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Background: Comedone extraction provides greater satisfaction for acne treatment than conventional treatment alone; however, post‐comedone extraction erythema (PCEE) remains a concern for patients. Objectives: To evaluate the efficacy of pulsed‐dye laser (PDL) in PCEE and comedone reduction. Methods: Mild‐to‐moderate acne patients were randomly allocated in split‐face fashion. Three comedones were extracted on each facial side. On the PDL‐treated side, 595‐nm PDL was delivered to the entire side with an additional shot on three comedone‐extracted sites. Erythema index (EI) and total acne lesion counts (TALC) were evaluated at baseline, week 2 and 4. The comprehensive acne severity scale (CASS) was assessed by three blinded independent pediatric dermatologists. Participant satisfaction surveys were completed at the end of the study. Results: Thirty‐five participants (age 12.9–24.2 years) showed no differences in the EI and TALC at baseline on both sides. At weeks 2 and 4, the EI on the PDL‐treated side was significantly lower (p < 0.001) with a greater EI reduction (p < 0.001) when compared to the control side regardless of gender and menstruation. There was significantly lower TALC on the PDL‐treated side at week 2 (p < 0.001) and week 4 (p = 0.02). No complications were noted with high participant satisfaction reported (median 8; IQR 7–9). PDL remained significantly associated with EI improvements after controlling for gender, menstruation cycle, and examination stress. Conclusion: PDL can be an adjunctive intervention for the treatment of PCEE and comedone reduction due to its effectiveness and high participant satisfaction. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and severe adverse drug reaction involving multiple organs. Data on DRESS syndrome among children are currently limited. The purpose of this study was to determine the clinical features, causative drugs, systemic organ involvement, laboratory findings, disease severity score, and treatment outcomes in pediatric DRESS patients. The medical records of all pediatric DRESS patients, based on the RegiSCAR diagnostic criteria and admitted to King Chulalongkorn Memorial Hospital, Bangkok, Thailand from January 2010 to December 2021, were reviewed. Twenty‐two cases were identified (males 54.5%) with a median age of 9.5 years. Anticonvulsants (54.5%) and antibiotics (27.3%) were the leading culprit drugs. Skin rash was reported in all cases, followed closely by liver involvement (95.5%). Eosinophilia and atypical lymphocytosis were identified in 54.5% and 31.8% of cases, respectively. The median latency period was 17.5 days. Liver enzyme elevation was detected at an average onset of 20.0 days and hepatocellular type was the most common pattern of liver injury. Nineteen patients (86.4%) were treated with systemic corticosteroids with prednisolone being the most prescribed medication. One case developed Graves' disease after DRESS and multiple relapses of DRESS. One case (4.5%) died due to refractory status epilepticus that was unrelated to DRESS. Anticonvulsants were the major cause of DRESS in pediatric patients. High suspicion for DRESS is crucial in patients receiving these drugs and presenting with fever, rash, and internal organ involvement. [ABSTRACT FROM AUTHOR]

Background: Concerns about the use of topical corticosteroids (TCS) in pediatric eczematous dermatitis management often hinder effective treatment. Limited data exist regarding the prevalence of these concerns and the effectiveness of interventions. This study aimed to assess the prevalence of TCS concerns among caregivers and determine the effectiveness of video education in mitigating these concerns. Methods: A single‐center prospective study was conducted from 2022 to 2023, involving caregivers of children under 18 years with eczematous dermatitis. Baseline and post‐intervention questionnaires were administered after a 4‐week period. Caregivers received video education on TCS use, and the TOPICOP score was evaluated before and after viewing the video. Results: The study included 150 caregivers, 85.3% female and 74% had a child with atopic dermatitis. The prevalence of TCS concerns among Thai caregivers was 62%. Following video education, the prevalence of TCS concerns significantly decreased to 10.7%. Mean belief score decreased from 43.81 ± 13.45 to 31.85 ± 16.56, mean worry score decreased from 56.22 ± 18.27 to 40.41 ± 18.55 and mean total TOPICOP score decreased from 50.02 ± 12.65 to 36.13 ± 13.52 (p‐value <.001). The intervention also resulted in reduced disease exacerbations, duration of the rash, and duration of TCS use. The optimal TOPICOP cut‐off score to predict TCS concerns was identified as 43.06. Conclusion: Video education effectively alleviated TCS concerns among caregivers, addressing beliefs, worries, disease exacerbations, and side effects. Integration of this intervention into the management of pediatric eczematous dermatitis can yield optimal outcomes. [ABSTRACT FROM AUTHOR]

Steroid phobia is an increasing phenomenon that affects treatment adherence. The purpose of this study was to assess the prevalence and associated factors of steroid phobia among adolescents with eczema and the caregivers of children and adolescents with eczema by using questionnaires and TOPICOP© scale. The prevalence of steroid phobia is approximately 12% and 37% in the adolescent and caregiver groups, respectively. Caregivers who obtained information about topical corticosteroid (TCS) from dermatologists and whose children had fewer number of flares, demonstrated less concern about using TCS. [ABSTRACT FROM AUTHOR]

LT and HSCT are now potentially curative treatments for many medical conditions. Dermatologic manifestations are one of the sequelae after transplantation. To study the prevalence and associated risk factors of dermatologic manifestations after pediatric LT and HSCT. A 20‐year retrospective cohort study was conducted in children, aged ≤15 years, who received LT or HSCT from January 1, 1997, to December 31, 2017. Medical records were reviewed for data collection until December 31, 2018. A total of 70 LT and 51 HSCT recipients were included. The percentages of overall dermatologic manifestations after LT and HSCT were 64.3% and 64.7%, respectively. Viral infection was the most common manifestation in both groups, with mucocutaneous HSV infection as the most prevalent. One HSCT recipient developed leukemia cutis. GVHD was revealed in 27.5% of HSCT recipients. Impetigo and xerosis were significantly observed in patients using azathioprine and prednisolone. Approximately two‐thirds of pediatric LT and HSCT recipients experienced dermatologic manifestations, potentially associated with immunosuppressive agents. Thus, regular skin examination and optimized immunosuppression would be beneficial in these recipients. [ABSTRACT FROM AUTHOR]

Summary: Background: Limited data of sun protection knowledge in laser treatment patients exists therefore, preventative information should be provided by dermatologists to minimize harmful effects. Objective: To assess sun protection knowledge‐behavior and knowledge to prevent adverse events from laser therapy among patients who visited a laser clinic at a tertiary university hospital in Bangkok, Thailand. Methods: This is a self‐reported questionnaire, cross‐sectional survey. All participants from the Laser Clinic in KCMH were recruited into the study. Results: A Total of 385 patients were enrolled into the study; 80.5% female participants. Patients who never received laser treatment significantly lacked proper sun protection knowledge to prevent adverse events of lasers when compared to those who previous received laser treatments regarding the application of sunscreen after laser treatment (56.6% vs 17.4%, P < .001), consistent application of sunscreen 4‐6 weeks prior to receiving laser treatment (60.5% vs 18.9%, P < .001), application of topical corticosteroid after laser (67.1% vs 54.1%, P = .048), and sun protection in the post laser area (41.9% vs 20.4%, P < .001). Conclusion: The attitude and knowledge of sun protection to prevent adverse events were significantly different among the group of educational levels and previous history of laser treatment. [ABSTRACT FROM AUTHOR]

The high prevalence of acne vulgaris in teenagers has increased comorbidities. Lasers offer alternative options for acne treatment because they have rapid action, low systemic adverse effects, and do not require everyday treatment. To study the efficacy and patients' satisfaction of 595-nm pulse dye laser ( PDL) treatment of acne vulgaris and acne erythema in adolescents and early adulthood, we designed a blocked-randomized, split-faced 595-nm PDL (fluence 8 J/cm3 pulse duration 10 ms, spot size 7 mm, 2 session every 2 weeks) study in patients with mild to moderate acne by comparing the laser-treated and non-treated side. The acne lesion counts, acne erythema grading, and acne severity grading were evaluated at baseline and 2, 4, and 8 weeks. Thirty patients were recruited. The results showed no statistically significant difference except the papule count at week 4 which was −1.828 on the treated side and 0.103 on the non-treated side of the face, P-value 0.0018. There was no statistically significant difference of acne severity grading and acne erythema grading between both sides of the face. The mean scores of patients' satisfaction on the laser-treated side were 75, 81, and 81%, respectively. The PDL treatment in this study reveals no significant improvement in acne therapy; however, the patients were satisfied with this laser treatment. [ABSTRACT FROM AUTHOR]

Chromhidrosis is a rare condition where colored sweat comes from the apocrine or eccrine glands. Pseudochromhidrosis is an uncommon condition where colored sweat is related to specific dye-producing bacteria, drugs, dyes, or chemical agents. This article provides a literature review of the various etiology, investigation, treatment, and prognosis. We propose an investigative algorithm to assist dermatologists, pediatric dermatologists, and general practitioners to diagnose this uncommon condition. The treatment options rely on the primary etiology such as removing dyes and chemical agents first and then treating the chromogenic bacteria. Topical and oral erythromycin seems to be the most effective treatment both in unidentified and identified chromogenic bacteria cases. Results and prognosis were excellent and without recurrence. [ABSTRACT FROM AUTHOR]

Flood is one of the most common natural disasters, which commonly occurs in all parts of the world. The effects of the disasters considerably become enormous problems to overall public health systems. Flood-related skin diseases are a portion of these consequences presenting with cutaneous manifestations and/or signs of systemic illnesses. We conducted a systematic literature review of research publications relating to flooding and skin diseases. The purpose of this review was to provide dermatologists as well as general practitioners with comprehensive conditions of flood-related skin diseases and suggested treatments. Moreover, we categorized these flood-related diseases into four groups comprising inflammatory skin diseases, skin infections, traumatic skin diseases, and other miscellaneous skin diseases in a bid to implement early interventions and educate, prevent, and efficaciously handle those skin diseases under such a catastrophic situation so that better treatment outcomes and prevention of further complications could be ultimately achieved and accomplished. [ABSTRACT FROM AUTHOR]

Background: Sun protection behavior is a proven intervention for aging skin and skin cancer prevention, especially if training on prolonged sun exposure can be performed early in life. Despite the fact that there are several study reports from multicenters in the West, there are limited data on sun protection in tropical countries where the prevalence of sunburn as well as sun protection behavior and knowledge are low. In Bangkok, sun protection behavior among adolescents is different from the studies performed in the West. Schools are key institutions in encouraging students to prevent themselves from acquiring problems of long-time sun exposure. Objective: To assess the amount of time exposed to the sun, sun protection behavior, attitudes, and knowledge about sun exposure protection among secondary school adolescents in Bangkok, Thailand. Methods: This is a nonrandomized, cross-sectional survey. All students from seven secondary schools in Bangkok (public/private, male/female/coed) were recruited in to the study. Results: A total of 10387 students were enrolled in to the study; 6176 (59.5%) and 4211 (40.5%) students were from grades 7 to 9 and 10 to 12, respectively. Male students significantly lacked proper sun-protecting behaviors when compared to the female students in the use of sunscreen (9.4% vs. 28.0%, P <0.001), staying under the shade (55.5% vs. 65.2%, P <0.001), and use of umbrellas (5.2% vs. 12.1%, p <0.001). Proper attitudes and sun-protecting behaviors among junior high school students were deficient when compared to high school students in the use of sunscreen (57.1% vs. 60.6%, P < 0.001), types of clothing (10.5% vs. 15.3%, P <0.001), and hat (3.2% vs. 3.9%, P <0.001). Conclusion: Sun protection behavior among adolescents in Bangkok was poor compared to Western countries. The attitudes and general knowledge about sun protection were significantly different among male and female students from grades 7 to 9 and 10 to 12. Limitation: The limitation of the study is the use of self-reported questionnaires in assessing sun exposure and protection. [ABSTRACT FROM AUTHOR]

Abstract Background Kasabach–Merritt syndrome (KMS) is a rare, aggressive, vascular tumor with thrombocytopenia and consumptive coagulopathy. A standard treatment regimen for KMS has not been established. We reviewed our experience of a stepwise approach for the treatment of 10 children with KMS. Methods All patients were first treated with oral corticosteroid (initially 3 mg/kg/day then 5 mg/kg/day) and dipyridamole. Interferon-alpha-2b (IFNα2b) was used as second therapy for steroid-resistant cases for 12 months, then tapered to an alternate-day regimen, and then discontinued. Adjunctive therapy, including embolization of the feeding vessel or chemotherapy, was additionally used in patients who failed to respond to IFN or could not be taken off IFN. Results Ten patients were treated on this protocol with a follow-up time of 1–6 years. Oral corticosteroid plus dipyridamole was successful in four patients, but was tapered off by 12 months without recurrence in only two cases. Of the eight steroid-resistant cases, IFNα2b successfully induced regression of the tumor and increased the platelet count in six patients; however, IFNα2b was successful as monotherapy in only three cases; two patients died of aspiration pneumonia whilst on therapy and one patient could not be taken off IFNα2b until weekly vincristine was given (eight doses). Two other patients did not respond to IFNα2b in 4 weeks; embolization and vinblastine was used in one patient to induce regression of the tumor and resolution of thrombocytopenia. Hypertension developed in all children on high-dose prednisolone. Conclusions KMS may be treated in a stepwise approach. High-dose steroid does not result in a high response rate and is not tolerated well. The response to IFNα2b is more favorable, but life-threatening adverse events may occur. Chemotherapy with vincristine or vinblastine may be useful as adjunctive therapy in KMS, but experience is still limited. [ABSTRACT FROM AUTHOR]

The normal value of the absolute CD4-positive T-lymphocyte count is relatively high in normal infants and declines steadily until 6 years of age, whereas the CD4 percentage of the total lymphocyte count is constant. The immunologic categories according to the 1994 revised pediatric human immunodeficiency virus (HIV) classification, based on CD4-positive percentage of the total lymphocyte count, is classified into three categories: no evidence of suppression (≥ 25%), moderate suppression (15–24%), and severe suppression (1–14%). Our objective was to determine the prevalence of mucocutaneous findings in pediatric acquired immunodeficiency syndrome (AIDS) related to the degree of immunosuppression. We prospectively examined 120 children less than 13 years of age who were born to HIV-seropositive women and developed definite HIV infection. The prevalence of mucocutaneous findings in those children who had severe, moderate, and no evidence of immunosuppression were 62%, 43%, and 20%, respectively. The mucocutaneous findings in patients in the moderate and severe suppression groups were significantly more common than in patients without evidence of immunosuppression (p < 0.001). In the moderate immunosuppression group, 11% had two mucocutaneous findings while 21% in the severe immunosuppression group had two or more mucocutaneous findings. The most common mucocutaneous finding was oral candidiasis (33%), which had a mean corresponding CD4 percentage of the total lymphocyte count of 11.3%. Herpes zoster was found in 6% of the patients (mean CD4 percentage of the total lymphocyte count = 13.5%). Chronic herpes simplex virus (HSV) stomatitis was found in 3% of the patients (mean CD4 percentage of the total lymphocyte count = 3%). Mucocutaneous manifestations are common in pediatric AIDS. The majority of these findings have an infectious etiology. The prevalence increases as the CD4-positive percentage of the total lymphocyte count decreases. More... [ABSTRACT FROM AUTHOR]

Investigates mucocutaneous manifestations of HIV infections in children born to HIV-seropositive women in Bangkok, Thailand. Concerns on mucus membrane disorder of children with HIV disease; Emphasis on recognizing patterns of mucocutaneous abnormalities; Occurrence of oral candidiasis..

Abstract Background Five children with pemphigus are reported: three with pemphigus vulgaris, one with pemphigus vegetans, and one with pemphigus foliaceus. Only one case of juvenile pemphigus vegetans has been published in the literature. Materials and Methods All three patients with pemphigus vulgaris were treated with oral corticosteroid; in two cases, azathioprine was added for steroid-sparing effect. The patient with pemphigus vegetans had a clinical presentation resembling pemphigus vulgaris, but the lesions in the perianal area healed as hypertrophic granulation tissue. He was treated with oral corticosteroid, azathioprine, and intralesional corticosteroid. The patient with pemphigus foliaceus presented with exfoliative dermatitis, and was treated with oral corticosteroid; methotrexate was added later for steroid-sparing purposes Results The patients were followed up for 1–4 years; the prognosis of childhood pemphigus is good. Conclusions Long-term follow-up is needed to detect flaring of the disease and the side-effects of immunosuppressive drugs. [ABSTRACT FROM AUTHOR]

Assesses the cutaneous manifestations of childhood systemic lupus erythematosus (SLE). Causes of death in patients with SLE; Occurrence of vasculitis in the nonspecific lesion; Classification of SLE.

Henoch-Schonlein purpura is a syndrome characterized by nonthrombocytopenic purpura accompanied by arthralgia, gastrointestinal symptoms, or renal involvement. We report a 5.5-year-old boy with high fever and hemorrhagic vesicles and bullae varying in size from 2 to 50 mm in diameter, on both pinnas, the hard palate, gums, dorsa of the hands, buttocks, and both legs, and review the pertinent literature. [ABSTRACT FROM AUTHOR]

To determine whether aeroatlergens could induce eczematous lesions, 30 patients with atopic dermatitis were studies in comparison with 30 patients with respiratory atopy without atopic dermatitis. All patients were between 2 end 14 years of age. Patch testing with five aeroallergens-housedust, mite, cockroach, mold mix and grass mix- was done on skin that was stripped by 10 applications of adhesive tape. Intradermal tests with the same antigens were done on the forearm. In 27 (90%) children with atopic dermatitis, patch testing with aeroallergens induced eczematous lesions at one or more sits. Mite, cockroach, house dust mold mix, and grass mix caused reactions in 21 (70%), 21 (70%), 19 (63%), 15 (50%), and 13 (43%) patients, respectively. Three patients had a dermatitis flare at the antecubital and popliteal fossae during testing. Only three (10%) atopic children without atopic dermatitis had eczematous lesions, which was significantly different from children with atopic dermatitis (P < 10-5) Intradermal skin tests in both groups were not significantly different. This study supports previous reports that aeroallergens play an important role in causing eczematous skin lesions. [ABSTRACT FROM AUTHOR]

The article offers two cases involving two juvenile patients who are infected with calcinosis cutis before other clinical manifestations of juvenile dermatomyositis. The first case was about a 14-year-old girl with asymtomatic subcutaneous nodules. The second case was about a 15-year-old boy with a severe calcinosis cutis. Both patients responded well to aluminum hydroxide therapy.

The article presents a case report of a 5-month-old female infant with a history of an indurated plaque on the left clavicular area which was diagnosed as tuberculid-like reaction after bacille Calmette-Guerin (BCG) intradermal vaccination on the left deltoid. The condition subsided after the patient was prescribed with anti-tuberculosis medication for three months. The adverse effects of BCG vaccination is discussed.

Panniculitis caused byl-asparaginase induced acute pancreatitis is an unusual condition. We report a case of a 7-year-old Thai boy with underlying acute lymphoblastic leukemia who developed pancreatic panniculitis caused byl-asparaginase administration. During the second week of induction chemotherapy, the patient developed acute pancreatitis with septic shock. Two weeks later he developed multiple subcutaneous nodules on the abdominal wall. Skin excisional biopsy showed the typical histopathological features of pancreatic panniculitis. Acute pancreatitis improved after 3 weeks of conservative treatment. The skin lesions resolved spontaneously within 1 month. [ABSTRACT FROM AUTHOR]

Epidermal nevus syndrome is a group of congenital neurocutaneous disorders characterized by epidermal nevi in association with cerebral, ocular, skeletal, and sometimes cardiac and renal abnormalities. These nevi have been classified according to their predominant component. We described a child presenting with inflammatory linear verrucous epidermal nevus on the head, which is an uncommon location. He also encountered ocular and central nervous system structural disorders. [ABSTRACT FROM AUTHOR]