Search

Pityriasis rubra pilaris (PRP) is an uncommon dermatosis in children. Few long-term studies on the treatment and prognosis of PRP in children have been performed.Our purpose was to retrospectively review the clinical course and treatment of all cases of PRP in children 19 years or younger who were seen at the Mayo Clinic.The clinical courses of the 30 patients with PRP seen at the Mayo Clinic between 1975 and 1997 were reviewed.The most common presenting form of PRP in children is the type III juvenile form (Griffiths' criteria). Treatment ranged from topical steroids, tar, and ultraviolet B to systemic retinoids and methotrexate. The best response was obtained with isotretinoin; 5 of 6 patients showed 90% to 100% clearing within 6 months of treatment. Follow-up information was obtained by questionnaire and was available for 83% of patients. Overall, 43% had 90% to 100% resolution of their disease, 23% had a moderate response (30%-90% improvement), and 17% had a poor response (30% improvement). One patient reported spontaneous resolution. Seventeen percent of those who had total clearing had recurrence of PRP within 1 year.PRP in children is a noninherited dermatosis with no sex predilection, occurring mainly in the type III classic juvenile form. Retinoids should be considered as first-line treatment for PRP. Recurrence rate, previously thought to be rare, was about 17% in our population.

A 14-year-old adolescent girl presented with a 2-year history of an exquisitely tender, vegetating cheilitis. Because of this, she was unable to drink fluids and was repeatedly hospitalized for dehydration and pain management. Lip and skin biopsies, as well as multiple laboratory studies did not support a definitive diagnosis. After 2 years, a diagnosis of factitial cheilitis was finally established.

Cutaneous tuberculosis remains a rare entity in the United States. We describe a case of cutaneous tuberculosis in a child. (J Am Acad Dermatol 1999;41:860-2.)

Objective To evaluate the possible association of Parkinson disease (PD) and melanoma in North America. Design, Setting, and Patients Thirty-one centers enrolled patients with idiopathic PD. At visit 1, a neurologist obtained a medical history. At visit 2, a dermatologist recorded melanoma risk factors, performed a whole-body examination, and performed a biopsy of lesions suggestive of melanoma for evaluation by a central dermatopathology laboratory. We compared overall prevalence of melanoma with prevalence calculated from the US Surveillance Epidemiology and End Results (SEER) cancer database and the American Academy of Dermatology skin cancer screening programs. Results A total of 2106 patients (mean [SD] age, 68.6 [10.6] years; duration of PD, 7.1 [5.7] years) completed the study. Most (84.8%) had received levodopa. Dermatology examinations revealed 346 pigmented lesions; dermatopathological findings confirmed 20 in situ melanomas (0.9%) and 4 invasive melanomas (0.2%). In addition, histories revealed 68 prior melanomas (3.2%). Prevalence (5-year limited duration) of invasive malignant melanoma in the US cohort of patients with PD (n = 1692) was 2.24-fold higher (95% confidence interval, 1.21-4.17) than expected in age- and sex-matched populations in the US SEER database. Age- or sex-adjusted relative risk of any melanoma for US patients was more than 7 times that expected from confirmed cases in American Academy of Dermatology skin cancer screening programs. Conclusions Melanoma prevalence appears to be higher in patients with PD than in the general population. Despite difficulties in comparing other databases with this study population, the study supports increased melanoma screening in patients with PD.

* Abbreviation: EMLA = : eutectic mixture of local anesthetics The use of EMLA (eutectic mixture of local anesthetics) cream, especially in pediatrics and dermatology, has significantly reduced emotional and physical discomfort during typically uncomfortable procedures such as venipuncture, intravenous cannulation, lumbar puncture, curettage of molluscum contagiosum lesions, laser therapy of vascular birthmarks, skin biopsy, and cryosurgery of verrucae. EMLA cream is a mixture of lidocaine (25 mg/L) and prilocaine (25 mg/L), [an emulsifier], arlatone 289, [a thickener], carbopol 934, [sodium hydroxide] to adjust the pH to 9.4, and distilled water.1 For EMLA cream to act as an effective topical anesthetic, it must be applied to intact skin for at least 1 hour before the procedure and occluded with either Saran Wrap or Tegaderm.2 The duration of application of EMLA cream varies with the site of application and type of procedure performed.2 The amount of EMLA applied will depend on the surface area involved. Usually, 1 to 2 g of EMLA cream are applied per 10 cm2. Most patients tolerate the application of EMLA cream without adverse effects. The most common local effect is transient blanching of the skin,3 which is most often noted upon removal of the dressing and is caused by the active ingredients in EMLA cream.4 However, the mechanism of this effect is not clear. Erythema can also be observed after the application of EMLA cream.4 Villada et al4 found that erythema was noted most often 2 hours after application of EMLA cream. The erythema is usually asymptomatic and transient. Although the mechanism of the transient erythema is not understood, it seems to occur with greater frequency as the application time of EMLA cream increases.5There have been few reports of other cutaneous reactions including allergic contact dermatitis6 7 and urticaria.5Rarely, petechial or purpuric …