Mycosis fungoides in pediatric patients: Clinical features, diagnostic challenges, and advances in therapeutic management

Mycosis fungoides (MF) is the most common primary cutaneous lymphoma in pediatric patients. Given the indolent nature of MF, symptoms often present in childhood but may not be diagnosed as MF until adulthood. Delayed diagnosis is associated with poor long-term prognosis. Thus, increased clinician recognition and accurate diagnosis of early-stage MF in pediatric patients is critically important. In this review, we summarize the clinical features of the most common pediatric MF subtypes and highlight important differences between pediatric and adult MF. Moreover, we reviewed all pediatric MF case series published between 2008 and 2018 to analyze treatment modalities and identify emerging therapies. As treatment of pediatric MF is complex, selection of therapy varies significantly depending upon the specific clinical characteristics, disease severity, and patients' preferences.

Comorbidities in Mycosis Fungoides and Racial Differences in Co-Existent Lymphomatoid Papulosis: A Cross-Sectional Study of 580 Patients in an Urban Tertiary Care Center

Background: Mycosis fungoides (MF) is a cutaneous T-cell lymphoma. Previous reports have suggested MF is associated with inflammatory conditions such as psoriasis, increased cardiovascular risk factors as well as secondary neoplasms. Methods: A cross-sectional study of MF patients seen from 2013 to 2019 was performed. Comorbidities were selected based on the 2015 Medicare report highlighting the most common chronic medical illnesses in the United States. Lifetime comorbidity occurrence in patients with MF were compared with that in patients with atopic dermatitis, psoriasis and patients without MF. Additional analyses were performed with patients sub-stratified by race. Results: Compared to control groups, MF was strongly associated with lymphomatoid papulosis and Hodgkin's disease, but not significantly associated with lung, breast or colon cancer. Interestingly, the association with lymphomatoid papulosis was observed in Caucasians (CI 1062-4338; p < 0.001) and not African Americans (p = 0.9). Patients with MF had a greater association with congestive heart failure, hypertension (HT) and hyperlipidemia (HLD) compared with the general population. However, they were significantly less likely to have HT and HLD when compared with psoriasis patients (HT CI: 0.6-0.9; p < 0.001, and HLD CI: 0.05-0.07; p < 0.001). MF patients were also significantly less likely to have concomitant vitamin D deficiency compared with atopic dermatitis (AD) and psoriasis (p < 0.001). Conclusions: Our results suggest that the association of MF with lymphomatoid papulosis varies by race. Compared to the general population, hypertension and hyperlipidemia were positively associated with MF, however, these were significantly less likely on comparison to psoriasis. Unlike previously described, vitamin D deficiency was found to be significantly less in patients with MF.

Regression of cutaneous invasive squamous cell carcinoma in a patient with chronic cutaneous graft versus host disease

Numerous complications can be observed in the post-transplant period among recipients of hematopoietic stem cells including graft-versus-host disease (GVHD), which is associated with significant morbidity and mortality. On the other hand, graft versus tumor (GVT) effect is a well-described phenomenon in patients with hematologic malignancies and has also been reported in renal cell cancer, ovarian cancer, breast carcinoma, and melanoma. We describe spontaneous regression of a cutaneous invasive squamous cell carcinoma and multifocal atypical intraepidermal proliferations in a patient with chronic graft-versus-host disease following initiation of extracorporeal photopheresis (ECP). This observation raises questions regarding the GVT in cutaneous neoplasms and potential immunomodulatory effects of ECP.

Frigipoint: a new cryosurgical instrument

Frigipoint, a new handheld dipstick cryoprobe, will be introduced. This apparatus has three components: (1) a thermal conductive housing chamber (reservoir) tapered to tips with diameters of 2-10 mm (applicator); (2) a cryogen absorbent member within the housing chamber; and (3) a low-thermal conductivity handle, which is threaded onto the housing chamber. Laboratory experiments employing a gelatin medium showed that the delivery of the cryogen is uniform over the area of application, producing a flat-bottom ice ball. In animal studies, liquid nitrogen spray produced greater depth of destruction and inflammation than Frigipoint. In preliminary clinical studies, 68 lesions, including actinic keratosis, molluscum contagiosum, verruca plana, solar lentigo, seborrheic keratosis, and verruca vulgaris, were treated in 16 patients. All but one resolved after cryosurgery with Frigipoint. Frigipoint is an effective, safe, and easily portable cryosurgical instrument that has a wide spectrum of dermatologic applications. It provides efficient, well-controlled focal cryosurgical treatment of multiple lesions with one immersion of the probe in liquid nitrogen. In addition, its simple operation is met with high patient and physician acceptance.

Management of congenital nevocytic nevi: a survey of current practices

Questionnaires were sent to the chairmen of 105 dermatology training programs and to sixty practicing dermatologists (randomly chosen from the American Academy of Dermatology directory) in order to identify current practices regarding the management of congenital nevocytic nevi. The return rate was 45.7% and 43.3%, respectively. A clear majority of dermatologists both in private practice and in academia recommend the removal of giant- and medium-sized congenital nevocytic nevi. There is less agreement among dermatologists with regard to the treatment of smaller lesions.

White superficial onychomycosis caused by Trichophyton rubrum

A patient with T. rubrum WSO is reported. The presence of this pathogen, a rare cause of this condition, can be confirmed by examination of smears and cultures taken from scrapings of the white spots on the nail plate.

Urinary tract infection in infants with unexplained fever: a collaborative study

Nine centers collaborated to determine the rate of urinary tract infection in infants with unexplained fever, to determine whether the rate is higher in febrile infants than in asymptomatic infants, and whether the yield justifies urine cultures in febrile infants. Urine cultures were done in 501 infants 0 to 2 years of age. The rate of confirmed urinary tract infections in the 193 febrile infants was 4.1%. All infections were in girls, with a rate of 7.4%. The rate of confirmed urinary tract infections in the 312 asymptomatic infants was 0.3%; again, all infections were in girls, with a rate of 0.7%. The rate in febrile girls was significantly higher than the rate in asymptomatic girls (P less than 0.01). The data support the advisability of culturing the urine of infant girls with unexplained fever.

Benign chronic bullous dermatosis of childhood: a review

Chronic bullous dermatosis of childhood is one of the nonhereditary blistering diseases of children. Clinically, it is characterized by predominantly monomorphous, large tense bullae, which often form a "rosette pattern" or "jewel-like" clustering and have a predilection for the lower trunk, pelvic region, and lower extremities. Histologically, a subepidermal blister is seen, which is indistinguishable from either bullous pemphigoid or dermatitis herpetiformis. Although usually responsive to sulfone therapy, some cases require the combination of sulfones and systemic corticosteroids or corticosteroids alone to control the disease. Recent advances in immunologic techniques reveal: 1. a linear band of IgA at the dermal-epidermal junction on direct immunofluorescence that has been reported both in the lamina lucida and below the basal lamina on immunoelectron microscopy; 2. IgA antibasement membrane antibodies on indirect immunofluorescence; 3. normal jejunal biopsies; and 4. a high association with HLA-B8. It remains unclear whether chronic bullous dermatosis of childhood represents a separate disease entity or is merely a variant of dermatitis herpetiformis. Chronic bullous dermatosis of childhood also differs from linear IgA dermatosis of the adult in that the latter is not associated with HLA-B8, and thus should not be confused with this disease by similar nomenclature.