Childhood lichen planus: A series of 42 patients

Abhinav Kumar, Vibhu Mendiratta, Shilpi Agarwal, Ram Chander, Sarita Sanke

Indian Journal of Paediatric Dermatology 2018 19(2):116-119

Background: Lichen planus (LP) is a papulosquamous disease of unknown etiology that is relatively uncommon in children. There is a paucity of data on the clinical profile of LP in children. Available case series are few and majority being retrospective. A cross-sectional observational study to evaluate the clinical profile of childhood LP was performed. Materials and Methods: All childhood cases (<18 years) with histopathologically confirmed diagnosis of LP were evaluated. Detailed clinical history, examination, and investigations were performed according to a proforma. Observation and Results: There were 42 children and childhood LP constituted 1.4% of the pediatric dermatoses. There were 26 females (61.9%) and 16 (38.1%) males with male to female ratio of 1:1.6. The age ranged from 2 to 18 years with a mean age of 11.6 ± 5.1 years. The duration of the disease ranged from 15 days to 5 years with a mean of 8.6 ± 9.4 months. History of recent hepatitis B vaccination was found in 6 (14.3%) patients, and exposure to X-ray radiation was seen in 3 (7.1%). The most common morphological presentation of LP was papules and plaques observed in 34 (81%) patients. Classical LP was the most common variant, found in 29 (69%) patients, followed by hypertrophic variant in 7 (16.7%) patients. Koebnerization was found in 31 (73.8%) patients. Oral mucosa involvement was seen in 28.6% of patients, nail in 42.85%, and scalp in 7.1% of patients. Conclusion: Childhood LP resembles adult LP in most of the aspects. However, etiological factors in childhood LP may be different. It is an under-reported disease. Large multi-centric prospective studies should be undertaken to acquire a better understanding of the clinical profile of childhood LP.

Co-occurrence of psoriasis, vitiligo, and lichen planus in a single patient

Swathi Neelagiri, B Janardhan, K Siva Rami Reddy, V Sreedhar

Indian Journal of Paediatric Dermatology 2018 19(2):157-160

Psoriasis is a common autoimmune skin disease affecting around 2%–3% of the world population. The disease has an autoimmune and complex genetic background. It may be associated with other autoimmune diseases such as vitiligo, lichen planus, discoid lupus erythematosus, and alopecia areata as reviewed in the literature. There are few case reports about the co-occurrence of one or two autoimmune diseases. Many speculations have been put forward about the pathogenesis of these conditions, but T-cell-mediated autoimmunity and true Koebner phenomenon background play a common etiological cause of co-occurrence of psoriasis, lichen planus, and vitiligo. We report a 9-year-old female patient who presented with psoriasis, lichen planus, and vitiligo lesions. Interestingly, she developed psoriatic plaques on the vitiligo patches in the knee. Histopathological diagnosis was consistent with the concurrence of psoriasis, lichen planus, and vitiligo.

Comorbidities in pediatric atopic dermatitis

Eliza I Pope, Aaron M Drucker

Indian Journal of Paediatric Dermatology 2018 19(2):102-107

Atopic dermatitis is a common chronic condition that often begins in early childhood. In addition to associations with other atopic conditions such as asthma, food allergy and hayfever, recent research has uncovered a number of other important potential comorbidities. In this review article, we summarize the reported comorbidities of pediatric atopic dermatitis including mental health disorders, infections, obesity, hypertension, injuries and anemia.

Waardenburg syndrome Type I

Virendra N Sehgal, Pardeep Venkatesh

Indian Journal of Paediatric Dermatology 2018 19(2):178-180

Treatment guidelines for atopic dermatitis by ISPD task force 2016

Deepak Parikh, Sandipan Dhar, Ramkumar Ramamoorthy, Sahana Srinivas, Rashmi Sarkar, Arun Inamadar, Manish Shah, Raghubir Banerjee, Amrinder Jit Kanwar, Vibhu Mendiratta, Renu George, Ram Gulati

Indian Journal of Paediatric Dermatology 2018 19(2):108-115

Lipoid proteinosis: A series of three cases

Astha Sharma, Lalit Kumar Gupta, Manisha Balai, Ashok Kumar Khare

Indian Journal of Paediatric Dermatology 2018 19(2):170-172

Lipoid proteinosis is a very rare progressive autosomal recessive disorder characterized by deposition of hyaline material in the skin, upper aerodigestive tract, and internal organs. Patients present with a history of repeated blistering, skin scarring, beaded eyelid papules, waxy papules over the body, and laryngeal and tongue infiltration leading to hoarseness of voice. This disorder is caused by mutations in the extracellular protein 1 gene present on chromosome 1q21. We report three cases of lipoid proteinosis, who presented to our outpatient department with aforementioned features.

Trichoscopy in pediatric age group

Subrata Malakar, Purva R Mehta, Samipa S Mukherjee

Indian Journal of Paediatric Dermatology 2018 19(2):93-101

Approach to trichology in the pediatric age group is based on the clinical expertise of the dermatologist and investigative techniques. Currently, the trichoscope is an indispensible, noninvasive tool in the diagnosis of trichological disorders. It not only highlights the subtle tricoscopic points invisible to the naked eye but also serves as a prognostic and monitoring tool in therapeutic management. Trichoscopy goes a long way in improving the diagnostic and clinical acumen of the physician. In the pediatric age group, trichoscopy deals with pattern analysis ranging from hair shaft patterns to follicular, perifollicular, and interfollicular patterns. It not only describes the key trichoscopic features of noncicatricial alopecias, cicatricial alopecias, and genetic hair shaft defects but also helps to delineate various trichological mimics from each other. For compiling data, all trichology cases presenting to a tertiary care center were examined and photographed with a Fotofinder, DermLite Foto II Pro, and DermLite DL 3N. All trichological data were analyzed, and interpretations were based on the literature available.

Therapy for involuting infantile hemangioma: Propranolol effectiveness

Luz Orozco-Covarrubias, Leticia Lara-Mendoza, Luis Martín Garrido-García, Ramón Ruiz-Maldonado

Indian Journal of Paediatric Dermatology 2018 19(2):120-123

Background/Objectives: The efficacy of propranolol as a treatment for infantile hemangiomas (IHs) has been documented. Until now, little has been written about the role of propranolol beyond the proliferation phase of IH. Our aim was to document propranolol efficacy and safety in the treatment of involutive IH. Patients and Methods: Two evaluations were conducted. Investigators evaluated the final clinical results by comparing clinical data at baseline and at the end of the study. Evaluators scored each panel of photographs and were blinded from any clinical information. Both groups used the same scoring system. Patients treated with propranolol in our department between 2009 and 2014 were reviewed. Results: A total of 15 patients with involuting IH treated with propranolol were eligible. Eleven (73%) were females, ranging in age between 16 and 110 months (median 41 months). The types of IH were mixed (n = 13) and superficial (n = 2). The median duration of the propranolol treatment was 20 months (range 6–33 months). The mean size reduction was from 6 cm ± 4.33 before the treatment to 3.98 ± 1.25 at the end of the treatment. The general mean involution according to the investigators' evaluation was 4.1 ± 2.7. The general mean involution according to the evaluators' evaluation was 4.9 ± 1.5. Telangiectasias showed no response. Recurrence was observed in one patient. Transient nightmares were documented in one patient, and nighttime awakenings were documented in another. The therapy was discontinued in neither of these patients. Conclusions: In our experience, propranolol was well tolerated and associated with limited adverse reactions. The use of oral propranolol was effective in the treatment of IH beyond the proliferative phase.

Neonatal purpura fulminans caused by rare Citrobacter species

Sanjiv Vijay Choudhary, Shivani Sanjeev Dhande, Taru Aghi, Prashant Mahajan

Indian Journal of Paediatric Dermatology 2018 19(2):164-166

A 23-day-old neonate, born of nonconsangious marriage, admitted to Neonatal Intensive Care Unit for hypernatremic dehydration with petechiae and ecchymotic patches and necrotic skin lesions for 10–12 days was referred to dermatology department. On the general examination, pulse was 158/min, and respiratory rate was 52/min, and systemic examination was normal. Hematological investigations showed pancytopenia. Bleeding time was normal but prothrombin time and activated partial thromboplastin time reports were prolonged. D-dimer levels were elevated. Urine and stool were normal. Blood culture and sensitivity report revealed the growth of Citrobacter species with sensitivity to ciprofloxacin, amikacin, tetracycline, and resistance to Imipenem. Histopathology revealed epidermal hyperkeratosis with epidermal-dermal splitting, vessels showing fibrin occlusion with red blood cell extravasation into the perivascular areas in dermis along with dermal necrosis. To the best of our knowledge, this might be the first case of purpura fulminans in a neonate caused by rare Citrobacter species.

A study of dermatoses in the early neonatal period from a tertiary care hospital in North West Punjab

Shiti Bose, Emy Abi Thomas, Anuradha Bhatia, Inderpreet Sohi

Indian Journal of Paediatric Dermatology 2018 19(2):124-129

Background: Neonatal life, as defined by the World Health Organization, constitutes the first 28 days of extrauterine life. The transition of neonatal skin from an aqueous to an air-dominant environment results in various changes, both physiological and pathological. Aims: This study was designed to find the prevalence and pattern of various physiological and pathological dermatoses as well as its relation to maternal and neonatal factors in the early neonatal period. Materials and Methods: This prospective study was done on 505 live born neonates at Christian Medical College and Hospital, Ludhiana. All consecutive live born babies and those presenting for follow-up within 7 days of birth were considered. Results: Out of 505 neonates that were examined, 284 (56.24%) were males and 221 (43.76%) were females. Physiological skin changes were seen in 460 (91.09%), the most common being physiological desquamation in 211 (41.78%) neonates followed by Milia in 199 (39.41%). Pathological changes were seen in 102 (20.20%) neonates of whom one had aplasia cutis congenita. The most common developmental abnormality was accessory nipple in 6 (1.19%) neonates. Icterus was most often seen in neonates delivered by normal vaginal delivery 134 (56.54%). Milia was more often seen in babies of multiparous mothers, 135 (67.84%) as compared to primiparous mothers. Conclusion: A good knowledge of neonatal dermatoses helps allay concerns in parents and treating physicians thereby avoiding diagnostic and therapeutic procedures, which may not be required, especially as most of the early neonatal dermatoses are transient in nature.

Varicella masquerading as pemphigus vulgaris

Ranjana Beniwal, Lalit Kumar Gupta, Ashok Kumar Khare, Asit Mittal, Sharad Mehta, Manisha Balai

Indian Journal of Paediatric Dermatology 2018 19(2):176-177

Geographic tongue in 8-month-old monozygotic twins: Case report with review of literature

Saru Thakur, Mudita Gupta, GR Tegta, Kuldeep Verma

Indian Journal of Paediatric Dermatology 2018 19(2):130-133

Geographical tongue is a benign inflammatory disorder of the tongue characterized by map like areas of erythema which are not constant in size, shape, or location. Positive family history may be reported in few cases, but so far there is a single case report of geographical tongue in monozygotic twins 5-year-old. We report a case of geographical tongue in monozygotic twins in infants 8-month-old, which is the first case in twins in infancy to the best of our knowledge.

Tufted angioma

Sharad Mehta, Manju Meena, Urvashi Goyal, Lalit Kumar Gupta, Ashok Kumar Khare, Asit Mittal

Indian Journal of Paediatric Dermatology 2018 19(2):182-183

Pityriasis rotunda in a child

Mrinal Gupta

Indian Journal of Paediatric Dermatology 2018 19(2):134-135

Pityriasis rotunda is an uncommon disorder of keratinization characterized by sharply defined hyper- or hypo-pigmented, perfectly circular, scaly patches with no inflammatory changes. The etiology of pityriasis rotunda remains unknown. Most authors believe that it is a form of acquired ichthyosis and it has been associated with a variety of conditions including tuberculosis, malnutrition, and malignancy. We report a case of pityriasis rotunda in a 7-year-old otherwise healthy female who was treated with topical retinoids and emollients with partial improvement.

Reiter's disease in a 8-year-old boy

Rohit Kapoor, Syed Md Azad, Anwesha Mukherjee, Sandipan Dhar

Indian Journal of Paediatric Dermatology 2018 19(2):154-156

An 8-year-old male child presented with complaints of pain abdomen and appearance of rashes all over the body, with pain and swelling of the left knee joint. The child was a known case of developmental delay with seizure disorder, and the rashes had appeared just after starting oral valproate. On examination, the child appeared well except for the rashes and local swelling with decreased range of motion in the left knee joint. Redness around the urethral meatus was also noted. Skin biopsy revealed features suggestive of reactive arthritis. The child responded well to nonsteroidal anti-inflammatory drugs.

Linear alopecia areata versus trichotillomania: The game of time

Samipa Samir Mukherjee, BS Chandrashekar

Indian Journal of Paediatric Dermatology 2018 19(2):136-138

Linear variant of alopecia areata (AA) is a rare entity posing as a diagnostic challenge owing to the ability to mimic multiple conditions ranging from trichotillomania, dermatitis artefacta to linear lupus erythematosus profundus. Awareness regarding this entity optimized with dermoscopy and histopathology examination is essential for an effective diagnosis and treatment. Herein, we describe a case of a 7-year-old female with linear AA simulating trichotillomania which we believe is the first reported case in pediatric age group in India.

Familial reactive perforating collagenosis in two siblings

Abhijna K Rai, Mamatha S Kusagur, KS Chandan

Indian Journal of Paediatric Dermatology 2018 19(2):161-163

Reactive perforating collagenosis (RPC) is a rare form of transepithelial elimination disorder, in which genetically altered collagen is extruded through the epidermis. Of the acquired and inherited form, the latter is extremely rare. Here, we present two cases of inherited form of RPC in siblings aged 4 and 7 years presented with a history of itchy raised lesions of 9 months and 3 years duration, respectively. Dermatological examination revealed multiple papules with a central keratotic plug distributed mainly over face and extensors of upper and lower extremities. Köebnerization was present. Skin biopsy revealed perforating collagen bundles in the upper dermis and epidermis.

Spiegler–Fendt sarcoid/lymphocytoma cutis: A focus on nomenclature and diagnosis

Virendra N Sehgal, Deepa Sehgal, Jangid B Lal, Sonal Sharma

Indian Journal of Paediatric Dermatology 2018 19(2):139-142

Spiegler–Fendt sarcoid/lymphocytoma cutis, presenting as an asymptomatic, slowly progressive, erythematous macule of the size of a guinea over the left cheek, is presented in a 7-year-old girl, the diagnosis of which was complimented by lymphocytic exocytosis with spongiosis of the epidermis. Immunohistochemistry revealed wide-ranging T-cell variations, which was more positive for T-cell markers, CD3, of which predominance of CD4 subset was seen, emphasizing its role as a diagnostic tool.

Furuncular myiasis in a 6-year-old boy

Manoj Kumar Sharma, Sumit Kumar Yadav, Ramesh Kumar, Suresh Jain

Indian Journal of Paediatric Dermatology 2018 19(2):167-169

Myiasis is caused by the invasion of tissues or organs of humans or animals by dipterous larvae. A 6-year-old boy presented with 1-month history of scalp ulcer that has initially started as a painful, itchy swelling in the vertex region. Cutaneous examination revealed live maggots in the ulcerous wound. Clinicians should be more alert to the possibility of myiasis in patients with furuncloid or boil-like lesions. Herein, we report this case because of its rarity.

Hemorrhagic varicella

S Nageswaramma, G Swarna Kumari, Bala Kumar Dorai

Indian Journal of Paediatric Dermatology 2018 19(2):143-145

Varicella is a benign disorder occurring commonly in children. Hemorrhagic varicella is a serious complication occurring in immunocompromised persons or those on immunosuppressive therapy. Our encounter with this case of Hemorrhagic varicella highlights that the rare hemorrhagic varicella can also occur in a chronic malnourished child. Prompt diagnosis and treatment with acyclovir leads to complete recovery.