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Management of urticaria in children
Kiran Godse, Harsh Tahiliani, Manjyot Gautam, Sharmila Patil, Nitin Nadkarni
September-December 2014, 15(3):105-109
Urticaria is a common condition in children for which physicians are consulted. The management of childhood urticaria is similar as in adults; however, there are pediatric-specific features that must be taken into account for better management of childhood urticaria.
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Benign pigmentation of nails
Biplab Maji, Sandipan Dhar
May-August 2014, 15(2):86-88
Nail bed pigmentation or melanonychia is common in Blacks. Sometimes it is seen in Whites and Japanese, and may be associated with pigmentation of lips and oral mucosa, termed as Laugier-Hunziker (LH) syndrome. Nail pigmentation is usually in the form of longitudinal bands, sometimes with nail dystrophy, mostly acquired, and majority of the times associated with a family history. Here, we are reporting two cases of Indian origin with benign hyperpigmented nails, in which no possible cause was identified and there was no family history with such lesions.
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Neonatal erythroderma (red baby)
Rashmi Sarkar, Shilpa Garg, Vijay Kumar Garg
September-December 2013, 14(3):47-53
Erythroderma in neonates is a rare but a well established life threatening entity. Though it has been studied extensively in adults, the literature is lacking in the paediatric age group. The underlying etiological causes of neonatal erythroderma are pre-existing cutaneous diseases, infections, immunodeficiency disorders, metabolic and nutritional disorders and drugs. It is a challenge to diagnose the underlying etiology of neonatal erythroderma due to the rare specific presentation of the characteristic clinical signs and histopathological changes. In this review we discuss the incidence, etiology, specific points in history and examination which can be useful at arriving at the diagnosis and outline of management.
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Blueberry muffin rash at birth due to congenital rubella syndrome
Guruprasada Shetty, Rashmi Kalyanshetti, Habeeb Ullah Khan, Pavan Hegde
September-December 2013, 14(3):73-75
We report a term, small for gestational age, female neonate presenting at birth with generalized reddish blue papulonodular lesions, thrombocytopenia, hepatosplenomegaly, cataract, sensorineural hearing loss, patent ductus arteriosus and subependymal cyst. A diagnosis of blueberry muffin rash in a child with congenital rubella syndrome was made based on the clinical and laboratory findings. The rash disappeared by 2 weeks of life.
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Disorders of nail in infants and children
Archana Singal, Kavita Bisherwal
April-June 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.
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Beta blockers in infantile hemangiomas: A practical guide
Manish K Shah
May-August 2014, 15(2):55-60
The use of oral and topical beta blockers has revolutionized the management of infantile hemangiomas. Oral propranolol at 2 mg/kg/d in divided doses not only prevents further proliferation, but actually shrinks IH. Propranolol should be administered for at least 6 months or until the baby reaches one year of age. Side effects to be watched out for include hypoglycaemia, bradycardia and hypotension. Oral propranolol should be prescribed only in those IH where clearly indicated. More cardioselective beta blockers like atenolol are also being explored for treating IH. Topical timolol has been prescribed for smaller and superficial IH or when propranolol is contraindicated.
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Cleansers: To use or not to
Samipa S Mukherjee, BS Chandrashekar, Rohini P Gaikwad
October-December 2015, 16(4):193-197
Cleansers are agents responsible of cleansing the skin to get rid of the dust, dirt, sebum, and dead cells accumulated as a part of normal desquamation process. Cleanser technology has come a long way from the traditional soaps and detergents to the more modernized liquid cleansing agents and syndets. They have thereby helped in reducing the side-effect potentials of cleansers and improved the beneficial effects. Addition of newer molecules helps in maintaining the skin barrier integrity and moisture on the skin. However, although the bright side of cleansers shines there is a gray zone of controversies regarding its usage. Discrepancy between the claims and evidences herewith make it imperative to consider the pros and cons. This article aims at summarizing the points in favor and against the usage of cleansers.
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Onychomadesis in a healthy child
Rachel Ranitha Peterson, R Spurgeon, KS Lakshmi, Suman Rath
October-December 2015, 16(4):264-265
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Blueberry muffin baby (dermal erythropoiesis) with non-ketotic hyperglycinemia
Farhana Tahseen Taj, Varun Sarin
January-August 2013, 14(1):30-32
Blueberry Muffin Baby is term given to characteristic eruption in neonates, often present at birth, comprising widespread, purple, erythematous, oval or circular macules, papules and nodules reflecting dermal erythropoiesis seen in a number of congenital infections, notably rubella, cytomegalovirus, coxsackie B2 infection, parvovirus B19, congenital syphilis, toxoplasmosis, rhesus incompatibility. Nonketotic Hyperglycinemia (NKHG) is an inborn error of glycine degradation in which large quantities of glycine accumulate in body tissues, including CNS, and has been associated with "Blue-Berry Muffin" Baby. We report an infant with blue berry muffin lesions associated with Non Ketotic hyperglycemia (NKHG). To the best of our knowledge Blue berry muffin baby with Non Ketotic hyperglycemia has been rarely reported in Indian literature.
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Indian Journal of Paediatric Dermatology - 'New era; New face'
S Criton
January-April 2012, 13(1):1-1
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Oil massage in babies: Indian perspectives
Sandipan Dhar, Raghubir Banerjee, Rajib Malakar
January-August 2013, 14(1):1-3
Oil massaging of the newborn has been a custom in India for ages. A variety of oils have been used for this purpose. Recently, it has gained popularity in the western countries as well.
  8,630 938 3
Idiopathic eruptive macular pigmentation
Asiya Begum, BV Ramachandra, Ajay Kumar
September-December 2014, 15(3):114-116
Idiopathic eruptive macular pigmentation (IEMP) is an uncommon, rather under-reported disease entity of the pediatric age characterized by asymptomatic, brownish hyperpigmented macules involving the neck and trunk with no preceding inflammation or exposure to drug. Here we report this case to increase awareness of this entity among dermatologists, dermatopathologists and pediatricians. A 11-year-old healthy boy presented with brownish-gray to dark, discrete, asymptomatic macules on the face, trunk, neck and limbs of insidious onset. Histopathologic examination showed melanophages, mild perivascular lymphohistiocytic infiltrate in the papillary dermis and papillomatosis. The natural course of the disease is spontaneous remission without treatment, which was so even in our patient. IEMP is a benign entity with an excellent prognosis as it exhibits spontaneous resolution. It falls into the differential diagnoses of asymptomatic hyperpigmentatory disorders in pediatric population. Awareness of the entity leads to avoidance of unnecessary aggressive damaging treatment.
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Scoring atopic dermatitis and six sign atopic dermatitis: Comparison of prognostic and predictive value in atopic dermatitis
Alpna Thakur, Suresh Kumar Malhotra, Suhail Malhotra
January-August 2013, 14(1):13-18
Introduction: Atopic dermatitis is an enigmatic chronically relapsing dermatosis which is difficult to quantify. Present scoring systems have their inherent limitations. Aims and Objectives: To evaluate and compare the scoring systems SCORAD and SASSAD for atopic dermatitis and to correlate values with clinical and hematological parameters. Materials and Methods: Fifty patients of atopic dermatitis were selected and assessed at presentation and at four weeks using SCORAD and SASSAD. Appropriate haematological investigations were done at the time of assessments. The data obtained was assessed statistically. Results: The changes in both the SCORAD and SASSAD correlated with the changes in clinical and hematological profile. Conclusion: SCORAD seems to be a better scoring system as it addresses both the subjective and objective parameters.
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Geographic tongue in 8-month-old monozygotic twins: Case report with review of literature
Saru Thakur, Mudita Gupta, GR Tegta, Kuldeep Verma
April-June 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.
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Hutchinson's signs in dermatology
Manjyot Gautam, Palak Sheth
October-December 2018, 19(4):371-374
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Annular erythema of infancy: A diagnostic challenge
Abhijit Saha, Joly Seth, Samipa Mukherjee, Suprit Basu
September-December 2014, 15(3):147-149
Annular erythemas in infancy are uncommon to rare in occurreance. Erythema migrans is the most common variety to be reported amidst the younger age group. This group of conditions poses a diagnostic challenge to the physician as the differentials can range from a benign annular erythema of infancy with good prognosis and no long-term defects to neonatal lupus erythematosus (NLE) having a bad prognosis with increased morbidity and mortality. We report a case of annular erythema of infancy in a 5 day old male infant to emphasize that in spite of the history of spontaneous abortions in the mother, which pointed towards a more grave diagnosis of NLE, benign conditions like annular erythema of infancy needs to be kept in mind.
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Childhood psoriasis - Clinical manifestations
Subash Lokre, Ravi Hiremagalore
January-April 2012, 13(1):3-8
Psoriasis is a chronic immune mediated inflammatory disease. It has different clinical patterns in childhood. It can vary from as simple as a napkin psoriasis to pustular and erythrodermic forms. The review discusses the epidemiology, trigger factors, clinical features of childhood psoriasis including the differential diagnosis of the various patterns.
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Juvenile plantar dermatosis: A barrier disease beyond eczema: An open prospective uncontrolled study in a tertiary care hospital of South India
Hari Kishan Kumar, S Naveen, Keerthi Shankar
January-March 2016, 17(1):13-17
Background: Juvenile plantar dermatosis (JPD), also known as “wet and dry foot syndrome,” is a skin disorder of the feet that commonly affects children from ages 3–14. JPD is frequently seen in children with eczema, but it is not a requirement for diagnosis. Forefoot eczema (FE) is synonymous with JPD is a condition characterized by dry fissured dermatitis of the plantar surface of the feet. Aims: To study the clinical patterns of FE and its associated risk factors. Methods: Twenty-five patients were recorded in the study during the period from April 2013 to March 2014. Fungal scrapings, patch testing, and biopsy for histopathological examination were done wherever required. Results: In our study, the most common site affected was the plantar surface of the toes in 8 (32%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in two patients (8%). Four patients (16%) had a personal history of atopy whereas a family history of atopy was present in 3 (12%). Nine patients (36%) had associated risk factors with reported aggravation of itching with plastic, rubber, or leather footwear, and with prolonged contact with water and detergents. Negative fungal scrapings and culture in all patients ruled out a dermatophyte infection. Patch testing with Indian Standard Series was performed in all patients and was positive in three. Conclusions: This study concluded FE as a distinctive dermatosis of the first and second decade, predominantly in males, with a multifactorial etiology and confirming the concept of FE as a barrier disease beyond eczema.
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Stevens-Johnson syndrome and toxic epidermal necrolysis in children
Sudip Das, Ramkumar Ramamoorthy
January-March 2018, 19(1):9-14
SJS and TEN are diseases characterised by epidermal detachment and necrolysis predominantly of drug induced etiology. SJS/TEN begins with a prodrome of fever, malaise, anorexia, pharyngitis, and headache lasting for 2-3 days, at times, extending to 10-11 days. Mucosal lesions usually precede skin lesion. Usually, two mucosal membranes are involved, most commonly conjunctiva and oral mucosa. Oral mucosal involvement is seen in 90% of SJS and almost all patients diagnosed with TEN. In SJS, mucosal involvement is widespread and confl uent in contrast to erythema multiforme where it is focal and seen in only 25%-60% of cases. The exact pathogenesis of SJS and TEN is not fully elucidated. In view of the paucity of T-cell infiltrate,keratinocyte apoptosis could be the result of autocrine or paracrine interaction between Fas, a death receptoron keratinocyte and Fas Ligand (FasL) produced by the keratinocytes along with the substantial contributionof soluble FasL from peripheral mononuclear cells. FasL upregulation in keratinocytes is nitric oxide-dependent anddriven by T-cell derived tumor necrosis factor (TNF) alpha and Interferon-gamma.The management revplves around immediate stoppage of drug and.,supportive care .IVIG,corticosteroids and cyclosporine are all effective drugs but no RCT is available for any of them
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Clinico-epidemiological profile of childhood vitiligo
Preeti Keyur Sheth, S Sacchidanand, GS Asha
January-March 2015, 16(1):23-28
Background: Vitiligo is a depigmenting and psychologically devastating disorder. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aim: To study the clinical and epidemiological characteristics of childhood vitiligo. Materials and Methods: First 100 pediatric patients younger than 18 years, with vitiligo who attended the Pediatric Dermatology Clinic of Victoria Hospital, Bangalore Medical College, Bangalore, India, between April 2013 and December 2013 were included in the study. A detailed history and examination along with autoimmune diseases, laboratory parameters, and vitiligo disease activity score (VIDA) score were recorded. Results: In the 100 patients who attended pediatric dermatology OPD in 9 months duration of the study, we had 55 female patients (55%) and 45 male patients (45%). The mean age at onset was 8.92 years (ranging day 1-16 years), with duration of disease varying from 2 months to 8 years with mean duration of 1.36 years. According to standard classification most common pattern of vitiligo was vulgaris (46%), followed by focal (36%), mucosal (8%), acro-facial (7%), segmental (3%). The most common site for vitiligo was lower limb (62%), followed by face (46%), upper limbs (30%), scalp (25%), and mucosal (18%). Segmental vitiligo was seen in 3% and nonsegmental vitiligo in 97%. VIDA score +4 was most common and was seen in 81%. Conclusion: Vitiligo is a common depigmenting disorder with vulgaris being the most common pattern and lower limbs being the most common site seen in pediatric patients. Autoimmune associations were more frequent in nonsegmental vitiligo. Among the cutaneous associations, atopic dermatitis was most frequently encountered. Patients with family history of autoimmune disorders tend to present at an early age.
  7,092 472 -
Combination treatment of extensive and recalcitrant alopecia areata with oral and topical steroids with topical minoxidil: An open-label study of efficacy and safety in pediatric patients
Vivek Kumar Dey
July-September 2016, 17(3):173-178
Background: Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring alopecia affecting scalp and body hair. Treatment of AA in pediatric age group is challenging because of unpredictable course, uncertain natural history, potential side effects of medicines, and psychological morbidity. Moreover, no clear guidelines for treatment of pediatric AA are available. Objective: The objective of this study is to assess efficacy and safety of a combination treatment of extensive and recalcitrant AA with oral and topical steroids with topical minoxidil. Materials and Methods: Sixteen children (nine girls and seven boys) aged 6–15 years with severe and recalcitrant AA were included in this study. All were prescribed the regimen of combination of oral and topical steroid with topical minoxidil 2% solution. Oral steroid was tapered over 12 weeks, and topical steroid was withdrawn at the end of 24 weeks. Patients were maintained on topical minoxidil for next 9–12 months and closely followed up. Results: The average age of participants was 10.81 years, and the duration of disease was ranged from 3 months to 30 months. Response to our regimen was good in cases of extensive AA and ophiasis, compared to alopecia totalis. The participant having alopecia universalis did not respond at all to the regimen. Participants tolerated the regimen well with mild and easy to manage side effects and only few relapses. Conclusion: Finding an effective and safe treatment regimen for AA, especially in children is difficult. Our regimen allows for more rapid lowering of oral doses with maintaining the cosmetic response and minimizing the side effects. Therefore, a trial course of this regiment would seem to be a reasonable approach for nearly hopeless but highly motivated pediatric patients of extensive and recalcitrant AA.
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Fatal Raoultella ornithinolytica sepsis and purpura fulminans in a preterm newborn
G Sandal, M Ozen
January-April 2014, 15(1):24-26
Raoultella ornithinolytica is a Gram-negative encapsulated aerobic bacillus belonging to family Enterobacteriaceae. It is an extremely rare causative organism of infections in humans. We reported R. ornithinolytica sepsis and purpura fulminans in a preterm female baby. Our case is the second newborn case of human infection by R. ornithinolytica that has been reported in the literature.
  6,978 439 12
Acitretin in pediatric dermatoses
Manjyot Gautam, Harsh Tahiliani, Nitin Nadkarni, Sharmila Patil, Kiran Godse
April-June 2016, 17(2):87-94
Acitretin, a synthetic retinoid and the active metabolite of etretinate has been increasingly used over the past two decades. It has proved effective in the treatment of many conditions associated with hyperkeratosis and dyskeratosis. A Google scholar search for the use of acitretin in pediatric dermatoses was done using the words “pediatric dermatoses,” “acitretin,” “etretinate,” “systemic retinoids,” “psoriasis,” “pityriasis rubra pilaris,” “ichthyoses,” “disorders of keratinization,” “Darier's disease,” “palmoplantar keratoderma,” “verrucae,” “lichen planus,” “lupus erythematosus,” and “lichen sclerosus.” All the articles were retrieved and classified into review articles, studies, double-blinded trials, and case reports. The final data were then analyzed and presented in a narrative fashion. It has been found that acitretin is useful in a number of pediatric dermatoses. It is preferred over other drugs in pustular psoriasis. Good results can be obtained in various disorders of keratinization, and it may even prove life-saving in conditions like harlequin ichthyosis. However, long-term maintenance therapy is required and exacerbations are known on discontinuing the drug. It can also be used as alternative therapy for many other pediatric dermatoses where the primary treatment has failed. Acitretin should be used even in children for the proper indications. However, proper clinical and laboratory surveillance has to be maintained in patients on long-term acitretin.
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Mastocytosis in children
Sahana M Srinivas, Sandipan Dhar, Deepak Parikh
April-June 2015, 16(2):57-63
Mastocytosis is a heterogeneous group of disorders with increase in mast cells in the skin and other extracutaneous organs. Mastocytosis is seen in children and adults. Cutaneous mastocytosis is more common in children than systemic forms. Among the cutaneous form urticaria pigmentosa is the most common type of mastocytosis seen in children. There is a tendency of regression with age. Childhood onset mastocytosis has a good prognosis. Counseling forms a major role in the management of pediatric-onset mastocytosis.
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Topical therapy of atopic dermatitis
Sandipan Dhar
January-August 2013, 14(1):4-8
Topical therapy is first line of treatment for mild to moderate atopic dermatitis (AD) which is the commonest form of the disease in India. Avoidance of overbathing, use of a synthetic detergent preferably with a slight acidic pH is recommended. Regular use of a moisturiser preferably containing an occlusive and a humectant which perfume free is to used liberally. Topical corticosteroids are the most important pillars of topical treatment of AD. Understanding the proper and judicious use of topical corticosteroids is of prime importance. The choice of the molecule, frequency and amount and method of application and whether or not to use combination and the proper monitoring will decide the optimum outcome to the treatment. Concomittant long term use with gradual tapering of corticosteriod is recommended. Mild recurrences can be controlled by monotherapy. Proper and judicious use of all the elements of topical therapy is needed for successful treatment outcome.
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