RESUMEN

OBJECTIVES: To establish the clinical, etiological, and prognostic features of acute urticaria in infancy and early childhood and to define its optimal management. DESIGN: Prospective study. The inception cohort was collected from April 1, 1992, through March 31, 1994. After initial evaluation, the course of the disease was assessed at 2 months and after 1 to 2 years. SETTING: Emergency department of a regional teaching pediatric hospital (referral center), which is also the only pediatric hospital for the general community in the city (population, 600,000 inhabitants). PATIENTS: Fifty-seven consecutive infants, aged 1 to 36 months, hospitalized with a final diagnosis of acute urticaria. Follow-up at 1 to 2 years was available in 40 of 57 patients. INTERVENTION: Oral antihistamines (dexchlorpheniramine maleate, terfenadine, or hydroxyzine hydrochloride) for 2 weeks. MAIN OUTCOME MEASURES: Recurrence and chronicity. RESULTS: Annular or geographic papules and plaques with hemorrhagic lesions were seen in 28 patients (49% of cases) and angioedema in 34 patients (60% of cases). An underlying cause was suspected or identified in 52 patients (91% of cases). Infection, either associated or not with drug intake, was the cause in 46 patients (81%) and foods were the cause in 6 (11%). Parasitic infestations were noncontributory. Hemorrhagic lesions and association with articular symptoms were statistically more frequent in urticaria caused by infections. Atopy in the patient or family was associated in 33 patients (58% of cases), and particularly atopic dermatitis was associated with urticaria caused by food. At 1- to 2-year follow-up, 12 (30%) of 40 patients surveyed had chronic or recurrent urticaria. CONCLUSIONS: Causative factors in urticaria are dominated by benign viral illnesses, often associated with antibiotic drug therapy. In most patients, laboratory investigations are not required. Twenty percent to 30% of cases evolve into chronic or recurrent disease.

Asunto(s)

RESUMEN

Immediate and delayed cutaneous hypersensitivity are believed to be implicated in the physiopathology atopic dermatitis (AD). The purpose of this study was to evaluate Type I and Type IV allergy to aeroallergens in children with AD. 59 children (mean age 5.2 years), presenting with AD according to Hanifin and Rajka's criteria, were skin tested (patch and corresponding prick tests) with common environmental aeroallergens and a restricted panel of the European standard series over a 1-year period. History and clinical data were carefully recorded using a standardized evaluation sheet; total and specific IgE serum levels were evaluated. 17 of 59 patients (28.8%) had at least 1 positive patch test, 32 of 59 patients (54.2%) had at least 1 positive prick test. Corresponding patch and prick tests were observed in 8 out of 17 patients. 5 children with positive patch tests had negative prick tests. Irritant pustular reactions (2/59, i.e. 3%), "angry back" reactions (6/59, i.e. 10%) and doubtful reactions (3/59, i.e. 5%) were excluded from the positive group. Positive patch tests observed included, in decreasing order: D. pteronyssinus and D. farinae (26.8%), garden trees (12.2%), plantain (9.8%), timothy grass, mugwort and damp area trees (4.9% each), and orchard grass (2.44%). 6 children with positive aeroallergen patch tests and 11 children with negative aeroallergen patch tests had at least 1 positive patch test to standard allergens. All children with an irritant reaction to aeroallergens had no reaction to standard patch tests. The relevance of aeroallergens in upgrading the severity of AD lesions has still to be explored by challenge studies and by long-term follow-up.

Asunto(s)

RESUMEN

BACKGROUND: Papulopustular eruptions of the face in neonates are frequently referred to as neonatal acne or sebaceous miliaria. Our findings suggest that there is an association between this type of eruption and Malassezia furfur infection. OBSERVATIONS: Direct examination of pustule smears showed M furfur yeasts in eight of 13 cases involving neonates with erythema and papulopustules of the face, neck, and scalp (mean age at onset, 22 days [range, 7 to 30 days]). The pustules were predominantly neutrophilic. Treatment with 2% ketoconazole cream applied topically twice daily was effective in 1 week. CONCLUSION: Malassezia furfur is frequently associated with a common nonfollicular pustulosis of the newborn, probably improperly termed neonatal acne.

Asunto(s)

RESUMEN

BACKGROUND: The granuloma annulare is a common benign disorder in childhood which may be difficult to recognize in its atypical forms, like deep granuloma annulare. CASES REPORT: Case 1: A 5-year-old girl suffered from subcutaneous nodules occurring on her soles. Open biopsy at the age of 6 years showed typical features of granuloma annulare. These nodules were still present one year later. Case 2: A 2-year-old girl suffered from nodular lesions on the anterior aspect of the lower legs similar to erythema nodosum with spontaneous outbreaks over 6 months. Histological examination showed typical features of granuloma annulare. CONCLUSIONS: Diagnosis of the deep granuloma annulare is often difficult. Its relation with rheumatic nodules which have similar histological patterns is discussed.

Asunto(s)

RESUMEN

BACKGROUND: Indications for active treatment of hemangiomas are those lesions which, by virtue of their size and site, compromise vital structures. The treatment of choice is oral or intravenous corticosteroids, but interferon alpha may represent alternative therapy. CASE REPORT: A 15-day-old girl was admitted for congenital hypothyroidism. She had a large cervicofacial hemangioma extending to periorbital and laryngeal areas. The patient was given systemic prednisone (2 mg/kg/day) and L-thyroxin without success. An episode of acute respiratory distress a few weeks later required tracheostomy while prednisone dosage was increased to 4 mg/kg/day. This drug was not tolerated and the hemangioma was treated by particle embolization that was followed by a partial decrease in the volume of the hemangioma. A second episode of cardiorespiratory distress at 7 1/2 months of age required interferon alpha, 3 million units/m2/day, that was progressively effective. After 11 months of treatment, the hemangioma disappeared, without relapse 6 months later. CONCLUSION: Interferon alpha is an interesting alternative therapy of infantile hemangiomas when they are resistant to steroid treatment.

Asunto(s)

RESUMEN

Over 20 months, we have treated 74 patients (59 children less than 12 years of age) with port-wine stains (PWS) using a 585-nm flashlamp-pulsed dye laser (SPTL-1, Candela Corp., Wayland, Mass., USA) after topical anesthesia with Emla cream. A 5-point reference color scale was used to evaluate the results. 45 patients had at least one treatment on the entire surface of the lesion. A mean of 88 impacts per session was delivered. There was a significant decrease in color in around two thirds of the cases after one complete treatment with a gradual tendency to improvement after subsequent treatments. Younger age at the beginning of treatment was not found to be predictive of a better outcome after the first treatment. In around one third of the cases, positive test site treatment was not correlated with significant improvement after one treatment. Lesions situated on the limbs were less responsive than those on the head and neck. Except for problems due to absence of general anesthesia in young children enduring repeated stressful and sometimes painful procedures, the overall impression is that early treatment of PWS is possible with very limited risks of scarring using this technique.

Asunto(s)

RESUMEN

INTRODUCTION: Among the viral purpuric cutaneous manifestations, papular-purpuric "gloves and socks" eruptions have been lately described. The responsibility of parvovirus B19 infection has been suspected. OBSERVATION: We report two pediatric cases of papular-purpuric eruption of the extremities with a seroconversion for the parvovirus B19. One patient, a twelve-year old girl, also had cellulitic plaques. DISCUSSION: Parvovirus B19 is known for causing various cutaneous manifestations, among which erythema infectiosum as the most classical. A papular-purpuric "gloves and socks" syndrome may be individualised. Previously described in adults, this type of eruption may be prevalent in childhood.

Asunto(s)

RESUMEN

BACKGROUND: We report an expanded series of patients with a distinctive childhood exanthem. OBJECTIVE: Our goal was to describe a new clinical entity. METHODS: This is a clinical study. Twenty-one patients, mostly seen in the spring and late fall, are described. RESULTS: The mean age at onset was 21 months. The eruption began in the periflexural area (close to the axilla, in which an enlarged lymph node was noted in most cases) and spread in an asymmetric pattern, leading to a more generalized eruption in 11 patients. Complete resolution occurred in 3 to 6 weeks. CONCLUSION: An inoculation disease was first suspected, but a systemic viral exanthem seems more probable. We propose to name this eruption asymmetric periflexural exanthem of childhood.

Asunto(s)

Asunto(s)

RESUMEN

16 children with atopic dermatitis and 4 nonatopics were skin tested with flavourings and perfumes. Immediate reactions to balsam of Peru and fragrance-mix were found in 9 atopics, and none among nonatopics. An irritant is more probable than an immunologic mechanism. Allergen solutions should probably be assayed at a lower concentration in atopic patients. This study points to a possible aggravating factor from perfumes and flavourings ingested, inhaled, or used as cosmetics.

Asunto(s)

RESUMEN

Cutaneous involvement is frequent in Shwachman syndrome, and includes various degrees of dry skin, and eczematous and ichthyosiform lesions. A 12-year-old boy with Shwachman syndrome had cutaneous involvement characterized by dry skin, perioral dermatitis, and follicular keratosis. Polymorphonuclear motility was decreased. A nutrition work-up showed a decrease in liposoluble vitamins, and suggested a causative link with the skin lesions.

Asunto(s)

RESUMEN

Acute infectious cellulitis is a common condition in pediatric patients. We retrospectively studied 28 cases seen over the last four years. Average age of patients was four years. Fever and a decline in general health were often found. Streptococcus pyogenes and Staphylococcus aureus were the most common organisms in our series. Outcome was favorable under early antimicrobial therapy selected according to age and clinical features. Before three months of age, cellulitis suggests a streptococcus B infection and should be treated by ampicillin or parenteral penicillin, combined with an aminoglycoside if called for. Between 4 months and 2 years of age, Haemophilus influenzae b or a pneumococcus are the most likely organisms; Haemophilus cellulitis should be treated by a third generation cephalosporin for ten days or longer, followed by ampicillin or ampicillin-clavulanic acid per os for ten or 15 days. Beyond 2-3 years of age, all organisms may be the cause of cellulitis, but the most likely are Streptococcus pyogenes and Staphylococcus aureus, treatment consists in administration of either a penicillin M or a macrolide, the route being selected according to the general condition and site of the cellulitis.

Asunto(s)