Condylomata acuminata in children are characterized by peculiar problems, regarding their causal factors, diagnosis and treatment. From a diagnostic point of view, condylomata acuminata should be differentiated from a physiological condition, the so called “irsuties papillarum penis”. On the other hand, condylomata acuminata can be easily differentiated from flat condylomata of syphilis, because the two disorders only share the site involved. Irsuties papillarum penis, which is well known by dermatologists, gets evident in the peripuberal period. It is responsible for significant psychological troubles in the teenage, when adolescents are particularly sensitive to the genital problems.
The serial Book of Pediatric Dermatology is finished. Now we review Pediatric Dermatology from another side. The latter will be more practical for those physicians, who are not yet skilled in pediatric dermatology. In the previous book the thread consisted of the primary skin lesions. Now the thread will be the site of the lesions, even with different references according to the age. The new handling is aimed at the differential diagnosis of dermatological disorders. Regarding the other topics, from etiology to treatment, we will refer to the previous book, only talking about what is new and about peculiar problems of the involved site. (...)
Whatever inflammatory disorder affecting the epidermis and superficial dermis from late spring to early autumn can be responsible for hypopigmented residua. Atopic dermatitis also follows this rule. Being atopic dermatitis the most frequent dermatitis of children, it is even the most frequent cause of hypopigmented residua in childhood. Although present in adults, atopic dermatitis is less frequent in adulthood. At this age pityriasis versicolor (its name is due to the simultaneous presence of hyper- and hypopigmented lesions) is most frequently responsible for hypopigmented lesions. Pityriasis versicolor is a superficial mycosis due to Malassetia furfur. The latter is characterized by a peculiar lipophilia. This is why pityriasis versicolor is rare in children, who present low levels of sebum due to the lack of androgens. The very frequent association between pityriasis versicolor and hypopigmented residua in adults gave rise to the prejudice that all hypopigmented lesions are mycotic. This prejudice is responsible for an excessive and unjustified consumption of antimycotic drugs. The increasing usage of oral antimycotic drugs could be also responsible for systemic side effects. This prejudice should not extend to children, even because pityriasis versicolor is rare in childhood.
A case of bullous pemphigoid arisen at the age of four months is reported and the relevant literature reviewed, picking out other 20 cases arisen within the first year. Bullous pemphigoid cannot be differentiated from linear IgA dermatosis and acquired inflammatory epidermolysis bullosa, basing themselves only on clinical features. The differential diagnosis from the latter is difficult even with the common immunofluorescence techniques. Bullous pemphigoid is more rare of dermatitis herpetiformis and linear IgA dermatosis in children. Moreover, it starts more precociously, given that one third of the cases arising in the first 14 years start in the first year and, among those ones arising in the first year, more than two thirds start in the first four months of life. The clinical severity of bullous pemphigoid in children is highly variable, ranging from cases which heal with only topical treatment to cases requiring, as the case here reported, an aggressive immunosuppressive treatment. In fact, the severity of our case, due to the hydroelectrolytic imbalance and to the alteration of inflammation indexes, with platelets more than 1,000,000, led us to administrate high dose -7 mg/kg- cyclosporin.
The clinical diagnosis of subcutaneous fat necrosis is not always easy, especially when the infiltrating lesions are covered by normal skin. It often starts when the newborn has been already discharged from the neonatal unit. This is why different specialists such as pediatrician, dermatologist, surgeon and oncologist may observe the disorder. Given its rarity, every specialist sees a few cases throughout his/her life. The clinical variability of the disorder regarding the number of lesions -from one to dozens-, their color -from red to bluish and flesh colored-, shape -nodules or plaques-, size -from a few mm to many centimeters- and finally the possible presence of ulceration and calcification, makes the clinical diagnosis sometimes difficult. This is confirmed by the case here reported. The latter was rightly and easily diagnosed thanks to the histological examination, whereas the suspected clinical diagnosis was initially myofibromatosis or neuroblastoma.
Atopic dermatitis and scabies are very different disorders. However, these very different disorders share a symptom, namely itching. The latter can be the first symptom in both the disorders and/or can be the main problem leading the patient to the doctor. The diagnosis of atopic dermatitis is usually easy. Some difficulties are met in the first period of life, when the typical chronic and recurrent clinical course cannot be appreciated or when sites other than classical are affected. On the other hand, the diagnosis of scabies is difficult even for skilled physicians. Here we compare only the symptoms and signs more useful for the differential diagnosis.
The skin covering the eyelids can be affected by whatever disorder and the dermatologist is the physician responsible for recognizing and treat such disorders. A skin disorder involving the skin of the eyelids unlikely affects simultaneously the cornea or other ocular structures, probably because there is a particular organ tropism and the skin of the eyelids belongs to the skin rather than to the eye. Two disorders characteristic of atopy are atopic dermatitis often localized on the eyelids and allergic conjunctivitis. However, these two disorders, although sometimes affecting the same subject, run an independent clinical course. Dermatitis is more precocious and spontaneously regress during summertime in most cases. Conjunctivitis starts later and worsens during summertime due to photo exposure. The same argument applies to recurrent herpes simplex. Although herpetic involvement of both the skin of the eyelid and the cornea is rather frequent, exceptionally the eyelid skin and cornea are simultaneously affected. (...)
Dermatologists tend to apply percutaneously whatever drug is effective on skin disorders when given systemically. This is why, in 1952, a few years after the appearance of systemic corticosteroids, Sulzberger and Witten (17) published the first report on the effectiveness of topically applied hydrocortisone acetate on atopic dermatitis. In the following 25 years two contrasting tentences were observed. On one hand, in the wake of the initial enthusiasm caused by the revolutionary new treatment, new increasingly powerful molecules were synthesized, through fluorination, acetylation, esterification and double-bound induction. On the other hand, the side-effects of the new molecules were reported. The latter were responsible for a prejudicial fear against corticosteroids till the actual corticophobia.