Disorders of transepidermal elimination. Part 1.
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Adolescent↗
Biomedical subjects
J E Rasmussen
Publications and source records attributed to J E Rasmussen.
Subungual osteocartilaginous exostosis.
Subungual exostosis arises underneath the nail plate, originating from the underlying bone. The characteristic appearance of this disorder may occasionally mimic a wide variety of tumors, including subungual verrucae, endochondroma, fibroma, or amelanotic melanoma. With such a wide variety of similar-appearing tumors, optimal treatment of this disorder clearly lies in proper recognition and treatment.
Child↗
Keratoderma hereditaria mutilans (Vohwinkel's syndrome): a trial of isotretinoin.
An 8-year-old girl with the classic findings of keratoderma hereditaria mutilans (Vohwinkel's syndrome) was seen. Treatment with isotretinoin was instituted to decrease the hyperkeratosis and to prevent further autoamputation. After a 12-week course at 2 mg per kg per day, the patient had only minimal decrease in the amount of hyperkeratosis. Because of the well-known long-term risks of systematic retinoids and her suboptimal improvement, therapy was discontinued.
Child↗
Juvenile linear scleroderma associated with serologic abnormalities.
We investigated 24 juvenile cases of linear scleroderma for the presence of systemic disease and serologic abnormalities. Thirteen of 24 patients had antinuclear antibodies (ANA) at titers of 1:40 or greater. Rheumatoid factor (titers greater than or equal to 1:20) was detected in seven of 17 patients tested, five of whom also had ANA. Two of five patients with ANA and rheumatoid factor had systemic diseases, such as nephritis and Raynaud's phenomenon. One patient with ANA developed typical dermatomyositis. Consequently, patients with linear scleroderma may be at some risk for developing systemic collagen-vascular diseases. On initial presentation, patients with linear scleroderma should give a complete history and receive a thorough physical examination as well as undergo laboratory evaluations for the presence of ANA and rheumatoid factor. Long-term observation with periodic reevaluation is appropriate for many members of this group.
Adolescent↗
The Tzanck smear in the diagnosis of cutaneous herpes simplex.
We examined the effectiveness of the Tzanck preparation compared with viral isolation in 32 lesions of cutaneous herpes simplex infection in 30 consecutive patients. Seventy-eight percent had positive cultures, even though the clinical history and lesion morphological findings were typical in all situations. Other authors have also noted that viral isolation does not reach 100% even in the face of typical clinical history. Fifty-three percent of the Tzanck smears were positive. These preparations had a high correlation with positive viral cultures (94.1%). Vesicles were more likely to yield a positive culture than Tzanck smear (100% and 66.7%, respectively). Pustules yielded positive cultures in 72.8% and positive Tzanck smears in 54.5%, while crusted-ulcer lesions were usually not positive by either technique (34%, 16%). A positive Tzanck preparation is an accurate, rapid tool for the diagnosis of cutaneous herpes simplex.
Cytodiagnosis↗
Scurvy. A case caused by peculiar dietary habits.
A 9-year-old girl had the insidious development of lethargy, gingival erosions, and follicular hyperkeratosis with perifollicular hemorrhage. A dietary history disclosed that she consumed only one kind of sandwich and beverage and took no other foods. A skin biopsy specimen was consistent with the diagnosis of scurvy, and marked improvement occurred with ascorbic acid therapy. Although it is an uncommon disorder in the United States, scurvy may occur in persons with prolonged and peculiar dietary habits.
Ascorbic Acid↗
Recent developments in the management of patients with atopic dermatitis.
Management of most patients with AD should be directed toward basic therapy--lubricants, moderate potency topical steroids, and antihistamines. Only the severe or unresponsive patient should be considered for management with some of the techniques that have been discussed previously. In part, this is because the addition of extra therapy will substantially decrease long-term compliance, increase the cost of medical care, and produce a dissatisfied patient. There are, however, definite situations in which dietary manipulation, topical and systemic antiseptics, dietary supplementation, and ultraviolet light may be useful. The uses of environmental control, biofeedback, and coal tar were not discussed but may also be useful in certain situations. Finally, all physicians should realize that Herpes simplex infection in patients with AD can be a serious and sometimes life-threatening problem. Rapid, accurate diagnosis is the key to effective management with the newer anti-viral agents.
Allergens↗
Recurrent granulomatous dermatitis with eosinophilia. Wells' syndrome.
A 27-year-old woman developed a chronic, recurrent eruption of the face and upper extremities with the clinical and histopathologic features of recurrent granulomatous dermatitis with eosinophilia (Wells' syndrome). As described in 15 previously reported cases, this disorder is characterized by two clinical phases (eosinophilic cellulitis and granulomatous plaque phase) and three histopathologic stages. The latter are particularly remarkable for a diffuse dermal and subcutaneous eosinophilia in acute lesions and scattered flame figures in chronic lesions. Distinctive findings in this case were the predominance of facial involvement and the symptomatic response to topical corticosteroids. Although etiology and pathogenesis are unknown, we feel that Wells' syndrome is a unique yet rarely recognized clinicopathologic entity.
Adult↗
Controversies in paediatric dermatology.
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Child↗
What's new in paediatric dermatology.
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Baths↗
Pediculosis and the pediatrician.
Head lice commonly evoke feelings of disgust, revulsion, anger, and shame among parents and patients. There should, however, be no great cause for such alarm if a physician suspects pediculosis capitis. The recent introduction of several new pediculicidal drugs now allows a choice among four distinct therapeutic agents, which should substantially improve control of isolated cases and epidemics. Physicians must be aware that consumer groups are pressing public health authorities and drug manufacturers to establish proper treatment standards and safety warnings for the use of these agents. In addition, some controversy surrounds the use of lindane in children. This paper reviews the epidemiology and clinical appearance of pediculosis capitis in children, with emphasis on these recent developments. Pubic lice (Phthirus pubis) and body lice (Pediculus humanus corporis), both of which are much less common pediatric infestations, are mentioned only briefly.
Child↗
Comparison of stratum corneum thickness in children and adults.
We compared the thickness of the stratum corneum from abdominal skin in infants less than 3 months of age, children between 3 months and 11 years, and adults. Measurements were made with a filar micrometer eyepiece on histologic sections obtained at autopsy. No significant differences were seen; therefore, a stratum corneum of different thickness cannot be used to explain differences in percutaneous absorption, supporting previous work which suggested that term infants and children have an efficient skin barrier. The greater toxicity from percutaneous absorption of topical compounds sometimes seen in children is more likely due to their increased surface to volume ratio and/or metabolic differences.
Adolescent↗
Plant dermatitis.
This review summarizes the major categories of plant dermatitis: (1) mechanical injury, (2) pharmacologic injury, (3) primary irritant phytodermatitis, (4) allergic phytodermatitis, (5) pseudophytodermatitis, (6) phytophotodermatitis, and (7) pseudophytophotodermatitis. Representative species from this classification are considered. Field characteristics, dermatitis produced, chemical constituents, and diagnosis are discussed.
Dermatitis↗
Antimalarials--are they safe to use in children?
From 1963 to the present, many reviews of antimalarials for use in dermatology have mentioned the special sensitivity of children to these drugs. Fatal reactions have been limited to accidental or intentional overdosage and two instances of IM injection. While 1 gm of chloroquine can produce fatal reaction in very young children, analysis of published and unpublished cases show that adults exhibit a similar sensitivity when compared on a mg/kg basis. This information should encourage a physician to use antimalarials where appropriate, but special precaution should be taken to prevent poisoning.
Adolescent↗
Intralesional corticosteroids in the treatment of nodulocystic acne.
We evaluated the effectiveness of intralesional injections of corticosteroids in the therapy for nodulocystic acne. Triamcinolone acetonide at a concentration of 0.63 mg/mL was as efficacious as a higher concentration of 2.5 mg/mL. Betamethasone phosphate had little, if any, effect on nodulocystic acne lesions at concentrations of 3.0, 1.5, and 0.75 mg/mL, when compared with saline controls.
Acne Vulgaris↗
Patient concepts and misconceptions about acne.
A questionnaire was completed by 178 patients and relatives with dermatologic conditions as the first phase of a two-part study of the interrelationships between understanding and treatment compliance. Substantial numbers of those surveyed had ideas about cause, treatment, and prognosis that might adversely affect therapy. Diet, dirt, soap and water, topically applied acne gels, and realistic expectations for cures seem to be the most important subjects to emphasize in the written or oral "teaching" of patients with acne.
Acne Vulgaris↗
Disseminated cutaneous Mycobacterium marinum infection.
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Ethambutol↗