Biomedical subjects
J E Rasmussen
Publications and source records attributed to J E Rasmussen.
Skeletal abnormalities of acrogeria, a progeroid syndrome.
We report the skeletal abnormalities in a 4 1/2-year-old boy with acrogeria, a progeroid syndrome of premature aging of the skin without the involvement of internal organs seen in Hutchinson-Gilford progeria syndrome. Acro-osteolysis of the distal phalanges, delayed cranial suture closure with wormian bones, linear lucent defects of the metaphyses, and antegonial notching of the mandible are the predominant skeletal features of the disorder. The skeletal features described in 21 other reported cases of acrogeria are summarized.
Alopecia areata, endocrine function, and autoantibodies in patients 16 years of age or younger.
Forty-five children with alopecia areata were prospectively studied by means of both clinical and laboratory evaluation for evidence of endocrine diseases and autoantibodies. Twenty-four percent had an abnormality as determined by one or more thyroid function studies (thyroxine, triiodothyronine, and thyroid-stimulating hormone) and/or elevation of microsomal antibody levels. In 16%, smooth muscle antibody was present, and in 4%, parietal cell antibody was present. Routine thyroid function testing is recommended for all children with alopecia areata.
Extensive congenital erosions and vesicles healing with reticulate scarring.
We describe two children with extensive erosions and vesicles at birth that healed with reticulate scarring. These add to the three other cases reported previously. Our two patients also have extensive neurologic deficits, which may represent another feature of this syndrome. Possible causes are discussed.
Perilesional linear atrophic streaks associated with intralesional corticosteroid injections in a psoriatic plaque.
Perilymphatic atrophy can be a complication of intralesional corticosteroid injections given for the treatment of conditions such as psoriasis, alopecia areata, and keloids, and intraarticular corticosteroid injections given in diseases such as rheumatoid arthritis. It may become manifest as perilesional linear, depigmented, atrophic streaks, which are usually most prominent in patients with dark-colored skin.
Classification of diaper dermatitis: an overview.
Several types of diaper dermatitis are discussed: generic diaper dermatitis is most common and involves a simple erythema and mild scaling of the gluteal crease, buttocks, thighs, and lower abdomen. Candidal diaper dermatitis involves clinically significant infection with Candida albicans and presents as a sharply marginated area of erythema with significant involvement of the anterior thighs, genital creases, abdomen, and genitalia. Noduloulcerative diaper dermatitis may develop in a small percentage of patients who have chronic diaper dermatitis, as large, raised erosions with rolled margins. The lesions are most noticeable on the prominent body parts-genitalia, abdomen, thighs, and buttocks. Infantile seborrheic dermatitis involves a distinctive pattern of inflammation that usually begins beneath the diaper as a sharply marginated area of erythema with satellite lesions. Within 1-2 weeks, lesions develop on the scalp, cheeks, arms, legs, and intertriginous parts of the body. Impetigo is common in the diaper area, particularly in the first 6 months of life and during the warmer summer season. The lesions are usually bullous and represent infection by Staphylococcus aureus. Folliculitis appears as small, perifollicular erythematous papules and pustules, usually on the buttocks, thigh and lower abdomen. It is common in the warm summer months and is usually caused by bacteria such as S. aureus. Intertrigo categorizes disease that does not fit into the above categories. Often the patient presents with simple erythema of the folds without pustules or induration. This probably represents irritation and low-grade infection. It is important for the clinician to be aware that many other diseases can have manifestations in the diaper area.(ABSTRACT TRUNCATED AT 250 WORDS)
Bacteriology of pustules occurring during treatment of psoriasis.
Pustular lesions developed in 16% of our psoriatic inpatients treated with a modified Goeckerman regimen. The role of bacterial infection in the development of these lesions remains controversial. Representative lesions were cultured, and the recovered organisms were quantitated. We were not able to culture a significant number of bacteria from these lesions. Pustules were prone to develop during the summer months in hirsute patients, in patients with hyperhidrosis, and in patients in whom topical treatment of a more occlusive nature was applied. The male-female ratio was 4.8:1. Topical antibiotic treatment of these pustules in psoriatic patients appeared to be unwarranted since the lesions resolved when topical therapy was discontinued. These pustules appeared to be distinct from pustular psoriasis.
Lipoatrophic panniculitis: a possible autoimmune inflammatory disease of fat. Report of three cases.
We observed three children with a clinically similar presentation of erythematous nodules that expanded centrifugally leaving lipoatrophy. Areas of lipoatrophy coalesced, resulting in clinical pictures similar to partial or total lipodystrophy. Histologic study revealed a lobular panniculitis with a mixed infiltrate of lymphocytes and mononuclear phagocytes. Of these three children, one had insulin-dependent diabetes mellitus and Hashimoto's thyroiditis, one developed juvenile rheumatoid arthritis, and the third developed insulin-dependent diabetes mellitus, suggesting that the pathogenic mechanism may be an expression of autoimmunity.
Multiple mesoectodermal defects in an infant. Focal dermal hypoplasia syndrome, or Goltz' syndrome.
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Hair abnormalities and a rash with a double-edged scale. Netherton's syndrome.
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Subcutaneous fat necrosis in an infant, occurring after hypothermic cardiac surgery. Case report and analysis of etiologic factors.
A female infant developed extensive subcutaneous fat necrosis 3 weeks following induced hypothermia used as an adjuvant in cardiac surgery. All lesions resolved without sequelae within 4 months. In this article we discuss the various causes of panniculitis in infants and the relevance of each cause to our patient. We believe that an underlying defect in composition and metabolism of fat, coupled with a variety of exogenous and endogenous stresses, can precipitate subcutaneous fat necrosis in infants. These stresses include physical trauma (e.g., hypothermia), poor nutrition, infection, and metabolic abnormalities.
Diet and atopic dermatitis.
Prevention or modification of the onset of atopic dermatitis has been difficult to document through prolonged breast feeding or delayed introduction of solid foods. Dietary management of established atopic dermatitis is not routinely indicated for the majority of patients. Dietary management of atopic dermatitis should not be continued indefinitely. Gradual reintroduction of the offending food(s) is often appropriate. The foods most commonly avoided in the management of atopic dermatitis are cow's milk, wheat, eggs, and nuts. Severe or prolonged dietary restrictions should not be instituted without full consideration of their impact on the patient's general health.
Pediculosis: treatment and resistance.
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A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster.
We compared the usefulness of the Tzanck smear to viral culture in patients with varicella and herpes zoster. All 11 patients with early lesions of varicella had a positive Tzanck preparation, while only seven (64%) of 11 had a positive culture. Twelve (80%) of 15 patients with zoster had a positive Tzanck preparation, while only nine (60%) of 15 had a positive culture. The predominance of the Tzanck yield over the culture is probably due to the increased difficulty in isolation of the varicella zoster virus. These results suggest that the Tzanck preparation is a valuable tool in the diagnosis of patients with varicella and zoster and offers a much more immediate answer than does viral culture, which often takes one to two weeks. These results contrast with those of our previous study of the Tzanck preparation and herpes simplex, in which the viral culture was more accurate than the Tzanck preparation.
Atrichia with papular lesions.
We report a case of atrichia with papular lesions in association with common variable immunodeficiency in an 11-year-old boy. There were identical findings in the patient's father. This rare variant of ectodermal dysplasia typically presents with shedding of normal fetal hair within the first three months. Eyelashes are typically spared. Numerous keratin-filled follicular cysts develop over extensive areas of the skin, usually between the age of 2 and 26 years. These lesions are most numerous on the face, neck, scalp, and extremities. Teeth and nails are entirely normal in these patients. The mode of inheritance of atrichia with papular lesions is uncertain. Our case suggests an autosomal-dominant inheritance pattern, while previous reports have shown autosomal recessive inheritance pattern.
Psoriasis in children.
Psoriasis in children 16 years of age and younger is common. Frequently the disease is associated with a positive family history and often appears as acute guttate psoriasis. Acute guttate psoriasis is seen commonly after streptococcal infection of the upper respiratory tract, but may be associated with other viral and bacterial diseases as well. Acute guttate psoriasis responds well to treatment but often recurs as more typical small- or large-plaque disease. The treatment of childhood psoriasis should be simple and, if the disease is significant, carried out in the hospital. Results are much more impressive in hospitalized patients than in outpatient settings. Topical corticosteroids should be used only for short periods of time, whereas tar, ultraviolet light, and anthralin have much longer beneficial effects.
Multiple areas of localized tissue loss in a child. Atrophic connective tissue panniculitis.
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