Necrobiosis lipoidica (NL) is a rare granulomatous disease of unknown etiology. Multiple therapies may be used with varying efficacy. We report a pediatric patient with a history of type I diabetes mellitus and NL with minimal response to an ultrapotent topical steroid, topical calcineurin inhibitor, and intralesional triamcinolone, complicated by steroid atrophy, who rapidly responded after addition of doxycycline. Pediatric Dermatology BRIEF REPORT cutaneous granulomatous diseases, such as granuloma annulare and sarcoidosis, has been reported with doxycycline. 4,5 Doxycycline is an appealing therapy, as it is usually well-tolerated and requires no laboratory monitoring. Prolonged use is only recommended in children older than 8 years of age. We report the case of a pediatric patient with NL with rapid response to doxycycline. While rapid improvement may have coincided with cumulative benefit of ILT, doxycycline may be a useful adjunctive treatment modality in NL for patients who have had either minimal response or have experienced side effects to topical or intralesional steroids.
DEAR EDITOR, Vitiligo is a disorder of hypopigmentation affecting 0Á5-1% of the population worldwide. 1 Much is still unknown regarding the epidemiology, causative factors and quality of life of patients with vitiligo. In order to gather more data from large groups of patients, internet-based or mailed questionnaires have been used. 2 These questionnaires rely on the accuracy of the patient for diagnosis and severity assessment; however, the accuracy of the data collected by this method should be validated. Few studies have sought to determine the accuracy of self-reporting in dermatology. Ming et al. 3 reported that patients were accurate when determining whether they had been previously treated for skin cancer, helping to determine the prevalence of cutaneous malignancies. Silverberg et al. 2 recently attempted to validate the accuracy of patient-measured body surface area (BSA) involvement with vitiligo in 30 patients by comparing patient-measured assessments with investigator-measured assessment of BSA; however, larger studies are needed to confirm this finding.We performed a cross-sectional study of patients enrolled in the Dallas Vitiligo Registry (DVR) at the University of Texas Southwestern Medical Center. The objective was to determine whether patient-reported BSA involvement using an existing scale corresponded with investigator-reported affected BSA. In addition, we examined quality-of-life scores with the accuracy of patient self-reporting. All patients attending the outpatient dermatology clinic in the Dermatology Department at the University of Texas Southwestern Medical Center were invited to enrol in the DVR. A total of 96 patients gave written informed consent for this study, which was approved by a local institutional review board. The information was collected using a questionnaire. The patients were asked: 'In your opinion, what percentage of your skin is affected with vitiligo?' The four response options were: 1-25%, 26-50%, 51-75% and 76-100%. Subsequently, determination of BSA involvement using hand units was performed by an investigator who conducted a full-body exam. A total of five investigators participated in conducting the exams, including a dermatologist, dermatology research fellow, medical students and a study coordinator. All investigators underwent training by the principal investigator (A.G.P.) on body surface estimation using hand units, after which they were tested by the principal investigator using three
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