Pediatric Dermatology Department Research Articles

Multifocal Infiltrative Lymphangiomatosis in a Child and Successful Treatment With Sirolimus

From the Department of Pediatric Dermatology, Great Ormond Street Hospital for Children, NHS Trust and the Institute of Child Health, London, United Kingdom. Both authors contributed equally to this work. A 13-year-old boy had a history of extensive multifocal lymphangiomatosis diagnosed at the age of 2 years following presentation with soft tissue swelling over the left flank (Figure A). His magnetic resonance imaging scan revealed an extensive lesion on the left side of the back, extending into the erector spinae muscles, paraspinal regions, left sacroiliac joint and ilium, and within vertebral bodies L5 to T11 and involving the retroperitoneum, rectocrural, left inguinal, mediastinal, and base of the neck. It also infiltrated the spleen and intravertebral foramina (Supplemental Figure 1). The most worrisome complication was acute and chronic intracoagulopathy. The diagnosis was histologically confirmed (Supplemental Figure 2). The patient’s blood parameters were significantly deranged, especially a persistently very low platelet count, low fibrinogen, very high level of D-dimer and elevation of prothrombin time and partial thromboplastin time (Supplemental Figure 3). The lymphatic malformation on his spine caused ongoing pain and scoliosis, which was associated with physical and mobility impairment. After 2 years of treatment with sirolimus (1.5 mg once daily 0.8 mg/m/day) the patient was clinically well and maintained a good quality of

Çocuklarda Oral Mukoza Hastalıklarının Oranı ve Demografi̇k Özelli̇kleri̇ni̇n Değerlendi̇ri̇lmesi̇

Objective: Our aim was to determine the frequency and demographic characteristics of the patients presenting at the department of pediatric dermatology with complaints of mouth and lip lesions and to compare their epidemiological data with the literature in this study. Material and Methods: Of the 3000 children aged between 0 and 16 who presented at the pediatric dermatology outpatients between 2011 January and 2011 December, the children who had been brought with complaints of mouth and lip sores were retrospectively assessed in terms of age, gender, socio-economic level (SEL), medicine use, disease history, systemic disease and presence of genetic disease. Results: Of the pediatric patients brought with mouth complaints, 64 (58%) were girls and 46 (42%) were boys. Fifteen different oral mucosal diseases were detected in 110 patients (3.6%). The most frequent oral mucosal diseases were RAS (recurrent aphthous stomatitis) (16.3%, n=18), perioral dermatitis (14.5%, n=16), and hand foot mouth disease (13.6%, n= 15). Conclusion: Although oral mucosal diseases are less frequently seen in children compared to adults, early diagnosis and treatment are important since they may be a sign of systemic disease, affect growth and development and may lead to psychological problems.

G52(P) The Rapid Eczema Severity Score (RESS)

BackgroundEczema is a common inflammatory dermatosis, with a rising incidence and significant effect on the quality of life for the child and the family. Known validated scoring systems are time...

Capillary malformation–arteriovenous malformation: a clinical review of 45 patients

Capillary malformation-arteriovenous malformation (CM-AVM) is a recently described autosomal dominant disorder that results from mutations in RASA1. It has been initially described as multiple CMs affecting several members of the same family, associated with fast-flow malformations in at least one family member. To report and analyze clinical data on 45 patients with CM-AVM assessed at the Department of Pediatric Dermatology, Ramos Mejía Hospital (Buenos Aires, Argentina). Retrospective clinical review of all the patients clinically diagnosed as having CM-AVM over a period of eightyears. Forty-five patients were recorded (24 females and 21 males). The age ranged from onemonth to 44years. In 36 patients, the stains were congenital; progressive acquired lesions were observed in 39. Family history was positive in 32 subjects. Well defined, round to oval, pink-purple or reddish-brown macules were found in all the patients; pinpoint red lesions with a pale halo were found in nine cases. The macules were warmer than normal skin in 15 cases and surrounded by a white halo in 26 cases. Three subjects presented associated overgrowth, lymphatic malformation was present in one case, retinal vascular lesion in one patient, and isolated port wine stain in two cases. Three patients also had infantile hemangioma. We had no cases of fast-flow vascular malformation or combined vascular syndromes. CM-AVM is a heterogeneous disorder with phenotypic variability, from fast-flow malformation, limb enlargement, or Parkes Weber syndrome to multiple CMs without internal involvement.

Patients' acceptance of medical photography in a French adult and paediatric dermatology department: a questionnaire survey

Despite the increasing use of medical photography by dermatologists, no study on patients' perceptions of photography in dermatology has been performed to date. Firstly, to evaluate patients' perceptions of medical photography. Secondly, to assess whether perceptions differed between patients in our adult department and parents accompanying a child in our paediatric department. An opinion survey was conducted at the Hospital of Tours (France) among adult patients (adult department) and accompanying parents (paediatric department) by completion of a questionnaire after any medical photography had been performed. We collected 272 questionnaires regarding 158 adults and 114 children. A camera used only in the department, and storage of the images in the department's records were the most accepted modalities (> 90%), especially in the paediatric survey. Respondents agreed with the sharing of the images with other practitioners and in medical meetings (> 85%) rather than distribution via publications (58·3%), e-mails (45·5%), health magazines (44·3%) and websites (32·0%). Most (78·8%) considered that the consent form should list all the possible uses of the images. Need for renewed consent for each use of the images was significantly more often expressed in the paediatric than the adult survey (44·5% vs. 24·5%, P = 0·001). More than 95% of respondents considered medical photography to be useful for improving diagnosis, monitoring of skin disease and aiding teaching. These findings could be used to improve practice, to increase the acceptability of medical photography and for devising a standardized consent form for medical practitioners performing medical photography.

Illness acceptance degree versus intensity of psychopathological symptoms in patients with psoriasis

IntroductionChronic inflammatory skin diseases such as psoriasis have undoubtedly a negative impact on the patients’ quality of life. Many of them may face various limitations in their psychosocial lives because of symptoms indicating the presence of psychopathological phenomena. Mental disorders in patients with skin diseases occur much more frequently than in the general population. Studies show that a considerable percentage (30-60%) of dermatological patients suffers from mental disorders (depressive and anxiety disorders being the most common). A person's attitude towards illness, its acceptance, and also the recognition of its limitations may be of a great importance in the process of the disease control.AimTo evaluate of the relationship between the illness acceptance degree, and the presence and intensity of psychopathological symptoms in patients with psoriasis.Material and methodsThe research was conducted on a group of 54 people (23 men and 31 women), who were treated for psoriasis in the Department of Dermatology and Venereology, Medical University of Lodz and in the Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz. The following research methods were used: a questionnaire prepared for the purpose of the research, Acceptance of Illness Scale (AIS) and Symptom Checklist (SCL-90).ResultsIt was found that there was a relationship between the skin illness acceptance degree and intensity of psychopathological symptoms in patients with psoriasis (negative correlations).ConclusionsThe higher the degree of illness acceptance is, the better mental condition of patients with psoriasis is. The intensity of psychopathological symptoms is also affected by the duration of illness, other people's attitude to the skin disease, age and education level of the patients examined.

Papular, Profuse, and Precocious Keratosis Pilaris

Keratosis pilaris (KP) is a frequent and benign condition in children characterized by the presence of rough, follicular papules and varying degrees of erythema. Different variants have been described, including simple KP and red KP. Between September 2007 and October 2010, 11 children with profuse and precocious KP seen at the department of pediatric dermatology were included. They defined an underemphasized clinical variant of childhood KP: the papular, profuse, and precocious KP characterized by early age of onset (<18 mos), extensive involvement of the limbs and cheeks, and papular nature of lesions. No clinical association has been found. The main complication was episodes of folliculitis. Diagnosis was delayed for all patients. Treatment is difficult, but association between emollient and keratolytic agents can provide some help.

DEFICIÊNCIA DE PROLIDASE – UMA CAUSA RARA DE ÚLCERAS DE PERNA EM IDADE PEDIáTRICA

A deficiência de prolidase (DP) é uma condição rara, autossómica recessiva, que resulta de uma muta- ção no gene da prolidase (PEPD), localizado no cromossoma 19. A deficiência desta enzima diminui a reciclagem de prolina e, consequentemente, a síntese de colagénio. Este defeito pode ser assintomático ou estar associado a mani- festações clínicas, tais como úlceras crónicas dos membros inferiores, infecções recorrentes, hepato-esplenomegalia, oligofrenia e fácies evocativa, as quais surgem habitualmente em idade pediátrica. Os autores descrevem o caso de uma criança de 14 anos de idade, com o diagnóstico de deficiência de prolidase, enviado à consulta de Dermatolo- gia Pediátrica pelo aparecimento de úlcera na região maleolar lateral do pé esquerdo. Foi realizado desbridamento cirúrgico e encetada a aplicação diária de manipulado de glicina e prolina (ambas a 5%) em vaselina purificada, tendo-se observado a cicatrização da lesão ao fim de 1 mês.PALAVRAS-CHAVE – Deficiência de Prolidase; Úlcera de Perna.

Le métronidazole, alternative thérapeutique des rosacées oculaires et cutanées de l’enfant

To assess the effectiveness and tolerance of systemic metronidazole in the treatment of childhood ocular and cutaneous rosacea. Single-center multidisciplinary retrospective study. Children aged between 1 and 15, with ocular and/or cutaneous rosacea, treated in the pediatric ophthalmology and dermatology department of Bordeaux, France, from January 1996 to September 2009. Eleven patients out of 20 had ocular and cutaneous rosacea, three had ocular symptoms only, and six had cutaneous symptoms only. In 11 patients (55%), the ocular symptoms preceded the skin disease. Meibomian cyst and phlyctenular conjunctivitis were the main symptoms. Keratitis was seen in four patients and lower corneal ulcer in two cases. The papulopustular form was the most frequent dermatologic form. All patients with ocular involvement received first-line treatment of eyelid hygiene. No topical ophthalmic treatment such as corticosteroid or cyclosporine 0.5% or 2% was used. Thirteen patients who showed no improvement despite eyelid treatment, the association of ocular and cutaneous rosacea, severe ocular involvement with keratitis, and severe recurrent cutaneous rosacea were treated orally. Two patients, aged between 12 and 14 years, received treatment with an anti-inflammatory dose of doxycycline for 2 to 3 months and achieved complete remission. One 22-month-old patient received oral treatment with erythromycin at a dose of 250 mg three times daily for 4 months. Ten patients, aged 12 to 64 months, were treated with systemic Metronidazole. Treatment lasting at least 3 months at a dose between 20 and 30 mg/kg per day was necessary to obtain complete and lasting remission. An early cessation of treatment, before 3 months, seems associated with partial remission of the disease and early recurrence. In cases complicated by ocular keratitis and corneal ulcer, prolonged treatment lasting 6 months led to clinical remission. The short courses (3-6 months) were preferred to long-term administration to prevent neurological toxicity. Maintenance therapy was based on eyelid hygiene. No recurrences and no toxic effects were observed at a median of 48 ± 6 months. Childhood ocular rosacea is not rare, but is often misdiagnosed. It often precedes skin symptoms but it can remain isolated. Metronidazole could be alternative treatment for ocular and cutaneous rosacea in the pediatric population.

Prevalência de dermatoses pediátricas em um hospital universitário na região sudeste do Brasil

Numerous dermatoses affects children, depending on age, region and socioeconomic status. To determine the prevalence of pediatric dermatoses at the Dermatology Department of a University Hospital, involving the diagnosis, age and sex. Epidemiologic cross-sectional study carried out in the period between July 2006 and December 2007. There were reviewed the handbooks of 264 patients from the Pediatric Dermatology Department of a University Hospital in this period. The dependent variable was the existence or not of dermatoses in children of age up to 19 years. Independent variables were: clinical diagnosis, sex and age. Of the 264 handbooks reviewed, there was a higher prevalence of allergic dermatoses in 74 cases (28,0%), followed by inflammatory dermatoses in 49 cases (18,6%), pigmentary dermatoses in 42 cases (15,9%), infectious dermatoses with 38 cases (14,4%), benign tumors in 25 cases (9,5%), miscellaneous in 14 cases (5,3%), genodermatosis with 12 cases (4,5%) and skin annexes disorders with 10 cases (3,8%). The infants represented 11,3 % of the total, the pre-school 15,9 %, the schoolboys 48,8 %, and the adolescents 23,8 %. There was greater prevalence of allergic dermatoses in pre-school with 15 cases (35,7%), infants with 10 cases (33,3%) and schoolboys with 39 cases (30,2 %). Among adolescents are highlighted inflammatory dermatoses. The study showed no statistical differences between sex and age. The study of the epidemiological profile makes easy the diagnosis of pediatric dermatoses encouraging good history and search for prevention.

Alopecia areata: a retrospective study of the paediatric dermatology department (2000-2008)

Alopecia areata usually presents as patchy, nonscarring hair loss. It seems to be an immune mediated disease, whereas genetic predisposition, environmental and psychological triggers may be involved in its aetiology. To study the epidemiology, clinical aspects, associations, and treatment of alopecia areata in the paediatric population of Peadiatric Dermatology outpatients over a 9-year period. Some psychologic characteristics were also assessed. Descriptive and retrospective study of all newly diagnosed AA cases seen from January 2000 to December 2008 at the Hospital de São Marcos' Paediatric Dermatology Department. Fifteen patients with AA were interviewed for psycologic evaluation. Forty-eight cases (54% male/46% female) were identified. Mean age at presentation was 7.8 years. Family history of AA was reported in 10% of the cases, and in 25% there was a personal and/or family history of atopy. The majority of patients (82%) had mild disease and topical corticotherapy was the first-line treatment for limited AA. Fifty-four percent of these patients had a complete resolution of the lesions with treatment. Systemic treatment (corticosteroids and/or ciclosporin) was used in 71% of patients with extensive disease (more than 50% hair loss). Only one of these patients had a sustained clinical improvement after treatment. Twelve out of 15 respondents (80%) recalled stressful events preceding hair loss. Our findings are similar to those reported in other studies. Epidemiologic studies of AA are available in adulthood but there is a paucity of literature on children with AA. A holistic approach is important in the management of childhood AA as the disease can have a severe psychologic impact on an individual's well-being.

Infantile Myofibromatosis: Report of Nine Patients

Infantile myofibromatosis is a rare fibrous tumor of infancy that can be solitary or multiple. Although most of the cases are limited to the skin, in some instances systemic involvement can be present. Solitary tumors limited to the skin usually present a good prognosis with spontaneous regression. We performed a retrospective observational review of the clinical and pathologic characteristics of nine patients diagnosed as having infantile myofibromatosis, followed during a 10-year period in a Pediatric Dermatology Department.

Picture of the Month—Quiz Case

A 15-YEAR-OLD HISPANIC BOY WITH A MEDIcal history of seborrheic dermatitis and mild facial acne was referred to the pediatric dermatology department for evaluation of “red-purple streaks” on his lumbosacral region. His pediatrician had referred him owing to concern of physical abuse by his parents; his case had been reported to the Department of Children and Families. The patient and his family denied trauma or physical abuse. On further questioning, it came out that he had a history of rapid vertical growth despite a negligible change in weight. Specifically, before his growth spurt, he was approximately 60% for height and 40% for weight; after his growth spurt, he was 85% for height and 50% for weight. On physical examination, the patient appeared thin with violaceous, atrophic, horizontal plaques of the lumbosacral region (Figure). All other physical examination findings were unremarkable. Author Affiliations: Departments of Pediatrics and Dermatology, University of Miami, Miami, Florida.

A case of primary erythermalgia with encephalopathy

Sirs, Primary erythermalgia is an autosomal dominant disorder characterized by burning pain in the limbs [10]. Encephalopathic symptoms associated with primary erythermalgia have previously been reported but are not well understood [9]. A 19-year-old woman has been followed for primary erythermalgia from childhood. Her sister had a similar phenotype and died as a result of uncontrolled sepsis. Her father was also affected, but less severely. A mutation in SCN9A has been reported in this family [3] (family 4, exon 5, c.647T [ C, p.F216S). Her symptoms, which have become more intense over time, could not be relieved by sympathectomy, lidocaine injection, or morphine, but they improved moderately when treated with oral mexiletine combined with ice applied to her legs. At the end of 2007, the mexiletine was replaced by a low dose of clonazepam and paracetamol because of continuing discomfort. Two months later, she became drowsy and mentally confused, presenting with auditory and visual hallucinations, deep psychomotor slowdown, and cerebellar ataxia without focal deficit or pyramidal syndrome. Hypothermia (31 C), hypoglycemia (3.65 mmol l), and hypercalcemia (2.66 mmol l) were observed. Despite our advice, she continued to use ice to reduce the pain. A cerebrospinal fluid analysis and the cerebral magnetic resonance imaging (MRI) examination did not reveal any abnormalities. However, the electroencephalography (EEG) showed aspecific encephalopathic features. Following admission to hospital, the patient was treated with a combination of risperidone, clonazepam, oral steroid, and mexiletine, which improved the erythermalgia, encephalopathic symptoms, and laboratory anomalies. The hypothermia disappeared. The combined drug treatment was stopped within a few days, but mexiletine therapy was continued. A clue to the pathogenesis of primary erythermalgia was first reported by Yang et al. [11] and then confirmed by Drenth et al. [3], both of whom identified mutations in SCN9A, which encodes the Nav1.7 sodium channel. These mutations, such as p.F216S [1], cause a hyperpolarizing shift in the voltage dependence of channel activation, which allows the channel to be activated by smaller than normal depolarizations. In humans, Nav1.7 channels are selectively expressed in the peripheral nervous system within the dorsal root ganglion and sympathetic ganglion neurons [4]. The hyperexcitability produced by these SCN9A mutations appears to account, at least in part, for the pain experienced by patients [4]. However, our patient also presented symptoms of encephalopathy, hypothermia, and hypoglycemia. To date, the pathomechanism of this erythermalgiaassociated encephalopathy remains obscure. Two cases of primary erythermalgia associated with encephalopathy have been reported previously [6, 9]. One of these [9] was very similar to ours: a 15-year-old boy who developed hypothermia, somnolence, and ataxic gait. However, in this case, the brain MRI revealed increased signal intensity in the splenium of the corpus callosum, which is in contrast to our normal MRI findings, although the EEG was very J. Seneschal A. Taieb Department of Dermatology and Pediatric Dermatology, Saint Andre and Pellegrin Hospitals, Bordeaux University Hospitals, 1 Rue Jean Burguet, 33000 Bordeaux, France e-mail: julien.seneschal@free.fr

Decreased number of Langerhans cells in basal cell carcinoma

Journal of the European Academy of Dermatology and VenereologyVolume 23, Issue 4 p. 471-473 Decreased number of Langerhans cells in basal cell carcinoma H Rotsztejn, Corresponding Author H Rotsztejn Section of Dermatology, Research Institute of the Polish Mother's Memorial Hospital, Lodz, Poland, Correspondence: H Rotsztejn. E-mail: [email protected]Search for more papers by this authorD Jesionek-Kupnicka, D Jesionek-Kupnicka Department of Tumor Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland,Search for more papers by this authorE Trznadel-Budźko, E Trznadel-Budźko Department of Dermatology and Pediatric Dermatology, Military-Medical Faculty, Medical University of Lodz, Lodz, PolandSearch for more papers by this author H Rotsztejn, Corresponding Author H Rotsztejn Section of Dermatology, Research Institute of the Polish Mother's Memorial Hospital, Lodz, Poland, Correspondence: H Rotsztejn. E-mail: [email protected]Search for more papers by this authorD Jesionek-Kupnicka, D Jesionek-Kupnicka Department of Tumor Pathology, Chair of Oncology, Medical University of Lodz, Lodz, Poland,Search for more papers by this authorE Trznadel-Budźko, E Trznadel-Budźko Department of Dermatology and Pediatric Dermatology, Military-Medical Faculty, Medical University of Lodz, Lodz, PolandSearch for more papers by this author First published: 17 March 2009 https://doi.org/10.1111/j.1468-3083.2008.02913.xCitations: 5 DOI: 10.1111/j.1468-3083.2008.02913.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume23, Issue4April 2009Pages 471-473 RelatedInformation

Picture of the Month—Quiz Case

A 15-YEAR-OLD HISPANIC BOY WITH A MEDIcal history of seborrheic dermatitis and mild facial acne was referred to the pediatric dermatology department for evaluation of “red-purple streaks” on his lumbosacral region. His pediatrician had referred him owing to concern of physical abuse by his parents; his case had been reported to the Department of Children and Families. The patient and his family denied trauma or physical abuse. On further questioning, it came out that he had a history of rapid vertical growth despite a negligible change in weight. Specifically, before his growth spurt, he was approximately 60% for height and 40% for weight; after his growth spurt, he was 85% for height and 50% for weight. On physical examination, the patient appeared thin with violaceous, atrophic, horizontal plaques of the lumbosacral region (Figure). All other physical examination findings were unremarkable. Author Affiliations: Departments of Pediatrics and Dermatology, University of Miami, Miami, Florida.

Bilateral Facial Capillary Malformation Associated With Eye and Brain Abnormalities

To establish whether the prognosis of bilateral facial capillary malformation (BFCM) is worse compared with that of unilateral facial port-wine stain. Retrospective study. Paediatric Dermatology Department, Great Ormond Street Hospital for Children NHS Trust, a tertiary referral center for vascular anomalies. A cohort of 350 children who presented with facial CM was seen between January 1, 1994, and June 30, 2004. Twenty-seven children with BFCM were identified. A control group of 27 children with unilateral CM was randomly selected from the total cohort. Demographic, clinical, and radiographic characteristics were recorded and compared between the 2 groups: age at presentation, sex, distribution, extension, extrafacial lesions, glaucoma, ipsilateral leptomeningeal angiomatosis, and epilepsy. The recorded information was collected from the database of the Paediatric Dermatology Department, the hospital records, and the patients' photographs. Compared with the 27 children with unilateral facial CM, the 27 with BFCM showed a higher frequency of association with extrafacial lesions (17 [63%] vs 6 [22%]), glaucoma (21 [78%] vs 2 [7%]), and ipsilateral leptomeningeal angiomatosis (14 [52%] vs 2 [7%]). All patients who had BFCM with bilateral and complete involvement of the ophthalmic area had ipsilateral leptomeningeal angiomatosis. Patients with BFCM must be considered as a group with a worse prognosis compared with patients with unilateral facial CM.

Human papillomavirus infections in children.

The human papillomavirus is a ubiquitous 55-nm DNA virus that causes a variety of clinical disease states in children, commonly referred to as warts. The natural history of warts is spontaneous regression through the development of a complex blend of cell-mediated and humoral immunity. Although spontaneous immunity can develop, as many as one third of children will have persistent human papillomavirus infection beyond 2 years. Therapeutic modalities are manifold, primarily because no therapy is universally effective. The purpose of this review is to update the reader with the latest information on the human papillomavirus and its therapeutics in children. Recently, encouraging research has been conducted in human papillomavirus, including destructive and immunologic therapies. Vaccines tailored to genital human papillomavirus strains are just coming into clinical use. Manipulation of the immune system through medications or vaccination will likely help contain human papillomavirus in the future and prevent secondary human papillomavirus oncogenesis of the skin and cervix.

Clinical study of 40 cases of incontinentia pigmenti.

To analyze the distribution of manifestations in a pediatric cohort and define guidelines for follow-up of incontinentia pigmenti (IP). Retrospective study of 47 children referred to the Department of Pediatric Dermatology with a diagnosis of IP between 1986 and 1999. The private or institutional practice of participating dermatologists and pediatricians. Evaluation of IP clinical diagnosis using the Landy and Donnai criteria. Because hyperpigmentation following the Blaschko lines may be observed in several pigmented disorders, 7 patients were found misdiagnosed. During the neonatal period, erythema, vesicles, and hyperkeratotic le sions were rarely absent in the patients with IP. Ocular and neurological abnormalities were frequent (20% and 30%, respectively) but rarely severe (8% and 7.5%, respectively). Clinical diagnosis is the first main step for a correct phenotype/genotype correlation, which remains indispensable to better understand the pathological mechanisms of IP and develop new therapies. In doubtful cases, molecular analysis is helpful but characteristic histological features must be added as major criteria for IP diagnosis. Multidisciplinary follow-up is needed, particularly during the first year of life, to detect possible ophthalmologic and neurological complications. Neuroimaging ought to be performed in the case of abnormal neurological examination results or when vascular retinopathy is detected.

Scalp ringworm in south-east London and an analysis of a cohort of patients from a paediatric dermatology department.

Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms. The aim of this paper is to present the detailed analysis of a cohort of 277 patients with tinea capitis seen during a 2-year period together with the latest local figures of tinea capitis cases from an inner city paediatric dermatology service. Methods Demographic, clinical and laboratory data were collected prospectively over 2 years from all cases of ringworm in patients seen in a paediatric clinic specially set up for scalp problems. Sixty-two per cent of 277 cases of scalp ringworm were caused by Trichophyton tonsurans, occurring mainly (91%) in patients with Afro-Caribbean hair type, more often in boys (68%), and in the 3-8 year olds (70%). Only 7% of the patients had received appropriate treatment with oral griseofulvin. An additional 156 cases from the general paediatric dermatology clinic showed 91%T. tonsurans infections. The prevalence of scalp ringworm appears to be reaching epidemic proportions in certain areas that include south-east London. The clinical problem is not yet well recognized by local general practitioners.