Do hair care practices affect the acquisition of tinea capitis? A case-control study.

OBJECTIVE: To determine the influences of hair-grooming practices and environmental factors as risk factors for the acquisition of tinea capitis (TC) in children. DESIGN: Case-control study comparing children with culture-proved TC with age-, sex-, and race-matched control subjects without scalp disease. SETTING: A multicenter study involving 3 urban referral centers in the United States. PARTICIPANTS: A convenience sample of 66 patients aged 12 years and younger presenting to pediatric dermatology clinics with clinical evidence of TC were enrolled as cases. Matched control subjects (n = 68), without known scalp disease, were enrolled from the outpatient pediatric clinics at the same institutions. RESULTS: Significant associations with TC in the conditional logistic regression model were a prior history of TC (odds ratio, 3.11; 95% confidence interval, 1.02-9.43; P =.04) and exposure to TC (odds ratio, 16.32; 95% confidence interval, 3.55-75.16; P =.001). The use of a hair conditioner was statistically significant in the univariable model but not in the multivariable model (odds ratio, 0.46; 95% confidence interval, 0.20-1.08; P =.07). Hairstyling, frequency of washing, use of oils or grease, and other hair care practices were not shown to be associated with the presence of TC. CONCLUSIONS: Hair-grooming practices do not appear to play a major role in the acquisition of TC. Hair conditioners may be protective in children at risk for TC, but further studies are needed to confirm this finding.

Cutaneous manifestations of chronic renal failure in children of color.

One hundred percent of adult patients with chronic renal failure (CRF) develop cutaneous findings as a result of uremia or due to therapeutic interventions. To date, pediatric incidence studies have been limited to Caucasian children. However, recent reports have indicated that more African American patients progress to end-stage renal disease (ESRD). This is the first study to assess the prevalence of renal failure-related skin disease in children of color, including African American and Hispanic patients. Thirty children were evaluated by history and physical examination, with assignment to one of three treatment categories: transplanted (n = 10), dialyzed (n = 16), or medically managed (n = 4). Skin findings were divided into uremic, drug-related, or infectious disease types. The incidence of skin disease was 100%. Xerosis was the single most common finding, often accompanied by pruritus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high incidence of gingival hypertrophy (72%) and an even higher incidence of hypertrichosis (100%). Acral warts and nevi were common findings, the latter correlating with the length of immunosuppression. There is a high incidence of cosmetically disfiguring side effects (Cushinoid facies, hypertrichosis, and gingival hypertrophy) in children within all treatment categories, primarily related to drug treatment. Further study is required to determine the long-term sequelae, including psychological disturbances, of cutaneous disease in children of color with CRF.

Partial lipoatrophy in a child.

A 2-year-old boy was referred to the pediatric dermatology clinic for evaluation of an idiopathic, hypopigmented, atrophic patch on the right gluteal area. After extensive questioning the patient's parents recalled a penicillin injection several months prior to the appearance of lipoatrophy. There were no associated abnormalities.

Toxic epidermal necrolysis in children--an update.

Toxic epidermal necrolysis (TEN) is a relatively rare disease, characterized by generalized erythema, bulla formation, and exfoliation of the epidermis that resembles scalding. It is usually drug-induced and mediated by immune reactions of several types. TEN has to be differentiated from erythema multiforme and Stevens-Johnson syndrome. TEN bears a life-threatening potential and a risk for significant complications such as dehydration; secondary infections; pulmonary, gastrointestinal, and renal involvement; and late scarring with cosmetic and functional implications. Therapeutic interventions include admission in a burn center unit, systemic antibiotics and corticosteroids, topical therapy with antibacterial agents and biological dressings, and supportive measures.

Perioral dermatitis in children.

Perioral dermatitis is a unique skin disorder of childhood. Its exact origin is unknown; it is probably an idiosyncratic response to exogenous factors such as the use of a topical fluorinated corticosteroid or other substances on the face. It is uncommon but not rare. The age of affected children has ranged from 7 months to 13 years, with the median being in the prepubertal period. Boys and girls, blacks and whites are equally affected. Clinical features include the following: (1) absence of systemic symptoms; (2) periorificial distribution (perioral, perinasal, periorbital); (3) skin lesions that consist of flesh colored or erythematous inflammed papules, micronodules, and rare pustules; and (4) variable pruritus. Laboratory tests are negative. Histologically, it is indistinguishable from rosacea; there is a superficial perifollicular granuloma consisting of epitheliod cells, and lymphohistiocytic infiltrate, with occasional giant cells. The disease waxes and wanes for weeks and months. Treatment consists of discontinuing topical fluorinated corticosteroid use if any, and using topical metronidazole alone or in combination with either oral tetracycline or erythromycin depending on the child's age. A low-potency topical steroid may also be used to suppress the inflammation and to wean off the strong steroid. Perioral dermatitis in childhood is probably a juvenile form of rosacea.

Atopic dermatitis in childhood.

Atopic dermatitis is one of the major challenging skin disorders in infants and children. Many flare factors come into play. Treatment is complicated. A simplified approach and overview to the problem is presented here. A parent education handout used in our clinic and reprinted here may be reproduced for patient education purposes.

Congenital Becker's nevus with a familial association.

Becker's nevus is a unilateral, hyperpigmented cutaneous hamartoma usually with hypertrichosis. It occurs predominantly in boys, becoming apparent during adolescence, although several cases of congenital Becker's nevus have been reported. Rarely it may be familial and as such is transmitted in an autosomal dominant pattern. We report a 16-month-old black boy with a hyperpigmented patch on his right shoulder and upper pectoral area that extended down his arm. The patient's father has a similar lesion with hair on his left shoulder which has been present since childhood. Histology of the child's lesion was consistent with Becker's nevus. We believe this to be the first reported case of a congenital Becker's nevus with a familial association.

Tinea capitis in a newborn caused by two organisms.

Tinea capitis is a common infection of childhood. There have been several reports of tinea capitis in newborns. Our patient presented at 19 days of age to the emergency room with a scalp lesion of 5 days duration. The fungal culture grew both Trichophyton rubrum and Trichophyton mentagrophytes. The patient was successfully treated with oral griseofulvin.

Transient cutaneous vesicles in a teenager: the final piece to a puzzle.

Cicatricial pemphigoid is a chronic blistering disease that predominantly affects the mucous membranes. It has a peak occurrence in the seventh decade. Pediatric cicatricial pemphigoid is a rare entity, with fewer than 20 cases reported. We report an 18-year-old man who was recently diagnosed with cicatricial pemphigoid after six years of diagnostic uncertainty.

Skin disorders in black children.

Recently, progress and developments have been made in six skin conditions relevant to black children. Infantile acropustulosis may either be idiopathic or may be a sequela of scabies in young infants. The approach to small- or medium-sized congenital melanocytic nevi in black children must be different because the risk for malignant transformation into melanoma is exceedingly small. Keloids and hypertrophic scars in children are effectively treated with silicone gel sheeting. Tinea capitis caused by Trichophyton tonsurans remains to be a very common infection among black children. The newer systemic antifungal agents have no significant advantage over griseofulvin. Hair problems resulting from grooming practices or hair styling are preventable. For postinflammatory hyperpigmentation, azelaic acid holds promise.