WHAT'S KNOWN ON THIS SUBJECT:Scabies is a frequent cause of consultation and has recently been classified as a neglected disease. The clinical presentation seems to be linked with age, although no specific study has aimed to delineate the clinical spectrum of scabies in infants and children.WHAT THIS STUDY ADDS: Scabies in infants and children has distinct clinical features. This prospective observational study found that infants were more likely to have relapse, nodules, and to present involvement with extremities, face, and scalp, arguing for specific cares in this age group. abstract OBJECTIVE: Scabies has a clinical presentation that seems to vary according to age. We conducted a prospective study with the goal of delineating the clinical presentation of the disease into 3 groups of age: infants, ,2 years; children, 2 to 15 years; and adults, .15 years. METHODS:This trial was a prospective, multicenter observational study in consecutive patients with a confirmed diagnosis of scabies who were seen in 13 French Departments of Dermatology and Pediatric Dermatology between April 2010 and April 2011. A standardized questionnaire was completed for each patient. To identify factors associated with patient age, comparisons between the 3 age groups were conducted by using univariate and multivariate multinomial logistic regression analyses.RESULTS: A total of 323 individuals were included; the gender ratio (female:male) was 1.2:1. In univariate analysis, infants were more likely to have facial involvement. In multivariate logistic regression, relapse was more frequent in children (odds ratio [OR] .51]) involvement were also found to be independently associated with the age group ,2 years. CONCLUSIONS:There is a specific clinical presentation of scabies in infants and children. Taking into account these specificities may be helpful for the early diagnosis and the identification of cases to prevent the propagation of the disease. Pediatrics 2014;133:e910-e916 AUTHORS:

Summary Background In most patients pseudoxanthoma elasticum (PXE) manifests with yellowish cutaneous papules and dermal elastorrhexis on skin biopsy. However, in a small number of cases there are no skin manifestations on clinical examination. To establish a diagnosis of PXE in such patients with limited manifestations such as angioid streaks and/or premature cardiovascular disease is challenging. It would therefore be valuable to predict the skin areas that would yield a biopsy specimen positive for elastorrhexis with a non-invasive procedure. High frequency ultrasonography (HFUS) should be evaluated in this respect. Objectives Prior to achieve the goal mentioned above we aimed at describing the characteristics of clinically visible PXE skin using HFUS, and to evaluate its relevance for diagnosis. Methods HFUS was performed in a cohort of PXE patients and controls at a referral centre. HFUS images of PXE skin were compared to those of other conditions. Five operators were tasked with the blind scoring of multiple HFUS images of photoprotected or photoexposed skin from patients with PXE and controls. The diagnostic relevance indices (sensitivity, specificity, likelihood ratios, inter-observer agreement) were calculated. Results The HFUS changes considered as diagnostic for PXE were primarily oval homogeneous hypoechogenic areas in the middermis. The size of these areas closely matched the extent of the histological changes. The sensitivity and specificity of the diagnostic items and inter-observer agreement were high, particularly in photoprotected skin. Dermal hypoechogenicity in PXE could be related to high hydration of connective tissue due to the presence of glycosaminoglycans despite elastic fibre mineralization. Conclusions HFUS provides suggestive images of PXE skin lesions. HFUS should be now studied to determine if it is a potentially valuable technique for the non-invasive identification of elastorrhexis in PXE patients in whom skin involvement is clinically minimal or absent.

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