Molluscum contagiosum and warts are two very common viral-induced diseases of childhood. We report our 1-year experience with intralesional candida antigen therapy for both warts and molluscum contagiosum. A retrospective chart review was performed and a total of 217 patients were identified. Follow-up was obtained either through clinic visits or telephone interviews for 25/47 molluscum patients and 55/170 wart patients. Of the molluscum patients with follow-up, 14/25 (56%) had complete resolution, 7/25 (28%) had partial clearing, and 4/25 (16%) had no improvement. For the wart patients with follow-up, 48/55 (87%) had complete resolution, 3/55 (6%) had partial clearing, and 4/55 (7%) had no improvement. It is important to note that our clearance rate may be overestimated, as many patients were also treated concurrently with liquid nitrogen or other therapies. All wart and molluscum patients experienced some discomfort at the time of injection, but no serious side effects were reported. Our experience suggests intralesional candida antigen may represent a treatment option for warts and molluscum contagiosum that is safe and effective.

On November 7-8, 2008, physicians gathered in Houston Texas for the first-ever workshop on PHACE syndrome, an important and recently described neurocutaneous syndrome. This article represents a summary of the discussions held at that workshop, which was attended by a broad range of medical specialists.

Multifocal lymphangioendotheliomatosis with thrombocytopenia is characterized by vascular skin and gastrointestinal (GI) tract lesions, thrombocytopenia, and GI bleeding. The first patient had scattered red macules and subcutaneous nodules on the skin with involvement of the lungs, liver, omentum, and right kidney. At 10 months of age he continues to have severe GI bleeding. The second patient had innumerable vascular plaques on the skin plus muscle, bone, lung, liver, and brain involvement. She died from respiratory failure at 8 months of age due to brainstem involvement. Both patients required aggressive management of GI bleeding, but had quite different skin findings and long-term outcomes.

Results. Eighteen of 24 questionnaires were completed and returned. The average age of onset of LS was 4.2 years, but average age at diagnosis was 5.2 years; only 1 patient was diagnosed correctly by her primary care physician. Itching was the most common symptom (78%). Severe constipation was reported in 67% of patients, and 89% had at least 1 gastrointestinal complaint (bleeding with bowel movements, fissuring, soiling, fecal impaction, or constipation).Conclusions. L ichen sclerosus (LS) is an uncommon inflammatory disorder that can occur at any age, but has a predilection for the vulvar skin of prepubertal girls and postmenopausal women (Fig 1). It is an eruption, the typical appearance of which is an ivory-white, sharply demarcated figure-8 pattern encircling the vagina and anus. It begins as papules containing a central depression and often coalesces into plaques. The skin surface may appear finely wrinkled or have purpuric spots, fissures, and erosions. Although less common, lesions may also present extragenitally. An often-unappreciated sign of LS, extremely distressing to these children, is severe constipation, which is unrelieved by standard treatment measures.During the past 2.5 years we have seen 24 girls with LS in the pediatric dermatology clinic at the Medical College of Wisconsin (Milwaukee, WI). A significant number of their parents have expressed considerable anger and frustration due to the failure of their physicians to recognize the association between severe constipation and LS, resulting in a long delay in diagnosis. The English-language literature, including major textbooks of medicine, pediatrics, obstetrics and gynecology, and dermatology, fail to mention constipation as a feature of LS. By reporting our experience with these patients, we hope to bring this association to the attention of primary care physicians. We asked about timing of complaints in relation to actual diagnosis of LS. The questionnaire also focused on specific signs and symptoms, diagnosis, and specialists consulted for the problem. RESULTSOf the 24 surveys mailed, 18 (75%) were completed and returned.The patients ranged in age from 4 to 17 years (mean: 8 years). The average age at onset of symptoms was 4.2 years, but the average age at diagnosis was 5.2 years. There was a time lag of ϳ1 year from onset of signs and symptoms until diagnosis of LS, the longest interval being 3 years. Only 1 patient was diagnosed by a primary care physician (a family practitioner). Two children were diagnosed in a hospital pediatric gastrointestinal (GI) clinic, and a pediatric dermatologist diagnosed all others. Efforts to obtain a diagnosis also prompted families to make multiple visits to pediatricians, gynecologists, and pediatric general and vascular surgeons. Table 1 lists the signs and symptoms of LS in our patients and indicates those that were most bothersome. Itching was the most common complaint, but GI-related complaints were also quite prevalent. Twelve of 18 patients had constipation, and 9 had perianal fissuring. Eleven o...

Phrynoderma is a distinctive form of follicular hyperkeratosis associated with nutritional deficiency. Although originally thought to represent vitamin A deficiency, several studies have demonstrated multiple etiologies. Characteristic skin lesions are hyperkeratotic papules that first appear on the extensor surfaces of the extremities, shoulders, and buttocks. We report a 14-month-old boy with malnourishment and hyperkeratotic papules and plaques with histologic changes typical of phrynoderma. Despite an extensive evaluation, a specific nutritional deficiency was not identified. Phrynoderma is believed to be a manifestation of severe malnutrition, not necessarily accompanying low vitamin A levels. While the literature supports a link between phrynoderma and vitamins E, B, A, and essential fatty acids general malnutrition seems to be the strongest association. The clinical picture typically improves with enhanced nutritional status. Phrynoderma must be considered in the differential diagnosis in patients with extensor surface hyperkeratotic papules and plaques in the setting of malnourishment and should prompt the clinician to evaluate cell markers of nutritional status, not just vitamin A. We believe this patient exemplifies the conundrum that faces clinicians in evaluating patients with extensor surface predominant hyperkeratotic papules and plaques in the setting of malnourishment.