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This document is a collection of summaries of various articles from the Australasian Journal of Dermatology. The first article discusses "pool palms," a common condition in children caused by frictional dermatitis from rubbing against rough pool surfaces. The second article presents a case of a delayed bullous drug eruption caused by Trikafta, a drug used to treat cystic fibrosis. The third article describes a case of a neonatal neurocristic cutaneous hamartoma, a rare developmental abnormality. The fourth article examines the efficacy of combination oral antifungal therapy in pediatric patients with cutaneous fungal infections. The fifth article analyzes dermatological presentations in a pediatric emergency department. The sixth article reviews plant-based therapies for treating pediculosis capitis. The seventh article explores the experiences and needs of families with children diagnosed with xeroderma pigmentosum, a skin cancer predisposition syndrome. [Extracted from the article]

Background/Objective: Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Methods: Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly‐selected patients. Results: 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8–1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very‐high‐risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Conclusion: Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease. [ABSTRACT FROM AUTHOR]

Idiopathic eruptive macular hyperpigmentation is a rare entity that should be considered in the differential diagnosis for children or adolescents presenting with hyperpigmentation disorders. Sarah amr Dawood SP 1 sp , Richard Goodwin SP 2 sp SP I 1 i sp I NHS, ULVERSTON, United Kingdom i SP I 2 i sp I Aneurin Bevan University Health Board i Epidermolysis bullosa acquisita (EBA) is a rare autoimmune condition that typically presents in the fourth or fifth decade of life. Abnormal hair that is sparse, short, brittle, fragile is characteristic of a range of isolated hereditary hair shaft disorders, with variable sparing of non-scalp hair. Idiopathic eruptive macular hyperpigmentation may be underdiagnosed as it is often mistaken for disorders that are morphologically very similar including lichen planus pigmentosus, ashy dermatosis, fixed drug eruption, urticaria pigmentosa, and post-inflammatory hyperpigmentation. [Extracted from the article]

Objectives: Literature on dermatology outpatient demographic and clinical data is limited, and the few studies on this topic are mainly conducted overseas, with medical systems and case mix different to Australia. This study presents demographic data relating to dermatology public outpatient referrals to a tertiary hospital in Brisbane, Australia, and determines what additional structured data should be collected to formulate and evaluate initiatives to address service issues such as referral quality, triage process and wait times. Methods: A four‐year retrospective audit was undertaken, summarising all referrals (n = 7140) and clinical dermatology encounters (n = 53 844) between January 2016 and December 2019 at Princess Alexandra Hospital (PAH), the largest hospital in Metro South Health (MSH), serving a population of one million. PAH has one of the two largest public dermatology clinics in Queensland and is the only dermatology service within MSH. Results: Patient demographic data, wait time by triage category, referral rates over time and encounter durations were collected. Structured diagnostic data (e.g. ICD‐10 coding) of the provisional diagnosis, comorbidities, medications and the final diagnosis are not collected in a structured format and would be a valuable addition. Conclusions: The clinical burden of public dermatology is increasing. Both collection and analysis of structured data pertaining to the referrals and encounters are important to help formulate, implement and evaluate initiatives that aim to improve health service provision in this area. [ABSTRACT FROM AUTHOR]

This document is a reply to a previous article by Adler et al. regarding the use of photographic surveillance in diagnosing melanoma. The authors address the concerns raised by Adler et al. and emphasize the need for controlled trials to determine the effectiveness of monitoring and imaging in melanoma diagnosis. They also discuss the differences in results between their study and others, highlighting the potential risks of delayed excision and the importance of early diagnosis. The authors argue that the use of shaves as a procedure for complete removal is widespread and supports early diagnosis. They also address concerns about histopathological overdiagnosis and the need for further research to determine the impact of imaging on metastasis and mortality. The article concludes by acknowledging the funding source and declaring no conflicts of interest. [Extracted from the article]

Red Ear Syndrome is an uncommon disorder that can affect all age groups. It is frequently referred to Dermatology as it can present similarly to erythromelalgia. Although the exact pathophysiology is unknown, a common hypothesis suggests a shared pathophysiological background with migraine due to their well‐known association. Currently, there are no established treatment guidelines. Delays in accurate diagnosis and commencing optimal treatment can significantly negatively impact on a patients quality of life. We discuss the clinical presentation and response to treatment of a case of Red Ear Syndrome in an 8‐year‐old boy. [ABSTRACT FROM AUTHOR]

Objective: The main objective of this study is to describe the clinical spectrum of CM‐AVM syndrome as well as radiological and genetic findings. Methods: This is a single‐centre prospective observational study performed at Sydney Children's Hospital. Patients under the age of 18 years that presented to our paediatric dermatology clinic or vascular birthmark clinic between January 2015 and September 2020 with one or more geometric shaped pink/ red/ brown macule with a peripheral pallor characteristic of a high‐flow vascular stain were included. Children subsequently diagnosed with other diagnosis or family members with CM‐AVM syndrome were excluded. Results: Sixty children were included, with two subsequently excluded. A third of patients (n = 22, 38%) presented with a single characteristic HFVS, whereas the remaining two thirds (n = 36; 62%) had multiple HFVS. In children with multiple HFVS, one notably larger HFVS was detected in the majority of children (n = 32, 88%). In 33 patients, a brain and spine MRI was performed, which detected a spine AVM in one symptomatic patient with sensorimotor deficits. No cerebral AVM or AVF was picked up in the cohort. A RASA 1 result was available for evaluation in 24, of which 16 (67%) were positive. An EPHB4 result was available in eight, two (25%) of which were positive. Conclusions: One large HFVS often accompanied by multiple small HFVS can be seen in most patients. Despite of the lack of genetic confirmation of diagnosis in single lesions, this phenotype might be of interest and warrants further investigation. [ABSTRACT FROM AUTHOR]

When assessing the quality of melanoma screening, the benign to malignant ratio of excised lesions, which was not reported by Brown et al.,[1] is more important than the ratio of in situ to invasive disease as it provides more accurate assessment of screening effectiveness. Monitoring is not recommended for lesions with specific melanoma dermoscopic features or nodules.[7] SSDI/TBP can identify featureless melanoma not diagnosable with clinical examination and dermoscopy. A melanoma screening quality framework is needed, which includes who to screen (targeted screening), how to screen (which methodologies) and how it should be evaluated. [Extracted from the article]

Impact of the COVID-19 pandemic on dermatology practice worldwide: results of a survey promoted by the International Dermoscopy Society (IDS). Half of those who saw inpatients before ceased to do so during the pandemic which may be due to their fear of acquiring COVID-19 in the hospital or due to fewer dermatology admissions as hospital beds were diverted to COVID-19 patients. To assess the impact of the COVID-19 pandemic on dermatology practice, we conducted an analytical cross-sectional study using an online questionnaire among members of the Philippine Dermatological Society (PDS) from September 25 to December 31 2020. Since the first local case of COVID-19 was reported in the Philippines in March 2020,1 varying degrees of community quarantine have been implemented by the national government. [Extracted from the article]

Mosaicism is defined as the existence of two or more distinct clonal cell populations within one individual, which is the product of a single fertilised egg.[1] Mosaicism is an acquired mutation during embryonic development and can be classified according to reproductive risk: I somatic i mosaicism is limited to non-reproductive cells; I gonadal i mosaicism is found only in reproductive cells and can be expressed constitutionally in future generations, and I gonosomal i mosaicism is in both.[[1]] Mosaic presentations of genetic disorders are often observable in a segmental form in the skin, due to post-zygotic I de novo i mutations.[1] Thus, cutaneous mosaic disorders offer a unique opportunity to investigate genetic mosaicism. Mosaicism of single gene disorders explains segmental skin lesions in a range of heritable skin disorders. A mutation was identified in DNA derived from skin biopsies, which was not present in peripheral blood DNA in five of these six cases. [Extracted from the article]

The newly revised Australian Infant Feeding Guidelines recommends that all infants, including those at high risk of allergy, be introduced foods traditionally considered allergenic (such as peanut butter, dairy, wheat and egg) within the first year of life. High-risk infants are those with early onset eczema (<3- months old) or with moderate to severe eczema not responding to treatment (<6-months old). Eczema can also represent a symptom of allergy presentation and the recommended introduction of some foods in this group may lead to allergic reactions at home. Although there have been no reported deaths from gradual food introduction to infants at home and cohort studies have only reported mild to moderate reactions, there is anecdotal evidence that more severe reactions can occur rarely. Allergic reactions, even if they are not life-threatening, can be a terrifying experience for parents. Dermatologists play an important role when dealing with high-risk infants in promoting the message of early allergenic food introduction yet also instigating appropriate allergy testing when necessary. This short review aims to provide an update to Australasian dermatologists on the newly revised Australian Infant Feeding Guidelines and provide a food allergy screening pathway for high-risk infants prior to commencement of allergenic foods. [ABSTRACT FROM AUTHOR]

Background/Objectives: The current literature suggests there is a possible connection between paediatric psoriasis and obesity. However, there is a paucity of research on the influence of increased adiposity on the severity of paediatric psoriasis and disease progression. We aimed to compare the prevalence of being overweight or obese in paediatric psoriasis patients and controls and assess the potential impact of being overweight/obese on disease severity and progression of disease. Methods: This multicentre prospective case-control study included 289 psoriasis patients (aged < 18 years) treated and followed up by one of the four university hospitals in Turkey. The control group consisted of 151 consecutive age-matched and sexmatched children who lacked a personal or family history of psoriasis. The participants’ characteristics, psoriasis-related parametres (e.g., initial subtype, psoriasis area and severity index, presence of psoriatic arthritis) and body mass index were determined. Results: The difference between the prevalence of being overweight/obese among psoriatics (28%) and the control group (19%) was significant (P = 0.024). Being overweight/obese had no significant impact on disease severity and unresponsiveness to topical treatment. Within a median follow-up time of 12 months, 23% of our patients with localised disease at disease onset progressed to generalised disease. The impact of being overweight/obese on disease progression was found to be non-significant; however, disease duration was found to have a significant impact on disease progression (P = 0.026). Conclusions: Although it is not associated with disease severity and course, increased bodyweight may be a health problem for psoriatic children. [ABSTRACT FROM AUTHOR]

One of the most visible and potentially disfiguring cutaneous manifestations of tuberous sclerosis complex is the development of multiple facial angiofibromas, present in over 80% of patients. Topical rapamycin has been shown in many reports to be a safe and effective treatment for facial angiofibromas. In February 2012 we reported the results of a pilot study of four patients undertaken at a paediatric tertiary hospital in Australia. Since then, we have continued to refine the optimal formulation and concentration of topical rapamycin and expanded our selection of patients. We present an update on our current cohort of treated patients, discuss the optimal formulation of topical rapamycin and include a literature review on all published cases to date. Although topical rapamycin is not a curative treatment, we have demonstrated that its early institution significantly reduces both the vascularity and palpability of angiofibromas and prevents their progression with age. It is well tolerated and now a cost effective option. [ABSTRACT FROM AUTHOR]

ABSTRACT We present a case series of childhood lymphomatoid papulosis (LyP), an entity which is commonly misdiagnosed and poorly described in the paediatric dermatology literature. Clinically and histologically, the features of LyP in children can mimic insect bite reactions, with prominent dermal neutrophils and eosinophils. However, CD30 immunohistochemical staining of atypical lymphocytes within a mixed inflammatory infiltrate should point to the diagnosis of LyP. There is no consensus to guide management of childhood LyP due to its rarity and largely unknown natural course. We discuss our experience with LyP in five children and the use of methotrexate to induce rapid resolution of persistent lesions and to reduce recurrences in two children. Although none of our cases have experienced malignant transformation to date, life-long monitoring is advocated. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: The most common skin infections affecting children in remote Aboriginal communities are scabies and impetigo. Group A streptococcal skin infections are linked to the high rates of heart and renal disease occurring in Aboriginal Australians. Methods: A retrospective review of medical records was conducted in a primary health care centre in the East Arnhem region of the Northern Territory. Data was collected from all presentations to the clinic in the first 2 years of life for 99 children born between 2001 and 2005 as a component of the East Arnhem Regional Healthy Skin Project. Results: The median number of presentations to the clinic in the first 2 years of life was 32. Skin disease was recorded in 22% of all presentations. By 1 year of age 82% of children had presented to the clinic with their first episode of impetigo and 68% with their first episode of scabies. Antibiotics were administered to 49% of children with impetigo. Conclusion: Skin infections are a major reason for presentation to primary health clinics and contribute to the high disease burden experienced by children in the first 2 years of life. This high frequency of presentation provides multiple opportunities for intervention and monitoring. [ABSTRACT FROM AUTHOR]

ABSTRACT Bullous dermolysis of the newborn is an inherited mechano-bullous disorder classed as a rare subtype of dystrophic epidermolysis bullosa. Fewer than 30 cases of bullous dermolysis of the newborn have been reported in the literature and the pathogenesis of the disease is poorly understood. Only a minority of cases have had pathogenic mutations identified. We present a case of a neonate born to non-consanguineous Caucasian parents with an exon 54 (c.5017G > A, p.G1673R) mutation reported as one mutant allele in a case of recessive dystrophic epidermolysis bullosa (generalized other). [ABSTRACT FROM AUTHOR]

The article describes a case study of a boy infected with Acrodermatitis Enteropathica including the symptoms, signs, and treatment of the disease. The skin lesions present in the patient are described, including alopecia of scalp, eyebrows, and eyelashes and erythematous scaling areas. The patient's successful treatment with diodoquin is outlined.

ABSTRACT We present a novel case of pyogenic granuloma occurring within a port-wine stain in two sequential pregnancies at different sites. There was no history of precipitating events such as trauma. We discuss why a pyogenic granuloma may occur within a port-wine stain and how pregnancy may increase the likelihood of this occurring. [ABSTRACT FROM AUTHOR]

A newborn baby boy was referred to the Paediatric Dermatology Unit with a solitary asymptomatic nodule overlying his right nasolabial fold. Complete physical examination, full blood count, serum chemistry, liver function tests and baseline imaging were unremarkable. Histopathological examination showed an atypical dermal infiltrate of mononuclear cells that stained positive with CD1a and S100. A diagnosis of congenital solitary Langerhans cell histiocytoma was made. The lesion completely resolved by 4 months of age. The baby is now 15 months old and repeat systemic evaluation has remained normal. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the efficacy and tolerability of combination therapy for molluscum contagiosum (MC) with topical cantharidin and imiquimod 5%. A prospective case series of 16 paediatric patients with a mean age of 4.8 years had cantharidin applied to lesions by a dermatologist, followed by home treatment with imiquimod 5% cream nightly for an average of 5 weeks. This regimen resulted in >90% of lesions clearing in 12 patients, with half of these being totally clear. Two patients had 80–90% of lesions resolve. Two patients had 30–50% clearance of lesions at the end of the treatment period. One patient found the cantharidin reaction too strong. The mean number of imiquimod 250 mg sachets used was 4.25. In conclusion, this study suggests that combination therapy using cantharidin and imiquimod for treatment of MC in children is effective and well tolerated. [ABSTRACT FROM AUTHOR]

The article describes the case of an 8-year-old boy who was diagnosed with amelanotic melanoma. Topics discussed include the patient's 10-month history of an erythematous asymmetric plaque surrounded by a hyperkeratotic collarete on the left knee, the difficulty of clinical and histopathologic diagnosis of amelanotic melanoma, and the importance of suspecting early the disease.

Juvenile dermatomyositis (JDMS) is a chronic Inflammatory condition characterized by muscle weakness and a distinctive rash caused by underlying vasculopathy. Long-term complications include subcutaneous and muscular calcification, contractures and in some cases the gradual development of a second connective tissue disease. Early aggressive treatment with systemic immunosuppressants and other agents such as intravenous immunoglobulin (IVIG) reduces mortality and morbidity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case of an eight-year old Australian boy with contagious ecthyma, a zoonotic viral infection caused by genus Parapox virus.

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti--Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis. [ABSTRACT FROM AUTHOR]

Terra firma-forme dermatosis (TFFD) is a relatively common but usually unrecognized clinical problem. The cause is unknown. The changes usually occur on the neck in childhood as dirty brown patches that cannot be removed with soap but are easily removed with alcohol. Terra firma-forme dermatosis may be mistaken for acanthosis nigricans. [ABSTRACT FROM AUTHOR]

A female infant with ectodermal dysplasia, bilateral cleft lip and palate and a recalcitrant scalp dermatitis is presented. She had features of both Rapp-Hodgkin syndrome and AEC syndrome. It has recently been suggested in the literature that these two syndromes are the same condition and this case report supports this viewpoint. [ABSTRACT FROM AUTHOR]

Granuloma gluteale infantum is an uncommon disorder, the pathogenesis of which remains unclear. Occlusion is a common factor and irritant napkin dermatitis is a frequent association. A six month old female infant with mild napkin dermatitis treated only with a dusting powder is presented. [ABSTRACT FROM AUTHOR]

Reports on an international, multidisciplinary symposium on clinical management of children and adults with epidermolysis bullosa, at the Great Ormond Street Hospital for Children in London, England. Meeting sponsor; Contact information.