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The motivation for developing patient-centered communication stems from a desire to enhance the quality of patient care, fulfill professional competency requirements, reduce medical errors, and improve health outcomes and patient satisfaction. Patient-centered communication skills can optimize the physician-patient relationship without significantly prolonging office visits. We propose a series of practical and generally effective techniques for verbal and nonverbal communication. We also suggest a targeted approach for specific difficult conversations that may occur frequently in the practice of dermatology., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Patient education is a fundamental part of caring for patients. A practice gap exists, where patients want more information, while health care providers are limited by time constraints or difficulty helping patients understand or remember. To provide patient-centered care, it is important to assess the needs and goals, health beliefs, and health literacy of each patient. This allows health care providers to individualize education for patients. The use of techniques, such as gaining attention, providing clear and memorable explanations, and assessing understanding through "teach-back," can improve patient education. Verbal education during the office visit is considered the criterion standard. However, handouts, visual aids, audiovisual media, and Internet websites are examples of teaching aids that can be used as an adjunct to verbal instruction. Part II of this 2-part series on patient-physician interaction reviews the importance and need for patient education along with specific guidelines and techniques that can be used., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Voriconazole is a broad-spectrum antifungal agent associated with photosensitivity and accelerated photoaging. A possible link with aggressive squamous cell carcinoma (SCC) has also been reported., Objective: We sought to determine the incidence and frequency of cutaneous SCC among patients undergoing long-term treatment with voriconazole who also manifest features of chronic phototoxicity., Methods: We conducted a retrospective review of patients who developed one or more squamous cell neoplasms during long-term treatment with voriconazole at 3 academic dermatology centers., Results: A total of 51 cutaneous SCC were identified in 8 patients (median age 34.5 years, range 9-54) treated with chronic voriconazole (median duration 46.5 months, range 13-60). Underlying diagnoses included graft-versus-host disease, HIV, and Wegener granulomatosis. Signs of chronic phototoxicity and accelerated photoaging included erythema, actinic keratoses, and lentigo formation., Limitations: The retrospective nature of the study cannot determine the true population risk of SCC associated with voriconazole therapy. A prospective cohort study is needed., Conclusion: A high index of suspicion for photosensitivity and SCC may be warranted with chronic voriconazole use when used in the setting of concurrent immunosuppression.

We report the case of a male infant with incontinentia pigmenti (MIM 308310) and low-grade XXY mosaicism. Fluorescence in situ hybridization may reveal the underlying genetic alteration in male patients with incontinentia pigmenti and a normal karyotype.

Hereditary benign intraepithelial dyskeratosis is a rare autosomal dominant disorder of the oral and ocular mucosa initially described in the Haliwa-Saponi Native American tribe of North Carolina. We describe 2 sisters with the characteristic oral and ocular findings. This entity should be distinguished from several other diseases that cause white lesions in the mouth including white sponge nevus.

Skin and nail changes from long-term hydroxyurea therapy are reported in adults. Skin and nail changes, including nail hyperpigmentation, longitudinal bands, and hyperpigmentation of the palms and other skin surfaces, developed in 7 children with sickle cell anemia after 6 to 16 weeks of hydroxyurea therapy. Cutaneous and nail changes may occur in children receiving hydroxyurea.

Background: An 8-year-old girl presented with hundreds of milia, measuring 1 to 2 mm; comedone-like lesions; skin-colored and hyperpigmented papules on the face, scalp, ears, neck, upper trunk, and lower arms along with diffuse scalp hypotrichosis; and pinpoint palm/sole pits. Onset was in early childhood and the disease was historically present in 6 generations., Objective: Our objectives were to delineate the clinical and histopathologic features and mode of inheritance as a base for gene studies., Methods: Eighteen family subjects were studied. Twenty-six skin biopsy specimens were examined. A detailed pedigree was constructed. A complete literature search was done concerning diseases with generalized basaloid follicular hamartomas., Results: The lesions were basaloid follicular hamartomas and other folliculocentric abnormalities. Inheritance was autosomal dominant. Extensive literature search confirmed the finding of a unique genodermatosis., Conclusion: A new genodermatosis termed dominantly inherited generalized basaloid follicular hamartoma syndrome was defined by delineating its clinical and histopathologic features and mode of inheritance and by extensive literature review.

Chronic recurrent multifocal osteomyelitis is rarely associated with pustular psoriasis in children. We describe a child with severe pustular psoriasis in whom multiple fractures, bone deformities, and severe growth failure from chronic recurrent multifocal osteomyelitis developed. The recurrent fractures led to an incorrect assumption of child abuse. Both the bone disease and pustular psoriasis responded to treatment with etretinate.

We describe three children with an acute onset and spontaneous resolution of angioma-like papules during an apparent viral illness. A biopsy specimen from one patient revealed a unique histologic appearance that consisted of dilated dermal blood vessels with plump hobnail-shaped endothelial cells. On the basis of the natural history and histopathologic features of this exanthem, we suggest the name eruptive pseudoangiomatosis.

We describe the tenth reported case of neonatal pemphigus that mimicked Bart's syndrome and review previously published cases. Unlike previous cases, the child was born with significant blistering to a mother who was in complete remission throughout the pregnancy. High antepartum maternal titers of anti-intercellular space antibodies, increased maternal disease activity, and maternal disease that requires high doses of corticosteroids or use of combined therapy correlate with poor fetal outcome, including intrauterine death.

The worldwide epidemic of human immunodeficiency virus (HIV) infection will likely be considered the most important public health event of the twentieth century. During the past 15 years, a wealth of information relating to the epidemiology, diagnosis, natural history, and treatment of HIV infection has accumulated. This article details the recent progress in each of these areas.

Noninfectious cutaneous granulomas, particularly in an acral distribution, may be an early sign of mixed cellular and humoral immunodeficiency. Special stains of skin biopsy sections and cultures for bacteria, acid-fast bacilli, and fungi are important in eliminating the possibility of underlying pathogens. In three children with combined immunodeficiency and cutaneous granulomas, the administration of moderate- to high-dose systemic corticosteroids was the most effective therapy. However, careful consideration should be given before administering systemic corticosteroids to an immunocompromised patient.

Severe, progressively enlarging inflammatory plaques of the upper trunk and neck developed in a 12-year-old girl. Histologic examination revealed a unique inflammatory cell infiltrate that consisted of chronic inflammation in the dermis subtending spongiosis with a diffuse neutrophilic epidermal infiltrate. A tumor in the right axilla was found by computed tomography. Tissue obtained at open biopsy examination demonstrated a large-cell lymphoma of B-cell origin. The tumor and dermatosis responded dramatically to chemotherapy. The distinctive histologic pattern and clinical course suggest that this dermatosis may represent an unusual paraneoplastic presentation of large-cell lymphoma.

Numerous flat and tinea versicolor-like warts developed on the face, trunk, and upper extremities of a 10-year-old boy with human immunodeficiency virus infection. Nucleic acid analysis of involved skin revealed human papillomavirus type 5, which has sometimes been associated with epidermodysplasia verruciformis. This human papillomavirus type has also been described in patients with common variable immunodeficiency and dyskeratosis congenita and in renal allograft recipients. Human immunodeficiency virus infection should be added to the list of immune-related disorders that predispose to widespread flat warts.

Four black children with Spitz nevi are presented. The initial clinical diagnosis was pyogenic granuloma for three patients. One child had two Spitz nevi. Histologic examination revealed melanocytic dendritic hyperplasia in all cases.

In recent years several dermatoses, palmoplantar pustulosis, acne fulminans, and Sweet's syndrome, have been associated with sterile lytic bone lesions. This article discusses the clinical, laboratory, and histologic findings of these disorders and postulates a common mechanism underlying the bone lesions.

Human immunodeficiency virus (HIV) infection in children has emerged as a major, rapidly growing public health problem. The majority of children become infected by perinatal transmission of the virus from an infected mother. The disease is frequently associated with progressive neurologic dysfunction and with opportunistic infections. The cutaneous manifestations of pediatric HIV infection include a wide variety of fungal, bacterial, and viral infections of the skin. These diseases tend to be less responsive to conventional therapies than in the healthy child. In addition, severe seborrheic dermatitis, vasculitis, and drug eruptions are sometimes signs of HIV infection.

Multiple benign juvenile melanoma is a rare entity, seen primarily in children. Two 3-year-old patients who developed multiple juvenile melanomas in areas of congenital hyperpigmentation are presented. The distinct clinical presentations of this lesion are discussed, and its ultrastructure is described.