Paediatric Dermatology

Childhood psoriasis: Disease spectrum, comorbidities, and challenges Soumajyoti Sarkar, Sandipan Dhar, Siba P Raychaudhuri Indian Journal of Paediatric Dermatology 2019 20(3):191-198 Psoriasis is a chronic, inflammatory, papulosquamous disorder with a variable clinical spectrum. Although it affects population of all age groups, the significance and negative impact of childhood psoriasis is often neglected worldwide. In nearly one-third of the psoriatic population, psoriasis appears during the childhood. In this article, we have focused on different issues and challenges faced during the management of childhood psoriasis. In addition to the varied clinical spectrum and associated comorbidities, in this article, we have given emphasis on the following real needs for childhood psoriasis: (i) psychological and social effects on the affected children, (ii) impact on their family members, and (iii) early diagnosis and management of psoriasis on children with psoriasis. We have concluded the article with the “concept of total care,” which is a third dimension for the management of psoriasis.

Childhood acanthosis nigricans Anupam Das, Priyankar Misra, Saumya Panda Indian Journal of Paediatric Dermatology 2019 20(3):199-204 Acanthosis nigricans (AN) is a frequently encountered dermatological condition seen commonly in middle aged or elderly, but in the recent times, there has been an increase in the childhood cases, especially in the adolescent age group. AN clinically manifested as dark, velvety, and thickened skin, symmetrically distributed over the neck, axillae, other flexural regions of the body and face. Facial AN, a somewhat recent entity that has been described and significant association with obesity, hyperinsulinemia, and metabolic syndrome, has been established. AN was once considered a rare paraneoplastic dermatosis but is now frequently observed in obese adolescents. Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. The purpose of this narrative review is to provide a comprehensive overview of AN in childhood, including history, definition, classification, its clinical significance, management challenges, and the direction of future research.

Contact dermatitis in pediatric age group: Indian scenario Yasmeen Jabeen Bhat, Saniya Akhtar, Iffat Hassan Indian Journal of Paediatric Dermatology 2019 20(3):205-211 Contact dermatitis was previously considered to be rare in children except some forms of irritant contact dermatitis which were seen commonly in children. However, nowadays, there are an increasing number of cases of allergic contact dermatitis (ACD) being reported in children due to increased exposure to a variety of allergens at an earlier age. Various predisposing factors which influence the occurrence of contact dermatitis include age, sex, atopy, and presence of any concomitant skin disease. Nickel has been identified as leading cause of ACD in children. Other common allergens reported are cobalt, fragrance mix, rubber, lanolin, thiomersal, neomycin, gold, mercapto mix, balsam of Peru, and colophony. Clinical presentation in children is similar to that in adults with eczema of the hands, feet, wrists, face, forehead, scalp, eyelids, earlobes, neck, axilla, trunk, thighs, and anogenital area being seen. Disseminated lesions can as well be seen. When ACD is suspected, patch testing is the gold standard diagnostic procedure. However, patch testing in children differs from adults as some technical difficulties are encountered in children due to their smaller test area and frequent movements. However, the general opinion stands that children can be patch tested with the same methods and patch test concentrations as adults. For the prevention of recurrence, allergen elimination should be the aim of treatment; however, in many cases, it is not possible to completely eliminate the allergen from the patients environment. Topical steroids and calcineurin inhibitors form the mainstay of treatment in most cases.

Clinical spectrum of dermatological disorders in children referred from pediatrics department Taru Garg, Riaz Ahmed, Srikanta Basu, Ram Chander Indian Journal of Paediatric Dermatology 2019 20(3):212-218 Background: Worldwide, limited studies have been done to study the spectrum of dermatological referrals in children. Aims and Objectives: The aim of this study was to analyze the spectrum of dermatological disorders in children referred from pediatrics department. Materials and Methods: It was a hospital-based observational study. Five hundred twenty-five children of either sex or age ≤18 years, in whom, parents had given written informed consent, and referred to Dermatology from Pediatric medicine department were included in this study. The diagnosis was made based on clinical features supported by necessary investigations. Working hours were considered as routine and emergency. Nelson' severity scoring system was used to classify children as sick. Results: Most of the children were referred during routine hours (85.7%), maximally from inpatient department (46%) followed by outpatient department (37%). Most common diagnosis was viral infections (21.2%), closely followed by eczematous disorders (17.6%) and disorders due to arthropods (17.1%). Majority of patients were not sick (83.61%). Pediatricians did not suggest any diagnosis in 70.85% of referrals followed by doubtful diagnosis in 26.85% and definitive diagnosis in 2.28% of patients. Conclusion: Majority of referrals were done during routine hours in nonsick patients. As many common easily treatable dermatoses were observed in all the referrals reiterating the fact that these referrals should be sought as early as possible to prevent unnecessary delays in the diagnosis and patient management. Furthermore, a robust dermatological training should be provided to undergraduates and interns to better equip the nondermatologists to diagnose common dermatological disorders.

Dermoscopy of congenital dermatoses in pediatric age group: An observational study Prachi Chetankumar Gajjar, Hita Hemant Mehta, Mehul Gosai Indian Journal of Paediatric Dermatology 2019 20(3):219-226 Objective: To study dermoscopic (DS) patterns of various congenital dermatologic conditions affecting pediatric age group. Background: DS helps to fill gap between histopathology and gross examination, especially in children as they are noncooperative for invasive procedure. It also helps in early detection of malignant change. Methodology: One hundred and forty-nine children with congenital dermatoses were enrolled in a study conducted from August 2017 to January 2018 in dermatology outpatient department (OPD). After proper history and examination, DS images were captured using DermLite DL IV and stored for analysis. Results: One hundred and forty-nine DS images of 22 congenital dermatoses were studied including 80 males and 69 females. Homogenous pattern (80%) was the most common pattern observed in melanocytic nevi (26). Mongolian spots (25) had greenish hue (100%) on DS. Hemangioma (13) and port wine stains (5) showed cherry red vacuoles and red dots against a pink background, respectively. Criss-cross, rhomboid, and lamellate pattern of scales were observed in DS of congenital ichthyosis (8). We also analyzed DS features of bullous and perforating disorders, syndromes, few rare miscellaneous conditions, and hair disorders. Conclusions: DS is a non-invasive diagnostic tool which enables visualization of deeper structures of the skin which are not seen with naked eyes. Melanocytic nevus, if disorganized, indicates increased risk for melanoma in situ. Pattern of scales on DS helps to classify ichthyosis. Regular brown dots suggest wart-like infection in epidermodysplasia verruciformis. DS of monilethrix and short anagen syndrome helps in differentiating from other hairs shaft disorders. Although time consuming, DS is easy to perform, especially in children and it aids to confirm the diagnosis.

Halo Nevi in children: A separate entity or a sign of vitiligo? N A Bishurul Hafi, Romita Bachaspatimayum, Ronibala Soraisham, N CP Muhammed Indian Journal of Paediatric Dermatology 2019 20(3):227-230 Background: Halo nevi (HN) can present either singly or along with vitiligo. Whether they are different entities, remains debatable. Objectives: The objective of the study is to compare clinicoepidemiologic and laboratory factors associated with HN, HN with vitiligo and vitiligo alone, in children. Methodology: A total of 205 children <18 years who presented to the outpatient department were sampled purposively to three groups: (a) HN without vitiligo, (b) HN with vitiligo, and (c) Vitiligo without HN. Results: There were seven patients in Group A, 11 in Group B, and 187 in Group C. A statistically significant difference was noted between Group B and C in the age of onset (0.004) as well as the age of presentation (0.031). Even though the disease process had started in head-and-neck region in more than half of the patients in each group, HN was present mostly on trunk (90.9%) in Group B and in 28.6% in Group A. No statistically significant difference was noted in associated disorders, personal or family history of autoimmune disorders, koebnerization, leukotrichia, or laboratory tests. Conclusions: Our study, particularly done among pediatric population, has failed to demonstrate much significant differences between HN and vitiligo, except in the age of presentation as well as the age of onset. It further gives proof to substantiate the hypothesis that HN can be a part of clinical spectra of vitiligo.

Evaluation of efficacy and safety of intralesional Measles-Mumps-Rubella virus vaccine for the treatment of common warts in children and adolescents Vikram K Mahajan, Pushpinder Singh Chauhan, Aditi Sharma, Karaninder Singh Mehta, Ritu Rawat, Vikas Sharma Indian Journal of Paediatric Dermatology 2019 20(3):231-235 Background: No single treatment for warts has proven 100% efficacy and most therapeutic modalities remain unsatisfactory. Immunotherapy with Measles-Mumps-Rubella (MMR) vaccine remains underevaluated, especially in children. Objective: To evaluate the efficacy and safety of intralesional MMR vaccine in the treatment of common warts in children. Materials and Methods: Fifty-five (36 boys and 19 girls) children aged 5–18 (mean ± standard deviation 12.8 ± 3.88) years with common warts received 0.25 ml of MMR vaccine injected intralesionally in the largest wart. The dose was repeated at 2-week interval until complete clearance or for a maximum of 5 doses. Thereafter, they were followed up once a month for 24-week study period. The response was evaluated as complete clearance (complete disappearance of the wart(s) including distant ones and appearance of normal skin), partial clearance (≤99% reduction in size and number including distant ones and few residual warts still visible), good response (some reduction in size only including that of distant ones but no decrease in number of warts), or poor response (no change in size and number). Results: Only 46 patients completed the study and 27 (58.7%) of them had complete clearance of warts, 9 (19.6%) showed partial clearance and 10 (21.3%) patients showed no response. In 15 of 27 patients complete clearance was achieved after 5 doses, 7 had complete clearance after 4 doses and 2 patients each showed complete clearance after 2 and 3 doses, respectively. Conclusion: Intralesional MMR vaccine immunotherapy appears promising, effective, and safe treatment for common warts in children with the advantage of single-lesion infiltration, and resolution without scarring or pigmentary changes commonly seen with destructive therapies. However, better designed larger controlled studies are warranted.

A girl with alopecia and skeletal deformities: Satoyoshi syndrome with review of literature Vishalakshi S Pandit, K Udaya Indian Journal of Paediatric Dermatology 2019 20(3):236-239 Satoyoshi syndrome is a rare disease characterized by alopecia, recurrent muscle spasms, diarrhea, and skeletal abnormalities. It is a multisystem disorder of suspected autoimmune etiology. We report a 12-year-old-girl presented with loss of hair from the scalp for 7 years. She had a history of muscle spasms of lower limbs, which used to last for a few minutes; the attacks of spasms were intermittent in nature and involved thigh and calf muscles. She had genu valgum deformity of the right knee and knock-knee gait. Central nervous system examination showed no abnormality. Her laboratory investigations including routine screening and endocrine evaluations were within normal limits, except for microcytic hypochromic anemia. Ultrasonography (USG) abdomen revealed relatively small uterus. X-ray of the right knee showed deformed shape of the epiphysis and dense metaphyseal band of bones. Histopathological examination (HPE) scalp showed noncicatricial alopecia with the absence of functional follicles and dermal lymphocytic infiltration. On the basis of clinical investigations, blood investigations, USG, and radiological findings, diagnosis of SS was made. SS is a sporadic disease with the mean age of onset of the disease being 10 years, but a few adult cases have also been reported. The usual initial symptoms are alopecia and painful muscle spasms. Treatment with oral corticosteroids has shown good response. The case is being presented to create awareness not only among dermatologists but also among pediatricians and orthopedicians about the multisystem involvement and long-term-associated complications and to emphasize the need of early diagnosis and treatment.

Eruptive collagenoma: A rare entity in pediatric age Pratiksha Sonkusale, Sonia Jain, Abhay Deshmukh Indian Journal of Paediatric Dermatology 2019 20(3):240-242 Eruptive collagenoma is a rare acquired connective tissue nevus predominantly composed of collagen, with elusive incidence and etiopathogenesis. Many cases are reported in young adults, but there is a dearth of literature in children. Herein, we report a rare case of eruptive collagenoma in a 5-year-old child who presented with multiple asymptomatic papules, plaques, and nodules over the back and face with no systemic involvement. There was no positive family history or history of consanguineous marriage, and diagnosis was confirmed histopathologically. We report this case due to its rarity in Indian literature in pediatric population with facial involvement.

Rothmund–Thomson syndrome presenting with bullous eruption: A rare case report Akshat Tamta, Jitendra Singh Bist, Gunjan Gupta, Sumeet Pal Saini, Anant Kumar Singh Indian Journal of Paediatric Dermatology 2019 20(3):243-245 Rothmund–Thomson syndrome is a rare, autosomal recessive genodermatosis characterized by an early-onset poikiloderma, skeletal abnormalities, short stature, premature aging, and increased susceptibility to malignancy. We report a case of a 1-year-old male child with bullous lesions and pigmentary changes over the face and extremities. Strict photoprotection and careful surveillance for malignancy forms the mainstay of treatment. The case is being reported due to its rarity and the diagnostic dilemmas associated with it.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com