Pub Date : 2023-04-01DOI: 10.4103/ijpd.ijpd_104_22
S. Thakkar, Nimisha D Desai
Hair loss in children is an important cosmetic concern, especially in adolescents where body image matters. Trichotillomania manifests through patchy hair loss which reflects underlying psychiatric conditions. It is a challenge for the dermatologist, who are first contact physicians, to deal with such cases who are secretly struggling with their inner turmoil. Hence, they must be well versed to deal with such patients. The current review aims to facilitate the dermatologist to handle them effectively. We performed PubMed and Google Scholar searches of English literature using the terms “Trichotillomania”, “Trichotillosis,” “Trichotillomania in Children,” “Trichotillomania in pediatrics,” “Trichotillomania in adolescents,” “Hair pulling disorder,” “Obsessive-Compulsive disorders AND Dermatology,” “Psychodermatology,” and “Psychocutaneous disorders.” The selected publications were reviewed for additional resources. Thorough psychological evaluation of the patient along with the cutaneous examination will help the dermatologists in establishing the diagnosis. Dermatologists should be empowered regarding the need of mental health referral and should be able to convey the same to the patient/family members empathetically. They can offer habit reversal therapy, mainstay treatment, as well as pharmacotherapy as and when needed after adequate training.
{"title":"Trichotillomania in Children − How can a Dermatologist Deal with it?","authors":"S. Thakkar, Nimisha D Desai","doi":"10.4103/ijpd.ijpd_104_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_104_22","url":null,"abstract":"Hair loss in children is an important cosmetic concern, especially in adolescents where body image matters. Trichotillomania manifests through patchy hair loss which reflects underlying psychiatric conditions. It is a challenge for the dermatologist, who are first contact physicians, to deal with such cases who are secretly struggling with their inner turmoil. Hence, they must be well versed to deal with such patients. The current review aims to facilitate the dermatologist to handle them effectively. We performed PubMed and Google Scholar searches of English literature using the terms “Trichotillomania”, “Trichotillosis,” “Trichotillomania in Children,” “Trichotillomania in pediatrics,” “Trichotillomania in adolescents,” “Hair pulling disorder,” “Obsessive-Compulsive disorders AND Dermatology,” “Psychodermatology,” and “Psychocutaneous disorders.” The selected publications were reviewed for additional resources. Thorough psychological evaluation of the patient along with the cutaneous examination will help the dermatologists in establishing the diagnosis. Dermatologists should be empowered regarding the need of mental health referral and should be able to convey the same to the patient/family members empathetically. They can offer habit reversal therapy, mainstay treatment, as well as pharmacotherapy as and when needed after adequate training.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"109 - 115"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42069033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gauri Padmawar, S. Gundewar, Arjun Prakashey, Bhushan Madke
Dermatitis neglecta is a condition secondary to inadequate cleansing of the skin due to underlying causes such as pain, surgical site, neurological deficit, and neglect or psychocutaneous disorders. The result is an accumulation of keratin debris, sweat, sebum, and dirt giving a hyperkeratotic, hyperpigmented, and waxy appearance of the affected area. Soakage of the lesion with alcohol swabs and frictional cleaning of the area leads to the clearing of hyperkeratotic debris. We report a case of a 2-year-old male with dermatitis neglecta over meningomyelocele in the sacral region.
{"title":"Dermatitis neglecta in a case of meningomyelocele","authors":"Gauri Padmawar, S. Gundewar, Arjun Prakashey, Bhushan Madke","doi":"10.4103/ijpd.ijpd_93_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_93_22","url":null,"abstract":"Dermatitis neglecta is a condition secondary to inadequate cleansing of the skin due to underlying causes such as pain, surgical site, neurological deficit, and neglect or psychocutaneous disorders. The result is an accumulation of keratin debris, sweat, sebum, and dirt giving a hyperkeratotic, hyperpigmented, and waxy appearance of the affected area. Soakage of the lesion with alcohol swabs and frictional cleaning of the area leads to the clearing of hyperkeratotic debris. We report a case of a 2-year-old male with dermatitis neglecta over meningomyelocele in the sacral region.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"171 - 172"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42219358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Scaly skin, bowed bones, and cloudy cornea in a 7-year-old child","authors":"H. Vyas, Shikha R. Shah, B. Shah","doi":"10.4103/ijpd.ijpd_51_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_51_22","url":null,"abstract":"","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"208 - 209"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49449660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Superficial epidermolytic ichthyosis (SEI) is a rare blistering disorder, manifesting as blisters and hyperkeratosis. It has characteristic histopathological features, hyperkeratosis, vacuolar degeneration of the granular layer, and subcorneal split. Clinically, peeling skin syndrome and epidermolytic ichthyosis can mimic SEI. Therefore, a skin biopsy is essential to diagnose this rare genetic condition. Here, we are reporting a rare case of SEI in neonates presented with peeling of the skin.
{"title":"Superficial epidermolytic ichthyosis in a neonate","authors":"Pandharinath Khade, S. Mahajan, Ketki Bhoite","doi":"10.4103/ijpd.ijpd_87_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_87_22","url":null,"abstract":"Superficial epidermolytic ichthyosis (SEI) is a rare blistering disorder, manifesting as blisters and hyperkeratosis. It has characteristic histopathological features, hyperkeratosis, vacuolar degeneration of the granular layer, and subcorneal split. Clinically, peeling skin syndrome and epidermolytic ichthyosis can mimic SEI. Therefore, a skin biopsy is essential to diagnose this rare genetic condition. Here, we are reporting a rare case of SEI in neonates presented with peeling of the skin.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"164 - 166"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43992003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jafir Ahmed, R. Kushwaha, Avinash Sharma, Morish Agarwal, Neha Sharma, S. Jain
Introduction: Warts are benign skin growths caused by human papillomavirus. Traditional methods of treatment usually include destructive modalities which are painful and scar-forming. Such modalities have disadvantage of recurrence. Consequently, immunotherapy is introduced to overcome these problems. Aims and Objectives: To study the comparative efficacy of intralesional measles, mumps, and rubella (MMR) vaccine with intralesional Vitamin D3 for the treatment of extragenital warts in the pediatric age group (5–18 years). Materials and Methods: Seventy-two immunocompetent patients aged between 5 and 18 years with multiple extragenital warts (2 or more) were enrolled and divided randomly into two groups (Group A and Group B). Group A and Group B received intralesional MMR vaccine and Vitamin D3, respectively, in the largest wart present. The injections were repeated every 2 weeks for a maximum of four injections. Results: Complete response (CR) in injected warts in Group A is seen in 25 (83.3%) patients, partial response (PR) in 3 (10%), and no or inadequate response (NR) in 2 (6.67%) patients. CR is seen in 23 (76.66%) patients of Group B, PR in 4 (13.33%) and no or NR in 3 (10%) patients. CR in distant warts in 22 (73.33%) patients in Group A and 20 (66.66) patients in Group B. Conclusion: Both MMR vaccine and Vitamin D3 are safe, efficacious, and less traumatic to the patients for multiple warts in comparison with destructive modalities.
{"title":"Comparison of the efficacy of intralesional measles, mumps, and rubella vaccine with intralesional vitamin D3 for the treatment of extragenital warts in pediatric age group (5–18 years)","authors":"Jafir Ahmed, R. Kushwaha, Avinash Sharma, Morish Agarwal, Neha Sharma, S. Jain","doi":"10.4103/ijpd.ijpd_61_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_61_22","url":null,"abstract":"Introduction: Warts are benign skin growths caused by human papillomavirus. Traditional methods of treatment usually include destructive modalities which are painful and scar-forming. Such modalities have disadvantage of recurrence. Consequently, immunotherapy is introduced to overcome these problems. Aims and Objectives: To study the comparative efficacy of intralesional measles, mumps, and rubella (MMR) vaccine with intralesional Vitamin D3 for the treatment of extragenital warts in the pediatric age group (5–18 years). Materials and Methods: Seventy-two immunocompetent patients aged between 5 and 18 years with multiple extragenital warts (2 or more) were enrolled and divided randomly into two groups (Group A and Group B). Group A and Group B received intralesional MMR vaccine and Vitamin D3, respectively, in the largest wart present. The injections were repeated every 2 weeks for a maximum of four injections. Results: Complete response (CR) in injected warts in Group A is seen in 25 (83.3%) patients, partial response (PR) in 3 (10%), and no or inadequate response (NR) in 2 (6.67%) patients. CR is seen in 23 (76.66%) patients of Group B, PR in 4 (13.33%) and no or NR in 3 (10%) patients. CR in distant warts in 22 (73.33%) patients in Group A and 20 (66.66) patients in Group B. Conclusion: Both MMR vaccine and Vitamin D3 are safe, efficacious, and less traumatic to the patients for multiple warts in comparison with destructive modalities.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"136 - 143"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43213002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Krishnan, B. Sarojam, R. Chandran, R. S. Jyothykrishna
{"title":"A case of post-COVID Bullous henoch–Schönlein purpura with cardiac involvement in an 11-year-old boy","authors":"R. Krishnan, B. Sarojam, R. Chandran, R. S. Jyothykrishna","doi":"10.4103/ijpd.ijpd_27_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_27_22","url":null,"abstract":"","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"193 - 194"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46899688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infantile systemic hyalinosis (ISH) is an extremely rare disorder inherited in an autosomal recessive manner. The syndrome clinically presents with multiple joint contractures with chronic severe pain, papulonodular skin lesions, hypotonia, gingival enlargement, developmental delay, and systemic manifestations. In this case report, we present the case of a 21-month-old Indian girl with ISH. This case demonstrates that ISH, though rare, should be considered in differential diagnosis in patients with subcutaneous nodules and raised lesions on the face and neck.
{"title":"Infantile systemic hyalinosis: A clinical masquerader for clinicians","authors":"C. Garg, Brijesh Parmar, Y. Patel","doi":"10.4103/ijpd.ijpd_56_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_56_22","url":null,"abstract":"Infantile systemic hyalinosis (ISH) is an extremely rare disorder inherited in an autosomal recessive manner. The syndrome clinically presents with multiple joint contractures with chronic severe pain, papulonodular skin lesions, hypotonia, gingival enlargement, developmental delay, and systemic manifestations. In this case report, we present the case of a 21-month-old Indian girl with ISH. This case demonstrates that ISH, though rare, should be considered in differential diagnosis in patients with subcutaneous nodules and raised lesions on the face and neck.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"147 - 149"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43519725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To identify the spectrum of cutaneous manifestations and to evaluate temporal relationship between each type of dermatological lesions and the severity of COVID-19-related illness in the pediatric population. Subjects and Methods: Retrospective observational study on 35 children (upto12 years) from Kolkata and different district areas of West Bengal, admitted to our tertiary care hospital with COVID-related illnesses (COVID-19 and/or multisystem inflammatory syndrome in children [MIS-C]). Results: Maculopapular rash was heading the list (n = 18, 51.4%) followed by chilblain-like lesions (n = 12, 34.2%), vasculistic lesion (n = 8, 22.8%), vesicular rash (n = 5, 14.3%), and urticaria (n = 3, 8.5%). In majority of patients (n = 26, 74.2%), dermatologic manifestations proceeded (n = 16, 45.7%) or merged (n = 10, 28.6%) with the onset of systemic symptoms. In rest of the patients (n = 9, 25.7%), skin manifestations occurred after the systemic symptoms, particularly in vascular lesions. 57.1% children required pediatric intensive care unit (PICU) admission. All children with vasculitis (n = 8) required PICU admission and 87.5% (n = 7) of them needed inotrope support. Intravenous immunoglobulin (IVIG) was mostly given in children with chilblains (n = 11, 92%). Methylprednisolone and repeat dose of IVIG was mostly needed in patients with vasculitis (75% and 25% of vasculitis children, respectively). The duration of PICU stay was least in patients with vesicular rash (4.4 ± 2.5 days) and longest in vasculistic lesions (18.75 ± 1 days), highest being 56 days. The overall mortality rate among MIS-C patients with cutaneous manifestations was 25.7% (n = 9) while patients with vasculistic lesions had the highest mortality rate of 50% (n = 4). Conclusion: Our study finding reveals that COVID-related disease severity is highly depends on the type of skin lesions but not just on mere occurrence of skin manifestations. Lesions such as maculopapular, chilblains, and vesicular rash had good prognosis and urticaria and vasculitis had poor prognosis.
{"title":"Dermatological manifestations in COVID-Related illness in children: A retrospective observational study at a tertiary care hospital of Eastern India","authors":"Radheshyam Purkait, Kakali Roy, Nivedita Manna, M. Samanta, Tapan Sinha Mahapatra","doi":"10.4103/ijpd.ijpd_35_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_35_22","url":null,"abstract":"Objectives: To identify the spectrum of cutaneous manifestations and to evaluate temporal relationship between each type of dermatological lesions and the severity of COVID-19-related illness in the pediatric population. Subjects and Methods: Retrospective observational study on 35 children (upto12 years) from Kolkata and different district areas of West Bengal, admitted to our tertiary care hospital with COVID-related illnesses (COVID-19 and/or multisystem inflammatory syndrome in children [MIS-C]). Results: Maculopapular rash was heading the list (n = 18, 51.4%) followed by chilblain-like lesions (n = 12, 34.2%), vasculistic lesion (n = 8, 22.8%), vesicular rash (n = 5, 14.3%), and urticaria (n = 3, 8.5%). In majority of patients (n = 26, 74.2%), dermatologic manifestations proceeded (n = 16, 45.7%) or merged (n = 10, 28.6%) with the onset of systemic symptoms. In rest of the patients (n = 9, 25.7%), skin manifestations occurred after the systemic symptoms, particularly in vascular lesions. 57.1% children required pediatric intensive care unit (PICU) admission. All children with vasculitis (n = 8) required PICU admission and 87.5% (n = 7) of them needed inotrope support. Intravenous immunoglobulin (IVIG) was mostly given in children with chilblains (n = 11, 92%). Methylprednisolone and repeat dose of IVIG was mostly needed in patients with vasculitis (75% and 25% of vasculitis children, respectively). The duration of PICU stay was least in patients with vesicular rash (4.4 ± 2.5 days) and longest in vasculistic lesions (18.75 ± 1 days), highest being 56 days. The overall mortality rate among MIS-C patients with cutaneous manifestations was 25.7% (n = 9) while patients with vasculistic lesions had the highest mortality rate of 50% (n = 4). Conclusion: Our study finding reveals that COVID-related disease severity is highly depends on the type of skin lesions but not just on mere occurrence of skin manifestations. Lesions such as maculopapular, chilblains, and vesicular rash had good prognosis and urticaria and vasculitis had poor prognosis.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"129 - 135"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44392076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Onychomycosis (OM) is common in adults but extremely rare in healthy infants. Here, we describe OM caused by Candida albicans and Trichophyton rubrum in two healthy and nonimmunocompromised infants. Multiple fingernails and toenails were involved in the form of onycholysis and yellowish discoloration in a 4-week-old neonate, whereas a 6-month-old infant presented with distal and lateral subungual type of OM. The diagnosis was established in both cases by the direct microscopic examination and fungal culture from nail scrapings. The infant with Candida OM responded to topical amorolfine with complete recovery within 3 months, while the case with T. rubrum OM was put on itraconazole pulse therapy for 3 months in the dosage of 5 mg/kg/day. We reported these cases for rarity of OM in infants, very young age of onset and multiple nail involvement in immunocompetent infants.
{"title":"Onychomycosis involving multiple nails in healthy infants - Uncommon but emerging fungal infection","authors":"A. Negi, S. Kumari, G. Verma, S. Verma","doi":"10.4103/ijpd.ijpd_43_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_43_22","url":null,"abstract":"Onychomycosis (OM) is common in adults but extremely rare in healthy infants. Here, we describe OM caused by Candida albicans and Trichophyton rubrum in two healthy and nonimmunocompromised infants. Multiple fingernails and toenails were involved in the form of onycholysis and yellowish discoloration in a 4-week-old neonate, whereas a 6-month-old infant presented with distal and lateral subungual type of OM. The diagnosis was established in both cases by the direct microscopic examination and fungal culture from nail scrapings. The infant with Candida OM responded to topical amorolfine with complete recovery within 3 months, while the case with T. rubrum OM was put on itraconazole pulse therapy for 3 months in the dosage of 5 mg/kg/day. We reported these cases for rarity of OM in infants, very young age of onset and multiple nail involvement in immunocompetent infants.","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"144 - 146"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biotin deficiency mimicking zinc deficiency in an infant with normal serum zinc levels","authors":"A. Rao, M. Naresh, B. Sindhuja, B. Pranaya","doi":"10.4103/ijpd.ijpd_67_22","DOIUrl":"https://doi.org/10.4103/ijpd.ijpd_67_22","url":null,"abstract":"","PeriodicalId":13275,"journal":{"name":"Indian Journal of Paediatric Dermatology","volume":"24 1","pages":"195 - 198"},"PeriodicalIF":0.2,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49521940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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