC syndrome in infants. Both patients demonstrated skin erosions with prominent scalp involvement. Histologic studies demonstrated mild basal layer vacuolization and rare dyskeratotic keratinocytes, with evidence of both acantholysis and cytolysis at the blister edge. Immunohistochemistry using anti-p63 monoclonal antibody demonstrated basal epidermal nuclear staining in both healthy control and patient tissue samples. Ultrastructural studies showed focal disruption of anchoring fibrils near the blister edge of one patient and normal desmosomes, hemidesmosomes, and basement membrane zone in the nonblistered skin of the other patient. The DNA analysis of each patient revealed 2 novel missense mutations in the TP63 gene that resulted in L514S and R555P amino acid substitutions within the sterile alpha motif region of the p63 protein. CONCLUSIONS: We report 2 novel TP63 mutations resulting in AEC syndrome. The R555P mutation is the most carboxy-terminal of all the reported AEC missense mutations of p63. The presence of skin fragility, manifested as erosive skin lesions in body areas in addition to the scalp, is postulated to be an important diagnostic feature of AEC syndrome.

Inflammatory actinic keratoses secondary to systemic chemotherapy.

Traditionally, systemic 5-fluorouracil has been associated with a reaction that produces inflammation of preexisting and subclinical actinic keratoses (AKs). We report a case of an inflammatory reaction occurring in AKs secondary to the use of doxorubicin. The cutaneous reaction was successfully managed with the application of high-potency topical steroids over the body and with pain management. When the doxorubicin was discontinued and another agent (paclitaxel) was instituted, the cutaneous reaction gradually diminished.

Rhabdomyosarcoma arising in a giant congenital melanocytic nevus.

We report the case of a 6-week-old girl who presented with a pedunculated embryonal rhabdomyosarcoma arising in a giant congenital melanocytic nevus (GCMN) on her lower back. There was no associated leptomeningeal involvement. The patient underwent surgical resection of the rhabdomyosarcoma at age 2 months, with subsequent chemotherapy consisting of actinomycin D and vincristine. No recurrences or metastases of tumor have been noted at 5 months of age.