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Acute annular urticaria is a common and benign cutaneous hypersensitivity reaction seen in children that manifests with characteristic annular, arcuate, and polycyclic urticarial lesions in association with acral edema. It is mistaken most often for erythema multiforme and, occasionally, for a serum-sickness–like reaction. Although these 3 entities may present in a similar manner, specific clinical features help to distinguish them, and it is important for the clinician to be able to differentiate among them. We present herein a series of 18 patients who were given a diagnosis of acute annular urticaria and review the clinical distinctions between acute annular urticaria, serum-sickness–like reactions, and erythema multiforme. Because of the frequency of its clinical confusion with erythema multiforme, we propose the term “urticaria multiforme” as a more apt description to highlight the distinctive clinical features of this urticaria variant.

Objectives. Terbinafine has been shown to be effective in tinea capitis, using different treatment durations. However, no direct comparison of treatment duration has previously been investigated. This randomized, double-blind, parallel-group, multicenter study was designed to assess the effect of terbinafine treatment duration on the outcome of Trichophyton tinea capitis in a North American population. Methods. A total of 176 patients with a clinical diagnosis of tinea capitis were enrolled in this study and treated with oral terbinafine (3–6 mg/kg/d) for 1, 2, or 4 weeks. All patients were to be followed until week 12. A total of 159 patients had culture-confirmed tinea capitis attributable to Trichophyton species and constituted the intent-to-treat population used for efficacy analysis (50, 55, and 54 patients in the 1-, 2-, and 4-week arms, respectively). Results. At the end of study, effective treatment, defined as negative culture and low scores on signs and symptoms, was achieved in 56%, 69%, and 65% of patients who were treated with terbinafine for 1, 2, and 4 weeks, respectively. A negative culture was achieved in 60%, 76%, and 72%, respectively. Overall, the efficacy data showed that both the 2- and 4-week treatment regimens are clinically superior to the 1-week regimen. Terbinafine was well tolerated, and the incidence of adverse events showed no relationship to the duration of therapy. Conclusion. When efficacy, cost, and compliance are taken into consideration, 2 weeks of terbinafine therapy appears to be the optimal treatment duration for patients with Trichophyton tonsurans tinea capitis.

A case of forehead lipoblastoma simulating a hemangioma in a male infant is reported, to alert pediatricians to this rare tumor and to increase the index of suspicion in atypical hemangiomas. A 2-month-old male infant developed a protruding forehead mass with increased vascularity. It demonstrated progressive and accelerated growth over the subsequent 6 months, unresponsive to steroid therapy. A magnetic resonance imaging scan supported the diagnosis of hemangioma because of the hypervascular nature of the lesion. Surgical excision was performed because of visual obstruction. Pathologic examination of the specimen was consistent with a very primitive lipoblastoma. This tumor is a rare, benign lesion of immature fat cells that is found almost exclusively in the pediatric population. Lipoblastomas are more common in males than females and frequently present as asymptomatic, rapidly enlarging, soft lobular masses on the extremities. Complete surgical excision is the definitive treatment. In the vast majority of reported cases, however, the preoperative diagnosis was incorrect, underscoring the diagnostic dilemma presented by these rare tumors.

Objective. Blue light phototherapy is commonly administered to neonates as treatment of indirect hyperbilirubinemia, often in conjunction with blood transfusions to treat hemolytic anemia. We observed a distinctive cutaneous complication of phototherapy in six neonates with hyperbilirubinemia. Methodology. We studied the clinical and histologic characteristics of the eruption, as well as the porphyrin levels in affected neonates. Five of the patients had erythroblastosis fetalis; the other had profound anemia from twin–twin transfusion. All of the neonates developed purpuric patches at sites of maximal exposure to the phototherapy lights, with dramatic sparing at shielded sites within 24 hours after initiation of the phototherapy. On discontinuation of phototherapy, all eruptions cleared within 1 week. Examination of skin biopsy sections showed purpura without significant inflammation or keratinocyte necrosis. Plasma porphyrins (copro- and proto-) were elevated in the two patients in which they were assessed. Conclusions. The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

Introduction Atopic dermatitis, also referred to as atopic eczema, infantile eczema, allergic eczema, disseminated neurodermatitis, and prurigo Besnier, is a common and important cause of morbidity in children of all ages. A total of 22% of patients seen in pediatric dermatology clinics have atopic dermatitis. In 1969, Wingert et al reported that 4% of pediatric emergency room visits at the Los Angeles County General Hospital were due to atopic dermatitis, and this did not include patients seen for impetigo, a common complication of atopic dermatitis. The prevalence of atopic dermatitis in the pediatric population has increased over the past 3 decades from 3% to 10%, and it appears to be even higher in heavily populated urban areas. Pediatricians, therefore, must understand its pathogenesis and management. Epidemiology Sixty percent of children who have atopic dermatitis manifest their disease in the first year of life; 90% do so by age 5 years. A genetically prone individual may not manifest the disease until exposed to a particular environmental situation. Onset has been associated with relocation from a rural to an urban location or from a region of high to low humidity. The course of adopic dermatitis is difficult to predict, although one 15-year longitudinal study revealed that the disease persisted in 60% of cases.

Selenium sulfide lotion used as a shampoo has been shown to be an effective adjunctive agent to griseofulvin in the treatment of tinea capitis. Of 16 children with Trichophyton tonsurans infections 15 had negative fungal cultures at two weeks following a regimen of daily oral griseofulvin and selenium suffide shampooing twice weekly. All patients treated with griseofulvin alone or in combination with either a bland shampoo or topical clotrimazole had positive cultures not only at the two-week interval but also as long as eight weeks later. In vitro analysis shows selenium sulfide to be sporicidal, correlating well with the in vivo observations. It is postulated that selenium sulfide usage may lessen the chances for spreading of infectious spores to other individuals.