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Skin care in the newborn
Syrnposiurt~S2. Pediatric dertnatology
S6 Sl 5 El
Dermatoses from environmental chemicals
Margarida Gotqalo. Cl. Dertnatologia, Hospital Uttiversidade Coitttbra, Portugal Inhaled or ingested environmental chemicals or those absorbed through the skin can induce dermatoses like lupus erythematosus (LE), scleroderma (SCL), lichen plannus, vitiligo, bullous skin diseases, morbiliform or erythema multiforme-like eruptions. These immune mediated skin diseases, observed in graft-versus-host disease, were also described in the “toxic oil syndrome” due to ingestion of aniline contaminated rapeseed oil. Drugs or related products (hydralazine and tartrazine, a related food dye) can induce LE, airborne silica or ingested L-tryptophan can induce SCL, environmental toxics or drugs inhaled during manufacture can induce fixed drug eruption or toxic epidermal necrolysis. Chemicals (drugs, metals) or their reactive intermediate metabolites (epoxides) may interfere with the immune system and cause hypersensitive or autoimmune skin reactions in individuals susceptible due to their metabolising capacities (tit P450 polymorphism, acetylation phenotype) or HLA haplotype (HLA-DR3 and immune reactions to gold 1): Often, skin lesions ate the visible tip of a systemic environmental aggression and may be the alarming sign - chloracne from halogenated aromatic compounds, acrosclerosis from vinyl chloride and keratosis/skin cancers induced by arsenic or polycyclic aromatic hydrocarbons. In most dermatoses we have to carefully consider the environment interacting with our body, and in this way we may understand better many “idiopathic” skin diseases. ElSl 6 Contact dermatitis from chemicals and
products - Preventive measures
J.E. Wahlberg. Departtttent of Occupatiottal attd Envitotttttetttal Dertttatology! Katolittska Hospital attd National Institute for Workittg Life, Stockholttt, Swedeu Prophylactic measures against the occurrence and reoccurrence of contact dermatitis that a dermatologist can institute: identification of allergens and irritants, exposure conditions, concentrations, their removal, replacement, inactivation, predictive testing; identification of individuals with previous atopic or contact dermatitis; avoidance of contact (gloves, barrier creams, etc.); cleansing agents without allergens and with low irritant potential, moisturizers; legislation, labelling. information, training, pamphlets and videos are other means where an experienced dermatologist can contribute,
s2.
Pediatric dermatology
I S2-1 Skin care in the newborn J.F. Staider. Clinique Dertttatologique Hotel Dieu CHU Nantes, France The skin of the newborn is the first interface with the environment. Cleaning the baby’s skin does not merely contribute to the baby’s esthetic aspect but it also prevents external factors such as germs, humidity, soaking from affecting directly the child.
As a majority of dermatoses are connected with the child environment, a better understanding of hygenic products’ effects on the baby’s skin will be very useful to improve prevention. Therefore today’s substantial economic stakes in paediatric cosmetics must not prevent us from knowing the real clinical effects of the products on patients. Finally, to prevent the prematured child from infection is the main rule to apply, knowing the major risk of nosocomial infections in newborn intensive care units. I S2-2
Birthmarks and other developmental abnormalities
H. Hamm. Departtttettt of Dertttatology, Chriversity of Wiirzbutg, Genttatty Birthmarks may be divided in vascular, hyperpigmented, hypopigmented, and other lesions. Salmon patches over the nape and glabella are by far the most common vascular birthtttarks in whites. In contrast to them, unilateral port-wine stains do not tend to resolve spontaneously. Hemangiomas can be present at birth as well but have to be differentiated from the above lesions as rapid growth can be prevented by early pulsed-dye laser treatment or cryotherapy. Among hyperpigtnented birthmarks, cafe-au-lait macules, multiple lentigines, and epidermal nevi may serve as cutaneous clues to congenital syndromes, and large congenital melanocytic nevi have to be evaluated for neonatal curettage or dermabrasion. Hypopigtttented tttacules may enable early diagnosis of neurocutaneous disorders, such as tuberous sclerosis and Ito syndrome. Congenital absence of skin includes a heterogeneous group of disorders in which one or multiple localized or widespread areas of the skin, in particular the scalp, are absent or scarred at birth. Differential diagnosis includes iatrogenic injuries by forceps and scalp electrodes, encephalocele, meningocele, and nevus sebaceus. ElS2-3
Blaschko-linear skin lesions as a diagnostic clue in female carriers of the X-linked IFAP syndrome
A. K&rig. Departtnent of Dertnatology, Philipp Uttiversity, Marburg, Gertnatty Ichthyosis follicularis with atrichia and photophobia (IFAP) syndrome is so far considered to be an X-linked recessive trait. Affected boys have congenital hairlessness, generalized ichtbyotic skin changes and spiky follicular hyperkeratoses. We report a one-year-old boy suffering from this syndrome. The patient’s 2-year-old sister had linear atrophoderma and ichthyotic skin lesions that followed the lines of Blaschko. A huge bald patch was present on her scalp. The children’s mother had similar linear lesions of scaling and atrophy. Circumscribed bald patches were found on her scalp, in the axillary region, and on her lower legs. We conclude that women heterozygous for IFAP syndrome exhibit lesions reflecting functional X-chromosome mosaicism. The pattern of hairlessness and atrophoderma is similar to that described in various other X-linked gene “recessive” defects such as hypohidrotic epidermal dysplasia or Menkes syndrome.
S6 Sl 5 El
Dermatoses from environmental chemicals
Margarida Gotqalo. Cl. Dertnatologia, Hospital Uttiversidade Coitttbra, Portugal Inhaled or ingested environmental chemicals or those absorbed through the skin can induce dermatoses like lupus erythematosus (LE), scleroderma (SCL), lichen plannus, vitiligo, bullous skin diseases, morbiliform or erythema multiforme-like eruptions. These immune mediated skin diseases, observed in graft-versus-host disease, were also described in the “toxic oil syndrome” due to ingestion of aniline contaminated rapeseed oil. Drugs or related products (hydralazine and tartrazine, a related food dye) can induce LE, airborne silica or ingested L-tryptophan can induce SCL, environmental toxics or drugs inhaled during manufacture can induce fixed drug eruption or toxic epidermal necrolysis. Chemicals (drugs, metals) or their reactive intermediate metabolites (epoxides) may interfere with the immune system and cause hypersensitive or autoimmune skin reactions in individuals susceptible due to their metabolising capacities (tit P450 polymorphism, acetylation phenotype) or HLA haplotype (HLA-DR3 and immune reactions to gold 1): Often, skin lesions ate the visible tip of a systemic environmental aggression and may be the alarming sign - chloracne from halogenated aromatic compounds, acrosclerosis from vinyl chloride and keratosis/skin cancers induced by arsenic or polycyclic aromatic hydrocarbons. In most dermatoses we have to carefully consider the environment interacting with our body, and in this way we may understand better many “idiopathic” skin diseases. ElSl 6 Contact dermatitis from chemicals and
products - Preventive measures
J.E. Wahlberg. Departtttent of Occupatiottal attd Envitotttttetttal Dertttatology! Katolittska Hospital attd National Institute for Workittg Life, Stockholttt, Swedeu Prophylactic measures against the occurrence and reoccurrence of contact dermatitis that a dermatologist can institute: identification of allergens and irritants, exposure conditions, concentrations, their removal, replacement, inactivation, predictive testing; identification of individuals with previous atopic or contact dermatitis; avoidance of contact (gloves, barrier creams, etc.); cleansing agents without allergens and with low irritant potential, moisturizers; legislation, labelling. information, training, pamphlets and videos are other means where an experienced dermatologist can contribute,
s2.
Pediatric dermatology
I S2-1 Skin care in the newborn J.F. Staider. Clinique Dertttatologique Hotel Dieu CHU Nantes, France The skin of the newborn is the first interface with the environment. Cleaning the baby’s skin does not merely contribute to the baby’s esthetic aspect but it also prevents external factors such as germs, humidity, soaking from affecting directly the child.
As a majority of dermatoses are connected with the child environment, a better understanding of hygenic products’ effects on the baby’s skin will be very useful to improve prevention. Therefore today’s substantial economic stakes in paediatric cosmetics must not prevent us from knowing the real clinical effects of the products on patients. Finally, to prevent the prematured child from infection is the main rule to apply, knowing the major risk of nosocomial infections in newborn intensive care units. I S2-2
Birthmarks and other developmental abnormalities
H. Hamm. Departtttettt of Dertttatology, Chriversity of Wiirzbutg, Genttatty Birthmarks may be divided in vascular, hyperpigmented, hypopigmented, and other lesions. Salmon patches over the nape and glabella are by far the most common vascular birthtttarks in whites. In contrast to them, unilateral port-wine stains do not tend to resolve spontaneously. Hemangiomas can be present at birth as well but have to be differentiated from the above lesions as rapid growth can be prevented by early pulsed-dye laser treatment or cryotherapy. Among hyperpigtnented birthmarks, cafe-au-lait macules, multiple lentigines, and epidermal nevi may serve as cutaneous clues to congenital syndromes, and large congenital melanocytic nevi have to be evaluated for neonatal curettage or dermabrasion. Hypopigtttented tttacules may enable early diagnosis of neurocutaneous disorders, such as tuberous sclerosis and Ito syndrome. Congenital absence of skin includes a heterogeneous group of disorders in which one or multiple localized or widespread areas of the skin, in particular the scalp, are absent or scarred at birth. Differential diagnosis includes iatrogenic injuries by forceps and scalp electrodes, encephalocele, meningocele, and nevus sebaceus. ElS2-3
Blaschko-linear skin lesions as a diagnostic clue in female carriers of the X-linked IFAP syndrome
A. K&rig. Departtnent of Dertnatology, Philipp Uttiversity, Marburg, Gertnatty Ichthyosis follicularis with atrichia and photophobia (IFAP) syndrome is so far considered to be an X-linked recessive trait. Affected boys have congenital hairlessness, generalized ichtbyotic skin changes and spiky follicular hyperkeratoses. We report a one-year-old boy suffering from this syndrome. The patient’s 2-year-old sister had linear atrophoderma and ichthyotic skin lesions that followed the lines of Blaschko. A huge bald patch was present on her scalp. The children’s mother had similar linear lesions of scaling and atrophy. Circumscribed bald patches were found on her scalp, in the axillary region, and on her lower legs. We conclude that women heterozygous for IFAP syndrome exhibit lesions reflecting functional X-chromosome mosaicism. The pattern of hairlessness and atrophoderma is similar to that described in various other X-linked gene “recessive” defects such as hypohidrotic epidermal dysplasia or Menkes syndrome.