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Objective To assess the safety and adverse events associated with the use of general anesthesia in children undergoing elective dermatologic procedures. Design A multicenter retrospective review. Setting Children’s Hospital and Health Center, San Diego, Calif, and Northwestern University School of Medicine, Chicago, Ill. Patients The study population comprised 269 children and adolescents ranging in age from 2 months to 18 years (881 procedures performed by 6 pediatric dermatologic and laser surgeons). Main Outcome Measures The risk of an adverse event occurring during general anesthesia for pediatric dermatologic procedures. Results The risk of general anesthesia in elective pediatric dermatologic procedures was low: 90% of patients experienced no clinically relevant complications. The most common clinically relevant adverse effect of general anesthesia was perioperative nausea and emesis, which was noted in 4% of patients. There were no serious life-threatening events noted, and the mortality rate was 0%. Conclusion The use of general anesthesia for dermatologic procedures in a children’s hospital setting appears safe, with a low rate of complications.

A 39-year-old man with Down syndrome presented with a long-standing history of an eruption over his hands and arms. The eruption, which was completely asymptomatic, had been an incidental finding by his general practitioner, who had been treating him for a fungal toenail infection. Physical examination revealed a pigmented papular eruption that tended to occur in clumps on the lateral and medial aspects of the patient’s feet (Figure 1) as well as on his forearms (Figure 2). He also had dystrophy of his toenails.Theresultsof therestof theskinexaminationwere unremarkable.Apunchbiopsyspecimenwasobtainedfrom one of the lesions on the forearm (Figure 3). What is your diagnosis?