Antihistamines are widely used drugs in pediatric population. First-generation antihistamines have been in use since last many years, though adequate data on their efficacy and safety in pediatric population is scarce. In contrast, second-generation antihistamines have been studied extensively in children and have a better safety profile with more receptor selectivity and less adverse effects. Pruritus has a significant impact on the quality of life in children and its management is of paramount importance. This article reviews the first and second-generation antihistamines in the light of recent advances in the understanding of their pharmacological properties and safety profile in children. An extensive literature search was done; all clinical trials, randomized double-blinded or single-blinded controlled trials, open-label studies, retrospective studies, reviews, case series, and case reports focusing on the use of antihistamines in pediatric age groups were screened. The selected articles were retrieved; the final manuscript was prepared, analyzed, and presented in a narrative fashion.

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The time-centered routine consultations have been shown to be inadequate in imparting the necessary knowledge and practical skills for the children and the family suffering from atopic dermatitis. There is a need to complement medical treatment with adequate counseling or focused psychological and educational interventions, directed at the patient and the parents. The authors discuss the various approaches in “counseling” that has been used worldwide and propose a practical approach for the same in the Indian scenario.

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“Terminology in Trichology” is a concise guide to the essential language of trichology. It has been written with the aim of making readers aware of commonly used terms in trichology. It has been structured in such a way that it should prove useful to the postgraduates and practicing dermatologists and trichologists. Terms are explained in simple language so that they are easy to understand, without including excessive details.

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Introduction: The quality of life of both the child and their caretakers has been noted to be adversely affected by visible birthmarks and resultant scarring, particularly in areas that cannot be easily covered. With the current knowledge about the uncertain trend in the progression of infantile hemangiomas (IH), the risks associated with it, and the availability of safe and effective treatment options available, a question arises, that should all hemangiomas be treated? A national survey was conducted to determine dermatologists' opinions throughout the country followed by the analysis and literature review. Methodology: An anonymous questionnaire of 10 questions was shared among dermatologists of the country using a link distributed through the electronic media. The data submitted anonymously by the responders were analyzed after due permission for its use for research and publication was received. Results: A total of 91 clinicians completed the questionnaires. 54.95% of the respondents answered that they would wait and watch in the majority of the cases presenting to them. 83.52% of the responders chose topical timolol as the most common medical treatment modality. 33.71% of the responders reported the resolution of IH in more than 75% of their patients and fibrofatty residue was the most common sequelae reported post the involuntary stage. 65.56% of the responders answered no to the question − “Should all hemangiomas be treated?” Conclusion: Clinical experience backed with research has proved the efficacy of beta-blockers in the resolution of IH beyond doubt. The need to identify, evaluate, and initiate timely treatment is required to avoid missing the window of opportunity to optimize the outcomes.

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Sarcoidosis always remains a diagnostic challenge due to its great imitating potential. Propensity to involve important organ systems such as lung points toward the importance of detailed evaluation and follow-up at regular intervals. It can present with a myriad of morphological forms. Isolated cutaneous involvement of sarcoidosis presenting as granuloma annulare (GA) like lesions have rarely been reported in children. Herein, we report a child with cutaneous sarcoidosis presenting as asymptomatic annular plaque on the face resembling GA without any systemic involvement. Our case has novelty from several aspects: presentation during childhood, isolated facial involvement, and morphological resemblance with GA.

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Background: Cutaneous adverse drug reactions (CADRs) have been seen to be one of the most common adverse drug reactions in various studies, and the incidence in developing countries is thought to be higher between 2% and 5%. Moreover, severe CADRs (SCADRs) constitute 2% of all CADRS and can be life-threatening. The pediatric population too is vulnerable, and like in adults, SCADRs are associated with serious mortalities and morbidity; hence, early diagnosis and prompt treatment are the cornerstone for better survival. Objective: This study was undertaken to assess the patterns of SCARDs among pediatric patients and to identify the causative drug/drugs and establish causality using Naranjo scale and also study various treatments given including the role of corticosteroids in their management. Materials and Methods: A total of 52 pediatric patients (</=18 years) were taken up for the study after written informed consent from the parents/guardian. The diagnosis of Steven-Johnson syndrome (SJS), SJS-toxic epidermal necrolysis (TEN), TEN, drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) was established using the recommended criteria. Results: A total of 52 patients were taken up for the study. The youngest was 9 months old, whereas the oldest was 18 years old. There were 34 (65.3%) males and 18 (34.6%) females. The most common SCADR was SJS seen in 27 (51.9%), followed by TEN in 9 (173%), SJS-TEN overlap in 8 (15.3%), DRESS in 6 (11.5%), and AGEP in 2 (3.8%). Conclusion: There is a lack of studies on SCADRs among the pediatric population and more so dilemma still exists regarding management. Thus, multiple such studies need to be carried out to establish clear-cut recommendations for the management of SCADRs in children and also to assess the role of corticosteroids in their management, particularly in a resource-poor nation like India.

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Context: Leprosy is a major public health problem in developing countries where districts and blocks are reporting high prevalence indicating ongoing transmission. According to the National Leprosy Elimination Program Report of March 2017, there were about 0.13 million cases of leprosy in India, 8.7% of which were children. This study offers insight into the current status of the pediatric leprosy. Aims: The aim of the study is to assess the current scenario and clinical profile and to describe the clinico-epidemiological features of childhood leprosy at our tertiary care hospital in Hubballi. Settings and Design: This study was a 13-year retrospective analysis of hospital data from April 2005 to March 2018. Subjects and Methods: A retrospective, record-based study was carried out on patients diagnosed and registered in urban leprosy center of our tertiary care hospital in Hubballi (April 2005–March 2018). Data regarding demographic details, clinical features, treatment started, and complications were noted and analyzed. Results: Of total 1305 patients, 189 (14.48%) pediatric patients were seen. Age group of 12–18 years constituted 64.02% of patients. Male: female ratio was 1.3:1. Family history was present in 22 (11.6%). 142 had lesions ranging from 1 to 5 (75.13%), among them single lesion was common. Skin lesions are most often seen on the upper limb (52.38%). Borderline tuberculoid leprosy was common (72%). Majority had ulnar nerve involvement. Deformity was present in 21 patients. Majority received multibacillary multidrug therapy. Conclusions: This study showed a prevalence of 15.6% of pediatric leprosy cases. Pediatric leprosy reflects that there are active infectious cases in the community, which needs active intervention including vigilant and rigorous screening for early diagnosis and treatment initiation, which are essential components for leprosy elimination and disability prevention.

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Introduction: Epidermolysis bullosa (EB) is a group of genetically determined rare disorders characterized by bullae, vesicles, and erosion of skin and mucous membrane, which can be spontaneous or following friction, minimal trauma, or heat. It has a complex genotype–phenotype correlation with different modes of inheritance and various degrees of presentation and severity. EB can also have extracutaneous manifestations involving oral mucosa, nail, hair, teeth, eye, gastrointestinal tract, and genitourinary system. Depending on the level of skin cleavage, EB is classified into four groups, among which EB simplex (EBS) is most common and further subclassified based on a phenotypical expression. Case Report: We present three cases of severe EBS manifested during the neonatal period with generalized extensive blister and erosion of skin, dystrophic nails, and healing with minimal scar and hypopigmentation. Discussion: Newborn presents with excessive fragile skin with widespread life-threatening blisters making the treatment and nursing care challenging. Proper wound care, prevention of infection, and other complications are the mainstay of treatment.

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Introduction: The rapidly adapting neonatal skin, being anatomically and physiologically distinct from an adult, may exhibit a variety of entities, ranging from mild self-limiting to the severe life-threatening ones. The transition of neonatal skin from an aqueous to an air-dominant environment results in various changes, both physiological and pathological. Physiological and pathological dermatoses should be differentiated to avoid unnecessary treatment and psychological distress to parents. The present study was carried out to determine prevalence and patterns of physiological cutaneous manifestations among early neonates in western Rajasthan. Materials and Methods: This hospital-based, descriptive, observational study was carried at a tertiary care hospital over a period of 1 year. After due informed consent, total of 5000 early neonates delivered during this time were included in the study. A detailed history was taken and dermatological examination of each neonate was carried out. Laboratory procedures were performed to confirm diagnosis if required. Data were collected in a predesigned pro forma. Results: Out of 5000 newborns, 64.96% were male and 35.04% female. Ninety-two percentage had physiological changes and 21% had pathological changes. The physiological skin changes observed in order of frequency were sebaceous hyperplasia (65.32%), milia (51.12%), physiological desquamation (41.02%), vernix (35%), and physiological jaundice (9.32%). Cutis marmorata, harlequin skin changes, and lanugo hair were seen more in low-birth weight and preterm neonates. Conclusion: Most of the early neonatal dermatoses are physiological and transient in nature. Hence, it is important to identify and differentiate them from other serious conditions, thereby avoiding unnecessary diagnostic and therapeutic procedures and provide reassurance to overenthusiastic dermatologists, pediatricians, and parents.

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A 15-year-old healthy boy presented with multiple eruptive brown-colored to hyperpigmented papules all over the body for 1 year. His serum lipids were normal, and HIV serology was negative. Biopsy revealed hyperplastic epidermis along with an ill-defined lesion in the dermis that was composed of spindle-shaped fibroblastic cells and multiple cholesterol clefts within foamy macrophages. A diagnosis of cholesterotic dermatofibroma was made. The case is unusual for the young age of presentation and the presence of multiple eruptive papules.

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Although Klippel-Trenaunay syndrome (KTS) is an infrequently seen dermatological disorder with plethora of associations. It is largely a clinical diagnosis made by the presence of at least two of the three classic findings. We are reporting a 16-year-old male child who presented to us with the limb hypertrophy, portwine stains, congenital heart disease, and bony abnormality. Multiple associations of KTS make it an interesting case.

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Leukemia cutis (LC) is the cutaneous infiltration of neoplastic cells rarely seen with acute lymphocytic leukemia. We report the case of a young female presenting with a morpheaform plaque on the face, subsequently diagnosed with B-cell acute lymphoblastic leukemia (ALL) and LC, on histopathology and immunohistochemistry. Among the limited cases of LC reported with B-cell ALL, such an atypical presentation has previously never been reported.

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Triple-A syndrome (Allgrove syndrome) is a rare, autosomal recessive disorder classically described with the triad of alacramia, achalasia, and ACTH-resistant adrenal insufficiency. Very few cases have been reported so far in the literature. Rarity leads to misdiagnosis. Phenotypic heterogeneity further adds to the confusion as classical triads are not constantly present in each and every case. The presence of additional autonomic disturbances in some cases brings about the proposal of the name 4A syndrome instead of 3A syndrome. Basic defect is mutation of achalasia, adrenocortical insufficiency, and alacramia syndrome gene. The entity needs multidisciplinary approach including endocrinologist, pediatrician, dermatologist, and ophthalmologist for best possible outcome. Although there is no definitive treatment, early diagnosis is extremely important to save life and prevent neurological sequel from adrenal crisis, to avoid unnecessary investigations and inappropriate treatment, and to improve quality of life. We report a 13-year-old boy with triple-A syndrome diagnosed clinically presented with repeated episodes of seizure, Addisonian pigmentation, the absence of tear, and difficulty of swallowing.

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Children with hereditary sensory and autonomic neuropathy (HSAN) Type IV present with loss of pain and temperature sensation and anhidrosis. They may sometimes exhibit aggressive and self-mutilating behavior. We present here the case of a 5-year-old male child who presented with a history of self-mutilating behavior leading to ulcers over knees, elbows, toes and occiput, and amputation of index fingers of both hands. The patient had loss of temperature and pain sensation, but touch was normal. There was anhidrosis. Serum uric acid levels were normal. Histamine test was absent, and nerve studies showed decreased conduction velocity. A diagnosis of HSAN Type IV was made. This case is being presented as self-mutilation was the prominent complaint of the parents of the child. We also discuss the differences between HSAN Type IV and Lesch−Nyhan syndrome.

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Zinsser-Engman-Cole syndrome or dyskeratosis congenital (DKC) is a rare progressive inherited disorder which is classically defined by the triad of ectodermal dysplasia including abnormal skin pigmentation, nail dystrophy, and leukoplakia of the oral mucosa. It has a highly variable phenotype and is characterized by shortening of telomeres. Here, we report a 19-year-old boy who presented to us with classic triad of DKC along with bone marrow failure and ventricular septal defect, a rare association. DKC is a rare disease but can be diagnosed by simple inspection of the mucocutaneous abnormalities.

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Linear calcinosis cutis is a very rare disorder; reported in association with lichen sclerosus etatrophicus, scleroderma, after intravenous infusion of calcium and acute monocytic leukemia. In available literature, idiopathic zosteriform calcinosis cutis is yet to be described. An 8-year-old child presented with spontaneous painful, slowly progressive, linear band-like nodules over the right half of the chest and back of the trunk. Histopathology with special stains was done to confirm the diagnosis. The patient was treated with diltiazem and responded well. We report a case of idiopathic zosteriform calcinosis cutis because of unusual presentation and rarity of the disorder.

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Mycetoma is a chronic, suppurative, localized, and destructive infection involving skin, subcutaneous tissue, fascia, muscle and sometimes invade the underlying bone. The infection is prevalent in tropical countries and involves chiefly adults. Etiologically, it is classified into eumycetoma and actinomycetoma caused by fungus and bacteria respectively. Clinically, mycetoma presents as a triad of firm to soft swelling with multiple sinuses and discharging grains of different colors. Mycetoma is reported rarely in children. We report an 11-year-old boy diagnosed with actinomycetoma of the left foot with classical clinical, histological, and radiological features.

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Linear porokeratosis is a rare disease that can be congenital or may occur typically during infancy and childhood. It presents clinically as streaks or plaques of reddish-brown papules along the Blaschko lines. The presence of cornoid lamella is pathognomonic on histopathology. We present the case of a 3-year-old female child with classical lesions over the left upper and lower limbs.

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Pachydermoperiostosis is an inherited osseocutaneous disorder. The unusual increased levels of prostaglandin E2 due to mutations in either HPGD gene or SLCO2A1 gene are regarded as the causative factor. Our case report is about a 16-year-old boy who presented with cutis verticis gyrata, clubbing of digits, arthralgia, seborrhea, acne vulgaris, blepharoptosis, macrocheilia, column-like legs, and periosteal thickening in all long bones of the extremities characteristic of complete form of pachydermoperiostosis. No effective treatment has been proposed for this condition. Hence, counseling the child and parents about the disease progression, detecting the complications, and efficaciously managing them will be the mainstay of the treatment.

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Co-localization of fungal infections in preexisting BT Hansen's patches is rare. Previously, co-localization of dermatophytic infection with BT Hansen has never been reported. Pathologically, it is a paradox, because tuberculoid leprosy has an increased expression of Langerhans cells and dendritic cell, which are the primary mediators of first-line cutaneous mediators of immunity. Since superficial fungal infections such as pityriasis versicolor and tinea favor skin appendages, it may explain why such co-localization is not seen even when both disease entities, tinea and Hansen, are highly prevalent in certain regions of India.

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Entomophthoromycosis is a rare yet potentially life-threatening, chronic deep fungal infection affecting immunocompetent host, primarily children, and young adults. The infection commonly affects trauma-prone sites mainly extremities and trunk with regional lymph node involvement. We report a 1.5-year-old child with postcleft lip surgery presenting with painless swelling on the right side of the face for the past 4 months. Although culture showed no growth in our case, histopathological examination was diagnostic of entomophthoromycosis which aided the treatment. There was partial improvement in the size of the swelling with amphotericin B and a complete resolution with oral potassium iodide.

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