Australian Doctor Australian Doctor 24th November 2017 | Page 15

Paediatrics. Dr Vanessa Brooks

Paediatrics. Dr Vanessa Brooks

Is this lesion of concern?

THIS newborn baby was born at term by normal vaginal delivery after an uneventful pregnancy and with a normal morphology scan.
She was noted to have this lesion on
THE QUIZ her scalp immediately after birth. Dr Brooks is a general paediatrician at Adelaide Paediatrics and North Eastern Community Hospital in
Adelaide, SA.
Discussion The choice of drug should weigh the expectation of effect against side effects commensurate with the illness. The use of prednisone in this situation, while widely accepted and effective, is inappropriate and is not supported by the evidence or guidelines.
The risk of side effects at this dose is too high for mere symptomatic gain.
A list of all the known side effects of corticosteroids would be long indeed. Some are great: the infection risk is up to 10-fold at this dose; there is a 15 % risk of depression and 30 % of mania, either of which could be profound. 1, 2
The correct treatment would be to recommence methotrexate at 20mg weekly unless contraindicated. 3
This is entirely safe and effective, will have a

Sunface

App of the Week
ACCORDING to a study published in the Journal of Medical Internet Research, photo-ageing apps are a useful tool in convincing young people to consider the health risks of sun exposure and tanning beds.
Sunface— the app the researchers looked at— was released worldwide about a month before the study was published.
Users open it on their smartphone, take a selfie and pick a type of UV to recreate their face with the addition of skin damage from either natural sun or artificial tanning.
The results are lifelike and even teenagers, so notoriously cynical, reported in the study that the results seemed realistic – one of
disease modifying effect and is unlikely to present problems, but it does require careful monitoring.
In life-threatening presentations, a bolus of corticosteroid might be appropriate, but the evidence for this is anecdotal at best.
The dose used here was also excessive. Maximal anti-inflammatory effect can be obtained with 10-15mg daily. Prednisone is a weak disease modifier; the proof for methotrexate is considerable.
If prednisone where introduced onto the PBS today, it would come with great restrictions on its use, dose and maintenance.
Just because it has been available for use for 60 years does not make it less toxic or dangerous.
While Daphne did not suffer ill-effects, her case is a timely reminder of the importance of applying best evidence-based care where practicable. ● References on request.
the big reasons it could persuade them to look after the health of their skin.
Specifications
COST: Free COMPATIBLE WITH: IOS 8.0 or Android 4.0.3
Q. What is the diagnosis? a. Laceration from fetal scalp electrode. b. Herpes simplex. c. Aplasia cutis congenita. d. Sebaceous naevus. A. The answer is c. Aplasia cutis congenita is a condition is which there is congenital absence of skin, and in 70-85 % of cases it occurs at a single location on the scalp. The defect is usually 0.5-10cm. It can be superficial— involving only the epidermis, or deeper— involving the dermis, subcutaneous tissue and rarely the skull. In most cases it is an isolated finding, but it can be associated with a number of genetic syndromes and congenital abnormalities. The estimated incidence is between 1 and 3 in 10,000 live births.
Q. Where are most isolated lesions of aplasia cutis congenita
found? a. On the forehead. b. On or near the midline between the anterior and posterior fontanelles. c. On the lateral parietal scalp. d. In the pre-auricular region. A. The answer is b. The clinical presentation at birth can be variable, but most commonly presents as a solitary, hairless skin defect, on the scalp vertex. The lesions have a punchedout appearance, and may be covered with granulation tissue, or may be ulcerated, eroded or scar-like. More than 80 % are found on or near the midline, between the anterior and posterior fontanelles.
Q. What are the complications of aplasia cutis congenita? a. Arterial bleeding. b. Localised infection. c. Meningitis. d. All of the above.
A. The answer is d. Complications of aplasia cutis congenital are rare, but include bleeding, infection, meningitis, leakage of cerebrospinal fluid and sagittal sinus thrombosis. These complications are usually associated with large lesions that involve the bone and dura.
Q. What is the immediate treatment for the lesion shown in the photograph? a. No treatment. b. Antibiotics. c. Surgical repair. A. The answer is a. Conservative treatment is usually recommended for small lesions. The lesions usually heal spontaneously over weeks to months. Sometimes gentle cleansing, dressings or topical antibiotics are recommended to prevent infection. Larger lesions may need to be repaired surgically with grafting.
References on request.
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