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.

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.

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.