Allergic contact dermatitis (ACD), a delayed hypersensitivity skin reaction to environmental allergens, has a prevalence that is similar in children and adults. However, diagnostic testing for ACD in pediatric populations accounts for less than one tenth of all patch tests. The relative infrequency of pediatric patch testing may be attributed to the difficulty in testing in this population, which includes a smaller surface area for patch test placement and maintaining cooperation during patch testing, especially in younger children. Diagnosis can be difficult in children because the appearance of ACD can mimic other common pediatric skin conditions, particularly atopic dermatitis and irritant contact dermatitis. Comprehensive history taking, guided by patient presentation, age group, and location of dermatitis, helps build clinical suspicion. Such clinical suspicion is one of the major reasons behind patch testing, with additional indications being recalcitrant dermatitis and dermatitis with atypical distribution. US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis, because ACD tends to persist if the allergen is not identified and can affect patients' quality of life.
Pediatric basal cell carcinoma burden and management preferences in Gorlin syndrome: A survey study To the Editor: Gorlin syndrome (GS) is a risk factor for early basal cell carcinomas (BCCs), 1 although its prevalence of fewer than 1 in 30,000 individuals 2 limits existing literature. There are sparse pediatric GS studies beyond case reports, creating a knowledge gap regarding childhood cutaneous findings and sequelae, including BCC age at onset, quantity, treatments, and impact. Herein, we describe a global survey to illustrate the clinical presentation, childhood perspectives, and BCC management trends for pediatric GS to improve the understanding and inform patient care.
Purpose of review
To inform pediatric providers of the clinical characteristics, underlying genetic drivers, and therapeutic options for skin cancer arising in childhood and adolescence.
Recent findings
The incidence of melanoma in pediatric patients has been declining in the past decades. Pediatric-specific diagnostic criteria should be utilized when assessing lesions concerning for melanoma to better account for the different presentations seen in pediatric disease compared with adults, such as an increased prevalence of amelanotic melanoma or frequent mimic of benign pediatric lesions. Pediatric melanoma often presents with a higher histopathologic stage and a higher Breslow depth as compared with adult melanoma. Pediatric nonmelanoma skin cancer including basal cell carcinoma and squamous cell carcinoma are associated with genetic conditions and immunosuppression, both iatrogenic and inherited.
Summary
Melanoma in pediatric patients often presents differently from conventional adult melanoma, including Spitz melanoma and melanoma associated with congenital melanocytic nevi. Pediatric patients with nonmelanoma skin cancers should be evaluated for predisposing risk factors. More research on therapeutic options for pediatric skin cancer is vital to understanding the tolerance and response of our pediatric patients to therapies that are more frequently utilized in adult disease.
Acne fulminans (AF) is an uncommon variant of inflammatory acne with abrupt eruption of painful nodules, pustules, and hemorrhagic ulcerations, often associated with systemic symptoms. Paradoxical adverse reactions to tumor necrosis (TNF)-alpha inhibitors have been reported, and rare cutaneous complications include pyoderma gangrenosum, Sweet syndrome-like hypersensitivity eruptions, and pustular folliculitis. We report an unusual case of AF in a patient with Crohn disease that worsened with doses of adalimumab, which is considered a second-line treatment for AF. This case highlights that acneiform eruptions may be an underreported paradoxical adverse reaction to anti-TNF alpha therapy.
Synopsis:
Children are a unique subset of patients in relation to the COVID-19 pandemic, often presenting asymptomatically, mildly, or atypically when infected with the virus. Manifestations of the skin may be a primary (or the only) presenting sign. Recognizing cutaneous manifestations of COVID-19 in the pediatric population is important to guide appropriate precautions, testing, and management for the patient and close contacts. Whereas some dermatologic signs in children overlap with those seen in adults, other skin findings have been reported with higher frequency in children and in some cases, may be a clue to downstream multisystemic sequelae. In this chapter, we describe the presentation, pathophysiologic theories, and management strategies for cutaneous manifestations of COVID-19 in children.
Children with autism spectrum disorder (ASD) can present with behaviors such as aggression, self-injury, or irritability, which can render traditional procedural interventions used in dermatology difficult or dangerous for the patient, caregiver, or practitioner. 1 Patients with ASD and other neurodevelopmental disorders who have difficulty tolerating procedures prompt consideration of different treatment approaches. 1 We present here the use of an ultrapotent topical steroid as an alternative treatment approach for a common pediatric dermatology presentation, pyogenic granuloma (PG). Alternative
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