Cutaneous mastocytosis in Thai children.

BACKGROUND: Mastocytosis is a disorder of mast cells proliferation within various organs, most commonly in the skin. The disease more commonly appears during infancy than adult. OBJECTIVE: To characterize the clinical features, response to therapy and prognosis of cutaneous mastocytosis in children. MATERIAL AND METHOD: A retrospective study of cutaneous mastocytosis was performed at Queen Sirikit National Institute of Child Health during January 1994 to December 2007.All cases were confirmed by histological diagnosis. RESULTS: There were a total of 50 patients. The male to female ratio was 1:1.2. Age at onset of lesions ranged from birth to 7 years. Forty-seven patients (94%) developed skin lesions within the first year of ife. There were 45 cases (90%) of urticaria pigmentosa, 3 cases (6%) of mastocytoma and 2 cases (4%) of diffuse cutaneous mastocytosis. None of the patient had a family history of cutaneous mastocytosis. Most of the children were healthy, except the one who had germ cell ovarian tumor Skin biopsies were performed in all cases and revealed mast cells infiltrate in the dermis. Treatment included oral antihistamine in all cases. Oral mast cell stabilizers were given in 6 patients (12%) and topical corticosteroids in 15 patients (30%). Four patients (8%) were treated with oral prednisolone. The skin lesions resolved only in 1 patient (2%) at age 7.8 years, the others still had skin lesions without systemic symptoms. CONCLUSION: Cutaneous mastocytosis is a benign disease in children without systemic involvement.

Subcutaneous fat necrosis of the newborn.

Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon disorder in full term infants who have a perinatal condition. The authors reported seven cases of subcutaneous fat necrosis of the newborn at Queen Sirikit National Institute of Child Health from 2002 to 2005. All cases were term babies with four male cases, and three female cases. Five cases (70%) had perinatal asphyxia. The mean age of onset was 14 days (range 3-42 days). The locations of SCFN were back (3 cases), shoulder (2cases), arm (2 cases), buttock (1 case), and neck (1 case). Skin biopsy was performed in three cases and was compatible with subcutaneous fat necrosis. The treatment was supportive with close monitoring of serum calcium. Hypercalcemia was seen in five cases (70%) and three cases were treated with oral prednisolone. Cutaneous lesions of all cases resolved without sequelae. In conclusion, infants with subcutaneous fat necrosis should have serial serum calcium determinations and should be observed closely for signs and symptoms of hypercalcemia such as irritability, anorexia, constipation, and failure to thrive.

Comparison of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from diarrhea: a multicenter study.

BACKGROUND: Severity of irritant diaper dermatitis (IDD) from diarrhea varies from patient to patient depending on the nature of feces and the number of bowel movements. The purpose of the present study was to compare the effectiveness of dexpanthenol and zinc oxide ointment with ointment base in the treatment of irritant diaper dermatitis from acute diarrhea in children by measuring transepidermal water loss (TEWL). MATERIAL AND METHOD: Forty-six children with diarrhea were prospectively, block randomized, investigator-blinded to receive dexpanthenol and zinc oxide ointment on one side and ointment base on the other side. TEWL was measured before and on days 1, 3, and 7 of treatment together with the assessment of severity score. The efficacy of treatment was defined by complete clearance of the lesion. RESULTS: TEWL in the treated and control side was not different before the application of the topical medication. In the present study, the efficacy of 5% dexpanthenol and zinc oxide ointment on D3 was 39% (18from 46 patients) compared to 32% in the ointment base side. On D7, the efficacy of the treated side was 58.7% and the ointment base side was 56%. The patients who still had skin lesions were those who had prolonged diarrhea. On the treated side, the mean of TEWL was lower than the control side on DI (p = 0.18) and had significant improvement on D3 (p = 0. 002). At the end of the present study, TEWL on the treated side was less than TEWL of the control side but it did not have statistical significance (p = 0.07). There was no rash or sign of abnormality on the treated side at the end of D7. CONCLUSION: In the treatment of lDD from acute diarrhea, 5% dexpanthenol and zinc oxide ointment significantly decreased TEWL in the treated side more than the ointment base on day 3 but the severity score was not significantly different on days 1, 3 and 7.

Immunobullous diseases in Thai children: report of 24 cases.

BACKGROUND: Acquired immunobullous diseases in children are very rare and difficult to distinguish clinically. OBJECTIVE: To study the clinical manifestations, immunopathologic features, treatment and outcome of immunobullous diseases in Thai children. MATERIAL AND METHOD: The authors reviewed 24 cases of immunobullous diseases in children under 18 years at Queen Sirikit National Institute of Child Health from 1983 to 2000. Diagnosis of all cases was made by clinical presentations of chronic blistering diseases and confirmed by histopathology and immunofluorescent studies. RESULTS: There were 18 cases of chronic bullous diseases of childhood (CBDC), 4 cases of bullous pemphigoid (BP) and 2 cases of pemphigus vulgaris (PV). The mean age of onset of CBDC and BP were 4 years and 2 years respectively. There was an equal male to female ratio in both CBDC and BP. Both cases of pemphigus (neonate and 4 years old) were female. Most CBDC patients (18 cases) responded well to dapsone therapy although 2 cases had to be treated with prednisolone simultaneously. All cases with BP were treated successfully with prednisolone and dapsone. Neonatal pemphigus was treated symptomatically without steroid therapy. The second case of oral pemphigus was controlled with low dose prednisolone. CONCLUSION: Immunobullous diseases are very rare in children. All patients improved with corticosteroid and/or dapsone therapy.

A comparative study between 10 per cent sulfur ointment and 0.3 per cent gamma benzene hexachloride gel in the treatment of scabies in children.

BACKGROUND: Scabies is a common contagious skin disease in children. Treatment of scabies in infants and children is the subject of worldwide concern because of risk and benefit of the variety of scabicides. OBJECTIVE: To compare the efficacy of 10 per cent sulfur ointment and 0.3 per cent gamma benzene hexachloride gel for the treatment of scabies in children. METHOD: A randomized investigator blind study was conducted to compare the efficacy of 10 per cent sulfur ointment and 0.3 per cent gamma benzene hexachloride (GBH) for the treatment of scabies in children at Queen Sirikit National Institute of Child Health from December 1999 to May 2000. Diagnosis was made by the clinical signs of excoriated papules in the classic distribution with nocturnal pruritus and family history of similar symptoms. Diagnosis for all patients was confirmed by positive skin scrapings for eggs, larva, mites or fecal pellets by light microscopy. Patients were followed-up at intervals of 2 and 4 weeks. RESULTS: One hundred children with an age range from 6 months to 13 years were randomized into 2 groups, 10 per cent sulfur group (50 cases) and 0.3 per cent GBH (50 cases). Age, sex, history of contact cases and clinical manifestations were not statistically different between the two groups. After 4 weeks of treatment, there were no statistical differences between the two groups in patients assessed cured (92% vs 94%), clinical cure (92% vs 91%) and parasitic cure (83% vs 84%). The adverse effect of foul odor in the sulfur group was more common than in the GBH group (p < 0.05). CONCLUSION: 10 per cent sulfur ointment is as safe and efficacious as 0.3 per cent GBH for the treatment of scabies in children.