Oral retinoid therapy for dermatologic conditions in children and adolescents.

The efficacy of systemic retinoid therapy in a number of dermatologic diseases is well established; however, concerns about potential side effects limit their use, especially in children. We review the efficacy and toxicity of oral retinoids in the pediatric population. The acute mucocutaneous toxicities commonly observed are typically well tolerated, readily treatable, and reversible. Systemic toxicities include teratogenicity and effects on the musculoskeletal, neurologic, and gastrointestinal systems. Children, like adults, generally tolerate short-term retinoid therapy without major complications. Concerns regarding serious systemic side effects are greater for those on high doses of oral synthetic retinoids for longer periods of time. Close patient monitoring and patient education can minimize the occurrence of complications. (J Am Acad Dermatol 2003;49:171-82.)Learning objective At the conclusion of this learning activity, participants should be familiar with use of oral retinoids for childhood dermatologic conditions such as psoriasis, acne, and ichthyoses as well as safety and risks associated with oral retinoid use in children and adolescents.

Congenital primary cutaneous rhabdomyosarcoma in a neonate.

We report a case of congenital primary cutaneous rhabdomyosarcoma, solid alveolar type, presenting as a solitary skin lesion on the right upper lip of a 2-week-old infant boy. Rhabdomyosarcoma originates from the embryonic mesenchyme precursor of striated muscle. Histologically it belongs to the group of "small round cell tumors." Its myogenic origin is ascertained by immunohistochemical studies positive for myogenin, muscle-specific actin, desmin, and myoglobin. Malignancy in the neonatal period is uncommon and the clinical management presents considerable challenges. Congenital alveolar rhabdomyosarcoma is a highly malignant tumor with no record of long-term survivors. Treatment options include chemotherapy, excision, and radiotherapy. This infant's tumor was responsive to chemotherapy and surgery and he was free of disease at the 6-month follow-up.

The role of cyclooxygenase-2 in the pathogenesis of skin cancer.

Prostaglandin synthesis occurs via the coordinate action of a phospholipase that liberates arachidonic acid from membrane phospholipids and a cyclooxygenase (COX) that converts the free arachidonic acid to prostaglandins. Several lines of evidence suggest that prostaglandins play a role in carcinogenesis. Two isoforms of COX have been described. COX-2 is highly regulated and induced by inflammation while COX-1 is considered primarily a housekeeping form. The acute up-regulation of COX-2 by UV radiation suggests that it may contribute to photocarcinogenesis in the same way that COX-2 has recently been shown to contribute to colon cancer.