Neonatal nasal necrosis: Case series and brief review.

There is limited information available on pressure-related neonatal nasal injuries. We present three neonates born with erythema and purpura of the nasal tip that subsequently ulcerated, then evolved into a thick eschar. Each healed well with conservative management but left behind significant scarring. The sharp demarcation and location of the lesions were suggestive of hypoxic tissue damage akin to halo scalp ring alopecia. Further investigation is necessary to elucidate the etiology and optimal management of this condition.

Isotretinoin Laboratory Monitoring in Acne Treatment: A Delphi Consensus Study.

Importance: Although isotretinoin may rarely be associated with laboratory abnormalities such as hypertriglyceridemia, the optimal approach to laboratory monitoring is uncertain, and there is wide variation in clinical practice. Objective: To establish a consensus for isotretinoin laboratory monitoring among a diverse, international cohort of clinical and research experts in acne. Design, Setting, and Participants: Using a modified electronic Delphi process, 4 rounds of anonymous electronic surveys were administered from 2021 to 2022. For laboratory tests reaching consensus (≥70% agreement) for inclusion, questions regarding more time-specific monitoring throughout isotretinoin therapy were asked in subsequent rounds. The participants were international board-certified dermatologist acne experts who were selected on a voluntary basis based on involvement in acne-related professional organizations and research. Main Outcomes and Measures: The primary outcome measured was whether participants could reach consensus on key isotretinoin laboratory monitoring parameters. Results: The 22 participants from 5 continents had a mean (SD) time in practice of 23.7 (11.6) years and represented a variety of practice settings. Throughout the 4-round study, participation rates ranged from 90% to 100%. Consensus was achieved for the following: check alanine aminotransferase within a month prior to initiation (89.5%) and at peak dose (89.5%) but not monthly (76.2%) or after treatment completion (73.7%); check triglycerides within a month prior to initiation (89.5%) and at peak dose (78.9%) but not monthly (84.2%) or after treatment completion (73.7%); do not check complete blood cell count or basic metabolic panel parameters at any point during isotretinoin treatment (all >70%); do not check gamma-glutamyl transferase (78.9%), bilirubin (81.0%), albumin (72.7%), total protein (72.7%), low-density lipoprotein (73.7%), high-density lipoprotein (73.7%), or C-reactive protein (77.3%). Conclusions and Relevance: This Delphi study identified a core set of laboratory tests that should be evaluated prior to and during treatment with isotretinoin. These results provide valuable data to guide clinical practice and clinical guideline development to optimize laboratory monitoring in patients treated with isotretinoin.

Pachydermodactyly associated with extensive computer gaming: A report of three cases.

Pachydermodactyly is an uncommon, progressive, nontender thickening of the fingers with prominent involvement of the proximal interphalangeal joints. Pachydermodactyly mimics inflammatory arthritis but plain film radiography is normal in this condition. Pachydermodactyly has been previously described in workers performing manual labor. Mechanical stimulation has been identified as a predisposing factor in the majority of cases. We present three cases in adolescent males arising in association with excessive computer gaming.

Representation of women in pediatric dermatology leadership and research: Trends over the past 45 years.

BACKGROUND/OBJECTIVES: The representation of women among practicing dermatologists has increased over the last several decades. Here, we analyze the evolving representation of women in the Society for Pediatric Dermatology (SPD) and the Pediatric Dermatology Research Alliance (PeDRA), with particular focus on the role of women as society leaders, researchers, and annual meeting speakers. METHODS: A retrospective review of SPD and PeDRA professional society leaders (SPD presidents, PeDRA co-chairs, PeDRA executive committee members), grant recipients (pilot grant recipients, team/collaborative grant recipients, William Weston Research Grant recipients), and annual meeting speakers (named lecturers at the SPD Annual Meeting, plenary lecturers at the PeDRA Annual Conference) was performed. Authors of research articles in Pediatric Dermatology were reviewed at three-year intervals from 1983 through 2019. The percentage of women among all leadership, grant, authorship, and lectureship categories was analyzed over time. RESULTS: Women have represented 70% of SPD presidents since 2011 and 75% of PeDRA co-chairs since 2013. The percentage of women among first and senior authors of research articles in Pediatric Dermatology increased significantly from 1983 to 2019 (Cochran Armitage test for trend, P < .01), and women earned the majority of SPD/PeDRA pilot project grants (2008-2018), collaborative team grants (2016-2018), and William Weston Research Grants (1995-2015). At SPD Annual meetings from 2010 to 2019, women comprised 44% of named lecturers but accounted for approximately 78% of the pediatric dermatology workforce (P < .01). CONCLUSION: Despite the widespread influence of women in pediatric dermatology leadership and research, gender discrepancies remain among named lecturer positions at national pediatric dermatology meetings.

Post-scabietic nodules: Mimicker of infantile indeterminate cell histiocytosis and potential diagnostic pitfall.

Indeterminate cell histiocytosis (ICH) is an extremely rare disease and little is known about its etiology. Patients usually present with nodular, dermal proliferations of indeterminate cells, which characteristically resemble Langerhans cells but lack Birbeck granules. The clinical course is highly variable, ranging from spontaneous regression to rapid progression with reports of extracutaneous involvement, subsequent acute myeloid leukemias, and associated B-cell lymphomas. Rare cases of ICH-like reactions have been reported in the setting of scabies infestations as well as in patients who had been bitten by ticks and mosquitos. We present a successfully treated case of indeterminate cell-rich post scabietic nodules in an otherwise healthy 8-month-old boy and review the literature on similar cases. Clinical context is essential for correct interpretation of these indolent ICH-mimicking lesions, and to avert unnecessary patient anxiety and aggressive management.

Linear lipoatrophy following intra-articular triamcinolone acetonide injection mimicking linear scleroderma.

A 12-year-old female with oligoarticular juvenile inflammatory arthritis developed an atrophic linear plaque involving the left medial forearm and proximal arm 7 months after intra-articular triamcinolone injection for arthritis. The plaque spontaneously resolved without treatment over approximately one year. It is important to recognize this rare complication of intra-articular steroid injection in order to avoid potential misdiagnosis as linear scleroderma and subsequent immunosuppressive treatment.

The ins and outs of an 'outside-in' view of allergies: atopic dermatitis and allergy prevention.

PURPOSE OF REVIEW: The skin barrier is a dynamic innate immune organ. This review summarizes the current understanding of how deficiencies associated with atopic dermatitis invite other atopic disorders of the allergic march. RECENT FINDINGS: Atopic dermatitis is characterized by skin barrier defects (such as mutations in filaggrin), intrinsic proallergic T-helper cell 2 immune dysregulation, and skin microbiome alterations. These factors promote the development of food allergy and asthma. Prevention of atopic dermatitis may involve topical emollients and oral probiotic supplementation, while some food allergies can be prevented by early introduction of potential food allergens to at-risk infants. Traditional therapies for atopic dermatitis involve skin hydration, emollients, and anti-inflammatory topical therapies including topical corticosteroids and calcineurin inhibitors. Dupilumab is a new and promising targeted biologic medication approved for use in adults with more severe atopic dermatitis; however, additional research is needed to determine whether this medication should be incorporated more broadly into management of severe childhood atopic dermatitis. SUMMARY: Atopic dermatitis management involves early diagnosis, skin barrier function support, mitigation of cutaneous inflammation, and concomitant risk stratification for the development of food allergy, asthma, allergic rhinitis, and environmental allergies.

Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients.

BACKGROUND: The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. OBJECTIVE: This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. METHODS: Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. RESULTS: Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. LIMITATIONS: The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. CONCLUSION: Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.

Is Routine Electrocardiography Necessary Before Initiation of Propranolol for Treatment of Infantile Hemangiomas?

BACKGROUND: In recent years propranolol has become the treatment of choice for infantile hemangiomas (IHs). There is broad variation in the approach to propranolol initiation in clinical practice. This retrospective study explored the effectiveness of routine pre-treatment ECG in screening infants being considered for systemic treatment with propranolol. METHODS: All patients seen in the outpatient pediatric dermatology clinics at Oregon Health and Sciences University (OHSU) and The Mayo Clinic Rochester (MCR), as well as those seen in multidisciplinary vascular anomalies clinics, who had ECGs obtained prior to planned initiation of propranolol for treatment of IH from 2008 to 2013, were identified. A total of 162 patients were included in the study. RESULTS: We found that 43% (69) of routine ECGs were read as abnormal, leading to 28 formal consultation appointments with pediatric cardiologists. After either formal consultation or informal discussion with cardiology, no patients with initially "abnormal" ECGs were ultimately excluded from treatment with propranolol based on routine ECG findings. Additionally no patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG prior to initiation of the propranolol. CONCLUSION: Our findings suggest that routine ECG may not be necessary or helpful in the vast majority of patients treated with propranolol for IHs.

Bullous Kaposiform Hemangioendothelioma Masquerading as Aplasia Cutis Congenita.

We present the case of a male infant with violaceous bullae on the scalp that were initially thought to be bullous aplasia cutis but at 3 months of age were diagnosed as a kaposiform hemangioendothelioma. This diagnosis should be considered when evaluating newborns with bullous plaques on the scalp that do not heal in the first 2-3 weeks of life. Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor that typically presents as a violaceous to purpuric plaque at birth or early infancy. It may be associated with Kasabach-Merritt phenomenon (KMP), a potentially life-threatening consumptive coagulopathy.

Multicentric reticulohistiocytosis: a case report of an atypical presentation in a 2-year-old.

Multicentric reticulohistiocytosis (MRH) is a rare systemic inflammatory granulomatous disease marked by severe and often rapidly progressive polyarticular arthritis and cutaneous papulonodules. Initial clinical diagnosis may be difficult. We describe a 2-year-old girl presenting with pink dermal papules on the forehead, thighs, elbows, knees, and palms of the hands. Based on clinical findings and skin biopsy results, she was initially diagnosed with granuloma annulare. At 5 years of age, she developed arthritis, fatigue, and more widespread skin papules leading to the diagnosis of MRH. To our knowledge, this is the youngest individual with MRH yet described. We outline the timeline and unique features of her case and review the literature pertaining to MRH in children. Although rare, MRH can be permanently debilitating, making prompt diagnosis critical. A standardized approach to investigation and management needs to be developed.