Randomized, double-blind, split-side comparison study of moisturizer containing licochalcone vs. 1% hydrocortisone in the treatment of infantile seborrhoeic dermatitis.

BACKGROUND: Infantile seborrhoeic dermatitis (ISD) is a common skin lesion in infants. There may be differences in recommendation for treatment of ISD. OBJECTIVE: To compare the efficacy of moisturizer containing licochalcone vs. 1% hydrocortisone for the treatment of ISD. METHODS: This was a randomized, prospective, split-side, double-blind study that was conducted in 75 infants between the age of 2 weeks and 1 year. Patients with a clinical diagnosis of ISD were treated twice daily, simultaneously with either moisturizer containing 0.025% licochalcone or 1% hydrocortisone on opposite sides of the lesion. The scoring system was used to assess the severity of the rash by the presence of erythema, scale and crusts. The lesions on each side were evaluated on day 0, 3-4, 6-7 and 14. RESULTS: A total of 72 patients completed the study. The moisturizer containing licochalcone group had a higher clearing rate (42%) compared to 1% hydrocortisone group (32%) (P=0.03) on day 3-4. Both products were equally effective in the treatment at day 6-7 and 14 (P=0.45 and 1, respectively). By the end of the second week, the cure rate of the moisturizer containing 0.025% licochalcone and 1% hydrocortisone group was 90% and 92%, respectively. LIMITATIONS: The small sample size was a study limitation. CONCLUSION: Moisturizer containing 0.025% licochalcone had higher cure rate compared to 1% hydrocortisone for the treatment of ISD at day 3-4. However, by the end of the first week, this difference was no longer significant.

Three novel mutations in the PORCN gene underlying focal dermal hypoplasia.

Focal dermal hypoplasia (FDH) is an X-linked dominant disorder characterized by patchy dermal hypoplasia with digital, ocular and dental abnormalities. Very recently, mutations in the PORCN gene were demonstrated to cause FDH. Here, we described three unrelated Thai girls who were sporadic cases of FDH. One of them had unilateral athelia, which has never been described in FDH. Mutation analysis by polymerase chain reaction sequencing the entire coding regions of PORCN successfully revealed three potentially pathogenic mutations, c.373+1G>A, c.737_738insA and c.1094G>A (p.R365Q). One was found in each of three patients. In addition, another sequence variant c.682C>T (p.R228C) with an inconclusive role was found in one patient and her unaffected mother. The two missense mutations were not detected in at least 100 ethnic-matched control chromosomes, and all four mutations had never been previously described. X chromosome inactivation studies showed random patterns in all of them. This study demonstrates that PORCN is the gene responsible for FDH across different populations and extends the total number of confirmed mutations to 26.

Transepidermal water loss during conventional phototherapy in nonhemolytic hyperbilirubinemia term infants.

The evaporation rate from the skin was measured in 40 healthy term infants and 40 non-hemolytic jaundice term infants who required phototherapy. All infants were born at the gestational age of 38-41 weeks. The method for measurement of evaporation rate was based on determination of the water pressure gradient close to the skin surface. Conventional phototherapy was given in open cribs. In the phototherapy group, non of the infants had received phototherapy before the start of measurement. Evaporation rate was measured at the chest, interscapular and buttock. The measurement was made before phototherapy, 30 minutes, and 6 hours after starting phototherapy. The mean evaporation rate increased from 7.2 to 7.8 and 8.4 g/m2 h, respectively (p<0.001). In the control group, the measurement was made at the consecutive time as in the phototherapy group. The mean of the evaporate rate was 7.3, 7.6 and 7.5 g/m2 h (p=0.30). We conclude that conventional phototherapy in full term infants in open cribs increases transepidermal water loss.

Scurvy: a case report.

An 8-year-old child with cerebral palsy came with progressive purpuric rash affecting the trunk and legs. He had tenderness on palpation of his extremities. Physical examination revealed a moderately pale and cachectic boy. There was bleeding per swollen gums and petichiae on the hard palate. Generalized multiple discrete palpable petichiae spots at hair follicles along the whole body, more on both legs, were observed. He also had tenderness on palpation of his extremities. His hemoglobin was 6.6 g/dl. Platelet count and coagulogram were normal. Roentgenographic findings showed generalized osteoporosis, metaphyseal white line of distal femur, proximal tibia. proximal fibula, distal radius, and distal ulna with submetaphyseal lucency bilaterally. Skin biopsy showed dilated hair follicles, filled with keratinous material and a small corkscrew hair. A diagnosis of scurvy was made; and vitamin C at a dosage of 300 mg per day was given. His swollen gums, bleeding per gums and muscle tenderness improved within 2 days. Perifollicular hemorrhage, follicular hyperkeratosis, and anemia improved in 2 and 3 weeks respectively.

Effects of clear topical ointment on transepidermal water loss in jaundiced pretermm infants receiving phototherapy.

Thirty jaundiced preterm infants, gestational age < or = 34 weeks and postnatal age < or = 7 days, receiving conventional phototherapy for hyperbilirubinemia of prematurity in incubators were included. 1.5 ml of clear topical ointment was applied on the right side of the trunk and extremities while the left side was used as control. Data collection included transepidermal water loss (TEWL), ambient temperature and ambient humidity, before and at 30 minutes, 4-6 hours after application of the ointment during phototherapy. The measurements were executed both the right and left side in 3 positions; upper arm, back, lower leg. TEWL was reduced by 29 per cent (P value < 0.002) and 26 per cent (P value < 0.011) at 30 minutes and 4-6 hours after the application of clear topical ointment, respectively. Ambient temperature and humidity were not significantly different (P value > 0.18). We concluded that application of clear topical ointment on the skin of jaundiced preterm infants receiving conventional phototherapy in incubators reduced TEWL significantly.

Mucocutaneous manifestations of HIV infection in 91 children born to HIV-seropositive women.

We examined 91 children under the age of 13 years with definite HIV infection born to HIV-seropositive women. The clinical spectrum of HIV infection in children younger than 13 years who are born to HIV-infected mothers was revised in 1994 into four clinical categories: category N (not symptomatic), category A (mildly symptomatic), category B (moderately symptomatic), and category C (severely symptomatic). Mucocutaneous manifestations were found in 47 (51.6%) of these children. The prevalence of mucocutaneous manifestations in categories A, B, and C were 4%, 62%, and 75%, respectively. The mucocutaneous manifestations in patients in categories B and C were significantly more common than in those category A (p < 0.001). The most common finding was oral candidiasis (36.3%). Drug rash, pruritic papular eruption, herpes zoster, cutaneous candidiasis, Penicillium marneffei infection, and herpes simplex virus stomatitis were found in 6.6%, 5.5%, 4. 4%, 3.4%, and 2. 2% of patients, respectively. All three patients who had disseminated P. marneffei infection were in category C.

Childhood pemphigus.

BACKGROUND: Five children with pemphigus are reported: three with pemphigus vulgaris, one with pemphigus vegetans, and one with pemphigus foliaceus. Only one case of juvenile pemphigus vegetans has been published in the literature. MATERIALS AND METHODS: All three patients with pemphigus vulgaris were treated with oral corticosteroid; in two cases, azathioprine was added for steroid-sparing effect. The patient with pemphigus vegetans had a clinical presentation resembling pemphigus vulgaris, but the lesions in the perianal area healed as hypertrophic granulation tissue. He was treated with oral corticosteroid, azathioprine, and intralesional corticosteroid. The patient with pemphigus foliaceus presented with exfoliative dermatitis, and was treated with oral corticosteroid; methotrexate was added later for steroid-sparing purposes RESULTS: The patients were followed up for 1-4 years; the prognosis of childhood pemphigus is good. CONCLUSIONS: Long-term follow-up is needed to detect flaring of the disease and the side-effects of immunosuppressive drugs.

Cutaneous manifestations of childhood systemic lupus erythematosus.

We assessed the mucocutaneous signs in 57 children with classical systemic lupus erythematosus seen during a 6 year period. The female:male ratio was 4.2:1. Ages ranged from 4 to 15 years (mean 11.9 years) at the time of diagnosis. Cutaneous manifestations (77%) were the second most common finding, next to renal involvement (84%). The skin changes noted were malar rash (74%), oral ulcer (46%), vasculitis (42%), photosensitivity (40%), alopecia (32%), and discoid lupus erythematosus (LE) (19%). All 11 discoid LE patients were girls. Periungual erythema, Raynaud's phenomenon, periungual gangrene, nail involvement, and subacute LE were rare. Antinuclear antibody reaction was positive in 93% and anti-dsDNA was positive in 46%. Eight patients died, six from severe infection and two from renal failure.

Henoch-Schönlein purpura in Thailand: review of 41 children.

The clinical features of 41 Thai children with Henoch-Schönlein purpura were presented, with particular emphasis on the cutaneous features and date of onset. There were 20 boys and 21 girls, ages ranged from 2 to 15 years. All patients had palpable purpura on the lower limbs. Palpable purpura were also present on forearms and pinna in 25 (61%) and 5 (12%) respectively. Scalp edema was found in five patients. Hemorrhagic vesicles and bullae were found in only one patient. Twenty six patients (63%) had skin lesions as the first sign. Thirty four patients (83%) had skin lesions in the first four days of the clinical course. Other dominant features included were abdominal pain, arthralgia and nephritis 73, 66 and 39 per cent respectively. The pertinent literature is reviewed.

Calcinosis cutis presenting years before other clinical manifestations of juvenile dermatomyositis: report of two cases.

Calcinosis cutis in dermatomyositis is dystrophic calcification appearing late in the course of the disease. Two cases are reported here of calcinosis cutis that presented years before other clinical manifestations of juvenile dermatomyositis. The first case was a 14-year-old Thai girl who had asymptomatic subcutaneous nodules that spontaneously ruptured, exuding a chalky discharge and healing with an atrophic scar 8 years before the onset of other clinical manifestations of juvenile dermatomyositis; that is, Gottron's papules, proximal muscle weakness grade IV/V with atrophy, slightly elevated serum creatinine phosphokinase level and an abnormal electromyogram compatible with myopathy. The second case was a 15-year-old Thai boy who had calcinosis cutis 3 years before the onset of other clinical manifestations of juvenile dermatomyositis, and the calcinosis cutis was so severe that it interfered with the movement of his extremities. Both cases responded well to aluminium hydroxide therapy.

Henoch-Schonlein purpura presenting as hemorrhagic vesicles and bullae: case report and literature review.

Henoch-Schonlein purpura is a syndrome characterized by nonthrombocytopenic purpura accompanied by arthralgia, gastrointestinal symptoms, or renal involvement. We report a 5.5-year-old boy with high fever and hemorrhagic vesicles and bullae varying in size from 2 to 50 mm in diameter, on both pinnas, the hard palate, gums, dorsa of the hands, buttocks, and both legs, and review the pertinent literature.

Eczematous skin reaction from patch testing with aeroallergens in atopic children with and without atopic dermatitis.

To determine whether aeroallergens could induce eczematous lesions, 30 patients with atopic dermatitis were studied in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 and 14 years of age. Patch testing with five aeroallergens--housedust, mite, cockroach, mold mix, and grass mix--was done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with atopic dermatitis, patch testing with aeroallergens induced eczematous lesions at one or more sites. Mite, cockroach, house dust, mold mix, and grass mix caused reactions in 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis (P < 10(-6)). Intradermal skin tests in both groups were not significantly different. This study supports previous reports that aeroallergens plays an important role in causing eczematous skin lesions.