Neonatal lupus in twins.

Neonatal lupus erythematosus (NLE) is a syndrome characterized by one or all of the following elements: cutaneous LE lesions, systemic disease, and congenital heart block. SS-A/Ro and SS-B/La have been implicated in the etiology of NLE, but because NLE is not uniformly manifested in all offspring of SS-A and SS-B autoantibody positive mothers, and because of the wide range of clinical manifestations associated with NLE, other contributing etiologic factors are being explored. HLA studies have revealed that infants of SS-A/Ro and SS-B/La positive mothers bearing HLA-A1, B8, DR3, DQ2, and DR52 are at greater risk of having NLE. Haplotyping in our dizygous twins supports these material HLA associations.

Exogenous ochronosis in the United States.

Two middle-aged black women reported hyperpigmentation of the face after using bleaching creams containing hydroquinone. Both noted initial lightening of facial pigmentation followed by progressive darkening of the areas to which the cream was applied. After biopsy, they were found to have exogenous ochronosis. These are the fifth and sixth cases of exogenous ochronosis reported in the United States. In this article we review the literature and discuss the possible pathogenesis of exogenous ochronosis.

Kawasaki disease and its diagnosis.

Mucocutaneous lymph node syndrome, or Kawasaki disease, is a febrile, exanthematous disease of children that has potentially fatal complications. The most important complication is the development of aneurysms in the coronary arteries, which may thrombose or occasionally, rupture and cause severe morbidity or death. Criteria for the diagnosis of Kawasaki disease have been developed that may help the clinician make the diagnosis and prevent complications. The major criteria include fever, skin eruption, ocular changes, oral changes, changes in the extremities, and lymphadenopathy. Prognosis may be evaluated by the clinical picture and cardiac work-up with echocardiogram.

Acute exanthems in children. Clues to differential diagnosis of viral disease.

The numerous viral skin diseases that affect children present a diagnostic challenge to the clinician. Most of these diseases may be conveniently grouped according to the clinical appearance of the exanthem as maculopapular, petechial, papular, or vesicular. In some situations, viral infection may be difficult to differentiate clinically from nonviral disease; thus, extensive laboratory evaluation is sometimes necessary to pinpoint the virus involved. Nonviral disease should be considered in the differential diagnosis of a patient with skin eruptions, especially of the maculopapular type. Common nonviral causes include Kawasaki disease, toxic shock syndrome, and drug reactions.

Photosensitivity in infants and children.

Childhood photosensitivity diseases may encompass many of the diseases seen in adults. In addition, there are a number of photosensitivity diseases that are exclusive to children, including both acquired and congenital or genetic syndromes. These syndromes and their etiologies, when known, are discussed.