Pediatric Dermatology最新文献

Jarisch-Herxheimer (JH) reaction is a known side effect involving the worsening of pre-existing skin lesions accompanied by systemic symptoms such as fever, chills, headache, and myalgias. This reaction typically occurs following the initiation of anti-syphilitic therapy but has also been reported with other antimicrobial therapies, such as those for leptospirosis. This case describes the occurrence of a JH-like reaction after the first intake of griseofulvin for the treatment of tinea capitis in a 14-year-old patient. Due to the rarity of the case, the purpose of this report is to raise awareness of the potential for such reactions with systemic antifungal therapies and to provide guidance on their management.

A 14-year-old boy was initially diagnosed with erosive oral lichen planus based on clinical and histopathological findings. However, the atypical clinical course and resistance to immunosuppressive therapy raised suspicion for an autoinflammatory disorder or inborn error of immunity. Genetic testing revealed a pathogenic SH2D1A mutation, confirming X-linked lymphoproliferative disease type 1 (XLP-1) in the absence of Epstein-Barr virus exposure. This case highlights oral mucosal lesions as a potential early, EBV-independent manifestation of XLP-1 and emphasizes the importance of considering monogenic immune disorders in persistent, treatment-refractory mucosal disease.

Social media are increasingly being used as a source of health information. We conducted an online, anonymous survey to learn how caregivers are interacting with social media and how this may impact their child's dermatologic care. There were 136 participants who started the survey and 97 who completed it (71.3% completion rate). The most common skin conditions participants sought information for were atopic dermatitis, 48% (47); acne, 40% (39); and dry skin care, 35% (34). Our results also found that participants of lower socioeconomic status use social media for skin care management more often (p < 0.01), highlighting the importance of providing reliable content on social media.

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in school-aged children. Various cutaneous reactions to M. pneumonia have been described, including reactive infectious mucocutaneous eruption, morbilliform eruptions, and vasculitis. This study highlights two cases of Mycoplasma infection that presented with a morbilliform eruption and had clinical and laboratory findings similar to drug reaction with eosinophilia and systemic symptoms (DRESS), a pattern not well documented in the literature, and emphasizes the clinical manifestations that help distinguish between these conditions.

Erosive lichen planus is a rare but severe variant of lichen planus with the potential for significant morbidity. We report a 7-year-old girl with complete vaginal stenosis secondary to erosive lichen planus. Early initiation of systemic corticosteroids and methotrexate resulted in complete resolution. This case underscores the importance of prompt recognition and aggressive management to prevent irreversible scarring.

Background/objectives: Lichen sclerosus (LS) is a chronic autoimmune inflammatory skin disease predominantly affecting the anogenital area that can be mistaken for non-accidental trauma (NAT) in pediatric patients, such as sexual abuse. Such misdiagnoses can be distressing for families. This systematic review examined pediatric patients investigated for both LS and NAT to provide clinicians with guidance on distinguishing these conditions.

Methods: MEDLINE, Embase, and Web of Science were searched. Retrospective studies, case series, and case reports describing pediatric patients investigated for both LS and NAT were included. Descriptive statistics were used to analyze data due to heterogeneity in study designs and reporting.

Results: Of 113 studies identified, 25 studies encompassing 146 patients were included. The suspected NAT was sexual abuse in all cases (N = 146). The final diagnosis was LS in 130 patients (89.0%), and LS and sexual abuse in 16 patients (11.0%). Patients who experienced sexual abuse often had known offenders in their families (n = 6/13) and displayed withdrawn or hypersexualized behavior (n = 2/13, unreported in n = 3/16), while those without abuse exhibited age-appropriate behavior (n = 8/41) and denied sexual abuse (n = 6/41) and demonstrated positive interactions with caregivers (n = 4/41, unreported in n = 89). On exam, hymenal disruption or scarring (n = 8/13) was more common in abused patients, whereas those without abuse typically lacked trauma to the hymen (n = 27/41) or anus (n = 10/41).

Conclusions: LS and sexual abuse may co-occur. Careful assessment of patient behaviors, home environment, and anogenital findings is crucial to avoid misdiagnoses that may be distressing for families. Limitations include small sample size, and lack of statistical comparisons.

A 15-year-old female with a longstanding, unresectable intracerebral arteriovenous malformation (AVM) involving the bilateral thalami and basal ganglia presented with progressive neurologic decline. Given the inaccessibility of the intracranial lesion, a lipomatous scalp nodule overlying the AVM was biopsied for molecular testing and revealed a somatic mosaic KRAS p.G12D variant, the most common variant detected in sporadic brain AVMs. Targeted therapy with the MEK inhibitor trametinib was initiated, but the treatment course was complicated by cutaneous toxicity and ongoing neurologic deterioration. This case illustrates that extracranial tissue in the skin can serve as a surrogate for molecular diagnosis in unresectable brain AVMs, underscoring the diagnostic and therapeutic importance of dermatologic assessment in complex vascular anomalies.

Psychiatric comorbidities associated with dermatological diseases, particularly in pediatric populations, are relatively understudied compared to psychiatric comorbidities of other chronic diseases. Research suggests that skin conditions in adolescence often co-occur with mental health difficulties, including heightened risk for suicide. Dermatologists play a vital role as early identifiers of suicidal thoughts and behaviors (STB) for their adolescent patients. Currently, there are no recommendations for screenings or assessments related to suicide risk in dermatologic settings. We provide evidence-based tools that can be helpful for STB assessment and highlight clinical pearls for increasing comfort when suicidal thoughts or behaviors occur in the pediatric dermatologist's office.

Giant cell fibroblastoma (GCF) is a rare predominantly pediatric tumor with frequent local recurrence that has clinical and histological similarities with DFSP. We conducted a literature review of published pediatric GCF cases to review demographics, management and outcomes. We identified 104 pediatric GCF cases from 52 articles, of which 81 were treated with excision of unspecified margins (EUM), 17 with wide local excision (WLE), two with Mohs micrographic surgery (MMS), and one with chemotherapy. Local recurrence was noted in 38/104 (36.5%); given the high recurrence rates of GCF following excision, and the advantages of MMS in treating DFSP, MMS is an important consideration for GCF when logistically possible.