1. Son suficientes los hallazgos clínicos para realizar el diagnóstico?
2. Le tomaría biopsia ?
3. Le indicaría tratamiento sistémico o tópico.
4. Cual espera sea la evolución de la enfermedad ?
Dr. Francisco Gonzalez
Dra. Rosmary Martin
Hospital de Clínica Caracas
Between 2005 and 2008, information was collected about all children diagnosed with psoriasis in the Pediatric Dermatology Unit of Andreas Sygros Skin Hospital, in Athens, Greece. Results
A total of 125 children with psoriasis were examined, the male to female ratio was 1.4 : 1 and the peak age of onset was in the 9- to 10-year-old age group. Only 16% of the patients had a positive family history. Plaque type psoriasis was the most prevalent type at presentation with 56.8% of the children affected, followed by scalp involvement (33.6%). The limbs were the most prevalent site of involvement (70 children, 56%), followed by the body (59 children, 47.2%) and scalp (60 children, 48%) equally affected. Most of the children had <5% of their skin affected by psoriasis (53.2%). Age of onset had no influence on the severity of the disease (P = 0.107), whereas a positive correlation was found with sex and severity of the disease, with male patients being more severely affected (P = 0.008). Family history did not influence the age at presentation (P = 0.68). Topical steroids were used in most commonly followed by keratolytics, calcipotriol, topical tacrolimus and topical pimecrolimus. Conclusion
Our study reflects the patterns of presentation of childhood psoriasis in sunny countries like Greece.Ampliar
Nail disorders in children can be divided into seven categories. The first is physiologic alterations, which every physician should be aware of in order to reassure parents. These usually disappear with age and do not require any treatment. Among congenital and inherited conditions, the nail-patella syndrome, with its pathognomonic triangular lunula, should not be missed as recognition of the disease allows early diagnosis of associated pathologies. The most common infection is the periungual wart, whose treatment is delicate. Herpetic whitlow should be distinguished from bacterial whitlow as their therapeutic approaches differ. Dermatologic diseases encompass eczema, psoriasis, lichen planus, lichen striatus, trachyonychia, and parakeratosis pustulosa. Lichen planus, when it presents as in adults, is important to recognize because, if not treated, it may lead to permanent nail loss. Systemic or iatrogenic nail alterations may be severe but are usually not the first clue to the diagnosis. Beau lines on several fingernails are very common in children after temperature crest. Tumors are rare in children. Radiographic examination allows confirmation of the diagnosis of subungual exostosis. Other cases should undergo biopsy. Single-digit longitudinal melanonychia in children is mostly due to nevi. Its management should be tailored on a case-by-case basis. Acute trauma should never be underestimated in children and hand surgeons should be involved if necessary. Onychophagia and onychotillomania are responsible for chronic trauma.Ampliar
Background. Allergic contact dermatitis in children is less recognized than in adults. However, recently, allergic contact dermatitis has started to attract more interest as a cause of or contributor to eczema in children, and patch testing has been gaining in recognition as a useful diagnostic tool in this group.
Objectives. The aim of this analysis was to investigate the results of patch testing of selected children with eczema of various types (mostly atopic dermatitis) attending the Sheffield Children’s Hospital, and to assess potential allergens that might elicit allergic contact dermatitis.
Patients and methods. We analysed retrospectively the patch test results in 110 children aged between 2 and 18 years, referred to a contact dermatitis clinic between April 2002 and December 2008. We looked at the percentages of relevant positive reactions in boys and girls, by age groups, and recorded the outcome of treatment following patch testing.
Results. One or more positive allergic reactions of current or past relevance was found in 48/110 children (44%; 29 females and 19 males). There were 94 allergy-positive patch test reactions in 110 patients: 81 had a reaction of current or past relevance, 12 had a reaction of unknown relevance, and 1 had reaction that was a cross-reaction. The commonest allergens with present or past relevance were medicaments, plant allergens, house dust mite, nickel, Amerchol® L101 (a lanolin derivative), and 2-bromo-2-nitropropane-1,3-diol. However, finding a positive allergen was not associated with a better clinical outcome.
Conclusions. We have shown that patch testing can identify relevant allergens in 44% of children with eczema. The commonest relevant allergens were medicament allergens, plant allergens, house dust mite, nickel, Amerchol® L101, and 2-bromo-2-nitropropane-1,3-diol. Patch testing can be performed in children as young as 2 years with the proper preparation.
N. Ho, E. Pope, M. Weinstein, S. Greenberg, C. Webster, B.R. Krafchik
Objective: To assess comparative efficacy and safety of these two therapies and placebo.
Methods: In this prospective study, children of 2-16 years of age with vitiligo, stratified into “facial”(n=55) and “non-facial”(n=45) groups, were randomized into three arms: CP 0.05% ointment (n =30), T 0.1% ointment (n=31) and placebo (n=29) for 6 months. Successful repigmentation, defined as > 50% improvement, was evaluated by comparing photographs taken at baseline and 2, 4, 6 months.
Results: In the facial group, 58.33% of the CP 0.05% group responded successfully compared with 57.78% of the T 0.1% group, and in the non-facial group, 38.9% of the CP 0.05% group compared with 23% of the T 0.1% group (p= 0.3820). There was a significant difference in response between the CP 0.05% group vs placebo (p <0.0001) and the T 0.1% group vs placebo (p=0.0004). Spontaneous repigmentation was evaluated as 2.4%. No significant clinical adverse events were noted in any group.
Limitations: Relatively small sample size; outcome measures based on digital photographs comparisons.
Conclusions: Both CP 0.05% and T 0.1% ointments offer similar benefit in both paediatric facial and non facial vitiligo. The facial lesions responded faster than the non-facial ones.Ampliar
Virginie Andres, MDa, Patricia Garcia, MDa, Yves Rimet, MDb, Claire Nicaise, MDc, Umberto Simeoni, MDa
PEDIATRICS Vol. 127 No. 4 April 2011, pp. e1073-e1076
In each case, the incident occurred in a healthy infant who was in a prone position on his or her mother’s abdomen during early skin-to-skin contact. In most cases, the mother was primiparous, and in all cases the mother and infant were not observed during the initiation of skin-to-skin contact and breastfeeding. There are many benefits of early skin-to-skin contact and breastfeeding in the delivery room. However, in view of the risk of a rare but significant ALTE, we suggest that surveillance of newborns is needed. Although many ALTEs are apparently caused by obstruction, we suggest that a standardized investigational workup be performed after an ALTE.
Key Words: newborn • apparent life-threatening event • sudden death • skin-to-skin • delivery roomAmpliar