Clinical Consequences of Delayed Treatment for Tinea Capitis (Ringworm of the Scalp): A Case Report.

A 6-year-old Hispanic patient presented with a 1-month history of pruritic patches on her scalp, characterized by hair loss, black dots, and dandruff-like scales. The patient was seen by her primary care physician, who prescribed ketoconazole 2% shampoo. This provided little relief for her symptoms, which prompted her admission to nearby hospital, where fluconazole was administered intravenously and mometasone lotion applied. The patient was discharged and instructed to use the ketoconazole shampoo and mometasone lotion. The previously prescribed medications failed to improve her now enlarged, inflamed, scaly, pustule-speckled lesions. Given her condition, she was admitted to the University Pediatric Hospital in San Juan, where the Dermatology Department was consulted. Cultures were taken from the lesions, revealing the presence of Trichophyton tonsurans, which led to the diagnosis of tinea capitis (ringworm of the scalp) with kerion formation. In addition, multiple nits and adult lice characteristic of Pediculus humanus capitis were observed. A 6-week course of griseofulvin, a 1-week course of permethrin solution, and a 5-day course of oral prednisolone were started, effectively cleared the patient's inflammation and fungal infection. This case highlights how there exist areas of improvement in terms of interprofessional communication between physicians, as well a need to increase awareness of the proper treatment for this common pediatric skin condition. We postulate that in doing so, similar cases could be spared the unfortunate results of untreated tinea capitis, that is, kerion formation and the possible scarring this lesion can produce.

Deficiency of Interleukin-1 Receptor Antagonist: New Genetic Autoinflammatory Disease as a Diagnostic Challenge for Pediatricians.

Deficiency of interleukin-1 receptor antagonist is a rare autoinflammatory disease that affects infants early in life. It often presents with systemic inflammation, skin and bone involvement. We present a 5-month-old boy who was hospitalized due to generalized erythematous pustular eruption with secondary impetigo, cellulitis, bronchiolitis, and elevated inflammatory markers. The patient was unresponsive to multiple courses of intravenous antibiotics, systemic, and topical steroid medications. The patient was evaluated by dermatology and rheumatology services among other subspecialities. Skin biopsy showed changes consistent with psoriasiform dermatitis, while bone scans showed multifocal osteomyelitis. The patient was started empirically on anakinra with improvement at 72 hours upon administration. This is one of the youngest reported case in the literature to be started on anakinra empirically prior to genetic confirmation of the mutation. A comprehensive literature review revealed that approximately 20 genetically confirmed patients, including our patient, have been reported with this genetic disease. It is imperative to recognize this disease early to achieve adequate response and remission. Therefore, clinical symptoms and the associated differential diagnosis for this disease should be constantly reassessed and reviewed by pediatricians and subspecialists to detect the disease as early as possible and reduce the high morbidity and mortality associated with delayed diagnosis and treatment.

Psoriatic Alopecia in a Patient With Crohn Disease: An Uncommon Manifestation of Tumor Necrosis Factor α Inhibitors.

Tumor necrosis factor α (TNF-α) inhibitors are used to treat multiple inflammatory diseases including rheumatoid arthritis, inflammatory bowel disease, and psoriasis, among others. This family of medications can cause various side effects, some as common as injection-site reactions and others as rare as the paradoxical induction of psoriasiform skin lesions. Alopecic plaques recently have been described as an uncommon adverse effect of the TNF-α inhibitors adalimumab and infliximab. We present the case of a 12-year-old girl treated with adalimumab for Crohn disease who developed an alopecic crusted plaque on the scalp 6 months after increasing the dose of the medication. Biopsies, special stains, and sterile cultures yielded a diagnosis of psoriatic alopecia secondary to TNF-α inhibitor. A literature review for similar cases found 24 additional patients presenting with similar findings, of which only 6 were part of the pediatric population.

Rare Variant of Agminated Spitz Nevi on a Hypopigmented Background and Segmental Distribution: Case Report and Review of Literature.

Spitz nevus is a type of melanocytic nevus that can arise as a solitary lesion or as multiple lesions either disseminated or agminated (grouped) in different skin backgrounds (eg, grossly normal, hyperpigmented, or hypopigmented). Agminated Spitz nevi have been rarely reported and are even rarer in a background of hypopigmented skin. We present the case of a 2-month-old girl with multiple, grouped, dome-shaped, red papules arising on a hypopigmented patch with a segmental distribution. Biopsy of 2 lesions showed findings characteristic of Spitz nevus, confirming the diagnosis. We also review 4 other cases of agminated Spitz nevi arising on hypopigmented skin reported in the literature.

Excellent response to ustekinumab in a 9-year-old girl with severe psoriasis.

We report the case of a 9-year-old girl with severe plaque psoriasis refractory to multiple topical and systemic therapies. Physical examination revealed extensive, erythematous plaques with overlying thick scales that covered more than 80% of her body surface area, which included the face, scalp, trunk, and limbs. Because of the severity of the disease and lack of treatment response to other systemic therapies, she was treated with ustekinumab. Three weeks after ustekinumab was initiated, her psoriatic lesions fully cleared.

Primary cutaneous B-cell lymphoblastic lymphoma: A pediatric case report.

FPrecursor T- or B-cell non-Hodgkin lymphoblastic lymphomas represent only a small fraction of pediatric cancer cases. Due to its rarity, the diagnosis of lymphoblastic lymphoma (LBL) in a pediatric patient is challenging, particularly if its manifestation is solely cutaneous. We describe the case of an infant with primary cutaneous B-cell LBL who was initially diagnosed by a primary care physician with an infectious etiology and consequently treated with topical and oral antibiotics. Subcutaneous nodules located on the head or neck of infants should raise suspicion for lymphoma and biopsy should be performed in order to rule out malignancy. A prompt diagnosis is imperative when considering the aggressive nature of LBLs. Expedited therapy has been known to help cease systemic involvement of primary cutaneous B-cell LBLs and encourage a more favorable outcome.

Bullous aplasia cutis congenita.

A tense yellow vesicle was noted on the back parietal scalp of a female newborn. This proved to be a bullous variant of aplasia cutis congenita. Only 16 cases of this apparently rare disorder have been previously reported. Histologic evaluation of such lesions reveals a distinct pattern containing fibrovascular stromas, edematous stroma, or both. Identical histologic findings are found in encephaloceles and meningoceles, supporting the recently proposed hypothesis that this variant of aplasia cutis may represent the form fruste of a neural tube closure defect. This disorder should be included in the differential diagnosis of vesicobullous lesions in the neonate. Bullous aplasia cutis congenita is a rare clinical subtype of aplasia cutis congenita with distinctive histologic findings. We present a new case, and summarize the clinical and histologic findings of the 16 cases previously reported in the English-language literature. Bullous or membranous aplasia cutis congenita may represent a form fruste of a neural tube defect.