Seminars in dermatology最新文献

Autoimmune blistering diseases are relatively rare in children and adolescents. LADC and DH are the most often seen of these conditions and respond well to therapy. Some newly recognized diseases have been reported in children including localized vulvar pemphigoid, intraepidermal neutrophilic IgA dermatosis, and paraneoplastic pemphigus.

Neonatal lupus erythematosus (NLE) is a rare disorder characterized by congenital heart block and/or cutaneous disease and less commonly is associated with hepatic and hematological abnormalities. The majority of affected infants acquire Ro/SS-A (Ro) autoantibodies transplacentally from the maternal circulation and it is generally thought that these antibodies are pathogenic. Mothers at increased risk of having a child affected by NLE should be followed closely during pregnancy to detect the development of fetal heart block, as this is associated with significant morbidity and mortality. Mothers of affected infants are at increased risk of developing a rheumatic disease if they have not already done so.

Non-acquired immunodeficiency syndrome disorders in children frequently have cutaneous manifestations that allow initial diagnosis to be suspected by the dermatologist and require continuing dermatologic management. Many recent developments have occurred in understanding the underlying gene defects, diagnosis of patients and carrier mothers of X-linked disorders, prenatal diagnosis, and new means of therapy of selected inherited immunodeficiency disorders.

Aproximately 1% of the population will have had alopecia areata by the age of 50 and the peak incidence occurs in children and young adults. All body hair may be affected including lashes and brows. Alopecia areata is a systemic disease with frequent involvement of nails or eyes. Alopecia areata has been associated with atopic dermatitis, autoimmune disease, vitiligo, and endocrine disease. The pathogenesis is unclear. There is no excellent therapy for alopecia areata although many interventions are tried. Immunotherapy with diphenylcyprone is currently being optimistically evaluated. The harmful psychological effects of alopecia areata in children must be anticipated and prevented.

Pulsed dye laser therapy has revolutionized the treatment of benign vascular neoplasms of the skin. Treatment is safe and generally effective in children of all ages. Because of the pain associated with the treatment, special techniques are discussed that may minimize the physical and psychological traumas associated with treatment.

With the continued use of bone marrow transplantation in the treatment of malignancies, immunodeficiencies, and some metabolic diseases in children, it remains important for the dermatologist to be aware of the clinical and diagnostic features, and pathophysiology of Graft vs. Host disease. Specifically, the dermatologist should keep in mind that the skin is a primary site for involvement in this process. Recognition of the spectrum of cutaneous disease, its methods of laboratory diagnosis, and treatment should be known to those physicians caring for patients undergoing this type of therapy. A brief review of these and other aspects of Graft vs. Host disease is presented in this report.

Tinea capitis caused by Trichophyton tonsurans is a common infection in children, and has become a significant public health problem in the United States. Epidemics of tinea capitis occur both in families and in institutions such as schools and day care centers. Infection is often difficult to eradicate. Fomites and asymptomatic carriers likely contribute to the spread of the disease and to re-infection of treated patients. The morphology of tinea capitis is diverse, from seborrhea-like scaling to tender, inflammed nodules on the scalp. Because a lengthy course of systemic griseofulvin is required to treat this infection, management of tinea capitis can be challenging. As newer antifungal agents are developed, more effective and convenient therapy for tinea capitis may become available.