21/32. Diaper area granuloma of the aged. Nine women, aged 77 to 89 years, suffered from diaper dermatitis, and many granulomas were seen in the genital or gluteal region restricted to the lesion of dermatitis. Because these granulomas resembled granuloma gluteale infantum of Tappeiner and Pfleger, we propose to call this condition diaper area granuloma of the aged. ( info) |
22/32. Fournier's syndrome. Report of three cases and review of the literature. Three children, aged 9 days, 3 weeks, and 9 1/2 months, were treated for Fournier's syndrome. The portals of entry for a miscellaneous group of pathogens included a circumcision in the first, a circumcision and a diaper rash in the second, and a hot water burn in the third. The development of the condition after a circumcision is noteworthy because it is an extremely common surgical procedure. Medical and minor surgical treatment of the gangrenous areas during the period of rapid healing was successful. This approach contrasts with those researchers who recommend grafts. All three children survived, although one died three years later of complications from the original burn, and in another, one testicle could not be palpated after healing. ( info) |
23/32. Diaper dermatitis with psoriasiform id eruption. Diaper dermatitis with psoriasiform id eruption has a distinct clinical presentation. Its etiology and relationship to psoriasis remain uncertain. Previous reports have shown histologic features of subacute to chronic dermatitis. Two cases are presented in which a biopsy of secondary lesions showed features characteristic of psoriasis. It is possible that such cases represent those patients with a psoriatic diathesis. ( info) |
24/32. Metabolic alkalosis secondary to baking soda treatment of a diaper rash. A 4-month-old infant was seen with hypokalemic metabolic alkalosis that was associated with prior application of liberal amounts of sodium bicarbonate (baking soda) to a diaper rash. After exclusion of other etiologies of the infant's acid-base disturbance, a complete resolution occurred following discontinuation of the baking soda applications. This case report provides a reminder of the significant side effects that may result from the excessive use of a seemingly harmless household substance. ( info) |
25/32. granuloma gluteale infantum. An infant had a persistent ulcerative nodular diaper dermatitis with negative laboratory findings for pathogens. With bland therapy and avoidance of powdering, the lesions cleared. This reaction was considered, without proof, to be granuloma gluteale infantum. This condition should be considered in the differential diagnosis of the various types of diaper dermatitis. This reaction may also occur in the incontinent elderly. ( info) |
26/32. Perianal pseudoverrucous papules and nodules after surgery for hirschsprung disease. We report two patients with hirschsprung disease in whom severe diarrhea and a distinctive diaper dermatitis developed after delayed ileoanal anastomosis. The perianal papulonodular lesions cleared in months or years without specific treatment after resolution of the diarrhea. These perianal pseudoverrucous papules and nodules represent a peculiar form of primary irritant diaper dermatitis, distinct from Jacquet erosive diaper dermatitis and granuloma gluteale infantum. ( info) |
27/32. methemoglobinemia induced by an over-the-counter medication. OBJECTIVE: To report a case of methemoglobinemia induced by benzocaine and resorcinol (Vagisil) cream, an over-the-counter medication that was used to treat diaper rash in a neonate. CASE REPORT: A 6-day-old, 3350-g white boy was found to be cyanotic with blue mucous membranes on presentation. He had a diaper rash that was red and irritated, which his mother had treated with Vagisil cream. methemoglobinemia secondary to absorption of benzocaine and resorcinol (1,3-benzenediol) from the Vagisil was diagnosed, with a methemoglobin level of 35% on admission (normal 0.4-1.5). Intravenous methylene blue 3 mg (1 mg/kg) was given; the neonate's skin color returned to normal 45 minutes after the dose. DISCUSSION: methemoglobinemia is a condition in which hemoglobin is oxidized to the ferric form. Oxidized hemoglobin, methemoglobin, is incapable of reversibly binding oxygen at the physiologic partial oxygen pressure. Main causes of methemoglobin formation are exposure to certain oxidizing agents and drugs, deficiency of one of the enzymes necessary for reduction of methemoglobin to hemoglobin, or the presence of an abnormal hemoglobin resistant to reduction. Clinical manifestations of methemoglobinemia include diffuse slate-gray cyanosis with low oxygen saturation in the absence of respiratory distress. A single intravenous dose of methylene blue 1-2 mg/kg is the treatment of choice. CONCLUSIONS: Newborn infants are at increased risk for methemoglobinemia due to diminished enzyme systems required to reduce ferrihemoglobin to ferrohemoglobin, as well as because fetal hemoglobin is more easily oxidized than is adult hemoglobin. It is important to recognize possible drug reactions and educate parents on the potential risks of treatment with over-the-counter medications, especially in neonates. ( info) |
28/32. granuloma gluteale infantum. granuloma gluteale infantum is an uncommon disorder, the pathogenesis of which remains unclear. Occlusion is a common factor and irritant napkin dermatitis is a frequent association. A six month old female infant with mild napkin dermatitis treated only with a dusting powder is presented. ( info) |
| We report 14 infants younger than 2 years of age with psoriasis vulgaris in order to call attention to the existence of infantile psoriasis. Three of the patients were noted to have psoriasis in the neonatal period; the onset may have been prenatal in one. In 13 of the 14 patients the site of onset was determined by the isomorphic effect (Kobners phenomenon). Although nail pitting is usually said to be infrequent in childhood psoriasis, 11 (79%) of our patients had typical psoriatic nail changes. psoriasis must be considered in the differential diagnosis of papulosquamous disorders in infants. ( info) |
| In this article, the author presents an overview of normal skin and a description of perineal skin injury. The focus is to identify the goals for treatment for persons with frequent diarrhea or fecal incontinence as it relates to their perineal skin care. Specific algorithms for acute care and ambulatory settings are defined, and two case studies are presented. The treatment goals include evaluation of and recommendations for reviewing and choosing perineal skin products. ( info) |