Vascular Lesions

Vascular lesions in childhood are comprised of vascular tumors and vascular malformations. Vascular tumors encompass neoplasms of the vascular system, of which infantile hemangiomas (IHs) are the most common. Vascular malformations, on the other hand, consist of lesions due to anomalous development of the vascular system, including the capillary, venous, arterial, and lymphatic systems. Capillary malformations represent the most frequent type of vascular malformation. IHs and vascular malformations tend to follow relatively predictable growth patterns in that IHs grow then involute during early childhood, whereas vascular malformations tend to exhibit little change. Both vascular tumors and vascular malformations can demonstrate a wide range of severity and potential associated complications necessitating specialist intervention when appropriate. Evaluation and treatment of the most common types of vascular lesions are discussed in this article. [Pediatr Ann. 2016;45(8):e299-e305.]

Serious Complications from Staphylococcal aureus in Atopic Dermatitis

Colonization with Staphylococcal aureus is markedly more frequent in individuals with atopic dermatitis (AD) than in unaffected individuals. Chronic scratching leads to worsening of an existing defect in the epidermal barrier, which can allow S. aureus invasion into the bloodstream and subsequent systemic infections. We report two unusual cases of systemic illness in individuals with AD. One developed infective endocarditis followed by a stroke and the other developed septic arthritis and osteomyelitis. We performed an extensive literature review of reported systemic complications caused by S. aureus in patients with AD. Although reports are rare, practitioners should be aware of these important, albeit unlikely, complications of staphylococcal superinfections in individuals with AD

Common Neonatal Rashes

Skin eruptions are commonly encountered in the neonatal and infant period and can be a source of concern for providers and parents alike. We present a brief, clinically focused discussion on topics commonly encountered by the pediatrician with a focus on pearls of knowledge to help distinguish diseases from one another and from more serious conditions. We review miliaria, transient neonatal pustular melanosis, neonatal cephalic pustulosis, erythema toxicum neonatorum, diaper dermatitis, seborrheic dermatitis, and atopic dermatitis. Treatment strategies are also discussed. [Pediatr Ann. 2019;48(1):e16-e22.]

Pediatric lichen sclerosus: A retrospective series

Objective: Lichen sclerosus (LS) is a chronic inflammatory disease of the skin that most commonly affects the anogenital area. Approximately 7%to 15% of cases affect children (1, 2). The estimated rate of extragenital LS in adults and children with anogenital involvement is 15-20%(3). We hypothesized that the prevalence of extragenital LS in patients with anogenital symptoms is higher in children than previously estimated. Methods: We conducted a retrospective chart review of pediatric patients with LS over the past 4 years; 12 cases were found. Results: Extragenital LS was diagnosed clinically and/or histologically in 7 of our 12 patients with LS. None of our patients had sole extragenital involvement. Conclusion: The prevalence of extragenital LS with anogenital lesionsmay be higher in children than previously reported

Molluscum Contagiosum: Review and Update on Clinical Presentation, Diagnosis, Risk, Prevention, and Treatment

Purpose of Review: Molluscum contagiosum (MC) is a self-limited cutaneous viral infection that most commonly affects children and immunocompromised populations. This review provides an update on the clinical manifestations, risk, diagnosis, treatment, and prevention of this frequently encountered infection. Recent Findings: A recent Cochrane review concluded that there is insufficient evidence to establish the superiority of any specific treatment modality or to confirm that active intervention is superior to benign neglect (van der Wouden JC et al., Cochrane Database Syst Rev 5:CD004767, 2017). Interim pilot study data suggests that cantharidin outperforms placebo (Guzman AK et al., Int J Dermatol 57:1001–1006, 2018). Imiquimod is no longer recommended for treatment of MC (van der Wouden JC et al., Cochrane Database Syst Rev 5:CD004767, 2017; Papadopoulos EJ, https://www.fda.gov/files/drugs/published/N20-723S020-Imiquimod-Clinical-BPCA.pdf, 2006; Katz KA et al., Pediatr Dermatol 35:282–283, 2018). Summary: Optimal management strategies for MC remain unclear due to the multitude of proposed therapies, lack of high-quality evidence, and uncertain benefit of intervention for uncomplicated disease. Aside from watchful waiting, destructive therapies such as cantharidin and curettage are among the best studied methods and remain the treatment of choice for most patients

Sleep-related rhythmic movement disorder: A case report of head banging alopecia

We present a case of alopecia associated with sleep-related rhythmic movement disorder (RMD) in an otherwise healthy 2-year-old boy. The alopecic patch he presented with on his scalp coincided with the location of repeated head banging in a video taken by the patient\u27s mother. Alopecia secondary to RMD is an under recognized entity and should be included in the differential diagnosis of pediatric alopecia

Harlequin ichthyosis

Harlequin ichthyosis is a rare, severe formof ichthyosis, which presents at birth. The neonate is encased in an \u27\u27armor\u27\u27 of thick scaly plates separated by deep fissures. As the skin barrier is severely compromised, neonates are more prone to sepsis, dehydration, and impaired thermoregulation, leading to a worldwide mortality close to 50%. We describe a case of a 35-week-old Lebanese female, born to a 26-year-old G1P1 mother via vaginal delivery. She presented at birth encased in thick, shiny, scaly plates separated by deep, erythematous fissures. The presence of ectropion (eversion of eyelids) placed the conjunctivae and cornea at risk for trauma and desiccation. Eclabium (outward eversion of lips) was noted, and the mouth was fixed open, making it difficult to feed orally. Her nose and ears were flattened. Her limbs were encased in thick hyperkeratotic skin, resulting in flexion contractures of the arms, legs, and digits. Her parents denied consanguinity and family history of ichthyotic disorders. Antenatal ultrasound at 30 weeks\u27 gestation showed ectropion, eclabium, and flexion contractures at the wrists and elbows. Amniocentesis performed at 30 weeks\u27 gestation and genetic testing showed homozygous mutation in ABCA12 gene for sequence variant defined as c.3882G \u3e A. Immediately after birth, the patient was taken to the NICU for hydration with IV fluids through an umbilical catheter, feeding, and multidisciplinary management. Treatment was largely supportive, with frequent emollient use and dilute bleach baths. The patient began to spontaneously shed her thick, keratotic crust during the first month of life and is progressing to a phenotype resembling congenital ichthyosiform erythroderma. Because oral retinoids in treatment of harlequin ichthyosis in the NICU is highly controversial, they were not initiated in our patient. Treatments in the NICU and after discharge were mostly conservative with frequent emollient use, bleach, baths, and IV hydration. Our patient survived and completely shed her \u27\u27armor\u27\u27 without the use of retinoids. She continues to develop skin changes resembling severe nonbullous congenital ichthyosiform erythroderma

Capillary Malformations

Capillary malformations (CMs) are the most common vascular anomalies, composed of enlarged capillaries and venules with thickened perivascular cell coverage in skin and mucous membranes. These congenital anomalies represent an error in vascular development during embryogenesis. Most of the CMs occur without any syndromic findings; the association between CMs systemic anomalies in some patients, however, makes the recognition of additional syndrome features critical. Some genetic disorders discussed, which feature CMs, include Sturge-Weber syndrome, diffuse CMs with overgrowth, Klippel-Trenaunay syndrome, CLOVES syndrome, among others. This article can aid clinicians in better identifying CMs and associated syndromes and provide consistent terminology to facilitate interdisciplinary management