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- Presentation
Finding Solutions to Challenging Pediatric Dermatology Cases: Lessons Learned from the First 3 Years in Practice
Description
In this presentation, Shawn Reynolds shares key lessons learned from challenging pediatric dermatology cases during his first three years in practice. He emphasizes the humbling nature of dermatology, the importance of fellowship training, and the value of thorough literature searches when confronting difficult cases. The first case involved a nine-year-old boy with a complicated skin lesion initially misdiagnosed and exacerbated by non-accidental trauma. Despite multiple antibiotic treatments, the lesion worsened, ultimately revealing a diagnosis of anaplastic large cell lymphoma after extensive imaging and biopsies. The second case highlighted a six-year-old girl with subtle cutaneous features indicative of capillary malformation-arteriovenous malformation syndrome (CMAVM), confirmed by genetic testing. Reynolds discusses the importance of recognizing such conditions early to avoid severe complications. He also shares rapid-fire cases underscoring the necessity of literature review in diagnosis, including conditions like traumatic onychoheterotopia and a recently described entity called bascule, associated with postural orthostatic tachycardia syndrome (POTS). Throughout the discussion, Reynolds acknowledges mentors and colleagues who have contributed to his growth and success in solving complex pediatric dermatology cases.
View moreConclusions
- Dermatology can be humbling, as diagnoses may be challenging despite thorough effort.
- Fellowship training is crucial for ongoing professional development and practical application.
- Using literature and consulting with colleagues can significantly aid in resolving complex cases.
- Child abuse should be a consideration in cases of unexplained lesions, especially with a history of trauma.
- Biopsy is an essential diagnostic tool that should not be overlooked when lesions evolve or worsen.
- The Morel-Lavallee lesion is an important differential diagnosis in cases of soft tissue injury with necrosis.
- Anaplastic large cell lymphoma can present similarly to more common skin conditions but requires specific histological evaluation for accurate diagnosis.
- Genetic testing can be pivotal in diagnosing conditions like capillary malformation-arteriovenous malformation syndrome.
- Awareness of rare manifestations such as ONYCHOHETEROTOPIA emphasizes the importance of comprehensive investigation and treatment.
- Collaboration with various specialties including surgery, pathology, and infectious disease is critical in managing pediatric dermatology cases effectively.
- Zamorano et al. Journal of the American Academy of Orthopaedic Surgeons 2016
- Braun M, Reynolds S, Shah SD. Posttraumatic onychoheterotopia: A case and review of the pediatric literature. Pediatr Dermatol. 2021 Sep;38(5):1272-1275. doi: 10.1111/pde.14702. Epub 2021 Aug 2.
- Dekeuleneer et al. Pediatric Dermatology 2020