Gianotti-Crosti syndrome in an infant following immunization

Gianotti-Crosti syndrome (GCS) is a distinctive, self-limiting acropapular or papulovesicular eruption. Typical clinical presentation is that of a monomorphic, nonpruritic eruption most commonly involving the face, neck, buttocks, and extremities. It tends to occur in childhood, though infrequently it has been reported in adults. We report GCS occurring in an infant following immunization.     

A study of benign chronic bullous dermatosis of childhood and comparison with dermatitis herpetiformis and bullous pemphigoid occurring in childhood

Eighteen patients with benign chronic bullous dermatosis of childhood were studied and the findings compared with those of dermatitis herpetiformis (twenty-two cases) and bullous pemphigoid (five cases) beginning in childhood. The patients with benign chronic bullous dermatosis of childhood had a moderately pruritic bullous eruption with maximal involvement of the pelvic and perioral regions which tended to occur at an earlier age than either dermatitis herpetiformis or bullous pemphigoid. In contrast to dermatitis herpetiformis one-third of the cases with benign chronic bullous dermaiosis of childhood went into remission. Evidence of coeliac disease was only found in the dermatitis herpetiformis group. Surprisingly both diseases shared HLA-B8. A linear BMZ band of IgA was detected on direct immunofluorescence in all but one of the cases with benign chronic bullous dermatosis of childhood and circulating antibodies were detectable in two-thirds. Routine histopathology was of little value in distinguishing between benign chronic bullous dermaiosis of childhood and dermatitis herpetiformis or bullous pemphigoid. Several paradoxes have yet to be explained before it can be determined whether benign chronic bullous dermatosis of childhood is a variant of dermatitis herpetiformis or linear IgA disease.     

The Course of Life of Patients with Childhood Atopic Dermatitis

Abstract:   Atopic dermatitis mainly covers the period of infancy to adulthood, an important period in the development of an individual. The impairment of quality of life and the psychological wellbeing of children with atopic dermatitis have been well documented but so far no data exist about the impact of atopic dermatitis in childhood on fulfilling age-specific developmental tasks and achieving developmental milestones during this period, referred to as the course of life. The aims of this study were to: (i) assess the course of life and define the disease-related consequences in young adult patients with childhood atopic dermatitis and (ii) determine whether the severity of atopic dermatitis is predictive for the course of life, the disease-related consequences and quality of life later in life. Adult patients who grew up with atopic dermatitis were asked to complete a medical history questionnaire, the Skindex-29, the "course of life" questionnaire and a subjective disease-specific questionnaire. Patients with severe atopic dermatitis in childhood showed a significant delayed social development in their course of life. The results of the disease-specific questionnaire demonstrated remarkable high percentages of psycho-social consequences and physical discomfort caused by atopic dermatitis in childhood. Patients showed a severely negative impact of atopic dermatitis on their current quality of life. This is the first study that applied the "course of life" questionnaire in atopic dermatitis. More insight in the course of life, disease-specific consequences and quality of life of atopic dermatitis is of high importance, especially in case of severe atopic dermatitis.     

Adult-onset Atopic Dermatitis

Adult-onset atopic dermatitis is still an under recognized condition as there are only few studies regarding this entity. As compared to childhood onset atopic dermatitis, clinical features of adult onset atopic dermatitis are still not categorized. Adult atopic dermatitis can present for the first time in adult age with atypical morphology or may progress from childhood onset. This article reviews the characteristic clinical features of adult atopic dermatitis, associated risk factors and management.     

Phenotypes of atopic dermatitis identified by cluster analysis in early childhood

Atopic dermatitis is a chronic, relapsing, inflammatory skin disease that usually appears in early childhood and develops into a heterogeneous disease during childhood. The clinical course and treatment for atopic dermatitis can differ according to its phenotype and/or endotype. This study aimed to identify clinical phenotypes of atopic dermatitis in early childhood. Data were obtained from 572 children under 3 years of age with atopic dermatitis. Cluster analysis applied to 11 variables, and we identified four clusters of atopic dermatitis. Children in cluster A (n = 141) had early‐onset atopic dermatitis with high blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to food allergens. Children in cluster B (n = 218) had early‐onset atopic dermatitis with low blood eosinophil counts, serum total immunoglobulin E and rates of sensitization to both food and inhalant allergens. Children in cluster C (n = 53) had early‐onset atopic dermatitis with high C‐reactive protein levels and white blood cell counts. Children in cluster D (n = 160) had middle‐onset atopic dermatitis with high serum total immunoglobulin E and rates of sensitization to inhalant allergens. Cluster A had the highest Scoring for Atopic Dermatitis and transepidermal water loss values. Age at onset, age at diagnosis, white blood cell count, eosinophil count, C‐reactive protein and serum total immunoglobulin E level were the strongest predictors of cluster assignment. Analysis of these six variables alone resulted in correct classification of 95.5% of the subjects. These results support the heterogeneity of atopic dermatitis, even in early childhood.     

Patch test results in a Turkish paediatric population

Allergic contact dermatitis is increasing in childhood. In children, population-based patch test studies point to different contact sensitizers and reflect the variations in the exposure to certain allergens among different countries. Our aim is to show common contact allergens in a paediatric population in Turkey. Contact dermatitis and identifying the suspected allergen in children are important as sensitization occurring during childhood may cause a susceptibility to the contact dermatitis later in their life.     

Atopic dermatitis at preschool age and contact allergy in adolescence: a population-based cohort study

Atopic dermatitis is a common skin disease in children. The disease presents with red, itching and scaly skin, and results in a weakened skin barrier. When atopic dermatitis starts in early childhood, children may be treated with medical ointments and moisturizers for a long time. Such products often contain substances that can cause contact allergy. Contact allergy is caused by skin contact with chemical substances that are allergenic, e.g. contact allergens. Repeated contact with the allergen will result in dermatitis. This study investigated if atopic dermatitis in early childhood increases the risk for contact allergy in the teenage years. The study was performed among 2215 16-year-olds in Sweden. These 16-year-old participants had been followed since birth with questionnaires, clinical examinations and blood tests, to study environmental factors and allergies in children as part of a large population study called the BAMSE study. At 16 years, the participants were tested for contact allergy with a skin patch test. Nickel allergy was the most common contact allergy and fragrance (perfume) allergy was second most common. The results of this study indicate that atopic dermatitis in early childhood may increase the risk of having contact allergy to perfumes at 16 years, but not the risk of nickel allergy at 16 years. This study indicates that avoiding scented and perfume-containing products is a good idea in children with atopic dermatitis in early childhood.     

Interstitial granulomatous lesions as part of the spectrum of presenting cutaneous signs in pediatric sarcoidosis

Abstract:  Skin findings in childhood sarcoidosis vary greatly, but only a few occurrences have been published in which the histopathology has been characterized well. We describe a child with sarcoidosis in whom the cutaneous findings were atypical, resembling granuloma annulare. Histologic examination of these cutaneous lesions, however, revealed areas of sarcoid-like epithelioid cell granulomas, a palisading granulomatous process with features of granuloma annulare, as well as palisading neutrophilic and granulomatous dermatitis and interstitial granulomatous dermatitis. This underscores the variability of skin findings in childhood sarcoidosis—even within the same patient—and suggests that sarcoidosis should be considered in the differential diagnosis of children initially diagnosed with granulomatous skin lesions, such as granuloma annulare, palisading neutrophilic, and granulomatous dermatitis or interstitial granulomatous dermatitis, who demonstrate associated signs of systemic disease.     

Compositae sensitivity and chronic hand dermatitis in a seven-year-old boy

Compositae dermatitis is rare in childhood, with few cases documented in the literature. We report a 7-year-old boy who presented with a dermatitis mainly affecting his dominant hand. Patch testing revealed contact sensitivity to sesquiterpene lactone (SL) mix, and subsequent testing with Compositae oleoresins showed sensitivity to daisy, dandelion and chrysanthemum. The dermatitis improved on avoidance of handling plants. We have not documented any other cases of Compositae sensitivity in 187 other children, aged under 16 years, who have undergone patch testing with SL mix between 1992 and 1996 in our department. This case illustrates that Compositae sensitivity may present with a localized dermatitis and that, although uncommon, sensitization may occur in early childhood.     

Allergic contact dermatitis to chlorhexidine in a very young child

Allergic contact dermatitis to chlorhexidine is an unusual condition, with sensitization in childhood rarely reported. We report the observation of allergic contact dermatitis to chlorhexidine in a 23-month-old boy.     

Factors influencing the occurrence of hand eczema in adults with a history of atopic dermatitis in childhood

A series of 955 persons aged 24-44 years, with atopic dermatitis in childhood, were interviewed in order to identify factors which increase the risk of developing hand eczema in adult life, or aggravate already existing hand eczema. Endogenous (constitutional) factors were in general of greater importance than exogenous factors, viz. chemicals, water, soil and wear (friction). Eczematous involvement of the hands in childhood was of predominant importance. In individuals without such involvement, severe (widespread) dermatitis in childhood was a dominant factor. Other factors, each of them significantly more important than the exogenous ones, were persistent eczema on other parts of the body and dry/itchy skin. The factors female sex, family history of atopic dermatitis and simultaneous bronchial asthma/allergic rhinitis were associated with increased risk of developing hand eczema in adult life, but were of limited importance compared with the other endogenous and the exogenous factors.     

Phototoxic dermatitis due to Chenopodium album in a child

In this article, we report a 2-year-old girl with severe phototoxic dermatitis caused by ingestion of Chenopodium album. To the best of our knowledge, this is the first case of phototoxic dermatitis due to Chenopodium album in childhood.     

Hand eczema in patients with history of atopic manifestations in childhood

A follow-up study of two groups of individuals aged 24-44 years, with a history of severe and moderate atopic dermatitis in childhood (n = 549 and 406 respectively), showed that the most common site of atopic dermatitis was the hands. The prevalence of hand eczema in the two groups was 41% and 25% respectively. The corresponding figure for a group of 222 individuals with respiratory allergy, but not atopic dermatitis in childhood, was 5%, and for a control group (n = 199), without family or personal atopy, 4%. In all four groups the majority of the patients had mild to moderate hand eczema. The fingers were the most common site in all groups. In 69%, 55%, 36% and 12% respectively, hand eczema was found simultaneously with other eczematous manifestations. Irritants were considered by 71-96% in the four groups to aggravate the hand eczema. Contact with various food substances, particularly proteins, was regarded by 38%, 43%, 30% and 9% as an eliciting/aggravating factor. Dust was looked upon as an eliciting/aggravating factor by 25% and 20% of the individuals in the two groups with atopic dermatitis in childhood, but by no one in the control group.     

Granulomatöse periorifizielle Dermatitis der Kindheit

Case report

A 14-year-old patient of African ancestry presented with multiple papules in the perioral, perinasal and periocular areas. Histopathology showed sarcoidal granulomas.

Diagnosis

After exclusion of systemic sarcoidosis, the diagnosis of childhood granulomatous periorificial dermatitis was made.

Therapy

Topical treatment with erythromycin resulted in complete regression.

Conclusion

Childhood granulomatous periorificial dermatitis is mainly observed in dark-skinned children of African, Caribbean, or Asian origin. The nosological position of the dermatosis is controversial. Originally classified as sarcoidosis, childhood granulomatous periorificial dermatitis is now generally regarded as a special form of perioral dermatitis.     

老年特应性皮炎的诊疗研究进展

 特应性皮炎(AD)是一种与遗传有关的慢性、炎症性、瘙痒性皮肤病。随着社会发展及人口老龄化,老年AD作为AD的一种新临床亚型出现在大家的视野并且受到广泛的关注。不同于其他三型AD（婴儿期、儿童期、成人期）,老年人常患有临床表现相似的其他瘙痒性疾病（如脂溢性皮炎、老年瘙痒症、大疱性类天疱疮等）并且伴有其他潜在病症（如高血压病、心脑血管疾病、糖尿病等）,因此老年AD的诊断与治疗较其他三型复杂。本文主要对老年AD的流行病学、临床特征、诊断、鉴别诊断、治疗与管理进行综述,以引起临床医生对该新临床亚型的重视以及为老年AD的诊断与治疗提供思路。     

Facial atopic dermatitis is associated with sensitization to cow's milk,egg whites,and peanuts in children under 36 months

Atopic dermatitis (AD) in early childhood often precedes the development of food sensitization and allergy, but the role of treating AD to prevent food allergy remains poorly understood. Our objective was to assess the relationship between facial dermatitis and food sensitization to cow's milk, egg whites, and peanuts in early childhood, as aggressive treatment of facial dermatitis could serve as a potential opportunity for food sensitization prevention. By 3 years of age, food sensitization levels to cow's milk, egg whites, and peanuts were 48% greater in children with facial AD than in children with no facial involvement of their AD. Additional research is needed to determine if facial involvement of AD in infants and young children is associated with increased food allergy.     

吗替麦考酚酯治疗免疫相关性皮肤病专家建议

【摘要】 吗替麦考酚酯可选择性抑制T、B淋巴细胞的增殖和活性，已广泛应用于多种免疫相关性皮肤病的治疗。在检索国内外文献的基础上，中国不同地域多位专家讨论和撰写了本建议。根据英国牛津大学循证医学中心制定的推荐等级标准，吗替麦考酚酯在成人中重度寻常型斑块状银屑病、成人大疱性类天疱疮和寻常型天疱疮的治疗中属于A级推荐；在成人系统性硬化症、成人中重度湿疹和中重度特应性皮炎的治疗中均属于B级推荐；在皮肤型红斑狼疮、皮肌炎、无肌病性皮肌炎、儿童系统性硬化症、儿童大疱性类天疱疮和儿童天疱疮、儿童中重度湿疹和特应性皮炎的治疗中属于C级推荐。     

The differential diagnosis of atopic dermatitis in childhood

Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides.     

Prognostic factors in atopic dermatitis

A long-term follow-up study (24 years minimum) was made of 955 individuals aged 24-44 years, who had atopic dermatitis (AD) in childhood. The material was divided into two groups; patients who in 1952-56 had been hospitalized on at least one occasion at the Department of Dermatology, Karolinska Hospital, Stockholm (Group 1), and patients who in 1955-56 had been out-patients in the same department (Group 2). At the time of investigation 62% and 40% of the patients in Groups 1 and 2 respectively had ongoing dermatitis, the majority with mild skin lesions. The frequency of healing of AD and severity of persistent or recurring dermatitis were influenced by several factors. In order of relative importance, disregarding sampling errors, persistent dry/itchy skin in adult life, widespread dermatitis in childhood, associated allergic rhinitis, family history of AD, associated bronchial asthma, early age at onset, and female sex were associated with low frequency of healing and increased severity of persistent or recurring dermatitis.     

“Slime” contact dermatitis: Case report and review of relevant allergens

Homemade “slime” is currently a popular childhood hobby that can cause allergic and irritant contact dermatitis. We describe a case of hand dermatitis due to homemade “slime” with a positive patch test to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and MI. The most common potential allergens in “slime” collected from a review of “slime” recipes found on the Internet are reviewed.