tag:blogger.com,1999:blog-9870114.post5787215744405736480..comments2024-03-10T08:41:32.400+00:00Comments on VIRTUAL GRAND ROUNDS IN DERMATOLOGY 2.0: Dermatitis and Failure to ThriveHumane Medicine Huihttp://www.blogger.com/profile/07113291188306363130noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-9870114.post-44081989244356042852011-01-30T17:40:13.717+00:002011-01-30T17:40:13.717+00:00This comment is from Brian Maurer:
(1) Severe atop...This comment is from Brian Maurer:<br />(1) Severe atopic dermatitis exacerbated by milk protein allergy. These kids may exhibit blood-tinged mucousy stools. Child exhibits mild eosinophilia, but IgE is normal.<br /> <br />(2) Scabies. The infantile form can be quite extensive, involving the face as well as the entire body. I would expect other family members to exhibit signs as well.<br /> <br />(3) HIV. These kids often exhibt FTT. Do we know the mother's HIV status?<br /> <br />(4) Histiocytosis X (infantile form is Letterer-Siwe disease). Characterized by scaly waxy eruption of the scalp, nape, axilla, and groin. Resembles seborrheic dermatitis but usually displays purpura and may have signs of hepatosplenomegaly, lymphadenopathy, and weight loss. Skin biopsy shows atypical histiocytes.<br /> <br />(5) Acrodermatitis enteropathica. Always with diarrhea and failure to thrive. Low serum zinc confirms, but this child's Zn is normal.<br /> <br />(6) Other immunodeficiency syndromes. See case report: http://www.ncbi.nlm.nih.gov/pubmed/11204605Humane Medicine Huihttps://www.blogger.com/profile/07113291188306363130noreply@blogger.comtag:blogger.com,1999:blog-9870114.post-62375171720102524232011-01-30T17:23:51.837+00:002011-01-30T17:23:51.837+00:00Interesting case. The "horseshoe" distr...Interesting case. The "horseshoe" distribution on the face and involvement of diaper could be caused by zinc deficiency (either acrodermatitis enteropathica or acquired, if he is breastfed) so would check a serum zinc level and an alkaline phosphatase. Langerhan's Cell Histiocytosis also came to mind - are there any other clues to this, like crusted papules on the palms and soles or petechial papules? I'd do a skin biopsy with staining for S100 and CD1a to rule this out.<br /><br />Would also consider biotin deficiency (check biotinidase levels), cystic fibrosis (but I believe Massachusetts includes CF on newborn screens now), and amino acidurias (check urine and plasma amino acids). If all workup is negative, this could be infantile psoriasis, especially if there is a family history - but this wouldn't explain the failure to thrive so would keep searching for underlying causes.Unknownhttps://www.blogger.com/profile/03186184400830217452noreply@blogger.com