Efficacy and Quality of Life Outcomes of Oxybutynin for Treating Palmar Hyperhidrosis in Children Younger than 14 Years Old

The effects of oxybutynin for treating hyperhidrosis in children are still unknown. Therefore the aim of this study was to investigate the effects of oxybutynin on improving symptoms of hyperhidrosis and quality of life (QOL) in children with palmar hyperhidrosis (PH). Forty‐five children ages 7–14 years with PH were evaluated 6 weeks after protocol treatment with oxybutynin. QOL was evaluated before and after treatment using a validated clinical questionnaire. More than 85% of the children with PH treated with oxybutynin experienced moderate or greater improvement in the level of sweating and 80% experienced improvement in QOL. Children who initially presented with very poor QOL were those who benefited most from oxybutynin therapy. Side effects occurred in 25 children (55.5%) and were mainly dry mouth. Only one patient had neurologic symptoms, which was reported as drowsiness. Oxybutynin is an effective treatment option for children with PH because it improves clinical symptoms and QOL. Further studies are required to determine the long‐term outcomes of treatment with oxybutynin.     

Long‐Term Efficacy of Oxybutynin for Palmar and Plantar Hyperhidrosis in Children Younger than 14 Years

Oxybutynin for treating hyperhidrosis in children has been evaluated only in short‐term studies. We aimed to investigate the long‐term effects of oxybutynin in treating children with palmar and plantar hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4–14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self‐assessment of hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).     

Periungual Bowen's Disease in a 12‐Year‐Old Boy Treated with Photodynamic Therapy

Bowen's disease (BD) usually occurs on sun‐exposed areas in elderly patients. BD rarely occurs in childhood and lesions of the nail unit and periungual area are likely associated with human papillomavirus infection. Herein, we report a case of BD presenting on the periungual area in a 12‐year‐old boy which was successfully treated with two sessions of photodynamic therapy.     

The Successful Use of Extracorporeal Photopheresis in a 12‐Year‐Old Patient with Refractory Epidermolysis Bullosa Acquisita

Epidermolysis bullosa acquisita is a rare autoimmune bullous disease of the mucosa and skin characterized by the presence of anti‐collagen VII antibodies at the dermoepidermal junction. Most patients respond to immunosuppressive or antiinflammatory agents, although patients whose condition is refractory to these therapies will require more aggressive treatment. We present a 12‐year‐old girl with refractory epidermolysis bullosa acquisita who responded to extracorporeal photopheresis.     

Congenital Multiple Clustered Dermatofibroma in a 12‐Year‐Old Girl

Abstract: Congenital multiple clustered dermatofibroma (MCDF) is a rare, idiopathic, benign tumor presenting at birth as an asymptomatic hyperpigmented patch that is stable until puberty, at which time it enlarges and develops papules. Ultimately, MCDF appears to follow a stable, benign course. We present a case of a 12‐year‐old girl with congenital MCDF. To our knowledge, this is only the third reported case of congenital presentation of MCDF and the only case featuring atrophoderma‐like depression.     

Cutaneous T‐cell Lymphoma of 12 Years Duration Initially Presenting in a Two Year Old

A 67‐year‐old Chinese man presented with a longstanding history of asymptomatic, brown‐red macules that diffusely involved his trunk and the extremities and was associated with generalized lymphadenopathy. His serum protein electrophoresis revealed a polyclonal hypergammaglobulinemia. No monoclonal Bence Jones protein was detected in the urine. Flow cytometry of his peripheral blood revealed a normal polyclonal population of B and T cells. Histopathologic examination demonstrated a dense nodular infiltrate of lymphocytes and numerous mature plasma cells in the reticular dermis. Immunoperoxidase studies for kappa and lambda light chains failed to demonstrate clonality. In addition, immunoglobulin gene rearrangement studies failed to reveal a monoclonal band. A bone marrow biopsy showed no abnormality. Cutaneous and systemic plasmacytosis is a rare lymphoproliferative disorder that is an important consideration in the differential diagnosis of cutaneous infiltrates in which plasma cells predominate.     

A Case of Psoriasis Replaced by Allergic Contact Dermatitis in a 12‐Year‐Old Boy

Allergic contact dermatitis is a significant clinical problem in children and one that the use of essential oils and natural remedies probably exacerbates. We report a case of chronic plaque psoriasis replaced by allergic contact dermatitis in a 12‐year‐old boy. We suspect that the immunologic response to a hapten in lavender oil disrupted the pathogenesis of psoriasis, causing the psoriasis to temporarily “disappear.”     

Behavioral Characteristics in 18‐ to 36‐Month‐Old Toddlers with Atopic Dermatitis Compared with Healthy Children

Abstract: Some differences in behavioral characteristics have been attributed to atopic dermatitis (AD). In this study, AD patients compared with healthy toddlers had significantly higher scores in perceptual sensitivity and high pleasure in an early childhood behavior questionnaire (ECBQ). They tended to be more energetic and impulsive, and also showed more excitement when subjected to novel stimuli.     

Concurrent Hidradenitis Suppurativa,Inflammatory Acne,Dissecting Cellulitis of the Scalp,and Pyoderma Gangrenosum in a 16‐Year‐Old Boy

We report the case of a 16‐year‐old boy who presented to our clinic with concomitant hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum. Recent reports describe the co‐occurrence of pyoderma gangrenosum, acne, and hidradenitis suppurativa. This case further expands the spectrum of concomitant pyoderma gangrenosum and dissecting cellulitis of the scalp.     

Vismodegib Therapy for Basal Cell Carcinoma in an 8‐Year‐Old Chinese Boy with Xeroderma Pigmentosum

Vismodegib is an oral inhibitor of the Hedgehog signaling pathway and has been used to treat basal cell carcinoma (BCC) in adults. This article reports clearance of a nodular BCC of the nasal tip in an 8‐year‐old boy with xeroderma pigmentosum (XP). BCC can pose therapeutic challenges when located in areas that are not amenable to traditional therapies such as Mohs micrographic surgery or topical agents. Vismodegib was used at a dose of 150 mg/day to treat the boy's BCC. After 4 months of therapy, we achieved complete clinical clearance. During 21 months of follow‐up, the patient's nose remained clinically clear of tumor. Vismodegib was successfully used to treat a child with XP and nodular BCC. Our goal in using vismodegib was tumor regression while avoiding cosmetic and functional disfigurement. Vismodegib was effective in clinically clearing the tumor, and the patient has shown no signs of recurrence. Further studies are warranted.     

Primary Cutaneous CD4+ Small to Medium‐Size Pleomorphic T‐Cell Lymphoma in a 12‐Year‐Old Girl

Primary cutaneous CD4+ small to medium‐size pleomorphic T‐cell lymphoma (PCSM‐TCL) is a rare disease that has been added as a provisional entity to the World Health Organization European Organization for Research and Treatment of Cancer (WHO‐EORTC) classification of lymphomas with primary cutaneous manifestations. Patients commonly present with a solitary nodule or plaque on the head or upper trunk, but are usually otherwise in good health. The prognosis is favorable, but the optimal treatment has not been defined. Recent publications have described the expression of programmed death‐1 in PCSM‐TCL and T‐cell pseudolymphoma, suggesting a diagnostic value of this marker in the differential diagnosis of PCSM‐TCL in contrast to other types of cutaneous T‐cell lymphoma. We present the case of a 12‐year‐old girl with a tumor of the right supraorbital area. She was treated as an outpatient four times with intralesional triamcinolone acetonide at intervals of 3 to 4 weeks. In addition to the case history, this report includes the clinical and histologic findings and a review of the current literature.     

Lichenoid Drug Eruption with Prominent Nail Changes Due to Leflunomide in a 12‐Year‐Old Child

We present the case of a 12‐year‐old‐girl who developed lichenoid dermatitis approximately 1 year after starting leflunomide for juvenile idiopathic arthritis. The eruption resolved promptly with discontinuation of the suspected culprit agent, supportive of a lichenoid drug eruption, but she subsequently developed markedly dystrophic nails with lichen planus–like features. A biopsy of her cutaneous findings at the time of initial presentation demonstrated lichenoid dermatitis, and a nail matrix biopsy was deferred given clinical correlation. Prominent nail changes in lichenoid drug eruptions, particularly in children, are rare but should be considered in children with new‐onset nail dystrophy.     

Treatment of Common and Plane Warts in Children with Topical Viable Bacillus Calmette‐Guerin

Abstract: Treatment of verrucae in children is difficult and may be painful using traditional methods, especially if they are multiple or on the face. The objective of the current study was to evaluate the efficacy and safety of topical application of viable Bacillus Calmette‐Guérin (BCG) in a paste formula as a new immunotherapeutic modality in the treatment of common and plane warts in children. The present study included 80 children with common and plane warts at different sites on the body. They were divided into two groups. Group A (40 patients) received topical viable BCG and group B (40 patients) received topical saline as control. All patients and controls had received a previous vaccination of BCG. BCG was applied once weekly for six consecutive weeks. Patients who had partial or no response received another course of treatment for another 6 weeks. Follow‐up was at 6 months to detect any recurrences. A highly significant difference was found between the therapeutic response of common and plane warts to BCG and saline (placebo) (p < 0.001). Complete response was achieved in 65% of children with common warts and 45% of patients with plane warts. No response was detected in the control group. No recurrences or side effects were observed in the BCG group. Topical immunotherapeutic BCG is a new, effective, safe treatment option for children with common and plane warts.     

Off‐label use of TNF‐alpha inhibitors in a dermatological university department: retrospective evaluation of 118 patients

Tumor necrosis factor‐alpha (TNF)‐alpha inhibitors are licensed for patients with severe refractory psoriasis and psoriatic arthritis. However, TNF‐alpha inhibitors have also been used off‐label for various recalcitrant mucocutaneous diseases. This study aimed to evaluate the efficacy and safety of TNF‐alpha inhibitors used for off‐label dermatological indications. We retrospectively evaluated patient records of 118 patients treated off‐label with TNF‐alpha inhibitors in a dermatological university department. Patients presented with severe aphthous stomatitis/genital aphthous lesions (26), chronic urticaria (25), hidradenitis suppurativa (29), acne conglobata (11), dissecting cellulitis of the scalp (two), orofacial granulomatosis (four), sarcoidosis (four), granuloma annulare (two), granulomatous rosacea (one), granuloma faciale (one), subcorneal pustulosis (one), pyoderma gangrenosum (four), Sweet's syndrome (four), Well's syndrome (one), benign familial pemphigus (one), lichen planus (one), and folliculitis decalvans (one). A significant number of these patients went into remission during therapy with TNF‐alpha inhibitors. A total of 11 patients (9%) experienced severe adverse effects during therapy. Off‐label therapy with TNF‐alpha inhibitors may be considered for selected patients with severe recalcitrant mucocutaneous diseases. The risk of severe adverse effects signals that a thorough benefit–risk assessment should be performed before initiating off‐label treatment with TNF‐alpha inhibitors for these conditions.     

荆州地区49例0～6岁儿童甲真菌病病原学分析

目的了解荆州地区0~6岁儿童甲真菌病的临床特征及病原菌分布特点。方法回顾性分析49例经真菌镜检和真菌培养诊断为甲真菌病的0~6岁儿童病例资料。结果儿童甲真菌病患者在3~6岁中构成比最高。最常见临床类型为远端侧位甲下型(59.18%)。可能危险因素为浅部真菌病家族病史、甲外伤史和其他部位浅部真菌病史。共分离出病原菌49株,包括皮肤癣菌17株,酵母菌30株,非皮肤癣菌2株,最常见的致病菌依次为光滑念珠菌(20.41%)、红色毛癣菌(18.37%)和近平滑念珠菌(18.37%)。结论荆州地区0~6岁儿童甲真菌病最主要致病菌种为光滑念珠菌,针对其临床特征及病原菌分布的研究十分重要。     

A Q‐Tip Tip: Use of a Cotton‐Tipped Applicator to Desensitize Children to Intralesional Candida Antigen

We suggest the following technique that uses readily available, inexpensive, nonthreatening cotton‐tipped applicators to model Candida antigen injection.