Dermatologic conditions in internationally adopted children

Abstract

Over 200,000 children have been adopted into United States (US) families from abroad since the year 2000. Health care providers who care for children adopted internationally should be aware of the spectrum of illnesses seen in this population, and should be prepared to encounter potentially unusual situations. An appreciation for the unique pre-adoption exposures and vulnerabilities inherent in international adoption is critical for proper diagnosis and treatment of this heterogeneous group of children. It is important to consider the impact of potential early childhood stressors such as nutritional, sensory, and emotional deprivation, trauma and abuse, as well as prenatal exposures to drugs, alcohol, and infectious diseases. Providers must also take into account international variation in health care practices, including immunization, treatment, surgical, and hygiene standards. The differential diagnosis for cutaneous eruptions in children adopted internationally is broad and must encompass endemic systemic illnesses with skin manifestations, such as measles, tuberculosis, leprosy, and congenital syphilis, and primary dermatologic diseases such as scabies and bacterial and fungal infections. The importance of maintaining a broad differential and open mind when addressing the dermatologic needs of these children cannot be overemphasized.

International Adoption of Children with Special Needs in Spain

“…Velopalatine malformations, such as cleft lip and palate, are one of the most prevalent conditions in our series, very frequently described in series of adopted children with SN [ 2 ]. Skin conditions are also frequently described in adoptees [ 10 ]. In our series, intestinal parasitosis and microcephaly were strongly underdiagnosed, according to pre-adoption reports.…”

Infectious Diseases in Internationally Adopted Children and Intercountry Discrepancies Among Screening Protocols, A Narrative Review

“…Skin infections in IAC are very common (6); having lived in an overcrowded institution and coming from a tropical country are the main risk factors for this type of infection. The most frequently reported dermatological disease is Tinea capitis infection, followed by Molluscum contagiosum , pediculosis of the head, and impetigo; scabies is frequently observed and should be promptly diagnosed and treated (6, 7). Skin examination is also crucial to detect a Bacille Calmette Guerin (BCG) scar and scars compatible with previous infections, such as varicella zoster infection (9–14).…”

“…Early diagnosis of infectious diseases is crucial both for the optimal management of IAC and to reduce risk of transmission to the community (1, 6, 7). Cases of transmission of the Hepatitis A and Hepatitis B viruses, scabies, tuberculosis, Tinea capitis / corporis , and measles to adoptive families have been reported in the literature (1, 6, 7).…”

Cutaneous tuberculosis in the pediatric population: A review

“…Tuberculosis is endemic to many countries such as China, Asia, and Africa. 6 In Europe, Asia, and Africa, 11.4, 12.2, and 12.8% of children had probable latent TB in addition to 3.4, 4.3, and 2.6% with confirmed TB, respectively. 7 An estimated 20% of international children adopted into the US with negative tuberculin skin tests (TST) upon arrival subsequently tested positive within the following 3 months.…”