Malignant melanoma in children. A review.

The increasing incidence during the last decades and the projection for the future places malignant melanoma (MM) among the most important public health problems world-wide. Given the limited success of therapy for MM, for the time being the fighting strategy against MM should focus mainly on prevention and early detection.

Universal acquired melanosis. The carbon baby.

A Mexican child was born white and progressively became black. At the age of 21 months, the whole integument was deep black in the absence of other alterations. Electron microscopy showed a Negroid pattern in the epidermal melanosomes. Among the different forms of progressive mucocutaneous pigmentations previously described in the literature, we were unable to find a similar case.

Therapeutic efficacy of interferon alfa-2b in infants with life-threatening giant hemangiomas.

BACKGROUND: Because of their size and the possibility of complications, giant hemangiomas represent a therapeutic challenge. Various forms of treatment have been used, with variable results, including surgery, embolization, lasers, pentoxifylline, and corticosteroids. Interferon alfa has been used successfully to treat life-threatening hemangiomas, possibly by means of its antiangiogenic activity. OBSERVATIONS: We treated 7 infants with organ-interfering and/or life-threatening giant hemangiomas with subcutaneous injections of 3 million U/m2 per day of interferon alfa-2b during the first month and subsequently every 48 to 72 hours, depending on the evolution in each case. The treatment lasted from 3 to 12 months. In 2 patients, interferon alfa-2b was administered while prednisone therapy was being tapered. In all 7 patients, there was considerable reduction of the volume of the hemangiomas and remission of their complications. All patients presented with fever, neutropenia, and an increase in serum aminotransferase levels. The patients who received interferon alfa-2b and prednisone seemed to improve at a faster rate. CONCLUSIONS: Interferon alfa-2b is a good option for the treatment of patients with steroid-resistant, organ-interfering and/or life-threatening giant hemangiomas. In our experience, the adverse effects were transient and minor and did not require the interruption of the treatment.

The use of retinoids in the pediatric patient.

Oral retinoids are molecules derived from vitamin A that represent one of the most important steps forward in dermatologic therapeutics in the present century. The treatment of acne, severe psoriasis, and severe disorders of keratinization, prevalent diseases in children and adolescents, have radically changed since the advent of oral retinoids. Like most highly-effective medications, oral retinoids also have important untoward effects. Specialists, and in particular, dermatologists and pediatricians should be prepared to maneuver the delicate balance between therapeutic efficacy and side effects in order to give the pediatric patient the maximum benefit with the lowest possible risk.

Postinflammatory hypopigmentation and hyperpigmentation.

Postinflammatory hypopigmentation and hyperpigmentation are frequently encountered problems and represent the sequelae of various cutaneous disorders as well as therapeutic interventions. However, the underlying mechanisms and the variability individuals show for developing hypopigmentation or hyperpigmentation are not well understood. The authors propose an inherited individual chromatic tendency that is based on "weak" or "strong" melanocytes and their tendency to respond to trauma or inflammation with either hypopigmentation or hyperpigmentation. Clinical examples and management of both hypopigmentation and hyperpigmentation are discussed.

[Familial dermo-chondro-corneal dystrophy (François' syndrome) (author's transl)]. / Dystrophie dermo-chondro-cornéenne familiale (syndrome de françois).

The François' syndrome associates disseminated firm nodular subcutaneous lesions, a deforming arthropathy and a corneal dystrophy. Inheritance seems to be recessive. Six cases of this rare syndrome have been previously published. The syndrome is reported here in two Mexican brothers. In the authors' opinion the François' syndrome is not related to the xanthomatoses. It should be considered as a genetically recessive arthropathic nodular fibromatosis.

[Familial dermo-chondro-corneal dystrophy (François' syndrome)]. / Dystrophie dermo-chondro-cornéenne familiale (syndrome de François).

The François' syndrome associates disseminated firm nodular subcutaneous lesions, a deforming arthropathy and a corneal dystrophy. Inheritance seems to be recessive. Six cases of this rare syndrome have been previously published. The syndrome is reported here in two Mexican brothers. In the authors' opinion the François' syndrome is not related to the xanthomatoses. It should be considered as a genetically recessive arthropathic nodular fibromatosis.

[Tuberous sclerosis. Early diagnosis with autonomic nervous system responses in hypopigmented skin]. / Esclerosis tuberosa. Diagnóstico precoz mediante respuestas de sistema nervioso autónomo en piel hipopigmentada.

The earliest clinical sign for the diagnosis of tuberous sclerosis (TS) is the presence of cutaneous hypopigmented macules. However, there are no clinical, histopathological or functional criteria to discriminate between hipopigmented macules of TS and those without associated pathology. In this prospective study, the responses of the autonomous nervous system, erythema and sweating induced through iontophoresis with pilocarpine, were studied in three groups of patients (20 with TS, 10 with hipomelanosis of Ito, and 10 with hipopigmented macules without associated pathology). In hipopigmented macules without associated pathology, the responses were similar to those observed in normal skin. In TS erythema and sweating were significantly diminished (p = < 0.001). In hypomelanosis of Ito the decrease in erythema and sweating were not statistically significant. In TS the degree of decrease of erythema and sweating correlated positively with the severity of the neurological alterations. Light and electronmicroscopic studies of the hypopigmented macules in the three groups showed morphologically normal sweat glands and nerves. The latter suggests a disfunction of the sweat glands in TS as a cause of their abnormal behavior. We conclude that sweat testing in hypopigmented macules is a useful mean for the early diagnosis of ET.

[Cicatricial, antibacterial and antimycotic effects of tepescohuite in experimental animals]. / Efectos cicatrizante, antibacteriano y antimicótico del tepescohuite en animales de experimentación.

The cicatricial and antibacterial effects of the sterile powder of the barks of tepescohuite (Mimosa tenuiflora), 2% mupirocin ointment, and 0.9% saline were compared. The experiment was performed in rabbits with chemically induced burns clinically, histopathologically, bacteriologically, and mycologically controlled. No statistically significant difference was found among the three treatment modalities. Due to the potentially hepatotoxic effects and low therapeutic efficacy of tepescohuite it should not be used in human beings.

[Candidiasis in children with diaper rash. Study of 140 cases]. / Candidosis en niños con dermatitis por pañal. Estudio de 140 casos.

The frequency of genito-crural candidiasis in infants presenting diaper rash, as well as the possible influence of bacterial flora in this region on the pathogenicity of Candida was studied. Skin scraping were made with sterile swabs and processed by bacteriological and mycological methods in 140 children whose ages ranged between 0 and 20 months. The most commonly found microbiological flora were Candida spp (65.7%), non hemolytic Streptococcus (18.5%), Staphylococus epidermidis (19.2%); beta hemolytic Streptococcus (12.8%) and alfa-hemolytic Streptococcus (9.2%). Of the 140 cases, 76 (54.3%) showed candidiasis associated with diaper rash and 16 (11.4%) had Candida as normal flora. C. albicans was most frequently found (66.3%) followed by C. tropicalis (19.6%). Candidiasis was more frequent in those infants that had no other associated of pathogenic flora. Factors significantly influencing the increase in the frequency of candidiasis were: A) Evolution time, which was directly proportional; B) Use of cotton diapers covered with plastic pants; C) Feeding with cow's as opposed to maternal milk; and D) Malnutrition associated with poor hygiene.

[Lichen nitidus in children. Study of 17 cases]. / Liquen nítido en niños. Estudio de 17 casos.

Seventeen children with clinical and histological diagnosis at lichen nitidus are reported. An incidence of one case for every 882 pediatric dermatology patients was found. LN predominated in males in a 3:1 relation. The lesions usually first appeared during infancy as grouped skin colored micropapules with shiny surface. The trunk and upper limbs were the most frequently affected body segments. The histological picture was diagnostic showing a local ganulomatous infiltrate in the papillary dermis in between two rate pages and in close contact with the epidermis. No effective treatment is known. The lesions spontaneously disappeared in an average time of 18 months.

[Pityrosporum ovale in seborrheic dermatitis in children and in other dermatoses in children]. / Pityrosporum ovale en dermatitis seborreica infantil y en otras dermatosis infantiles.

60 children aged from one month to two years were studied: 15 presenting with childhood seborrheic dermatitis, 15 with childhood atopic dermatitis, 15 with various childhood dermatoses and 15 healthy asymptomatic children. Samples of cutaneous scales from the scalp, face, sternal area and inguinal area were taken for the purpose of determining the presence of ovale by direct microscopy examination and culture. P. ovale was found in 73% of the infants presenting with seborrheic dermatitis, in 33% of those with atopic dermatitis, in 33% of those with other dermatoses and in 53% of the healthy infants. The proportion of infants in whom all four samples were found to be positive to P. ovale was as follows: 42% for seborrheic dermatitis, 20% for atopic dermatitis, 20% for other childhood dermatoses and 23% in the healthy infants. The majority of infants with both positive microscopy and culture for P. ovale were aged one to eight months. The group presenting with seborrheic dermatitis was treated with 2% ketoconazole cream or two weeks. Clinical cure was achieved in 11; mycological examination was negative in 13. P. ovale was significantly more frequent in infants with seborrheic dermatitis than in infants belonging to the other three groups. The role of P. ovale in the pathophysiology of seborrheic dermatitis is discussed.

[Incidence of malignant, primary and metastatic solid skin tumors at a pediatric dermatology service]. / Incidencias de tumores cutáneos sólidos malignos, primarios y metastásicos en un servicio de dermatología pediátrica.

The incidence of primary and metastatic cutaneous malignant solid tumors was investigated in a pediatric dermatology department. Among 25,000 first time patients seen between 1971 and 1985, 19 had cutaneous malignant solid tumors with an annual incidence of 0.7 for every 1,000 pediatric dermatology patients. Nine cases had primary cutaneous tumors and 10 cases metastatic tumors. The majority of patients were infants (zero to two years). The tumors found were rhabdomyosarcoma, six cases; basal-cell carcinoma, four cases; neuroblastoma, three cases; malignant melanoma, two cases, squamous-cell carcinoma, dermatofibrosarcoma, atypical fibroxanthoma and myxopapillary ependymoma, one case of each. Predisposing factors for the developing of malignancy were present in 42% of patients.

[Inflammatory linear verrucous epidermal nevus. Clinical and histopathological aspects of 7 cases]. / Nevo epidérmico verrugoso inflamatorio lineal (N.E.V.I.L.). Aspectos clínicos e histopatológicos en siete casos.

The inflammatory linear verrucous nevus is a recently described variety of epidermal nevus clinically and histologically characterized by an inflammatory component. The lesion stars at birth or at early age, pruritus is constant. Histologically the picture is psoriasiform. The therapeutic response is poor. Seven cases are presented. Associated extracutaneous alterations were presented in four of them.

[Staphylococcal epidermal exfoliation (Ritter's disease)]. / Exfoliación epidérmica estafilocóccica (Enfermedad de Ritter)

According to the authors the best designation of Ritter's disease would be "staphilococcic epidermal exfoliation" SEE. The physiopathological and agnoslogical basis for this denomination could be the following: 1st The "S. aureus" is the ehtiological agent of the SSE in man. The Koch postulates necessary to confirm this hypothesis have been accomplished. 2nd "Staphylococcus aureus" produces a thermostable toxin that is active indepently of the staphilococcus and gives rise to the separation of the cells of the stratum granulosus of the epidermis and eventually exfoliation in suckling babies and in the newborn mouse. 3rd The "Staphylococcus aureus" may be present on the skin or in other localisations such as the bowel or pharinx. 4th The viable "S. aureus" when administered subcutaneously to the adult mice gives rise to lesions clinically and histologically similar to the impetigo observed in children. 5th The "S. aureus" killed by means of autoclave (that is, the staphylococcic toxine by itself does not give rise to any lesion when administered to the healthy adult mouse). Neijther has the SEE been observed in healthy adult man. The authors reach the conclusion that the SSE and the toxic epidermal necrolysis are basically different according to the histopathology therapeutic response and prognosis and they must be considered as independant entities.