LAS VEGAS — As a pediatric dermatologist, Dr. Fred Ghali is often faced with worrisome hemangiomas, grim genetic dermatoses, or serious drug eruptions, so he relishes being able to say to a family: “No worries.”
Such is the case with three common but sometimes unrecognized diagnoses presenting to his practice in Grapevine, Tex. He spoke about the following conditions at a dermatology seminar sponsored by Skin Disease Education Foundation:
▸ Pseudo acne. Most parents recognize children are maturing earlier these days, but they still panic when they see what they think is acne developing in their 5- or 6-year-old. The white papules on a young child's nose are likely “pseudo acne,” small milia created when a child constantly rubs his or her nose, often in response to nasal allergies. If these miniature epidermal cysts rupture, they may take on an inflammatory appearance resembling acne. Less nose-rubbing will help, and topical comedolytics and antibiotics may be prescribed if necessary.
▸ Striking striae. These deep, dark, horizontal marks lining the back of 13- or 14-year-old boys, usually “[white] children who are extremely skinny,” appear as welt-like striations. Dr. Ghali first theorized that the bands of discoloration might be caused by carrying heavy backpacks or doing wacky skateboard maneuvers. However, adolescents with this condition “have lots of vertical growth over a short period of time,” he said. The striae tend to fade over time and resolve far better than striae of pregnancy. No treatment is needed.
▸ Retention keratosis. Darkly pigmented, nonpruritic regions in the flexural areas of a child's neck or underarm might point to a diagnosis of acanthosis nigricans, but in a child of normal weight, with no other signs of metabolic illness, this condition is easily dispensed with. “Just walk in with a little bit of alcohol and wipe it off. You can look like a hero,” said Dr. Ghali. The condition is common in young children.
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