Utility of ultrasonography in hair‐thread tourniquet syndrome

A 2‐year‐old girl presented with a 2‐month history of an erythematous, indurated plaque with well‐defined borders on the third toe of the right foot. Bedside high‐resolution ultrasonography demonstrated a thickened epidermis overlying a hyperechoic focus within the dermis. Her clinical and sonographic presentation was in keeping with a foreign body causing hair‐thread tourniquet syndrome. The foreign body was surgically extirpated without neurovascular sequelae. Ultrasonography expedited accurate diagnosis and is a promising adjunct to clinical evaluation for radiolucent foreign bodies.     

Analysis of dermatology emergency consultations in a pediatric population: One-year retrospective audit from the largest Portuguese tertiary teaching hospital

A retrospective study was conducted on pediatric patients examined via dermatology emergency consultation over 1 year. A total of 1352 diagnoses, including 100 distinct disorders, were recorded. Regardless of the diversity of skin conditions observed, a relatively small number of disorders were found repeatedly. We encourage education aimed at ED providers to focus on the diagnosis and management of the more commonly encountered disorders, including atopic dermatitis and infectious skin disorders.     

Linear juvenile dermatomyositis: A segmental manifestation

A 7-year-old girl presented with proximal muscle weakness and skin lesions. Physical examination revealed violaceous papules on the right forearm in a blaschkoid distribution. Her symptoms and test results were consistent with juvenile dermatomyositis. An unusual superimposed segmental manifestation of this disease is discussed.     

Hair weathering and hair capacitance mapping: a pilot study

Background Currently, there is no reported objective method allowing confident assessment of hair hydration mapping. Thus, assessing hair moisture kinetics and versatility according to hair shaft damages and hair care products is difficult to perform. Aim To explore a new method for assessing hair moisture. Method A new method of hair capacitance mapping (HCM) is introduced for monitoring hair surface damage and hydration. This study was performed on intact and weathered hair locks. Samples were soaked in 10% solutions of regular shampoos or in tap water alone. HCM was performed using the SkinChip^® device based on a semiconductor image sensor technology. Time to complete water desorption from cuticular cells was recorded. Results Hair surface moisture was increased for <30 min after soaking in the shampoos or water alone. The method was sensitive enough to disclose a gradient of moisture from the base to the tip of the hair shafts. Weathered hairs lost their moisture more rapidly than intact hairs. Conclusion Hair capacitance mapping appears to be a promising method in the assessment of the dynamics of hair surface moisture.     

Psychosocial impact of pediatric alopecia areata: A survey study

This study, which aimed to identify distress by sites of hair loss and psychosocial stressors for a pediatric alopecia areata population, enrolled 50 patients (32 females, 18 males, ages 7–17 years) from pediatric dermatology clinics, including a monthly hair disease clinic. Patients completed a 47-question survey. Scalp hair loss was rated as often or always bothersome in 34.7%; eyebrow loss in 24.3%; and eyelash loss in 21.6%, and 6 patients (12%) discontinued a social activity due to hair loss. Referral to behavioral/mental health specialists should be considered to improve psychosocial outcomes.     

Hair cross-sectioning in uncombable hair syndrome: An epoxy embedding technique

Uncombable hair syndrome is a rare disorder of the hair shaft that leads to silvery and unruly hair. The hair shaft anomaly is characterized by a longitudinal groove that is detected by scanning electronic microscopy—considered to be the gold standard for diagnosis. Recently, hair cross-sectioning has been reported as a viable alternative, but currently available methods still have some flaws, especially because of hair samples' processing specificities. Here, we present two cases of uncombable hair syndrome and a new embedding technique using epoxy to perform the diagnosis.     

The impact of personalized reminders in addition to an automated patient reminder system on pediatric dermatology no‐show rates: A pilot study

We investigated the impact of a personalized telephone call reminder for patients that had not confirmed their clinic appointment, in addition to automated reminders, on monthly no‐show rates. Our data revealed a reduction in the monthly no‐show rate from 16.0% (SD = 3.91%) before the intervention to 13.1% (SD = 0.27%, P = 0.0997) after the intervention, which was not statistically significant. The standard deviation of the no‐show rate with the intervention was reduced, leading to a predictable monthly no‐show rate (range 12.93%‐13.51%). Thus, the number of patients attending clinic was more predictable. This study highlights the need for additional investigation of factors associated with appointment nonadherence in pediatric dermatology.     

Two for two: Dual therapy with erlotinib and acitretin for twins with severe keratoderma in Olmsted syndrome

Olmsted syndrome (OS) is a rare genetic disorder, characterized by painful palmoplantar keratoderma (PPK), periorificial and intertriginous hyperkeratoses, and alopecia. Fewer than 75 cases have been described. Variants in TRPV3 result in constitutive activation of transient receptor potential vanilloid 3, leading to increased epidermal growth factor receptor (EGFR) signaling, palmoplantar epidermal hyperproliferation, and exquisite lesional pain. We describe pre-school aged twins with OS with partial improvement from oral erlotinib, an EGFR inhibitor, but dramatic reduction of their persistent palmoplantar thickening and pain from adding acitretin.     

Primary scarring alopecia: A retrospective study of 89 patients in Taiwan

Primary scarring alopecia (PSA) is caused by irreversible damage to the hair epithelial stem cells that reside in hair follicles. There is limited published work regarding PSA amongst the Asian population. The aim of this study was to evaluate the clinical features and to characterize the subtypes of PSA in southern Taiwan. In this retrospective case series, we reviewed 89 patients with pathology‐confirmed PSA. The data was collected from National Cheng Kung University Hospital between 1988 through 2016. The clinical and histological data were reviewed, and the patients were characterized into different subtypes of PSA based on the clinical features and histological findings. We noted seven different subtypes of PSA. The most common type was dissecting cellulitis (DC) (30.3%), followed by lichen planopilaris (LPP) (23.5%), central centrifugal cicatricial alopecia (CCCA) (12.4%) and acne keloidalis nuchae (AKN) (12.4%). The other subtypes include folliculitis decalvans (FD), discoid lupus erythematosus (DLE) and pseudopelade of Brocq (PPB). Interestingly, FD, DC and AKN were more common in males, while CCCA, LPP, DLE and PPB had a female predominance. The mean age of patients with DLE, DC and AKN were younger, while patients with CCCA, LPP, PPB and FD tend to be older. The pattern of hair loss was more likely to be unifocal‐ragged border in CCCA and DLE, multifocal‐interconnected in LPP and FD, and multifocal‐separated in DC. The pathogenesis of PSA may be influenced by sex, age and genetic background. It is important to identify the hair loss pattern to differentiate the subtypes of PSA.     

Considerations in surgical management of a Buschke–Lowenstein tumor in Netherton syndrome: A case report

Netherton syndrome is an autosomal recessive ichthyosis caused by mutations in SPINK5, with the classic triad of linearis circumflexa, trichorrhexis invaginata, and atopy. There are few reports of surgical management in individuals with Netherton syndrome and clinicians may be reluctant to operate for fear of wound‐healing complications. This report describes a pediatric case of a Buschke–Lowenstein tumor of the natal cleft in a patient with Netherton syndrome that had failed to respond to medical management. We reviewed the literature for previous cases of surgery in individuals with Netherton syndrome using MEDLINE and PubMed searches. Our patient underwent surgery to remove the lesion without complication. Using conventional dressings and topical negative‐pressure therapy, the wound was managed and healed within a reasonable time frame despite the underlying skin condition. This case indicates that surgery and topical negative‐pressure therapy is a safe and reasonable treatment for individuals with Netherton syndrome.     

Pediatric consultative dermatology: A survey of the Society for Pediatric Dermatology workforce reveals shortcomings in existing practice models of pediatric dermatology consult services in the United States

The rate of pediatric hospitalization for cutaneous pathology has been increasing in recent years, often requiring the expertise of consulting pediatric dermatologists; however, the infrastructure of inpatient pediatric dermatology consultative services remains poorly characterized. We sought to assess the structure, consult volume, physician compensation, and utilization of teledermatology in pediatric dermatology inpatient services to better understand the current care model. Our survey of 118 pediatric dermatologists revealed that 89% of respondents see between 1 and 10 new consults per week, 39% perform all inpatient consults including evening and weekends without assistance from other providers, 71% do not have protected time during the week to provide inpatient consultations, and only 10% receive financial compensation via stipend. By highlighting both the high demand for pediatric consultative dermatology as well as the significant burden placed on these providers by existing practice models, we hope to encourage a reappraisal of the current infrastructure of pediatric inpatient dermatology to increase structural and financial support for this vital service.