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Impiego di lamine autoadesive di poliuretano per il trattamento compressivo degli ematomi infantili. Osservazioni preliminari
No full textInnovative therapeutics in pediatric dermatology
No full textAlthough clinical trials for new drugs are often limited in children because of safety concerns or restrictions, new therapies or novel strategies with old drugs have recently expanded dermatologic armamentarium for pediatric patients. Oral propranolol is currently the first choice in the treatment of alarming infantile hemangiomas. In atopic dermatitis, proactive strategy with topical calcineurin inhibitors can safely prevent disease exacerbation. Tacrolimus, in particular, is also useful for the treatment of vitiligo occurring in sensitive areas such as the eyelids. Among biologic drugs, use of etanercept is safe and efficient in children and adolescents with moderate-to-severe plaque psoriasis. Engineered tissues with special antimicrobial properties (silver-coated fabrics or engineered silk) are now used to treat eczema and fungal diseases in children. In athlete's foot, the use of 5-finger socks can also be helpful
The hair in childhood and old age
No full textMore than 20 syndromes, most congenital, have hypertrichosis as a feature. An excessive growth of non-androgen-dependent hair has been reported in association with many acquired diseases and medications, some of which, as cyclosporine, can be administered also in children. Even though primary hypertrichosis is benign in most cases, it may result in cosmetic disfigurement and psychosocial trauma; a pediatric assessment is necessary to rule out associated diseases. Lanugo hair can occur in otherwise healthy individuals but can be associated with polymyositis and neoplasms. Hirsutism can be idiopathic, but often can be associated with an adrenal or ovarian cause. Thus all women with hirsutism require careful evaluation. More, growing evidence has linked hyperandrogenism to increased risk of cardiovascular disease, genital tract neoplasms, and non-insulin-dependent diabetes mellitus. An application from the study of hairs comes from oligoelements. A recent study investigating the zinc status of eighty newborn babies with neural tube defects and their mothers compared with controls found a positive association between this defects and decreased hair zinc levels. As far it concerns the color of hairs our group has demonstrated that heterochromia of the scalp hair can be a sign of pigmentary mosaicism even without underlying malformations. The present elucidation of pathogenesis of androgenetic alopecia has lead to second generation steroidal 5α reductase inhibitors, such as G-198745 (a combined type 1 and type 2, 5α reductase blocker), W09704002, Turosteride, Mk-963, MK-434, Episteride, and MK-386. A variety of non-steroidal inhibitors such as zinc and saw palmetto are also under investigation. The possibility of gene therapy for androgenetic alopecia has been advanced in animal by the development of a cream capable to deliver DNA to hair follicles. Finally, the study of the stem cells of the hair follicle will give us new possibilities of treatment
Magnetic resonance imaging application in infantile hemangiomas and vascular malformations
No full textAim. The aim of this paper was to review the role of modern diagnostic imaging in the evaluation of patients with vascular anomalies: hemangiomas and vascular malformations. Methods. We have analyzed 20 pediatric patients using the magnetic resonance imaging (MRI) and the magnetic resonance angiography. For each pathology, we have compared the literature findings with our clinical cases. Results. MRI leaves some doubts in the diagnosis of 2 types of lesions. The first type concerns the high-flow lesions: in this case the differential diagnosis among a small arteriovenous fistula, a hemangioma in the proliferation phase, a venous malformation with high feeding arteries and an arteriovenous malformation in the preclinical phase can be impossible. The second type concerns the low-flow lesions, in which the diagnosis of combined vascular malformations such as venolymphatic malformations can be very difficult. Conclusion. Nowadays, MRI is the best technology in order to provide information about type, location and extension of this type of lesions. It is not invasive neither dangerous, does not require the use of ionizing radiations, and presents minimum disadvantages as sedation. Nevertheless, MRI alone is not sufficient to provide the necessary informations for the diagnosis and treatment of all vascular anomalies
PEODDN (Porokeratotic eccrine ostial and dermal duct naevus) sistematizzato lungo le linee di Blaschko
No full textInflammatory linear verrucous epidermal nevus (ILVEN) and psoriasis in a child?
No full textA male infant, whose father was affected by psoriasis, was first seen in our department at 1 month of life for a "bipolar" seborrheic dermatitis, that resolved without treatment at 7 months of age.
At 15 months of life, the child returned for an eruption of erythematous and finely scaling papules disposed in a linear, band-like fashion over the left part of the body, involving the volar surface of the arm, the left leg from the inguinal fold to the ankle, and the abdomen and thorax, where they assumed the typical S-shaped curve following Blaschko lines. The lesions were not itchy. A punch biopsy of a linear lesion on the left arm was performed. Histopathologic examination showed parakeratosis with absence of the granular layer, mild acanthosis with papillomatosis, necrosis of single keratinocytes, and a mild lymphohistiocytic infiltrate located in the superficial dermis. A tentative diagnosis of lichen striatus was made. After a few days, a diffuse eruption of pinpoint-sized, lenticular, erythemato-desquamative lesions occurred on the trunk and limbs, with the typical clinical appearance of guttate psoriasis (Fig. 1). The child was in good general condition, and routine blood tests were within the normal range. No triggering factor was found. Treatment with emollients led to the resolution of the psoriatic lesions within 4 months; in contrast, the linear lesions were not grossly changed by this treatment and just appeared more flattened.
The child was seen again at 3 years of age: the linear papular lesions on the left side of the body were unchanged, and stilt asymptomatic. The previous diagnosis of lichen striatus was then changed to linear psoriasis.
The clinical picture remained unchanged until the age of 10 years, when the child presented with eruptive, small patches of psoriasis on the trunk and abdomen. Concomitant with this eruption, the child experienced a sudden change in the clinical aspect of the linear lesions, that became more inflammatory, assuming a verrucous and, in some cases, crusting aspect; intense itching developed. Two punch biopsies of a linear lesion on the left leg were performed. The lesion specimen showed orthohyperkeratosis, with the presence of the granular layer, and mild dilation of the vessels of the superficial plexus, with edema and a discrete mononuclear infiltrate. The second specimen showed mild hyperkeratosis with neutrophil microabscesses in the stratum corneum; in a single portion of the specimen, a mononuclear infiltrate in the mid-dermis with edema, exoserosis, and exocytosis was found. Based on the clinical course and on the histopathologic aspect, we made a diagnosis of inflammatory linear verrucous epidermal nevus (ILVEN) with concurrent psoriasis. Treatment with calcipotriol ointment every day for 2 months cleared the nonlinear psoriatic lesions. The linear lesions partially improved (Fig. 2), but did not clear (Fig. 3). Further treatment with clobetasol propionate every day for 1 month improved the itching, but left the linear lesions unchanged
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