Vascular Lesion in a Six Year-Old

The patient is a 6-year-old boy who was seen for evaluation of a lesion on his right knee that has been present since infancy.  When he is active it swells up a bit and is uncomfortable, if not painful. He is in otherwise good health and his identical twin has no such lesion.  The child has seen by his family practitioner and two or three pediatricians.  He has had ultrasounds and x-rays, but none were diagnostic.  

O/E:  The examination shows a subtle dusky area on the right knee.  There are some vascular lesions within the area that are a millimeter in diameter or less.   Dermatoscopy more clearly defines them.

Clinical Photos:

PLAN:  A 4 mm punch biopsy was taken for diagnostic purposes. He may need to be referred to a center where they deal with vascular anomalies.   

Pathology:
Lymphatic malformation consistent with, in the appropriate clinical setting, lymphangioma.
The specimen exhibits compact hyperkeratosis, papillomatous epidermal hyperplasia, focal acanthosis, a sparse superficial perivascular lymphocytic infiltrate, and multiple dilated, irregular thin-walled vessels lined by a single layer of bland endothelial cells in the papillary dermis.

IMPRESSION:  Vascular anomaly: Lymphangioma    

FitBit Dermatitis

The patient is a 54-year-old woman with a history of severe  atopic dermatitis.  She was seen today for evaluation of a dermatitis on the left wrist that began under her Fitbit Alta.  She thought that it might be an infection so she started applying Neosporin and within a day, it was much worse. 
During the intervierw, the patient said, with feeling, "I love my FitBit."

O/E:  The examination shows a localized area of dermatitis with crusting on the left wrist.  It is quite inflamed.

Images:

IMPRESSION:  Possible irritant versus allergic reaction to Fitbit followed by application of Neosporin with what appears to be an allergic contact dermatitis.           

PLAN:  She will need to stop the Fitbit for the time being.  Fluocinonide 0.05% ointment twice a day to area.  Wet compresses.  Return as necessary.

References:

Initially, "Fitbit recalled the trackers and blamed rashes on allergic reactions to the nickel and glue in the wristband. However, scientists at the Consumer Product Safety Commission were testing a different theory.

They found that sweat in the charger caused a chemical reaction that produced a toxic compound, saying: "This scenario is supported by one consumer stating their injury occurred after charging... and a skin burn the shape of the charging port in another incident."
See: Possible cause of Fitbit rashes uncovered.

This it is unclear at this point.  Nickel allergy is easy to test for, however.

 

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