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Great advances have been made in the field of heritable skin disorders using next-generation sequencing (NGS) technologies (ie, whole-genome sequencing, whole-exome sequencing, whole-transcriptome sequencing, and disease-targeted multigene panels). When NGS first became available, the cost and lack of access to these technologies were limiting factors; however, with decreasing sequencing costs and the expanding knowledge base of genetic skin diseases, fundamental awareness of NGS has become prudent. The heritable ichthyoses comprise a genotypically and phenotypically heterogeneous group of monogenic keratinization disorders characterized by persistent scaling, with at least 55 distinct genes currently implicated in causing nonsyndromic and syndromic forms of the disease. By providing a simplified overview of available NGS techniques and applying them in the context of ichthyosis, one of the most common genodermatoses, we hope to encourage dermatologists to offer, when appropriate, genetic testing earlier in patients with unsolved presentations. With the aid of NGS, dermatologists can provide diagnostic certainty in cases of suspected genodermatoses and offer potentially life-changing genome-guided and targeted therapies as they become available.

Nevoid basal cell carcinoma syndrome (Gorlin syndrome) is a rare, autosomal dominant syndrome that is known to have variable expressivity in multiple organ systems. We describe the case of a young male child with nevoid basal cell carcinoma syndrome and scalp lesions, including a branchial cleft cyst with respiratory epithelium and a rudimentary meningocele. These are both new, previously unreported findings, possibly associated with nevoid basal cell carcinoma syndrome.

A 38-year-old Hispanic woman presented with a widespread papulosquamous eruption with accentuation on the palms and soles (Fig 1, A). Travel history was remarkable for a recent trip to her native country (Dominican Republic). Her 13-year-old son, who accompanied her on the trip, developed a similar rash after their return (Fig 1, B). In addition, the patient noted that her boyfriend, whom she was visiting in the Dominican Republic, had a rash when she arrived. The rapid plasma reagin (RPR) test produced negative findings whereas the skin biopsy specimen from the patient’s foot showed a psoriasiform lichenoid dermatitis teeming with spirochetes highlighted by a Steiner stain. After discussion with the laboratory about the RPR results, serial dilutions proved positive (prozone effect). At follow-up 4 days later, the son was evaluated for his rash. As expected, the patient’s fluorescent treponemal antibody absorption (FTA-ABS) test result was positive, but the son’s test finding was only minimally reactive.

A newborn female infant presented with an asymptomatic eruption that first began on her fifth day of life. The lesions developed over a 24-hour period, lasted for approximately 3 to 6 weeks before spontaneously resolving, and recurred several days later. When the patient was treated with prednisone by her primary physician for an upper respiratory tract infection, her lesions quickly cleared, only to recur a few days after stopping treatment with the medication. The infant was otherwise healthy with normal growth and development, and no household contacts were experiencing any eruptions or pruritus. Skin examination revealed discrete, annular, erythematous plaques with raised borders and central clearing on the infant’s chest, arms, and neck (Figure, A). At follow-up, it was found that the previous lesions had resolved completely without scarring or residual hyperpigmentation, and new lesions of variable size had developed on her scalp, neck, arms, vulva, and trunk (Figure, B). Results of a complete blood cell count with differential, peripheral smear, complete metabolic panel, and assays for C-reactive protein, antinuclear antibody, anti–double-stranded DNA antibody, anti-SSA, and anti-SSB autoantibodies were all normal. A punch biopsy was performed of a representative lesion of her left medial arm (Figure, C and D).

The field of pediatric dermatology has been rich in new developments. Part II of this continuing medical education article will focus on new therapeutic modalities for several entities encountered in pediatric dermatology. The treatment of atopic dermatitis, exciting advances in the use of propranolol and other beta-blockers for the use of infantile hemangiomas, the use of rapamycin for vascular anomalies, the use of biologics in children, the central nervous system risks of general anesthesia in young children, side effects in the use of isotretinoin, the treatment of tinea capitis, treatment of herpes simplex infections, and the use of technologies such as texting and social media in medicine will be discussed.

The field of pediatric dermatology has been rich in new developments. Part I of this continuing medical education article will focus on new diagnoses and new insights into the etiology and pathogenesis of pediatric skin disorders. Insights into the pathogenesis of atopic dermatitis, new forms of contact dermatitis, recently recognized mimickers of port wine stains, associations with infantile hemangiomas, the concept of genetic diseases being classified by common pathways (RASopathies), newly recognized genetic discoveries in mosaic disorders, the recognition of cystic fibrosis being associated with aquagenic wrinkling of the palms, new forms of epidermolysis bullosa, and genital ulcers in non-sexually active adolescent girls will be discussed.

Squamous cell carcinoma arising from balanitis xerotica obliterans is rarely reported. We describe an 83-year-old man in whom metastatic penile squamous cell carcinoma developed after 18 years of observation for balanitis xerotica obliterans. It is important to recognize the possibility of this uncommon complication of balanitis xerotica obliterans, because survival of patients with squamous cell carcinoma depends on early diagnosis and treatment.

Granuloma annulare (GA) is a benign, granulomatous condition that usually presents on areas of trauma such as the dorsal hands and feet, fingers, elbows, and knees (1). However, there are occasional cases of GA occurring on unusual sites such as the occipital scalp, periocular region, and eyelid (2-4). The world literature contains 10 cases of GA of the penis-only two cases occurred in adolescent males (5-11) (Table 1). Historically, patients with penile GA have presented to the urologic and infectious disease specialists and are later referred to dermatology.

C urrent information identifying risk factors for cutaneous diseases such as atopic dermatitis in childhood is limited. Cutaneous disease prevention programs and health promotion strategies in children and adolescents have not been addressed in a concerted way by government agencies or relevant medical societies. Disease-based interventions often emphasize adult disease, but many diseases may be prevented or minimized by intervention during childhood years. Research may be more effectively coordinated and carried out with the establishment of consensus on how best to diagnose and treat diseases such as atopic dermatitis (AD) in children and identify the most critical issues related to this condition. A consensus conference was convened by the American Academy of Dermatology on January 1921, 2001 to (1) define the core dermatologic issues related to AD in children and adolescents that can influence their dermatologic health over a lifetime and (2) prioritize future research efforts on epidemiology, pathogenesis, prevention, and management of AD. The following focus questions were addressed and responses/recommendations were developed

Four patients with eccrine angiomatous hamartoma are described. Blue-purple color, enlarging size, location on an extremity, pain, and hypertrichosis were common features and aided differentiation from other vascular anomalies and hamartomas of childhood. None of our patients experienced lesional hyperhidrosis, and simple excision alleviated pain.

The term twenty-nail dystrophy (TND) of childhood has evolved since its initial description in 1977. TND has also been reported in adults, and many clinical as well as histopathologic associations have been described. We describe the third case of a rare association of TND with vitiligo in a 10-year-old girl.

The field of pediatric dermatology has been rich in new developments. Part I of this continuing medical education article will focus on new diagnoses and new insights into the etiology and pathogenesis of pediatric skin disorders. Insights into the pathogenesis of atopic dermatitis, new forms of contact dermatitis, recently recognized mimickers of port wine stains, associations with infantile hemangiomas, the concept of genetic diseases being classified by common pathways (RASopathies), newly recognized genetic discoveries in mosaic disorders, the recognition of cystic fibrosis being associated with aquagenic wrinkling of the palms, new forms of epidermolysis bullosa, and genital ulcers in non–sexually active adolescent girls will be discussed.

REPORT OF A CASE A 4-month-old female infant presented with 1 month of blisters on her chin and temple that progressed to diffuse blistering. Blisters formed if the infant was scratched or rubbed (Figure 1). She had numerous bullae and erosions on her trunk and extremities and her skin had a diffuse doughy texture. The patient had no wheezing or gastrointestinal symptoms and was otherwise healthy. The family history was negative for any dermatologic, gastrointestinal, or hematologic diseases. One month of antibiotic therapy resulted in no change and bacterial blister culture results were negative. Biopsy samples showed a dense dermal infiltrate of mast cells consistent with mastocytosis. A Leder stain accentuated the mast cell granules. Evaluation for systemic involvement, including bone marrow biopsy and aspiration, computed tomography of the abdomen, a bone scan, and an upper gastrointestinal tract series with small-bowel follow-through, produced normal results. Initial treatment consisted of topical

REPORT OF A CASE A healthy 16-month-old white boy presented with 5 months of erythematous papules on his left arm and leg, chest, and back. The papules later spread to his scalp and became more tender. He had previously been treated empirically for scabies with lindane, without relief, and was also using mometasone furoate cream, with minimal resolution of the papules. On examination, he had a few scattered papules on the anterior aspect of his chest and left thigh and on his left arm and buttock and 20 to 25 papules on his scalp, primarily the vertex (Figure 1). The erythematous papules, vesicles, and crust ranged from 2 to 5 mm in greatest dimension. A 1.2-cm right postauricular lymph node was palpated. A punch biopsy specimen was obtained from the patient's scalp (Figure 2throughFigure 4). What is your diagnosis? Papules and Vesicles in an 18-Month-Old Boy DIAGNOSIS: Eosinophilic

Noninvasive external cardiac pacing has been used safely in various cardiac emergencies for over 30 yr. Its use in neonates, however, has been associated recently with burns. We report the case of a 7-wk-old infant who sustained a full-thickness burn after prolonged use of an external pacing device.

Foreign bodies of the external auditory canal are a common and challenging problem. Several techniques have been described and utilized to remove the many objects placed in ears. The tightly wedged smooth round foreign body remains one of the most difficult to remove. A new method, using a cyanoacrylate adhesive (Super Glue) was used successfully to remove a soy bean in a 16-year-old male. The glue was placed on the blunt end of a cotton swab, which was then introduced into the canal to make contact with the bean. Removal was easy, safe, and effective. This procedure avoided the morbidity associated with many well known techniques, eg, the use of forceps, and may have prevented removal under general anesthesia.