Publications by authors named "Marissa J Perman"

23 Publications

  • Page 1 of 1

Bowel-associated dermatosis-arthritis syndrome in a child with very early onset inflammatory bowel disease.

Pediatr Dermatol 2021 Mar 21. Epub 2021 Mar 21.

Section of Pediatric Dermatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

A 6-year-old boy with severe very early-onset inflammatory bowel disease (VEO-IBD) was admitted for 1 week of high fevers, loose stools, joint pains, and myalgias. He subsequently developed a progressive, papular, and vesiculopustular eruption on his face with rapid spread to his trunk and extremities. Histopathology demonstrated dense dermal neutrophilic inflammation. Findings were consistent with bowel-associated dermatosis-arthritis syndrome (BADAS), which is rarely reported in children and requires further characterization.
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http://dx.doi.org/10.1111/pde.14544DOI Listing
March 2021

A progressive, diffuse atrophic and dyspigmented eruption.

Pediatr Dermatol 2020 Nov;37(6):1153-1155

Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1111/pde.14345DOI Listing
November 2020

Development and Initial Validation of a Multidimensional Acne Global Grading System Integrating Primary Lesions and Secondary Changes.

JAMA Dermatol 2020 03;156(3):296-302

Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.

Importance: The qualitative grading of acne is important for routine clinical care and clinical trials, and although many useful systems exist, no single acne global grading system has had universal acceptance. In addition, many current instruments focus primarily on evaluating primary lesions (eg, comedones, papules, and nodules) or exclusively on signs of secondary change (eg, postinflammatory hyperpigmentation, scarring).

Objectives: To develop and validate an acne global grading system that provides a comprehensive evaluation of primary lesions and secondary changes due to acne.

Design, Setting, And Participants: This diagnostic study created a multidimensional acne severity feature space by analyzing decision patterns of pediatric dermatologists evaluating acne. Modeling acne severity patterns based on visual image features was then performed to reduce dimensionality of the feature space to a novel 2-dimensional grading system, in which severity levels are functions of multidimensional acne cues. The system was validated by 6 clinicians on a new set of images. All images used in this study were taken from a retrospective, longitudinal data set of 150 patients diagnosed with acne, ranging across the entire pediatric population (aged 0-21 years), excluding images with any disagreement on their diagnosis, and selected to adequately span the range of acne types encountered in the clinic. Data were collected from July 1, 2001, through June 30, 2013, and analyzed from March 1, 2015, through December 31, 2016.

Main Outcomes And Measures: Prediction performance was evaluated as the mean square error (MSE) with the clinicians' scores.

Results: The scale was constructed using acne visual features and treatment decisions of 6 pediatric dermatologists evaluating 145 images of patients with acne ranging in age from 0 to 21 years. Using the proposed scale to predict the severity scores on a new set of 40 images achieved an overall MSE of 0.821, which is smaller than the mean within-clinician differences (MSE of 0.998).

Conclusions And Relevance: By integrating primary lesions and secondary changes, this novel acne global grading scale provides a more clinically relevant evaluation of acne that may be used for routine clinical care and clinical trials. Because the severity scores are based on actual clinical practice, this scoring system is also highly correlated with appropriate treatment choices.
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http://dx.doi.org/10.1001/jamadermatol.2019.4668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990806PMC
March 2020

Skin cleansing and topical product use in patients with epidermolysis bullosa: Results from a multicenter database.

Pediatr Dermatol 2020 Mar 15;37(2):326-332. Epub 2020 Jan 15.

Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York.

Background/objectives: Epidermolysis bullosa (EB) comprises a group of inherited skin blistering diseases. There is currently no cure, and management includes skin protection and prevention of infection. To date, there has been no systematic investigation of home skin care practices among EB patients on a multicenter scale.

Methods: This cross-sectional, observational study included data collected from patients with EB enrolled in the Epidermolysis Bullosa Characterization and Clinical Outcomes Database (EBCCOD) who provided answers to a patient-directed questionnaire between January 1, 2017, and December 31, 2017.

Results: Of 202 respondents, 130 (64.4%) had dystrophic EB, 51 (25.2%) had EB simplex, 21 (7.4%) had junctional EB, 3 (1.5%) had Kindler syndrome, and 3 (1.5%) had an unspecified subtype. Seventy-eight patients reported cleansing in plain water only (39%). Of those who used an additive in their cleansing water, 75 (57%) added salt, 71 (54%) added bleach, 36 (27%) added vinegar, and 34 (26%) endorsed the use of an "other" additive (multiple additives possible). Reported concentrations of additives ranged widely from 0.002% sodium hypochlorite and 0.002% acetic acid solutions, which are thought to have negligible effects on microbes, to 0.09% sodium hypochlorite and 0.156% acetic acid, concentrations shown to be cytotoxic. One hundred eighty-eight patients answered questions regarding topical product use (93%). Of those, 131 reported topical antimicrobial use (70%). Mupirocin and bacitracin were the most commonly reported topical antibiotics (59, 58 [31.4%, 30.9%], respectively).

Conclusions: These findings highlight the variety of skin care routines and frequent use of topical antimicrobials among EB patients and have potential implications for antibiotic resistance. The reported range of bleach and vinegar additives to cleansing water, including cytotoxic concentrations, emphasizes the need for clear and optimized skin cleansing recommendations.
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http://dx.doi.org/10.1111/pde.14102DOI Listing
March 2020

Verruciform xanthoma in a patient with recessive dystrophic epidermolysis bullosa: Case report and literature review.

Pediatr Dermatol 2020 Mar 26;37(2):355-357. Epub 2019 Dec 26.

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Verruciform xanthoma (VX) is a rare finding thought to be caused by epidermal damage from trauma or inflammation and has been reported in a limited number of patients with recessive dystrophic epidermolysis bullosa (RDEB). Herein, we describe a 20-year-old woman with RDEB who developed a large, verrucous, pink plaque on the posterior thigh that was histologically proven to be a VX. We review cases of VX in patients with RDEB and summarize the clinical features, pathophysiology, and management principles.
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http://dx.doi.org/10.1111/pde.14079DOI Listing
March 2020

Complete resolution of primary cutaneous marginal zone B-cell lymphoma on the cheek of a 7-year-old boy with intralesional triamcinolone and tincture of time.

Pediatr Dermatol 2020 Jan 30;37(1):228-229. Epub 2019 Oct 30.

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

A 7-year-old healthy boy presented with an asymptomatic smooth, firm red plaque on the cheek. Histopathology, immunostaining, molecular testing and imaging confirmed a diagnosis of a primary cutaneous marginal zone B-cell lymphoma. The lesion was treated with intralesional triamcinolone, with complete clinical resolution achieved within one year. Intralesional steroid injection is an effective first-line modality for the treatment of patients with limited disease in cosmetically sensitive areas.
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http://dx.doi.org/10.1111/pde.14028DOI Listing
January 2020

Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases.

Arthritis Care Res (Hoboken) 2021 02 3;73(2):215-220. Epub 2021 Jan 3.

Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

Objective: To estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor inhibitor (TNFi) exposure as compared to children without TNFi exposure and to the general pediatric population.

Methods: This was a single-center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors.

Results: Of the 4,111 children who met inclusion criteria, 1,614 (39%) had TNFi exposure and 2,497 (61%) did not, with 4,705 and 6,604 person-years of follow-up, respectively. There were 58 cases (IR 12.3 per 1,000 person-years) and 25 cases (IR 3.8 per 1,000 person-years) of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [95% CI] 15-22) overall, 30 (95% CI 23-39) for children with TNFi exposure, and 9.3 (95% CI 6.3-14) for children without TNFi exposure. The hazard ratio of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28-6.47; P < 0.001).

Conclusion: Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.
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http://dx.doi.org/10.1002/acr.24100DOI Listing
February 2021

Acquired port-wine stains in six pediatric patients.

Pediatr Dermatol 2020 Jan 20;37(1):93-97. Epub 2019 Oct 20.

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Background/objectives: Port-wine stains, also known as capillary malformations, are due to dermal vascular ectasia and dilation and are most commonly congenital; however, acquired port-wine stains (APWS) developing later in life have been noted in the literature, most commonly in the context of trauma.

Methods/results: This case series presents 6 pediatric patients with APWS who first developed lesions between ages 3 and 11 years in the absence of a traumatic or other etiologic trigger.

Conclusions: The epidemiology, clinical features, and treatment response of these patients are compared to what has been previously described in other cases in the literature.
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http://dx.doi.org/10.1111/pde.14019DOI Listing
January 2020

Generalized, severe epidermolysis bullosa simplex caused by a Keratin 5 p.E477K mutation.

Pediatr Dermatol 2019 Nov 3;36(6):1007-1009. Epub 2019 Oct 3.

Division of General Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Epidermolysis bullosa simplex (EBS) is a skin fragility disorder resulting from mutations of structural proteins in the epidermis. We provide a brief report of long-term survival and reproduction in a mother with EBS due to keratin 5 (KRT5) c.1429G > A (p.E477K) mutation, which causes a particularly severe form of the disease.
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http://dx.doi.org/10.1111/pde.13965DOI Listing
November 2019

Tumor necrosis factor-α inhibitor-induced psoriasis in juvenile idiopathic arthritis patients.

Pediatr Dermatol 2019 Sep 25;36(5):613-617. Epub 2019 Jun 25.

Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Background/objectives: The development of psoriasis while on tumor necrosis factor inhibitors (TNFi) is a paradoxical effect of agents that treat psoriasis. There is a paucity of data available on this entity in juvenile idiopathic arthritis (JIA). Our objectives were to determine the prevalence of TNFi-induced psoriasis in patients with JIA at two pediatric centers, and psoriasis response to therapeutic modifications.

Methods: We performed retrospective chart review on patients with JIA treated with TNFi (adalimumab, etanercept, infliximab) who developed psoriasis. TNFi-induced psoriasis was defined as an incident diagnosis of psoriasis after starting a TNFi. Patients with personal histories of psoriasis prior to TNFi therapy were excluded. Following diagnosis, responses to medication changes were defined based on physician assessments.

Results: Nine of 166 (5.4%) patients on TNFi for JIA were diagnosed with TNFi-induced psoriasis. All cases were female. One had a family history of psoriasis. The median age was 10 (range 2-16) years. Five (55%) patients experienced scalp psoriasis, including four (44%) with alopecia. Two (22%) patients achieved significant improvement after switching to different classes of biologic agents, while three (33%) patients had significant improvement following discontinuation of biologic therapy. One of five patients who switched to a different TNFi had complete resolution, while four had worsening symptoms or partial improvement.

Conclusions: Our findings demonstrate the prevalence of TNFi-induced psoriasis in JIA at two centers. Though larger studies are needed, our data suggest discontinuation of TNFi or biologic class switching should be considered as treatment strategies in select patients.
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http://dx.doi.org/10.1111/pde.13859DOI Listing
September 2019

Late growth of infantile hemangiomas in children >3 years of age: A retrospective study.

J Am Acad Dermatol 2019 Feb 5;80(2):493-499. Epub 2018 Oct 5.

University of California, San Francisco, California.

Background: The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported.

Objective: To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient >3 years of age.

Methods: A multicenter, retrospective cohort study.

Results: In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or β-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (β-blockers) for late IH growth.

Limitations: The retrospective nature and ascertainment by investigator recall are limitations of the study.

Conclusion: Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.
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http://dx.doi.org/10.1016/j.jaad.2018.07.061DOI Listing
February 2019

Prurigo Pigmentosa: An Itchy, Urticarial Eruption Confused for Food Allergy.

J Allergy Clin Immunol Pract 2018 Jul - Aug;6(4):1381-1382. Epub 2018 Mar 23.

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Section of Dermatology, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pa.

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http://dx.doi.org/10.1016/j.jaip.2018.02.033DOI Listing
November 2019

Unilateral hypertrophy of the labia minora: A case series.

Pediatr Dermatol 2018 May 24;35(3):e198-e199. Epub 2018 Mar 24.

Section of Dermatology, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management.
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http://dx.doi.org/10.1111/pde.13467DOI Listing
May 2018

Diagnostic Accuracy of Pediatric Teledermatology Using Parent-Submitted Photographs: A Randomized Clinical Trial.

JAMA Dermatol 2017 12;153(12):1243-1248

Section of Dermatology, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Importance: Advances in smartphone photography (both quality and image transmission) may improve access to care via direct parent-to-clinician telemedicine. However, the accuracy of diagnoses that are reliant on parent-provided photographs has not been formally compared with diagnoses made in person.

Objective: To assess whether smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to permit accurate diagnosis.

Design, Setting, And Participants: A prospective study was conducted among 40 patient-parent dyads at a pediatric dermatology clinic at the Children's Hospital of Philadelphia from March 1 to September 30, 2016, to assess concordance between diagnoses made by an independent pediatric dermatologist based on in-person examination and those based on parental photographs. Half of the patient-parent dyads were randomized for a secondary analysis to receive instructions on how best to take photographs with smartphones. Clinicians were blinded to whether parents had received photography instructions.

Exposures: Half of the patient-parent dyads received a simple, 3-step instruction sheet on how best to take photographs using a smartphone (intervention group); the other half did not (control group).

Main Outcomes And Measures: Concordance between photograph-based vs in-person diagnosis in the intervention vs control groups, as quantified using Cohen κ, a measure of interrater agreement that takes into account the possibility of agreement occurring by chance.

Results: Among the 40 patient-parent dyads (22 female children and 18 male children; mean [SD] age, 6.96 [5.23] years), overall concordance between photograph-based vs in-person diagnosis was 83% (95% CI, 71%-94%; κ = 0.81). Diagnostic concordance was 89% (95% CI, 75%-97%; κ = 0.88) in a subgroup of 37 participants with photographs considered of high enough quality to make a diagnosis. No statistically significant effect of photography instructions on concordance was detected (group that received instructions, 85%; group that did not receive instructions, 80%; P = .68). In cases of diagnostic disagreement, appropriate follow-up was suggested.

Conclusions And Relevance: Parent-operated smartphone photography can accurately be used as a method to provide pediatric dermatologic care.

Trial Registration: clinicaltrials.gov Identifier: NCT03246945.
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http://dx.doi.org/10.1001/jamadermatol.2017.4280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817452PMC
December 2017

Congenital Self-Healing Langerhans Cell Histiocytosis.

J Pediatr 2017 05 21;184:232-232.e1. Epub 2017 Feb 21.

Section of Pediatric Dermatology Children's Hospital of Philadelphia; Department of Pediatrics and Dermatology University of PennsylvaniaPhiladelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.jpeds.2017.01.040DOI Listing
May 2017

Degos disease mimicking primary vasculitis of the CNS.

Neurol Neuroimmunol Neuroinflamm 2016 Apr 2;3(2):e206. Epub 2016 Feb 2.

Children's Hospital of Philadelphia (S.G., A.T., S.N., L.B., T.B., P.L., M.J.P., A.V., B.H., J.B., B.B.), PA; and Seattle Children's Hospital (M.D.B.), WA.

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http://dx.doi.org/10.1212/NXI.0000000000000206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747475PMC
April 2016

Presentation of Acute Megakaryoblastic Leukemia Associated with a GATA-1 Mutation Mimicking the Eruption of Transient Myeloproliferative Disorder.

Pediatr Dermatol 2015 Sep-Oct;32(5):e204-7. Epub 2015 Jul 23.

Section of Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Children with trisomy 21 are prone to developing hematologic disorders, including transient myeloproliferative disorder (TMD) and acute megakaryoblastic leukemia (AMKL). The papulovesicular eruption of TMD provides an important clue to the diagnosis. In contrast, AMKL rarely has associated cutaneous findings. We report the case of a 22-month-old child with trisomy 21 who presented with the acute onset of diffusely scattered and crusted papules, plaques, and vesicles. A thorough infectious evaluation was negative and the patient was unresponsive to empiric antibiotic and antiinflammatory therapies. Complete blood count (CBC) was notable for mild pancytopenia, with a normal peripheral smear. Two weeks later he was reassessed and found to have a population of blasts on repeat CBC. Subsequent evaluation ultimately led to a diagnosis of AMKL. This is the first reported case of a cutaneous eruption in a young child with Down syndrome and transformed AMKL. When children with trisomy 21 present with the acute onset of crusted papules and vesicles that cannot be accounted for by an infectious etiology, a diagnosis of AMKL should be considered even in the absence of a history of TMD.
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http://dx.doi.org/10.1111/pde.12643DOI Listing
June 2016

Retrospective analysis of beta-blocker instituted for treatment of hemangiomas (RABBIT study).

Clin Pediatr (Phila) 2014 Oct 21;53(11):1084-90. Epub 2014 May 21.

Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

Objective: To evaluate the safety and efficacy of our institutional beta-blocker protocol for treatment of complicated infantile hemangiomas (IH).

Study Design: A retrospective descriptive study of 76 infants/children with IH treated with oral propranolol at the Children's Hospital of Philadelphia between June 2008 and August 2010 was performed, assessing both the safety and efficacy of propranolol. Based on preliminary data showing hemangioma recrudescence off-treatment, we reviewed 9 additional patients with recrudescence between August 2010 and December 2011.

Results: Mild adverse events included asymptomatic bradycardia, gastrointestinal symptoms, asymptomatic hypotension, cool hands/feet, asymptomatic hypoglycemia, and sleep disturbance. Sixteen patients had recrudescence of IH off-treatment, with propranolol discontinued at a median age of 14 months (interquartile range 10-15 months).

Conclusions: Propranolol appears to be associated with minor, not severe symptomatic adverse events. Propranolol appears to be effective in treating complicated IH. Recrudescence can occur off-treatment, even with discontinuing propranolol as late as 15 months of age.
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http://dx.doi.org/10.1177/0009922814535660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312282PMC
October 2014

Differential diagnosis of infantile hemangiomas.

Pediatr Ann 2012 Aug;41(8):1-7

The Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA.

1.Compare and contrast infantile hemangiomas with other vascular anomalies that may be confused clinically.2.Describe the vascular anomalies classification system according to the International Society for the Study of Vascular Anomalies (ISSVA), highlighting the differences between vascular tumors, such as infantile hemangiomas, and vascular malformations.3.Briefly review associated signs or syndromes found in the context of certain vascular anomalies.Infantile hemangiomas are the most common benign vascular tumor in infancy but may mimic many other types of vascular anomalies. In many cases, the appearance, time of onset, growth pattern, and consistency of infantile hemangiomas make the diagnosis straightforward (see "Pathogenesis of Infantile Hemangiomas" on p. 321). However, many other vascular lesions can appear quite similar to infantile hemangiomas, especially early in life, and at times this makes the correct diagnosis challenging.
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http://dx.doi.org/10.3928/00904481-20120727-09DOI Listing
August 2012

Five cases of anti-tumor necrosis factor alpha-induced psoriasis presenting with severe scalp involvement in children.

Pediatr Dermatol 2012 Jul-Aug;29(4):454-9. Epub 2011 Oct 13.

Division of Dermatology, College of Medicine, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Although anti-tumor necrosis factor alpha (TNF-α) agents are commonly used to treat psoriasis and other inflammatory diseases in adults and children, numerous reports have documented new-onset or flaring psoriasis in adults treated for the other conditions. Individual case reports have documented similar observations in three children. We report a series of anti-TNF-α-induced psoriasis in children with juvenile idiopathic arthritis or inflammatory bowel disease treated at a large children's hospital. All five patients presented with severe scalp involvement. One child was treated with adalimumab for juvenile idiopathic arthritis, and four received infliximab for inflammatory bowel disease. The five patients developed psoriasis 2 to 10 months after initiating anti-TNF-α therapy. They presented with erythematous, scaly, crusted scalp lesions. Three of the five patients were initially treated with griseofulvin for presumed tinea capitis. The anti-TNF-α agent was discontinued at the time of diagnosis in two cases. Topical steroids were the mainstay of psoriasis therapy, with improvement in four of five patients. Anti-TNF-α agents have been associated with the onset or worsening of psoriasis in adults, but this has rarely been reported in children. We describe five pediatric cases of anti-TNF-α-induced psoriasis presenting with severe scalp involvement and review their subsequent management. We hope that clinicians caring for patients receiving anti-TNF-α agents will consider psoriasis from the onset of cutaneous symptoms and institute appropriate therapy or referral.
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http://dx.doi.org/10.1111/j.1525-1470.2011.01521.xDOI Listing
November 2012

Giant merkel cell carcinoma masquerading as a benign cyst on the buttock of an african american man.

Case Rep Oncol Med 2011 22;2011:849767. Epub 2011 Sep 22.

Department of Dermatology, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.

We report a case of a 60-year-old African American man who presented with a 4-year history of a previously asymptomatic, recently enlarging nodule on his left buttock, which was initially presumed to be an epidermoid cyst. Physical examination revealed a large, fixed, subcutaneous tumor, and a biopsy revealed merkel cell carcinoma. Immunohistochemical staining was positive for pankeratin, CAM 5.2, synaptophysin, and CD56 and negative for CK7, CK20, TTF-1, chromogranin, CD3, CD20, CD57, MART1, and HMB 45. The patient underwent wide local excision of the lesion with removal of the fascia overlying the gluteus and full body positron emission tomography (PET) and was found to have Stage IIb disease. He subsequently received adjuvant radiotherapy limited to the tumor bed at a dose of 60 gray.
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http://dx.doi.org/10.1155/2011/849767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3350009PMC
August 2012

Transilluminator burns in the neonatal intensive care unit: a mimicker of more serious disease.

Pediatr Dermatol 2007 Mar-Apr;24(2):168-71

Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland, USA.

We report an outbreak of erythematous to purpuric papules and vesicles in four neonates whose lesions arose within a 72-hour period in a neonatal intensive care unit. As isolated lesions, the clinical presentation mimicked cutaneous aspergillosis. Ultimately, because of the number of patients with similar lesions, an exogenous source was suspected and determined to be a faulty transillumination device.
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http://dx.doi.org/10.1111/j.1525-1470.2007.00368.xDOI Listing
July 2007