Pediatric Dermatology最新文献

Food insecurity (FI) presents unique challenges for individuals with food allergies (FA) and atopic dermatitis (AD), conditions that often encompass tailored dietary management and medical care. Limited access to safe, nutritious foods exacerbates symptoms and complicates disease management, leading to poorer health outcomes and increased healthcare costs. This review explores the complex relationship between FI, FA, and AD, focusing on the challenges faced by affected individuals and identifying potential strategies for reducing disparities. The intersection of FI, FA, and AD creates barriers to disease management, increasing the risk of allergic reactions and disease flares due to limited access to allergen-free foods and over-the-counter topical emollients. Financial strain forces individuals to consume cheaper, less nutritious foods and limit emollient use, worsening health outcomes. Nutritional deficiencies and psychological stress from managing multiple conditions further exacerbate both FA and AD, underscoring the need for multi-level solutions. Public health policies should address these issues by improving access to allergen-free foods and reducing associated financial burdens. This review highlights the bidirectional relationship between FI, FA, and AD and calls for integrated interventions to address both immediate nutritional needs and long-term disease management. Further research is needed to understand the mechanisms linking FI to allergic diseases and to develop strategies to mitigate these risks.

Infantile digital fibroma (IDF) is a benign tumor of myofibroblasts occurring in infancy and early childhood. IDF occurs almost exclusively on the digits and presents as a firm, red or flesh-colored nodule. We describe an atypical case of IDF presenting on the lateral heel that was excised due to obstruction of gait and normal development. The case illustrates that IDF can present outside of the digits and highlights specific treatment considerations that must be taken at this location.

This retrospective study of 110 pediatric patients with psoriasis identified significant age-related variations in the clinical presentation and key predictors of remission. The prevalence of chronic plaque psoriasis increased with age, whereas guttate psoriasis, which is strongly associated with elevated ASO titers, was more common in younger children. The median time to remission progressively increases with age. Older age (≥ 11 years), chronic plaque morphology, higher baseline PASI scores (≥ 10), and nail involvement were independent predictors of longer time to remission. Conversely, biologic therapy and methotrexate were associated with a shorter time to remission. The findings of this study suggest that high-risk pediatric patients should be identified and treated with early systemic therapy.

Cutaneous Rosai-Dorfman disease (CRDD) is a rare non-Langerhans cell histiocytosis that mimics various granulomatous and neoplastic dermatoses, often leading to misdiagnosis. We report an 18-year-old male with a 13-year history of progressively enlarging erythematous plaques over the nasal bridge and right forearm, initially diagnosed as granulomatous inflammation. Histopathological examination revealed emperipolesis only after meticulous serial sectioning, and immunohistochemistry confirmed the diagnosis of CRDD. This case underscores the diagnostic challenges of CRDD, particularly in regions endemic for tuberculosis and leprosy, and highlights the importance of thorough histopathological and immunohistochemical evaluation in differentiating it from other dermatoses.

Proteus syndrome (PS) is a rare genetic disorder caused by mosaic AKT1 mutations, leading to progressive and asymmetric overgrowth. We report a mildly symptomatic 12-year-old male with left lower limb overgrowth and an epidermal nevus, whose diagnosis was confirmed through molecular diagnostics. Targeted NGS identified the pathogenic AKT1 c.49G>A mutation in affected tissues, supporting the diagnosis despite the absence of hallmark features like cerebriform connective tissue nevus. This case highlights the importance of genetic testing in subtle presentations of PS, enabling early diagnosis, monitoring, and intervention to mitigate potential complications.

Background: Upper-facial capillary malformation (CM) may be concerning for Sturge-Weber syndrome (SWS). Use of screening magnetic resonance imaging (MRI) for neuroradiographic findings of SWS is controversial. MRI within a few months of life may allow for prompt reassurance, preventive treatments, and avoidance of contrast and sedation. However, false-negative MRI before 1 year of age has been reported. We examined the ability of early MRI to predict seizure development in infants with upper-facial CM.

Methods: Infants with forehead or temple CM presenting to the Sturge-Weber Clinic at Boston Children's Hospital from 2012 to 2022 were identified. The records were reviewed for clinical features and for findings from MRI performed before 1 year of age (MRI 1) and repeated around or after 2 years of age (MRI 2). Patients with seizures before MRI 1 or with a diagnosis of nevus simplex were excluded.

Results: Thirty-three patients with forehead or temple CM without seizures before MRI 1 were identified. MRI 1 was abnormal in 20/33 and normal in 13/33. Fourteen of 20 patients with abnormal MRI 1 developed seizures. Of the 13 patients with normal MRI 1, 11 underwent MRI 2. In patients with MRI 2, 3/11 developed SWS-related abnormalities, but none (0/11) developed seizures. The remaining 2 patients with normal MRI 1 also did not develop seizures. Mean follow-up age was 6.1 years (0.83-15 years).

Conclusion: Early, high-quality non-contrast 3 T MRI may screen for seizure development in infants with upper-facial CM.

Background: Although essential for overall health and wellbeing, little is known about skin health in urban-living Australian Aboriginal children. This co-designed, research-service project aimed to describe skin health and document skin disease frequency in urban-living Aboriginal children and young people (CYP, i.e., 0-18 years) in Western Australia (WA) and investigate housing associations for skin infections.

Methods: Cross-sectional studies were conducted at Aboriginal Community Controlled Health Organizations in Bunbury and Perth, WA, over 2 weeks in September-October 2022. Aboriginal CYP were eligible to participate. Questionnaire responses and examination findings were analyzed.

Results: Of the 164 CYP recruited, 149 (91%) were urban-living Aboriginal CYP. Fifty-three percent (78/148) of caregivers described a dermatological concern in their child; with high caregiver diagnostic accuracy for impetigo (96%), tinea (92%), and atopic dermatitis (AD) (89%). AD (18%, 26/147), head lice (18%, 27/147), tinea (12%, 18/147) and impetigo (7%, 10/147) were most prevalent. Social housing predicted current head lice (odds ratio [OR] 4.63; 95% confidence interval [CI] 1.72-12.50), current tinea (OR 3.15; 95% CI 1.06-9.36) and ever impetigo (2.39; 95% CI 1.09-5.27). Crowded living conditions predicted ever impetigo (OR 6.28; 95% CI 2.03-19.37); whereas frequent bathing (p value 0.032) and regular swimming in a chlorinated pool (OR 0.12; 95% CI 0.02-0.95) were protective.

Conclusions: We report high caregiver diagnostic accuracy for skin conditions. AD is prevalent, with undertreatment, frequent impetiginization, and sleep disturbance indicating barriers to care. Healthcare providers must advocate for improved housing, as the link between skin infections and socioeconomic disadvantage impacts overall health for urban-living Aboriginal CYP.

Two 4-week, phase 2, open-label, maximal usage pharmacokinetic (PK) and safety studies of once-daily roflumilast cream 0.3% (a potent phosphodiesterase 4 inhibitor) were conducted in children aged 2-5 years and 6-11 years with psoriasis. Evidence of systemic exposure to roflumilast and its active N-oxide metabolite was seen in most patients following daily application, consistent with previous studies. Under maximal use conditions, once-daily roflumilast cream 0.3% was well tolerated and improved signs and symptoms of psoriasis in children aged 2-11 years, consistent with phase 3 results in adults and adolescents. Trial Registration: Clinicaltrials.gov listing: 215: NCT04655313; 216: NCT04746911.