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Most popular medical Questions
What type of agents can cause allergic contact dermatitis in children?Allergic contact dermatitis can occur in all age groups, but it is often under recognized in pediatric patients. Sensitizers include plant resins (poison ivy, sumac, or oak), nickel in jewelry, metal snaps and belts, topical neomycin ointment, preservatives (formaldehyde releasers), and materials used in shoes, including adhesives, rubber accelerators, and leather tanning agents.
When does the rash in poison ivy appear relative to exposure?
Poison ivy, or rhus dermatitis, is a typical delayed hypersensitivity reaction. The time between exposure and cutaneous lesions is usually 2-4 days. However, the eruption may appear as late as a week or more after contact in individuals who have not been previously sensitized (this explains why lesions continue to erupt after the initial "outbreak" of rash).
Are the vesicles in poison ivy contagious?
No. The contents of blisters do not contain the allergen. Washing the skin removes all surface oleoresin and prevents further contamination.
What is the "id" reaction?
Your superego will be stroked if you identify the "id" reaction in a confusing dermatologic case. This reaction is the generalization of a local inflammatory dermatitis (e.g., contact dermatitis, tinea capitis following treatment) to sites that have not been directly involved with the offending agent. The exact mechanism remains unclear, but it may be immune-complex mediated.
What are useful methods for diagnosing tinea infections?
Although the microscopic examination of potassium hydroxide (KOH) preparations is employed in the search for hyphae, the use of dermatophyte test medium is reliable, simple, inexpensive, and more definitive. Samples from hair, skin, or nails are obtained by scraping with a scalpel, cotton-tipped applicator, or toothbrush (the latter especially for tinea capitis), and these are inoculated directly onto the test medium. After approximately 1-2 weeks, a color change from yellow to red in the agar surrounding the dermatophyte colony indicates positivity. If the most definitive diagnosis is needed, culture on Sabouraud medium is the test of choice.
How should children who are receiving griseofulvin for tinea capitis be monitored?
The incidence of hepatitis or bone-marrow suppression from griseofulvin in children is rare. Children who are undergoing an acute course of treatment (6-8 weeks) do not need obligatory blood counts or liver function tests. However, a history of hepatitis or its risk factors would warrant a pretreatment evaluation of liver function and intermittent monitoring. For those rare cases in which griseofulvin is going to be used for >2 months, one should consider obtaining complete blood counts and liver function tests on an every-other-month basis.
What is the likely diagnosis in a child who develops diffuse hair loss 3 months after major surgery?
Telogen effluvium. This is the most common cause of diffuse acquired hair loss in children. In a healthy individual, most hairs are present in a growing (anagen) phase. After a physical or emotional stress such as a significant fever, illness, pregnancy, birth, surgery, or large weight loss, a large number of scalp hairs can convert to the resting (telogen) phase. About 2-5 months after the stressful event, the hair begins to shed, at times coming out in large clumps. The condition is temporary and usually does not produce a loss of more than 50% of the hair. When the hair roots are examined, there is a characteristic lighter-colored root bulb, which characterizes a telogen hair. The hair loss can continue for 6-8 weeks, at which time new, short, regrowing hairs should be visible.
Anagen effluvium, which the loss of growing hairs, is most commonly seen during radiation and chemotherapy treatments for cancer.
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