Trichomegaly in a 3-Year-Old Girl with Alopecia Areata

Abstract:   We report here a case of bilateral trichomegaly associated with alopecia areata in a 3-year-old girl, healthy except for mild atopic dermatitis. Trichomegaly is a rare condition and, in many cases, is a side effect of medication such as ophthalmic solution prostaglandin analogs and epidermal growth factor receptor inhibitors. Trichomegaly has also been associated with acquired medical conditions such as HIV, systemic lupus erythematosus, anorexia nervosa, porphyria cutanea tarda, hypothyroidism, and dermatomyositis. In very rare circumstances, trichomegaly has been described as part of congenital conditions such as Oliver-McFarlane syndrome. We believe that the development of bilateral trichomegaly in conjunction with alopecia areata in this patient represents a novel finding as it occurred in the absence of any significant health problems, congenital abnormalities, or medications.     

Factitious Purpura in a 10-Year-Old Girl

Abstract:  We describe a 10-year-old girl who presented with bizarre purpura. Both congenital and autoimmune hemorrhagic disorders were excluded based on her past medical history and physical and laboratory findings. Child abuse was also ruled out as purpura continued to develop after child–family separation. Histologic examination of the skin lesions revealed disruption of collagen fiber bundles. This finding indicated application of external force, leading to a definitive diagnosis of factitious purpura. Although it is very rare in school-age children, the diagnosis of factitious purpura should be included in the differential diagnosis of purpura in children. Histologic analysis of skin biopsies may aid in establishing the diagnosis.     

Acquired Acral Lipodystrophy in a 6-Year-Old Girl

Abstract:  We report a case of partial lipodystrophy in a 6-year-old girl with normal lipid and glucose metabolism and no family history for similar disorders. The clinical presentation, the laboratory investigations and the natural history in our patient do not match the diagnostic criteria for any of the established lipodystrophy subsets.     

全身性苔藓样结节病伴秃发1例国内首报

报告国内首例全身性苔藓样结节病1例。患者男,18岁,11年前腹部及项部出现数个绿豆大、肤色的丘疹,后皮损继续增多,并蔓延至全身。2年前出现脱发。胸部X线片正常,结核菌素试验阴性。腹部丘疹组织病理示:真皮上层呈非干酪坏死性上皮样细胞肉芽肿,染色示:网状纤维围绕并渗入上皮样肉芽肿。     

Macular Arteritis Mimicking Pigmented Purpuric Dermatosis in a 6-Year-Old Caucasian Girl

Abstract:   A 6-year-old Caucasian girl presented with a 4-month history of a mildly pruritic, brown and pink, focally petechial macules on the posterior aspect of her left leg, clinically consistent with a pigmented purpuric dermatosis. Biopsy, however, revealed lymphocytic inflammation with occlusion of the lumen of a small artery at the dermal–subcutaneous junction, characteristic of macular arteritis. This is a recently described entity that is not known to be associated with systemic disease, and remains stable over years without treatment. So far, it has not been reported in a Caucasian patient. We review the clinical and histologic features, as well as the laboratory evaluation of this case, and the previously reported cases.     

Case Report of Darier Disease Localized to the Vulva in a 5-Year-Old Girl

Abstract: A 5-year-old girl with Darier disease had numerous verrucous papules coalescing into plaques on both labia major a of approximately one year's duration. She was diagnosed as having genital warts, raising the suspicion of sexual abuse. Subsequently, a biopsy specimen from one of the vulvar lesions revealed histologic characteristics consistent with a diagnosis of Darier disease. The case is unusual for the age of onset and the site of initial involvement, and stresses the importance of including acantholytic disorders such as Darter disease in the differential diagnosis of a child with clinically verrucous lesions.     

Generalized Infestation of a 31/2-Year-Old Girl With the Pubic Louse

Abstract: A 31/2-year-oid girl had a Pthirus pubis infestation of the scalp, neck, eyelashes, back, and pubic area. The child's body, Including the scalp, was treated with a 1% permethrln cream rinse formulation for 10 minutes. The treatment was repeated after 10 days. The eyelashes were treated by application of the permetnrin solution with a cotton-tip swab.     

Lichenoid dermatitis in 3 professional footballers

We describe 3 professional footballers who developed lichenoid dermatitis over a short period of time. Clinically, the eruption in all 3 of them can he classified as lichenoid photodermatitis. We suggest an influence of possible contact allergens or photo-active substances, Histologic evidence points to features of classical lichen planus with purpura. typical of lichen aureus (purpuricus), but showing some clinical and morphological differences.     

Solitary Morphea Profunda in a 5-Year-Old Girl: Case Report and Review of the Literature

A 5-year-old girl had a solitary sclerotic plaque on the back of recent onset. The histopathologic features were consistent with morphea profunda. Thickening and homogenization of collagen bundles were demonstrated in the dermis and subcutaneous tissues, admixed with a prominent lymphocytic and plasma cell inflammatory infiltrate. Solitary morphea profunda is a variant of localized scleroderma that has not been reported previously in childhood. Cases described in the literature as nodular or keloid morphea may represent a similar entity.     

Papulonecrotic Tuberculid in a 9-Year-Old American Girl: Case Report and Review of the Literature

Papulonecrotic tuberculid is a rare cutaneous manifestation of tuberculosis that can also be associated with other mycobacteria. Clinically, it is an asymptomatic, recurrent eruption of papules with a necrotic center in a symmetric, acral distribution. Tubercle bacilli are not present in skin biopsies. The eruption resolves promptly with antituberculoid therapy. Few patients with this entity have been reported in the United States over the last 50 years. We report a 9-year-old, otherwise healthy, American girl whose sole initial findings were lesions of papulonecrotic tuberculid secondary to Mycobacterium tuberculosis.     

Simultaneous Occurrence of two Squamous Cell Carcinomas within a Nevus Sebaceous of Jadassohn in an 11-Year-Old Girl

Abstract:   The development of a squamous cell carcinoma within a nevus sebaceous of Jadassohn is very rare. We report here for the first time, the simultaneous occurrence of two squamous cell carcinomas within a single nevus sebaceous of Jadassohn.     

Papulonecrotic Tuberculid in a 2-Year-Old Girl: With Emphasis on Extent of Disease and Presence of Leucocytoclastic Vasculitis

Abstract: The clinicopathologic features of childhood papular necrotic tuberculid (PNT) have been detailed in 10 patients. PNT is characterized by symmetric, acral papular lesions that undergo necrosis. Despite widespread cutaneous involvement, the number of lesions is usually sparse. The extensor aspects of the limbs are usually involved and trunk involvement is uncommon. Vasculitis, an integral component of PNT, has been documented only once in childhood PNT. We describe PNT in a 2-year-old girl in whom a multitude of lesions were present all over the body, including unusual involvement of flexor surfaces of the limbs, trunk, perineum, and vulva. Biopsied tissue revealed the characteristic features of PNT, including leucocytoclastic vasculitis. There was prompt response to antituberculous therapy. Based on the findings in this patient, we believe that the clinical spectrum of this eminently treatable disease in children must be expanded in terms of distribution and number of lesions to include extensive limb and trunk, perineal, and vulval involvement; the histopathologic spectrum of childhood PNT must include leucocytoclastic vasculitis; and adult and childhood PNT share common histopathologic features, including a common cellular immunohistochemical profile, thereby suggesting a common pathogenesis.     

Oral Pemphigus Vulgaris Associated with Inflammatory Bowel Disease and Herpetic Gingivostomatitis in an 11-Year-Old Girl

Abstract: An 11-year-old girl with recently diagnosed oral pemphigus vulgaris developed a severe exacerbation of mouth ulceration due to superinfection with herpes simplex virus type I. A concurrent diagnosis of chronic inflammatory bowel disease was established to explain symptoms of weight loss and intermittent bloody diarrhea that predated the oral ulceration by several years. Herpes simplex infection is a recognized complication of pemphigus vulgaris that may be mistaken for a recrudescence of the disease. The association of pemphigus with chronic inflammatory bowel disease has been documented in a small number of adults. Its relationship to pyostomatitis vegetans, an acknowledged marker for ulcerative colitis and Crohn disease, remains unclear.     

Lichenoid eruptions in children

Lichenoid eruptions are quite common in children and can result from many different origins. In most instances the precise mechanism of disease is not known, although it is usually believed to be immunologic in nature. Certain disorders are common in children, whereas others more often affect the adult population. Lichen striatus, lichen nitidus, Gianotti-Crosti syndrome, and lichen spinulosus are examples of lichenoid lesions that are more common in children than adults. Distinguishing these diseases is necessary for prediction of the course of the eruption and for optimal management. In most cases, certain clinical characteristics enable the clinician to reach a diagnosis, whereas in other cases biopsy is required for a definitive answer. Many of these lesions are self-limited and only require symptomatic treatment, although corticosteroids can hasten resolution in certain disorders. Discontinuation of the medication is often sufficient for resolution of lichenoid drug eruptions.     

Sarcoidosis appearing in a tattoo

BACKGROUND: Sarcoidosis is a systemic disease that may present as tattoo granulomas. OBJECTIVE: A patient with systemic sarcoidosis who developed a granulomatous reaction within a tattoo is presented to stimulate interest in this unusual phenomenon. METHODS AND RESULTS: A patient with a 6-year history of pulmonary sarcoidosis developed sarcoidal granulomas restricted to one pigment of a tattoo. Previous reports of sarcoidal granulomas within tattoos are reviewed, and information about the pathogenesis of this process is explored. CONCLUSION: Sarcoid granulomas may develop in tattoos as an isolated local reaction or as the presenting sign of systemic sarcoidosis. The reaction itself may provide insight into further understanding the pathogenesis of sarcoidosis.