ABSTRACT
A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti-Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.
Subject(s)
Acrodermatitis/etiology , Acrodermatitis/pathology , Vaccination/adverse effects , Acrodermatitis/physiopathology , Biopsy, Needle , Chickenpox Vaccine/administration & dosage , Chickenpox Vaccine/adverse effects , Diphtheria-Tetanus-Pertussis Vaccine/administration & dosage , Diphtheria-Tetanus-Pertussis Vaccine/adverse effects , Emergency Service, Hospital , Exanthema/etiology , Exanthema/physiopathology , Follow-Up Studies , Humans , Immunohistochemistry , Infant , Male , Measles-Mumps-Rubella Vaccine/administration & dosage , Measles-Mumps-Rubella Vaccine/adverse effects , Risk Assessment , Vaccination/methodsABSTRACT
BACKGROUND: Virtual microscopy is used for teaching medical students and residents and for in-training and certification examinations in the United States. However, no existing studies compare diagnostic accuracy using virtual slides and photomicrographs. The objective of this study was to compare diagnostic accuracy of dermatopathologists and pathologists using photomicrographs vs. digitized images, through a self-assessment examination, and to elucidate assessment of virtual dermatopathology. METHODS: Forty-five dermatopathologists and pathologists received a randomized combination of 15 virtual slides and photomicrographs with corresponding clinical photographs and information in a self-assessment examination format. Descriptive data analysis and comparison of groups were performed using a chi-square test. RESULTS: Diagnostic accuracy in dermatopathology using virtual dermatopathology or photomicrographs was similar: 0.70 vs. 0.73 respectively, p = 0.465. Order of administration of virtual dermatopathology and photomicrographs did not affect diagnostic accuracy. The vast majority (93%) of the participants felt the virtual slides were adequate for diagnosis and that virtual dermatopathology represented a useful tool for learning; 90% felt that virtual dermatopathology is useful tool for teaching dermatopathology. CONCLUSION: No significant difference was observed in diagnostic accuracy using virtual dermatopathology compared to photomicrographs. Most participants felt virtual dermatopathology was adequate for diagnostic purposes and a useful tool for learning and teaching dermatopathology.
Subject(s)
Dermatology/standards , Diagnosis, Computer-Assisted/standards , Pathology, Clinical/standards , Skin Diseases/diagnosis , Computer-Assisted Instruction/methods , Dermatology/education , Diagnostic Errors/prevention & control , Diagnostic Errors/statistics & numerical data , Education, Medical, Graduate/methods , Educational Measurement , Humans , Photomicrography , Reproducibility of Results , Self-Assessment , User-Computer InterfaceABSTRACT
A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti-Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.
Subject(s)
Acrodermatitis/diagnosis , Acrodermatitis/etiology , Chickenpox Vaccine/adverse effects , Diphtheria-Tetanus-Pertussis Vaccine/adverse effects , Measles-Mumps-Rubella Vaccine/adverse effects , Acrodermatitis/pathology , Humans , Infant , MaleABSTRACT
A 14-year-old girl presented with a 3-week history of mucosal erosions, injected conjunctiva, dehydration, and respiratory distress. She had been treated with intravenous acyclovir for herpes simplex infection with positive herpes simplex virus immunoglobulin M and immunoglobulin G. Physical examination and imaging revealed a large abdominal mass. Incisional biopsy was obtained, and pathology demonstrated angiofollicular hyperplasia with hyalinized germinal centers and Castleman's syndrome-like features. Based on the mucosal erosions, herpes simplex virus serology and positive herpes simplex virus-1 direct fluorescent antibody, Castleman's disease secondary to overwhelming herpes simplex virus infection was the initial impression. The poor response to antivirals and subsequent development of a bullous eruption on the hands resulted in dermatology consultation. Skin biopsy was obtained from a bullae and revealed suprabasilar acantholysis with necrosis as well as upper dermal, perivascular, and interface infiltrate of lymphocytes and eosinophils. No viropathic changes were present. Direct immunofluorescence was significant for immunoglobulin G deposition intercellularly and along the dermoepidermal junction and focal trace C3 deposition along the dermoepidermal junction consistent with paraneoplastic pemphigus, later confirmed by indirect immunofluorescence. We report this case of paraneoplastic pemphigus secondary to Castleman's syndrome confounded by herpes simplex virus-1 positive mucosal erosions.
Subject(s)
Castleman Disease/virology , Herpes Simplex/diagnosis , Paraneoplastic Syndromes/virology , Pemphigus/virology , Acantholysis/drug therapy , Acantholysis/immunology , Acantholysis/pathology , Acantholysis/virology , Acyclovir/therapeutic use , Adolescent , Antiviral Agents/therapeutic use , Biopsy , Castleman Disease/drug therapy , Castleman Disease/immunology , Castleman Disease/pathology , Complement C3/analysis , Complement C3/immunology , Eosinophils/immunology , Female , Fluorescent Antibody Technique , Herpes Simplex/drug therapy , Herpes Simplex/immunology , Herpes Simplex/pathology , Humans , Immunoglobulin M/analysis , Immunoglobulin M/immunology , Lymphocytes/immunology , Paraneoplastic Syndromes/drug therapy , Paraneoplastic Syndromes/immunology , Paraneoplastic Syndromes/pathology , Pemphigus/drug therapy , Pemphigus/immunology , Pemphigus/pathology , Treatment OutcomeSubject(s)
Fingers , Nerve Sheath Neoplasms/pathology , Skin Neoplasms/pathology , Child , Humans , Male , SclerosisABSTRACT
This study sought to identify barriers to treatment in children with chronic inflammatory skin disease, particularly those with atopic dermatitis, psoriasis, and acne vulgaris. Caregivers of 101 patients seen in the Children's Specialty Group Division of Dermatology, Children's Hospital of The King's Daughters, Norfolk, Virginia, completed an 11-item Likert scale questionnaire. This survey addressed complexity and time requirements for treatment, medication cost, vehicle formulation, perceived safety, and caregiver understanding of chronicity of skin disorders. Parents and caregivers indicated that adequate instructions for using the medications were provided but that they felt less comfortable with treating their child's skin disease during a severe flare. The complexity of treatment programs, time required to apply medications, and vehicle type were not considered prohibitive factors. Caregivers were concerned about the cost and safety of prescribed medications and had a less understanding of the chronicity of inflammatory skin disorders.
Subject(s)
Dermatology/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Patient Compliance/statistics & numerical data , Pediatrics/statistics & numerical data , Skin Diseases/therapy , Acne Vulgaris/economics , Acne Vulgaris/therapy , Adolescent , Child , Child, Preschool , Cost of Illness , Dermatitis, Atopic/economics , Dermatitis, Atopic/therapy , Dermatology/economics , Female , Health Services Accessibility/economics , Humans , Infant , Infant, Newborn , Male , Pediatrics/economics , Psoriasis/economics , Psoriasis/therapy , Skin Diseases/economics , Young AdultABSTRACT
Melanocytic nevi can have a wide range of histologic appearances. Within the spectrum of nevi, there exists a group that presents in certain anatomic locations with histologically worrisome features but nonetheless benign behavior. This group of nevi has been broadly categorized as nevi of special sites. The anatomic locations affected by this group include the embryonic milkline (breast, axillae, umbilicus, genitalia), flexural areas, acral surfaces, ear, and scalp. Nevi in these locations may be mistaken for melanomas because of their histologic appearance, resulting in inappropriate overtreatment of patients. In this article, the authors review the histologic features of these special site nevi and discuss the criteria that help distinguish them from melanoma.
Subject(s)
Nevus/pathology , Skin Neoplasms/pathology , Ear Neoplasms/diagnosis , Ear Neoplasms/pathology , Humans , Nevus/diagnosis , Skin Neoplasms/diagnosis , Urogenital Neoplasms/diagnosis , Urogenital Neoplasms/pathologyABSTRACT
Pseudomonas aeruginosa is common cause of folliculitis following contact with contaminated water. We report a case of pseudomonal folliculitis that occurred after swimming in a children's pool filled with water from a well.
Subject(s)
Folliculitis/etiology , Pseudomonas Infections/etiology , Pseudomonas aeruginosa , Swimming Pools , Anti-Bacterial Agents/therapeutic use , Bleaching Agents/therapeutic use , Child , Clindamycin/therapeutic use , Female , Folliculitis/drug therapy , Folliculitis/microbiology , Humans , Pseudomonas Infections/drug therapy , Treatment OutcomeSubject(s)
Sarcoidosis/pathology , Skin Diseases/pathology , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Our objective was to compare the efficacy of selenium sulfide shampoo 1% and ciclopirox shampoo 1% as adjunctive treatments for tinea capitis in children. Forty children aged 1-11 years with clinically diagnosed tinea capitis were randomized to receive selenium sulfide shampoo 1% or ciclopirox shampoo 1% twice a week as adjuncts to an 8-week course of ultramicronized griseofulvin dosed at 10-12 mg/kg/day. At weeks 2, 4, and 8, subjects returned to the clinic for evaluation and scalp cultures. Subjects then returned for follow-up visits 4 weeks after completing treatment. Overall, by 8 weeks, 30 of 33 (90.9%) treated children demonstrated mycological cure. Selenium sulfide shampoo 1% and ciclopirox shampoo 1% were equally effective as adjunctive treatments for tinea capitis in children in our study.
Subject(s)
Antifungal Agents/therapeutic use , Hair Preparations/therapeutic use , Pyridones/therapeutic use , Selenium Compounds/therapeutic use , Tinea Capitis/drug therapy , Child , Child, Preschool , Ciclopirox , Double-Blind Method , Female , Humans , Infant , Male , Treatment OutcomeABSTRACT
Virtual microscopy is being used in medical schools to teach histology and pathology. It is also being used in resident education, in-training examinations (dermatology), and certification examinations (pathology). There are, however, few studies comparing its diagnostic accuracy and acceptability compared with traditional glass slides. This study sought to compare residents' abilities in diagnosing dermatopathology disorders in 2 image formats (traditional microscopic slides and whole mount digitized images) and to assess their perceptions of virtual microscopy in dermatopathology. Residents in dermatology and pathology training programs at 14 institutions were given a randomized combination of 20 virtual and glass slides and were asked to identify the diagnoses from multiple foils. They were then asked to give their impressions about the virtual images. Descriptive data analysis and comparison of groups using Pearson chi(2) and Fisher exact tests for categorical variables and Student t test for continuous variables were performed. Residents in dermatology and pathology performed similarly in diagnosing dermatopathology disorders using virtual slides or glass slides (mean [SD] correct for virtual versus glass, 5.48 (1.72) versus 5.57 (2.06); P = .70). The order of administration of virtual versus glass slides did not affect the percentage of questions answered correctly. Most residents supported the use of virtual microscopy as a learning aid, whereas fewer favored its use in testing (79% versus 44%, respectively). Residents performed similarly in making dermatologic diagnoses using virtual slides compared with glass slides despite the residents' preference for the latter.
Subject(s)
Dermatology/education , Education, Medical, Graduate/methods , Microscopy/methods , Pathology, Clinical/education , Skin Diseases/diagnosis , User-Computer Interface , Humans , Internship and Residency , Medical Staff, Hospital/educationABSTRACT
Cutaneous manifestations of congenital herpes simplex virus (HSV) have been classically described as grouped vesicles on an erythematous base. We report two cases of HSV infection wherein both infants presented at birth with widespread erosions and an absence of vesicles or vesicopustules. The presence of skin lesions at birth, neurologic changes seen on radiographic imaging, and a cesarean section delivery in one case suggests intrauterine transmission in both neonates.
Subject(s)
Herpes Simplex/pathology , Herpes Simplex/transmission , Infectious Disease Transmission, Vertical , Skin/pathology , Biopsy , Diagnosis, Differential , Female , Herpes Simplex/congenital , Humans , Infant, Newborn , Male , NecrosisABSTRACT
Melanocytic nevi can have a wide range of histologic appearances. Within the spectrum of nevi, there exists a group that presents in certain anatomic locations with histologically worrisome features but nonetheless benign behavior. This group of nevi has been broadly categorized as nevi of special sites. The anatomic locations affected by this group include the embryonic milkline (breast, axillae, umbilicus, genitalia), flexural areas, acral surfaces, ear, and scalp. Nevi in these locations may be mistaken for melanomas because of their histologic appearance, resulting in inappropriate overtreatment of patients. In this article, the authors review the histologic features of these special site nevi and discuss the criteria that help distinguish them from melanoma.