Patient education materials (PEMs) are a powerful tool to improve patient comprehension and disease self-management. However, poor health literacy is a well-established barrier for PEMs to serve their purpose. 1 The average American reads at an 8th grade level; however, the National Institute of Health (NIH) recommendation for PEMs is at the 6th grade level. 2 Dermatology PEMs routinely have reading levels above the national recommendations. 3,4 This is unsurprising, as dermatology involves complex terminology that is often an unavoidable component of patient education-referred to hereafter as "educational content" (ie, use of "melanoma" in a PEM about concerning moles). 5 Low health literacy has led to improper use of medications and overall increased morbidity. 4 This poses a particularly significant challenge in the pediatric population, as appropriately caring for a child's skin needs is contingent on effective communication between physician and parent. Outlining a detailed method for generating dermatology PEMs that balances the delicate interplay between readability and educational content stands to greatly benefit physician-patient communication. This study aimed to assess and optimize pediatric dermatology PEMs to identify which specific changes are most effective at lowering reading level without diluting educational content.
Infantile choriocarcinoma (ICC) is a rare, highly malignant form of gestational trophoblastic neoplasia. Rapid diagnosis and initiation of treatment are paramount in reaching a successful outcome. Patients with these tumors typically present with a triad of anemia, hepatomegaly, and precocious puberty. Cutaneous manifestations of ICC are extraordinarily rare with few documented cases. Here, we describe a male neonate who presented to our Dermatology clinic with a rapidly growing, markedly vascular glabellar mass associated with abnormal laboratory values suggestive of Kasabach-Merritt phenomenon. The initial clinical impression of infantile hemangioma led to an initial treatment with propranolol. However, the mass continued to enlarge and a biopsy was obtained. Histology revealed a high-grade, poorly differentiated carcinoma. A robust immunohistochemical battery demonstrated tumor reactivity with Glut-1, GATA3, Glypican-3, CAM5.2, and β-hCG establishing the diagnosis of metastatic choriocarcinoma. The diagnosis was further supported by the elevated serum β-hCG. In addition to the glabellar mass, imaging demonstrated tumor foci in the liver and lung. Clinical investigation of the mother revealed no evidence of disease.
Here, we report a case of unilateral ocular mydriasis in a pediatric patient with longstanding hyperhidrosis, as well as similar findings in her cat. The patient had been undergoing treatment of her hyperhidrosis with topical glycopyrrolate. This case highlights the potential side effect profile of topical antimuscarinics and the importance of counseling patients on proper precautions.
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