Prevalence and risk factors for vitamin D deficiency in children with iron deficiency anemia

PurposeThe increasing prevalence of breast feeding has led to concerns about vitamin D deficiency (VDD) and iron deficiency anemia (IDA) in children. We evaluated the prevalence of VDD in a population of Korean children with IDA and assessed the risk factors for VDD in these children.MethodsA total of 79 children who were diagnosed with IDA were prospectively surveyed from April 2010 to March 2011. Data were collected by questionnaire, medical assessment, and laboratory tests, including measurement of 25-hydroxyvitamin D (25OHD), hemoglobin, and wrist radiography.ResultsThe median age was 22 months and 30% of the subjects were female. Over a half of subjects (58%) had subnormal vitamin D level (25OHD<30 ng/mL), and VDD (25OHD<20 ng/mL) was present in 39% of children. There was no difference in serum hemoglobin level between IDA patients with VDD and those without VDD. Most subjects (89%) were currently or had recently been breastfed and almost all subjects (97%) who had VDD received breastfeeding. Children with VDD were more likely to be younger than 2 years, to have been breastfed, and to have been tested in winter or spring. Multivariable analysis indicated seasonal variation was a significant independent risk factor for VDD in our IDA patients.ConclusionOur results demonstrated that VDD has a high prevalence in Korean children with IDA. Primary care physicians should be aware of the possibility of VDD in children with IDA and should supplement the vitamin D as well as iron

Efficacy and safety of tretinoin 0.05% cream to prevent hyperpigmentation during narrowband UV-B phototherapy in patients with facial vitiligo: a randomized clinical trial

Background Narrowband UV-B (NBUVB) phototherapy is the mainstay of vitiligo treatment, but hyperpigmentation is one of the limitations. Meanwhile, topical tretinoin is effective against pigmentary disorders. Objective To determine whether tretinoin 0.05% cream would prevent hyperpigmentation when patients with facial vitiligo underwent phototherapy. Methods A randomized, controlled, split-face trial was conducted. Adult patients with stable, non-segmental facial vitiligo were enrolled. The left/right sides of the face were randomly allocated to receive either topical tretinoin 0.05% cream or moisturizer twice daily. The entire face was subjected to NBUVB phototherapy twice weekly for 12 weeks. The degree of hyperpigmentation was assessed as the delta L* (brightness) value of the darkest spot in each side of the face at baseline and every 4 weeks. The degree of repigmentation was assessed. Results Twenty-five patients were enrolled; 21 completed the study. The delta L* value was significantly different between the two groups: −0.5% in the tretinoin group and −8.7% in the control group at 12 weeks (p = .002). Marked repigmentation was achieved in 15 patients of both groups. Conclusions Tretinoin 0.05% cream prevented hyperpigmentation during NBUVB phototherapy in patients with facial vitiligo, and did not compromise the overall treatment response. Trial registration ClinicalTrials.gov NCT0393377

Iron and vitamin D status in breastfed infants and their mothers

PurposeWe assessed the relationships between iron and vitamin D statuses in breastfed infants and their mothers and evaluated the determinants of iron and vitamin D deficiencies in breastfed infants.MethodsSeventy breastfed infants aged 4-24 months and their mothers participated in this study from February 2012 to May 2013. Complete blood counts, total iron binding capacity, and levels of C-reactive protein, iron, ferritin, calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D (25(OH)D) in infants and their mothers were measured.ResultsA history of maternal prepregnancy anemia was associated with lower ferritin and 25(OH)D levels in both infants and their mothers. The 25(OH)D level of infants correlated with maternal 25(OH) D levels. The independent risk factors for iron deficiency in breastfed infants were the duration of breastfeeding (odds ratio [OR], 6.54; 95% confidence interval [CI], 1.09-39.2; P=0.04) and infant body weight (OR, 2.65; 95% CI, 1.07-6.56; P=0.04). The determinants for vitamin D deficiency were the infant's age (OR, 0.15; 95% CI, 0.02-0.97; P=0.046) and maternal 25(OH)D level (OR, 0.74; 95% CI, 0.59-0.92; P=0.01).ConclusionA maternal history of prepregnancy anemia requiring iron therapy was associated with lower current ferritin and 25(OH)D levels in both infants and their mothers. Therefore, physicians should monitor not only iron but also vitamin D levels in infants who are breastfed by mothers who had prepregnancy anemia

A Case of Post-Injury Angiokeratoma Circumscriptum of the Chest

Angiokeratomas represent vascular lesions and are histologically characterized by superficial vascular ectasia and overlying acanthosis and/or hyperkeratosis. Angiokeratomas can be classified into five types, with angiokeratoma circumscriptum representing the least common of the five types. Angiokeratoma circumscriptum presents at birth and frequently occurs unilaterally on the leg. Herein, we report a rare case of long term angiokeratoma circumscriptum (twelve years) on the right chest, discovered following the excision of a lipoma from the same area

A Case of Metastatic Squamous Cell Carcinoma Arising from Actinic Cheilitis

Actinic keratosis (AK) is a common, sun-induced, pre-malignant lesion with a strong likelihood of progressing to a malignancy. The reported risk of AK progressing to squamous cell carcinoma (SCC) varies from less than 1% to 20%. Clinically, induration, pain, large size, marked hyperkeratosis, ulceration, bleeding, rapid growth, and recurrence or persistence may be markers of AK progression into SCC. The risk of SCC metastasizing ranges between 0.5% and 3%. However, SCC of the lip arising from actinic cheilitis is more prone to metastasis than cutaneous SCC, with rates of the former varying between 3% and 20%. Here we report a typical case of SCC from actinic cheilitis with metastasis to the lymph nodes during a 4-year follow-up period. To exclude SCC, we emphasize the need for regular follow-up and prompt evaluation, including careful pathologic examination for actinic cheilitis