Paediatric Dermatology

Prevention of atopic dermatitis: Etiological considerations and identification of potential strategies John C Su, Adrian J Lowe Indian Journal of Paediatric Dermatology 2019 20(2):93-100 Research during the last decade has given many new insights into factors contributing to the development and evolution of atopic dermatitis (AD). Factors identified include skin barrier defects, proinflammatory predispositions, anomalies in the microbiome, and some environmental influences. There is now the possibility of personalizing therapy and potentially, of disease prevention. However, discerning the respective roles of early factors leading to AD development is complex. Stringent analysis for confounders must precede attribution of causality to any factor. This review examines current understandings of AD pathogenesis and related research approaches in AD primary prevention.

Disorders of nail in infants and children Archana Singal, Kavita Bisherwal Indian Journal of Paediatric Dermatology 2019 20(2):101-111 Nail disorders in infants and children do not contribute to substantial pediatric consultations as they are relatively uncommon. Nail changes are often missed as specific nail examination is not routinely done in this age group. The presentation and management of nail disorders in children are different from adults; few being specific to the children. Physiological alterations are common in infants and pediatric age. These should be known to a clinician so as to differentiate from pathological conditions, to reassure parents, and to avoid unnecessary medical intervention. The congenital nail disorders can be a part of major hereditary syndromes requiring further evaluation. Several acquired causes may cause nail dystrophy. Some of them are self-limiting while others may require long-term management. Meticulous and careful nail examination is, therefore, important in neonates, infants and children for early diagnoses, management and to prevent complications. There are few epidemiological studies delineating nail changes in infants and children. In this script, we have comprehensively reviewed nail conditions seen in pediatric population through all stages, i.e., neonates, infants, and children.

Childhood leprosy: A review Swetalina Pradhan, Bibhu Prasad Nayak, Gaurav Dash Indian Journal of Paediatric Dermatology 2019 20(2):112-116 Leprosy in children is of special importance as it is the indicator of transmission in community. It affects both the child and family members psychologically and functionally. In this review, we will discuss regarding epidemiology of childhood leprosy in detail, types of leprosy in children, diagnostic difficulties in children, prevention of disabilities in children, and effect of childhood leprosy on the community.

Hot Topics in Paediatric Dermatology Vishal Thakur, Dipankar De Indian Journal of Paediatric Dermatology 2019 20(2):117-121

A study assessing the knowledge, attitude, and practices of parents regarding childhood hypopigmented lesions Akila Ravindra, Veranna Shastry, Chetana Prakash, Jaydev Betkerur Indian Journal of Paediatric Dermatology 2019 20(2):122-127 Background: Pigmentary disorders are believed to be the most common group of dermatoses in the pediatric age group. Loss of pigment can have a profound psychological impact on parents of the affected child. There are few studies available in India about the evaluation of hypopigmented lesions in the pediatric age group. Objectives: The objective of this study was conducted to assess the knowledge and attitude and various practices of parents toward hypopigmented disorders. Materials and Methods: A total of 130 pediatric patients were evaluated for hypopigmented lesions. Parent of each child was given a preformed questionnaire for the assessment of knowledge and attitude and various practices of their skin condition. Results: The frequency of hypopigmentary disorders among children was 3.28/1000. The mean age was 8.41 years. Nearly 9.33% of patients had onset at birth. In the study of 130 parents, 82 had low, 32 had moderate, and 14 had high knowledge levels, and 84 had unfavorable, and 46 had favorable attitudes. The parents, who had incorrect practices, were 53% and 35.67% had correct practices. Conclusion: The most common hypopigmentary conditions are benign and self-limiting, which requires proper counseling of the parents. A good knowledge and attitude will not only liberate them from traditional beliefs and home remedies that have been used in most of the Indian households but will also make them understand the magnitude of the problem their child could face if they do not seek proper advice from a doctor at the right time.

Childhood vitiligo: A hospital-based study on 200 patients in Northeast India NA Bishurul Hafi, Nandakishore Singh Thokchom, Shyamsunder Ch Singh, Romita Bachaspatimayum Indian Journal of Paediatric Dermatology 2019 20(2):128-133 Background: Vitiligo is a depigmenting disorder which can be psychologically devastating. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aims and Objectives: The aim was to study the clinico-epidemiological and hematologic investigation profiles of childhood vitiligo. Materials and Methods: First 200 pediatric patients younger than 18 years, with vitiligo who attended the dermatology outpatient department of a tertiary center in Northeast India, between September 2015 and August 2017 were included in the study. A detailed history and examination along with autoimmune diseases and laboratory parameters were recorded. Results: Among the 200 patients, 62% were girls. The mean age was 10.3 ± 4.9 years. The mean age at onset was 9.1 ± 4.9 years (ranging 2 months–17 years), with duration of disease varying from 1 month to 8 years with mean duration of 1.39 ± 1.63 years. Most common pattern of vitiligo was vulgaris (39.5%) followed by focal (25%), segmental (15.5%) genital (10%), acral and lateral lip (8%), and acrofacial (4%). Family history of vitiligo was seen in 12% of patients. In 96% patients, only <5% of body surface area was affected. Nearly 8.5% had Koebnerization while 9% showed leukotrichia. Thyroid-stimulating hormone and antithyroid peroxidase abnormalities were seen in 4.5% and 1% patients, respectively. Low Vitamin D level was seen in 21.5%. Conclusion: Any depigmented lesion in children should be evaluated and followed up properly to rule out vitiligo. Dermatologists and pediatricians should understand the characteristics of childhood vitiligo properly since it behave differently from adult-onset disease.

Factitious disorders in children: A diagnostic labyrinth of cases Chinmoy Raj, Maitreyee Panda, Debasmita Behera, Bikash Ranjan Kar Indian Journal of Paediatric Dermatology 2019 20(2):134-137 Factitious disorders are among the most underdiagnosed and less explored group of disorders in pediatric patients. Studies from different parts of the world have reported varying prevalence rates. In this article, we present a series of nine cases of factitious disorders that we encountered in the pediatric age group. Factitious disorder remains highly elusive in developing countries like India. It is highly necessary to remain vigilant to clinch an early diagnosis and manage appropriately.

A rare early presentation of staphylococcal scalded skin syndrome in a Neonate Srinivas Abhishek Gaddam, Srinidhi Thirunagari Indian Journal of Paediatric Dermatology 2019 20(2):138-140 Staphylococcal Scalded Skin Syndrome (SSSS) is caused by the exfoliative toxins (ETs) of Staphylococcus aureus. We present a case of a 3 days old infant with complaints of fever and diffuse erythematous exfoliation all over the body with bilateral conjunctivitis. The diagnosis of SSSS was reached based on clinical features and positive blood culture report. He responded well to the antibiotics paracetamol, and intravenous fluids for rehydration. He was discharged after 14 days, with complete resolution of symptoms. Having a high clinical suspicion for SSSS, early diagnosis/treatment, and following strict aseptic measures in neonatal intensive care unit are important.

Congenital erythropoietic porphyria in an Indian Child Archana Singal, MN Kayarkatte, Deepika Pandhi Indian Journal of Paediatric Dermatology 2019 20(2):141-144 Congenital Erythropoetic Porphyria (CEP) also called the “Günther disease”, is a rare variant of porphyria. It is caused by the deficiency of uroporphyrinogen III synthase (URO-III-synthase), an enzyme in the heme biosynthetic pathway. Clinically, CEP presents with blistering over face and extremities, scarring, hypertrichosis and dyspigmentation. Acral blistering leads to mutilation of the fingers with acro-osteolysis of distal phalanx We, hereby, report an 8-years-old boy with classical clinical features and porphyrin assays.

Vincristine, aspirin, and prednisolone therapy in Kasabach–Merritt phenomenon: Response in 2 cases Shikha Gupta, Subhash Bharti, Niyaz Ahmed Khan, Lavleen Singh Indian Journal of Paediatric Dermatology 2019 20(2):145-147 Kasabach–Merritt phenomenon (KMP) is a severe thrombocytopenic coagulopathy which usually occurs in the presence of enlarging vascular tumors such as kaposiform hemangioendothelioma (KHE) and tufted angioma. The treatment for this potentially fatal condition is challenging without a consensus on appropriate management. The authors report two cases of KHE with KMP, wherein improvement in size of tumor and coagulopathy occurred after treatment with prednisolone, vincristine, and aspirin.