Children with dermatological conditions admitted to paediatric intensive care: analysis of a national clinical audit database.

There is little published literature about dermatological conditions in paediatric intensive care units (PICUs). The aim of this study was to describe the range of skin disorders in children admitted to PICUs in the UK and Ireland using data from a national audit. An analysis was conducted using data for 2002 - 2010 from the Paediatric Intensive Care Audit Network (PICANet). In total, 999 admissions of 882 children were identified, representing 0.8% of all PICU admissions. The most frequent dermatological conditions were skin infections, including cellulitis and necrotizing fasciitis, and inflammatory conditions. In 28% of cases, the dermatological diagnosis was considered the reason for PICU admission, in 35% it was a manifestation of systemic disease and in 37% it was considered incidental. Overall mortality was similar to the general PICU population, with 52 deaths (5.2%), but was greater in children with vascular/haematological conditions.

Symptoms of notalgia paresthetica may be explained by increased dermal innervation.

Notalgia paresthetica is a sensory neuropathy characterized by infrascapular pruritus, burning pain, hyperalgesia, or tenderness. To assess whether the symptoms may be caused by alterations in the cutaneous innervation, skin from the affected area of patients (n = 5) was compared with controls (n = 10) comprising the contralateral unaffected area from the same patients and site-matched biopsies of normals, using immunohistochemistry. Frozen sections were immunostained with antisera to the neuropeptides substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, and neuropeptide with tyrosine, and to the general neural marker PGP 9.5 and the glial marker S-100 to show the overall innervation and glial cells, respectively. No discernible change in the distribution of neuropeptide-immunoreactive axons was found, but all of the specimens from the affected areas had a significant increase in the number of intradermal PGP 9.5-immunoreactive nerve fibers compared with unaffected areas from the same patients and normal controls. Epidermal dendritic cells immunoreactive for S-100, possibly Langerhans cells, were substantially increased. It is concluded that there is an increase in the sensory epidermal innervation in the affected skin areas in notalgia paresthetica, which could contribute to the symptoms, and that neural immunohistochemistry of skin biopsies could be helpful in the diagnosis of the disease.

Malignant eccrine poroma: report of three cases.

The characteristic clinical and histological features of three cases of malignant eccrine poroma are discussed, in addition to the metastatic disease that had occurred in two cases. These cases were compared with previously reported cases of malignant eccrine poroma that had metastasised, and it is suggested that a strict classification of malignant eccrine sweat gland tumours should be made.

A case of focal dermal hypoplasia (Goltz) syndrome with exophytic granulation tissue treated by curettage and photodynamic therapy.

Focal dermal hypoplasia (Goltz) syndrome is a rare genetic disorder characterized by cutaneous, ectodermal and mesodermal defects. We present a case in which painful, exophytic granulation tissue has been the main symptom over the past 15 years. After unsatisfactory results with a number of treatment modalities including topical steroids, silver-nitrate applications, cryotherapy, curettage, excision and pulsed-dye laser, we achieved significant benefit with curettage in combination with photodynamic therapy. Although impaired wound healing has been described in focal dermal hypoplasia, this is, to our knowledge, the first time that pyogenic granuloma-like lesions have been reported.

Acne conglobata of the buttocks aggravated by mechanical and environmental factors.

The case is described of a young woman who experienced a marked worsening of her acne as a result of friction, salt water and heat. She had crossed the Atlantic Ocean in a sailing boat and spent several months in the tropics.

Eruptive melanocytic naevi following severe bullous disease.

Two patients developed eruptive naevi following severe bullous disease. The naevi developed after an interval of months and remain unchanged 4 years later. Eruptive naevi have been described after convulsions and both patients developed bullous disease after treatment for convulsions.

Xanthoma disseminatum: a case with hepatic involvement, diabetes insipidus and type IIb hyperlipidaemia.

Xanthoma disseminatum (XD) is a rare benign non-X-histiocytic disorder of unknown aetiology. We report a 37-year-old man who presented with XD preceded by a decade of cranial diabetes insipidus, with associated type IIb hyperlipidaemia and computed tomographic evidence of hepatic involvement. A review of the literature is also included.

Unilateral naevoid telangiectasia syndrome in pregnancy.

We report the case of a 22-year-old woman presenting with the unilateral naevoid telangiectasia syndrome in her third pregnancy. The development of this is well documented but the occurrence in a third pregnancy is unusual. A brief review of the literature is included.

Glaucoma induced by periorbital topical steroid use--a rare complication.

Eye complications arising during systemic and ophthalmic steroid use are well known. In contrast, there is little highlighting the similar risks associated with topical steroid use around the eyelids. We now describe a 29-year-old lady who used topical steroids in prolonged fashion throughout most of her life for severe eczema, with the recent application of large quantities of potent steroid continuously for one month, including to the periorbital region. Soon after, she presented to her ophthalmologist with severe bilateral glaucoma and irreversible visual loss attributed to the steroid use. Here we emphasise the possible risks of periorbital topical steroid use, as well as the importance of patient education and ophthalmological follow-up.

Bizarre parosteal osteochondromatous proliferations of the tubular bones of the hands and feet.

A case of a rare condition with which dermatologists are unlikely to be familiar is presented. The lesions involve the tubular bones and therefore usually present to orthopaedic surgeons. This is the first case affecting a distal phalanx to be reported.

Comedonal Darier's disease.

Darier's disease is an inherited disorder with well-recognized patterns of presentation. Lesions commonly affect the trunk and flexures. The diagnosis is based on the typical clinical appearance and histology showing acantholytic dyskeratosis. We report two unusual cases with prominent nodular, comedonal lesions on the face and scalp.

Squaric acid dibutyl ester in the treatment of alopecia areata.

A controlled trial of contact allergen therapy of alopecia areata (AA) using squaric acid dibutyl ester (SADBE) was performed on 17 patients. The right side of the patient's scalp was treated and the left side acted as an untreated control. Minimal signs of terminal hair growth were present in only 3 patients after 8-12 weeks of therapy. A majority of patients experienced adverse effects which led to the early withdrawal of 2 patients and the premature termination of the trial. We do not recommend the use of SADBE in the treatment of AA.

A comparison of the potencies of several diluted and undiluted corticosteroid preparations using the vasoconstrictor assay.

10 subjects were assessed using the vasoconstrictor assay technique in a double-blind study in order to evaluate the relative potencies of several diluted and undiluted proprietary corticosteroid preparations. Dermovate ointment achieved a significantly higher score than any other preparation but there was no significant difference between the scores for Betnovate ointment (betamethasone valerate 0.1%), Propaderm Forte cream (beclomethasone dipropionate 0.5%), Propaderm ointment (beclomethasone dipropionate 0.025%), Nerisone Forte ointment (diflucortolone valerate 0.3%), and Nerisone ointment (diflucortolone valerate 0.1%). Furthermore, no significant difference in scores could be demonstrated between Adcortyl ointment (triamcinolone acetonide 0.1%), Ledercort ointment (triamcinolone acetonide 0.1%) and extemporaneous dilutions of these ointments 1 part in 4 in their recommended diluents (triamcinolone acetonide 0.025%). The relevance of these findings to clinical practice is discussed.

Phaeohyphomycosis caused by Exophiala dermatitidis following intra-articular steroid injection.

A patient with long-standing rheumatoid arthritis presented with a painful pigmented chronic nodule on the dorsum of the right hand, at the site of intra-articular steroid injections undertaken 5 years previously. Histology showed pigmented fungal elements consistent with phaeohyphomycosis. Cultures yielded black yeast-like colonies, identified as Exophiala dermatitidis and sensitive to itraconazole and amphotericin. A 1-month course of itraconazole resulted in marked clinical improvement but surgical excision and skin grafting were required for complete resolution. Phaeohyphomycosis has been related to inoculation injury but association with intra-articular steroid injection appears hitherto to be unreported.

Childhood dermatitis herpetiformis: an unusual presentation.

Childhood dermatitis herpetiformis (DH) is rare. The true prevalence and incidence of this condition are unknown. We report a 7-year-old boy presenting with nonpruritic inflammatory papules on the buttocks and extensor surfaces, clinico-pathologically consistent with Sweet's neutrophilic dermatosis. Immunofluorescence studies showed IgA deposits in the dermal papillae consistent with DH. Remission was achieved with a gluten-free diet and dapsone. Childhood DH may present different clinical signs to the adult form and misdiagnosis can occur if immunofluorescence is not requested on skin biopsy.

An attempt to evaluate the relative clinical potencies of various diluted and undiluted proprietary corticosteroid preparations.

Two series of tests have been performed in order to assess the vasoconstrictor potency of several diluted and undiluted proprietary corticosteroid preparations. Results showed that differences in concentration of a particular corticosteroid were not always reflected as significant differences in vasoconstrictor potency. A previous finding that Eumovate ointment exhibits early vasoconstrictor activity similar to that of Betnovate ointment was confirmed. The extemporaneous dilution of proprietary corticosteroid preparations remains a widespread but controversial habit. In addition, several proprietary products are represented by a range of dilutions of the same corticosteroid with each concentration targeted at a different segment of the market place. Recent work by our group has revealed some interesting results concerning the vasoconstrictor potency of both diluted and undiluted preparations (Gibson et al., 1982). The aim of this study was to extend the investigation to cover a number of widely used preparations.

Low sex-hormone binding globulin levels in young women with diffuse hair loss.

We measured plasma sex-hormone binding globulin (SHBG) and testosterone levels in a pilot study of eight women aged 21-41 years who complained of diffuse hair loss; and subsequently in a larger group of fifteen patients of a similar age range. There was a significant reduction in SHBG levels in both groups of patients when compared ot controls, but testosterone values were normal.