Vitamin D Deficiency and Atopic Dermatitis: Consider Disease, Race, and Body Mass.

Vitamin D deficiency causes rickets, but has been associated with various diseases, including atopic dermatitis (AD). This study analyzes serum vitamin D in pediatric medical center patients with AD and potential confounding factors. At Cardinal Glennon Children's Hospital, charts of 665 children with serum 25-hydroxyvitamin D levels taken between 2009 and 2013 were retrospectively reviewed. Defining vitamin D deficiency as <20 ng/mL, neither average 25-hydroxyvitamin D nor deficiency prevalence varied among disease groups, except for cystic fibrosis (CF), which demonstrated significantly higher average vitamin D and lower deficiency prevalence. Children with AD had the lowest prevalence of vitamin D sufficiency, without significant association with disease severity. No seasonal variation was detected. Strong correlations were observed between 25-hydroxyvitamin D levels, body mass index (BMI), and race. Our data showed no strong association between vitamin D levels and AD or AD severity. A strong association was noted between skin type and BMI. The lower prevalence of vitamin D deficiency among children with CF may be explained by lighter skin and lower BMI. A high prevalence of vitamin D insufficiency and deficiency as currently defined among children with dark skin and high BMI suggests a need to reevaluate normal vitamin D levels in these populations.

The Wave Flap: A Single-Stage, Modified Nasal Sidewall Rotation Flap for the Repair of Defects Involving the Mid-Alar Groove.

BACKGROUND: Reconstruction of defects straddling the alar groove presents the dual challenges of resurfacing the nasal sidewall and alar subunits while simultaneously recreating the alar groove. The wave flap (WF) is a modified, medially based, nasal sidewall rotation flap that uses locally recruited tissue from the nasal sidewall to facilitate color and texture match and permit camouflage of scars. OBJECTIVE: To detail a surgical repair for defects in the horizontally oriented middle third of the alar groove. MATERIALS AND METHODS: This retrospective case series describes a technique for repair of defects involving the alar groove. Using postoperative photographs, outcomes were assessed by blinded noninvestigator dermatologist raters using the Observer Scar Assessment Scale. RESULTS: Between February 2012 and June 2013, 10 patients were reconstructed using a WF design. Subjective assessment of scar vascularity, pigment, pliability, relief, and thickness by 3 independent reviewers yielded an overall cosmesis score of 11.1 (out of 50). No complications were noted. CONCLUSION: The WF provides an excellent reconstructive option for Mohs defects of the middle third of the alar groove by recruiting local tissue and permitting maximum scar camouflage. A well-designed and executed WF provides cosmetically exceptional results for defects of the alar groove.

Clinicopathologic evaluation of cardiofaciocutaneous syndrome: overcoming the challenges of diagnosing a rare genodermatosis.

We report the case of a 2-year-old boy from a family with limited financial resources who presented with cutaneous abnormalities, a history of congenital heart defect, and a presumptive diagnosis of Noonan syndrome. Genetic testing had been deferred because of a lack of funds. Skin findings were characteristic of cardiofaciocutaneous syndrome, including keratosis pilaris, ichthyosis, sparse eyebrows, and multiple nevi. A biopsy of a perifollicular thick papule with background hyperpigmentation was obtained to further characterize the cutaneous findings. Clinical evaluation allowed rapid, cost-effective, specific diagnosis in this patient with a RASopathy-spectrum genetic disorder who did not have access to genetic testing. This time-honored clinical approach is adequate for providing information important for prognosis, follow-up, and counseling. We will also discuss available resources for genetic testing and specialized care for patients with RASopathies.