Paediatric Dermatology

Indian Society of Pediatric Dermatology Annual conference (18th to 20th August 2017)

Indian Society of Pediatric Dermatology held its annual conference in the national capital between 18th and 20th august 2017.  The academic content was widely appreciated as was the hospitality. Here are a few snippets taken from the deliberations held during the conferences

  1. Black piedra may present as a patchy non scarring circumscribed alopecia.
    1. Trichoscopy helps in diagnosis. Closest differentials are black dot Tinea and trichotillomania. Good improvement of the condition is seen with topical terbinafine
  2. Rain drop like hypopigmentation on a background of hyper pigmentation points towards chronic arsenicosis. Tongue may also be involved. Have to be differentiated from Addisonian disease (check BP) and Vit B12 deficiency (check peripheral blood smear and also changes in hair colour). Alternative medicine and homeopathic medicine also can cause arsenicosis.
  3. Macular Hypopigmentation (sometimes generalised but mostly on neck folds, nasolabial and eye folds) can actually be extensive idiopathic Pityriasis alba. Treatment is with emollient is only. It clears in 6 weeks. A review article is recently published (Miazek, N., Michalek, I., Pawlowska-Kisiel, M., Olszewska, M. and Rudnicka, L. Pityriasis Alba-Common Disease, Enigmatic Entity: Up-to-Date Review of the Literature. Pediatric Dermatology, 32(6), pp.786-791. 2015)
  4. Bilateral periorbital symmetric erythema surrounded by hypopigmentory zone in a child : D/D can be heliotrope rash . But what is commonly unappreciated is Pigmented Pityriasis alba . Management is with emollient / pimecrolimus.
  5. Weakness, lustreless hair, hyperpigmentation on knuckle, lip: peripheral blood smear showing hypersegmented nucleus. Diagnosis is vitamin B12 deficiency. Clinically differentiating point with Addisonian is that palmar crease have pigmentation in Addisonian , whereas in B12 deficiency there is angular cheilitis
  6. Diaper area is not involved in atopic dermatitis. In case of infantile seborrheic dermatitis the margin will not be well defined, but psoriasis will have sharply demarcated margin.
  7. Approach to follicular keratotic papular lesion
    1. Keratosis pilaris may be associated with obesity, syndromes and drugs like nilotinib and vemurafenib
    2. A spinous variant of follicular lichen nitidus is to be differentiated from lichen spinulosus.
    3. Scurvy still seen mainly because of faulty diet habit; presents with hyper keratotic papule with perifollicular hemorrhage, gum bleeding, edema, cork screw hair and pseudoparalysis .
    4. Phrynoderma patients may be given vitamin B12 substitute along with vitamin A, along with a diet rich in omega 3 fatty acid.
  8. Recurrent pompholyx should be treated with a course of antibiotics and then a short courses of oral steroid can be given. Recalcitrant / relapsing pompholyx should be biopsied to rule out Bullous Pemphigoid.
    1. Rajeev Sharma stressed patients should avoid touching nickel, dietary nickel, excessive use of detergents
    2. Deepak emphasized that tinned food and sea food contain nickel should be avoided. Rubber of sports racket and shoes can induce similar lesions.
    3. Dr Sandipan said at least two weeks of Steroid should be given , if considered .
  9. Dr Rajeev Sharma spoke on chronic dermatophytosis. He doesn’t recommend oral antifungals in infants and uses topical antifungal twice daily 2 cm beyond the lesion. In children more than one year old, he recommends griseofulvin and beyond 2 years he prescribes terbinafine in recommended doses. Itraconazole reserved for children greater than 10 years.
  10. Should we prescribe vit D to a child with AD? Meta analysis shows vitamin D is low in Atopics. Hence supplementation of  vitamin D is warranted
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