Clinical images: Paediatric problems

Dermatitis, alopecia and molluscum contagiosum. By Dr Philip Marazzi

Alopecia

This is the scalp of a 12-year-old boy who was troubled by significant psychological problems. One of his abnormal responses was to pull out his hair, producing this area of traction alopecia. In spite of advice to stop pulling at his hair, he could not do so, until eventually he managed to obtain psychological help and break this behaviour cycle, allowing his hair to regrow.


 

Dermatitis

This thumb-sucker has a history of atopic dermatitis. The constant moisture on the skin produced a progressively deteriorating eczema of the thumb. It took considerable effort to stop him sucking his thumb. This, along with the use of emollients and topical steroids, allowed his skin to settle down.


Gynaecomastia

This two-year-old girl started to develop gynaecomastia. She was investigated with blood tests and an MRI looking for pituitary pathology, but none was found. The diagnosis was central precocious puberty. She also appeared to demonstrate cyclical monthly mood changes. Treatment is aimed at suppressing the excessive hormonal activity. She is now being treated with regular injections of triptorelin. This was initially at three-monthly intervals, but has been increased to 10-weekly intervals.


 

Overriding toes

This young girl has a symmetrical abnormality of both feet, with overriding of her second toes. She had no pain, but her mother was concerned about her future foot development. The child was referred for physiotherapy and had some orthotics made. This has virtually solved the problem over a period of a few months.


 

Plagiocephaly

This little boy was a forceps delivery and had a rather asymmetrical skull. This is a common problem, which is always rather alarming to the family. His parents arranged for him to wear a special type of corrective helmet, which helped to mould his head back into a completely normal shape by the age of two years. There were no associated neurological problems.


 

Molluscum contagiosum

Although extremely common, many parents do not recognise, or have never heard of, this viral infection. Caused by a pox virus, it produces these characteristically shaped lesions which, like warts, will eventually disappear on their own. A variety of treatments are available, ranging from the use of an orange stick dipped in phenol to the application of various herbal and homeopathic remedies, although most are ineffective.


 

Brugada syndrome

This 11-year-old patient collapsed and lost consciousness. It was unclear why and he was referred to paediatricians and subsequently to a paediatric cardiologist. The child had various investigations, including cardiac catheterisation. This image shows the device, which was subsequently implanted to diagnose his dysrhythmia. He was found to have sinus arrest and thought to have a variation of Brugada syndrome, a potential genetic cause of sudden death. The patient had a pacemaker implanted and has had no further problems. His family are being investigated in case they are also affected.

  • Dr Marazzi is a GP in East Horsley, Surrey

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