Do hair care practices affect the acquisition of tinea capitis? A case-control study

OBJECTIVE

To determine the influences of hair-grooming practices and environmental factors as risk factors for the acquisition of tinea capitis (TC) in children.

DESIGN

Case-control study comparing children with culture-proved TC with age-, sex-, and race-matched control subjects without scalp disease.

SETTING

A multicenter study involving 3 urban referral centers in the United States.

PARTICIPANTS

A convenience sample of 66 patients aged 12 years and younger presenting to pediatric dermatology clinics with clinical evidence of TC were enrolled as cases. Matched control subjects (n = 68), without known scalp disease, were enrolled from the outpatient pediatric clinics at the same institutions.

RESULTS

Significant associations with TC in the conditional logistic regression model were a prior history of TC (odds ratio, 3.11; 95% confidence interval, 1.02-9.43; P =.04) and exposure to TC (odds ratio, 16.32; 95% confidence interval, 3.55-75.16; P =.001). The use of a hair conditioner was statistically significant in the univariable model but not in the multivariable model (odds ratio, 0.46; 95% confidence interval, 0.20-1.08; P =.07). Hairstyling, frequency of washing, use of oils or grease, and other hair care practices were not shown to be associated with the presence of TC.

CONCLUSIONS

Hair-grooming practices do not appear to play a major role in the acquisition of TC. Hair conditioners may be protective in children at risk for TC, but further studies are needed to confirm this finding.

Cutaneous manifestations of chronic renal failure in children of color

One hundred percent of adult patients with chronic renal failure (CRF) develop cutaneous findings as a result of uremia or due to therapeutic interventions. To date, pediatric incidence studies have been limited to Caucasian children. However, recent reports have indicated that more African American patients progress to end-stage renal disease (ESRD). This is the first study to assess the prevalence of renal failure-related skin disease in children of color, including African American and Hispanic patients. Thirty children were evaluated by history and physical examination, with assignment to one of three treatment categories: transplanted (n = 10), dialyzed (n = 16), or medically managed (n = 4). Skin findings were divided into uremic, drug-related, or infectious disease types. The incidence of skin disease was 100%. Xerosis was the single most common finding, often accompanied by pruritus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high incidence of gingival hypertrophy (72%) and an even higher incidence of hypertrichosis (100%). Acral warts and nevi were common findings, the latter correlating with the length of immunosuppression. There is a high incidence of cosmetically disfiguring side effects (Cushinoid facies, hypertrichosis, and gingival hypertrophy) in children within all treatment categories, primarily related to drug treatment. Further study is required to determine the long-term sequelae, including psychological disturbances, of cutaneous disease in children of color with CRF.

Toxic epidermal necrolysis in children--an update

Toxic epidermal necrolysis (TEN) is a relatively rare disease, characterized by generalized erythema, bulla formation, and exfoliation of the epidermis that resembles scalding. It is usually drug-induced and mediated by immune reactions of several types. TEN has to be differentiated from erythema multiforme and Stevens-Johnson syndrome. TEN bears a life-threatening potential and a risk for significant complications such as dehydration; secondary infections; pulmonary, gastrointestinal, and renal involvement; and late scarring with cosmetic and functional implications. Therapeutic interventions include admission in a burn center unit, systemic antibiotics and corticosteroids, topical therapy with antibacterial agents and biological dressings, and supportive measures.

Partial lipoatrophy in a child

A 2-year-old boy was referred to the pediatric dermatology clinic for evaluation of an idiopathic, hypopigmented, atrophic patch on the right gluteal area. After extensive questioning the patient's parents recalled a penicillin injection several months prior to the appearance of lipoatrophy. There were no associated abnormalities.

Perioral dermatitis in children

Perioral dermatitis is a unique skin disorder of childhood. Its exact origin is unknown; it is probably an idiosyncratic response to exogenous factors such as the use of a topical fluorinated corticosteroid or other substances on the face. It is uncommon but not rare. The age of affected children has ranged from 7 months to 13 years, with the median being in the prepubertal period. Boys and girls, blacks and whites are equally affected. Clinical features include the following: (1) absence of systemic symptoms; (2) periorificial distribution (perioral, perinasal, periorbital); (3) skin lesions that consist of flesh colored or erythematous inflammed papules, micronodules, and rare pustules; and (4) variable pruritus. Laboratory tests are negative. Histologically, it is indistinguishable from rosacea; there is a superficial perifollicular granuloma consisting of epitheliod cells, and lymphohistiocytic infiltrate, with occasional giant cells. The disease waxes and wanes for weeks and months. Treatment consists of discontinuing topical fluorinated corticosteroid use if any, and using topical metronidazole alone or in combination with either oral tetracycline or erythromycin depending on the child's age. A low-potency topical steroid may also be used to suppress the inflammation and to wean off the strong steroid. Perioral dermatitis in childhood is probably a juvenile form of rosacea.

Atopic dermatitis in childhood

Atopic dermatitis is one of the major challenging skin disorders in infants and children. Many flare factors come into play. Treatment is complicated. A simplified approach and overview to the problem is presented here. A parent education handout used in our clinic and reprinted here may be reproduced for patient education purposes.

Congenital Becker's nevus with a familial association

Becker's nevus is a unilateral, hyperpigmented cutaneous hamartoma usually with hypertrichosis. It occurs predominantly in boys, becoming apparent during adolescence, although several cases of congenital Becker's nevus have been reported. Rarely it may be familial and as such is transmitted in an autosomal dominant pattern. We report a 16-month-old black boy with a hyperpigmented patch on his right shoulder and upper pectoral area that extended down his arm. The patient's father has a similar lesion with hair on his left shoulder which has been present since childhood. Histology of the child's lesion was consistent with Becker's nevus. We believe this to be the first reported case of a congenital Becker's nevus with a familial association.

Tinea capitis in a newborn caused by two organisms

Tinea capitis is a common infection of childhood. There have been several reports of tinea capitis in newborns. Our patient presented at 19 days of age to the emergency room with a scalp lesion of 5 days duration. The fungal culture grew both Trichophyton rubrum and Trichophyton mentagrophytes. The patient was successfully treated with oral griseofulvin.

Transient cutaneous vesicles in a teenager: the final piece to a puzzle

Cicatricial pemphigoid is a chronic blistering disease that predominantly affects the mucous membranes. It has a peak occurrence in the seventh decade. Pediatric cicatricial pemphigoid is a rare entity, with fewer than 20 cases reported. We report an 18-year-old man who was recently diagnosed with cicatricial pemphigoid after six years of diagnostic uncertainty.

Skin disorders in black children

Recently, progress and developments have been made in six skin conditions relevant to black children. Infantile acropustulosis may either be idiopathic or may be a sequela of scabies in young infants. The approach to small- or medium-sized congenital melanocytic nevi in black children must be different because the risk for malignant transformation into melanoma is exceedingly small. Keloids and hypertrophic scars in children are effectively treated with silicone gel sheeting. Tinea capitis caused by Trichophyton tonsurans remains to be a very common infection among black children. The newer systemic antifungal agents have no significant advantage over griseofulvin. Hair problems resulting from grooming practices or hair styling are preventable. For postinflammatory hyperpigmentation, azelaic acid holds promise.

Neonatal lupus erythematosus: discordant disease expression of U1RNP-positive antibodies in fraternal twins--is this a subset of neonatal lupus erythematosus or a new distinct syndrome?

Neonatal lupus erythematosus (NLE) is an uncommon disease that is manifested by cutaneous lesions, cardiac conduction defects, or both, that appear in utero or shortly after birth. In approximately 95% of patients, anti-Ro antibody (Ro[SS-A]) has been identified and has become the serologic marker for NLE. Since 1987 there have been four reported cases of Ro- and anti-La antibody (La[SS-B])-negative, U1RNP antibody-positive, NLE. Our affected twin, as well as all other infants with U1RNP-positive NLE, had cutaneous lesions similar to those in Ro-positive NLE, although they lacked systemic abnormalities, including cardiac conduction defects. HLA typing of mothers with infants with U1RNP-positive NLE revealed the presence of HLA-DR4, DQw1, or DQw3 phenotypes. Our typing confirms these findings. As with Ro-positive NLE, no distinct HLA associations were demonstrated in the infants. Unlike Ro-positive mothers, all mothers with a U1RNP-positive infant with NLE had connective tissue disease at the time of the diagnosis and had a different spectrum of disease. We describe the clinical, serologic, and immunogenetic findings in the first reported case of U1RNP-positive NLE in dizygotic twins in whom the NLE disease expression was discordant.

Approach to dermatologic disorders in black children

Skin diseases in black children differ because of pigment lability, fibroblastic activity, and folliular predominance. Normal findings may include Futcher's or Voight's line, linea alba, Mongolian spot, and pigmentation of the mucous membranes and nails. Disorders that are more frequent in black children are transient neonatal pustular melanosis, infantile acropustulosis, tinea capitis, pomade acne, traction alopecia, and proximal trichorrhexis nodosa. Disorders that vary in appearance but not incidence include pityriasis alba, vitiligo, and alopecia areata. A knowledge of this helps in the treatment of the black child with a skin disorder.

Congenital malignant melanoma

A 6-week-old girl with congenital melanoma of the skin is reported and the literature is reviewed. We believe this to be the first case of congenital melanoma in a black infant who had no underlying giant melanocytic nevus. Because of the significant relationship between the early treatment and prognosis of malignant melanoma, we wish to alert pediatric clinicians to the existence of this rare congenital neoplasm.

Tinea capitis in Brooklyn

Tinea capitis, a disease of children, occurs throughout the United States. We studied 144 clinically diagnosed cases of tinea capitis within a 12-month period. Ninety-six of them had positive cultures; Trichophyton tonsurans grew in 89% and Microsporum organisms in 11%. Ninety-five (99%) of the patients with positive cultures were black, and one (1%) was hispanic. The peak incidence was in the 4-to-5-year age group. Boys and girls were equally affected. Sixty percent of the 96 culture-proved cases were noninflammatory, and 40% were inflammatory (kerions). In four patients, the initial clinical manifestations were severe diffuse seborrhealike scales and crusting of the scalp with minimal alopecia. Mycologic and clinical cure were obtained by a mean of 4.7 weeks of griseofulvin therapy. Neither systemic erythromycin, topical antifungal agents, nor systemic prednisone resulted in earlier eradication. However, prednisone caused the inflammation of the kerions to subside dramatically.

Lichen sclerosus et atrophicus in an eleven year old girl. Report of a case

An elevent year old girl who presented with constipation of two years' duration was found to have atrophy and depigmentation of the anogenital area. Results of a skin biopsy confirmed the diagnosis of lichen sclerosus et atrophicus, which is a rare disease in children. Treatment of the disease is non-specific, and it usually disappears in half of the patients around the time of menarche. Long-term follow-up of persistent anogenital lesions is necessary.

Shigella vulvovaginitis in childhood: a case report

Vulvovaginitis due to Shigella sonnei is reported in a four-year-old child.Shigella sonnei as a rare primary pathogen causing vulvovaginitis, the prolonged nature of the clinical course, and the therapeutic implications of increasing resistance to ampicillin by the organism are discussed.

Childhood pemphigus treated with gold

A case of childhood pemphigus is reported. The natural history of this rare entity and past methods of treatment are reviewed. We also report on what is to our knowledge the first known use of gold in the treatment of childhood pemphigus. This modality appears to have been of benefit in our patient to date.

Congenital lentiginosis

Because lentiginosis may be associated with multiple somatic anomalies (as in the "LEOPARD syndrome"), its recognition is important clinically. A case of lentiginosis detected in the neonatal period, without accompanying defects, is reported. The significance of histologic confirmation and the importance of searching for other abnormalities are discussed.

The comparative efficacy of cephalexin and sulfisoxazole in acute urinary tract infection in children

A double blind, comparative study of the efficacy of cephalexin versus sulfisoxazole was conducted on 100 children with initial episodes of urinary tract infections. The overall bacteriologic and clinical cure rates were comparable for both antimicrobials. Children treated with cephalexin had a clinical cure rate of 86 per cent and a bacterial cure rate of 84 per cent, while those given sulfisoxazole were found to have rates of 82 and 92 per cent respectively. However, cephalexin was noted to have a rather high rate of failure in the therapy of Proteus micrabilis infections (4/8), casting some doubt on its use in urinary infections caused by the organism. Untoward effects associated with either medication were minimal.

A chart audit peer review system in an ambulatory service

A system of providing rapid review of ambulatory patient records using a set of criteria was developed and tested. Of 337 records selected for review, 25% were not reviewable. Of the remaining 75%, virtually one half proved to be lacking in one or more of the established criteria. Deficiencies tended to occur most often in criteria related to the physical examination of the child. Physician compliance with the criteria could not be conclusively shown to improve during the five-month study period, although physician acceptability was judged as good. A large percentage (47.3%) of deficient records could be corrected by the responsible health professional. The chief advantages of the system are that it is rapid and easy to perform. It focuses on the major service provided by the facility, i.e., acute medical care, and on the performance of the individual providing that service.