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  • Presentation

Pediatric Dermatology M&M

Description

The Pediatric Dermatology M&M session discussed several cases focusing on specific dermatological conditions and their management. The first case involved a patient diagnosed with Henoch-Schönlein purpura after presenting with a rash, abdominal pain, and edema. The diagnosis was confirmed through biopsy and direct immunofluorescence, leading to treatment with corticosteroids and immunosuppressive agents due to renal involvement. The second case featured a 13-year-old girl who developed Stevens-Johnson syndrome (SJS) following a drug reaction to Bactrim, marked by mucositis and skin lesions. Early recognition and treatment with cyclosporine resulted in improvement. Another case involved a 9-year-old patient with a scalp lesion initially thought to be melanoma but later diagnosed as an atypical Spitz nevus with a BAP1 mutation, leading to close monitoring after excision. The final case was an 8-year-old with a Spitz neoplasm that showed aggressive growth but was ultimately confirmed as a Spitz melanoma. The discussion highlighted variability in diagnoses and the importance of re-evaluation and genetic testing, emphasizing the generally favorable prognosis of Spitz nevi and atypical Spitz lesions.

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Conclusions

  • Recognition and early monitoring of Henoch-Schönlein purpura is essential to prevent long-term renal complications.
  • Supportive treatment is effective for mild forms of Henoch-Schönlein purpura while moderate to severe cases may require corticosteroids and immunosuppressants.
  • A significant subset of pediatric patients with Stevens-Johnson syndrome (SJS) may present with drug eruptions that require prompt diagnosis and management.
  • The introduction of cyclosporine as a treatment option for SJS may improve patient outcomes and warrant further research.
  • There is a need for rapid intervention in cases of SJS to halt the progression of the disease and improve recovery rates.
  • Atypical Spitz nevus can exhibit mutations that may influence management strategies and consultations with genetics specialists may be advisable.
  • Spitz nevi generally exhibit favorable outcomes, reducing the need for aggressive treatment, particularly in benign cases.
  • Sentinel lymph node biopsies are typically not necessary for atypical Spitz lesions due to their favorable prognosis.
  • Trapani S, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005
  • Gómez, Silvia et al. "Henoch-Schonlein purpura in pediatrics: Ten years of experience at a moderate risk office of a general hospital. Archivos argentinos de pediatria vol. 118,1 (2020): 31-37.
  • Cheng L. Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Pharmacol. 2021;12:588063
  • Ramien M, Goldman JL. Pediatric SJS-TEN: Where are we now? F1000Res. 2020 Aug 13;9:F1000 Faculty Rev-982
  • Derek Y. Hsu, BA,a Joaquin Brieva, MD,a Nanette B. Silverberg, MD,d Amy S. Paller, MD, MS,a,b and Jonathan I. Silverberg, MD, PhD, MPHa,c. J Am Acad Dermatol 2017;76:811-7.
  • Luo, S., Sepehr, A., & Tsao, H. (2011). Spitz nevi and other Spitzoid lesions. Journal of the American Academy of Dermatology, 65(6), 1073-1084.
  • Kapur, P., Selim, M., Roy, L. et al. Spitz nevi and atypical Spitz nevi/tumors: a histologic and immunohistochemical analysis. Mod Pathol 18, 197-204 (2005). https://doi.org/10.1038/modpathol.3800281
  • Raghavan SS, et al. Spitz melanoma is a distinct subset of spitzoid melanoma. Mod Pathol. 2020 Jun;33(6):1122-1134.
  • Bartenstein D W, et al. Clinical features and outcomes of spitzoid proliferations in children and adolescents. Br J Dermatol. 2019 Aug;181(2):366-372. doi: 10.1111/bjd.17450. Epub 2019 Feb 10.
  • Mazza M, Cavallin F, Galasso E, Del Fiore P, Cappellesso R, Cassalia F, Tropea S, Russo I, Alaibac M. Sentinel Lymph Node Biopsy in Atypical Spitz Tumor: A Systematic Review. J Clin Med. 2024 May 30;13(11):3232. doi: 10.3390/jcm13113232.