Pediatric Dermatology

Port Wine Stains

Port-wine stains (nevus flammeus) are malformations of tiny blood vessels located in the upper levels of the skin. These irregularly shaped patches range in color from light pink to red to dark red-violet and may become nodular and darken with age. Port-wine stains, usually located on the neck, face, and scalp, occur in about 0.5% of newborns. The gold standard for treatment is Hughes Dermatology's 585nm pulsed dye laser (Cynosure Photogenica V) which is FDA-approved for use in newborns. We use topical anesthesia in conjunction with forced cold air anesthesia (Zimmer Cryo 5) for comfort and safety. We have decade of experience! New: Our long-pulsed Nd:YAG laser (Lyra-i) effectively treats older, nodular, darker port wine stains. It is easiest to treat a port wine stain shortly after birth, so bring in your child for evaluation by Dr.Hughes or Dr. Tichy right away!

Port Wine Stain Removal - Pulsed Dye Laser Cynosure Photogencia V

Hemangiomas

These are benign tumors of the vascular endothelium. Hemangiomas of infancy are the most common type of hemangiomas, characterized by rapid growth in early infancy, followed by slow involution of some over the next decade. They may threaten vision or the respiratory system. In most cases, lesions become evident after birth, usually within the second to fourth weeks of life. Hemangiomas may be treated with the 585nm pulsed dye laser (if thin), or, if thicker, with the long-pulsed Nd:YAG laser, intralesional coticosteroids, systemic steroids (if vision or the respiratory system are threatened) or, more recently, the topical immune response modifier, imiquimod (Aldara). Thinner hemangiomas respond best to treatment, so early therapy is generally best.

The latest breakthrough: propanolol orally triggers resolution of serious infantile hemangiomas (New England Journal of Medicine, June 2008)!

Warts and Molluscum Contagiosum

Warts are benign tumors that commonly involve the skin and other epithelial tissues. The etiologic agent for these infections is a double-stranded DNA virus called human papillomavirus. Warts are generally classified by their clinical features and morphology (e.g., common, flat, filiform) or by location (e.g., genital, plantar, respiratory papillomatosis). The wart on this patient's finger was successfully treated by injection immunotherapy, which is a new nonscarring method. Molluscum contagiosum is another DNA viral-induced contagious tumor.

Treatment

These can be treated with immunotherapy (injecting antigens or using Aldara cream topically), chemically with anti-viral agents (eg. glutaraldehyde, 5-fluorouracil), with liquid nitrogen or with laser therapy. Pulsed dye laser therapy for molluscum contagiosum was first described and published by Hughes Dermatology and is the treatment of choice for multiple lesions in a cooperative patient (Dermatologic Surgery, 1998).

New: With the 2006 FDA approval of the HPV vaccine (Merck's "Gardisil" vaccine), some warts will be a thing of the past in the immunized population. The vaccine contains types 6/11 (which cause genital warts) and 16/18 (the cervical cancer oncogenic viruses).

Pediatric Mole Management

If a mole is abnormal according to the ABCD rule, it should be examined by Dr. Hughes or Dr. Tichy with a dermatoscope. If it is irregular under the dermatoscope, it should be biopsied. Usually this can be done via a cosmetically elegant shave or punch biopsy right at the time of the initial visit. Hughes Dermatology recommends annual whole body skin cancer checks in order to identify a malignant melanoma at an early and curable stage. If a mole is malignant (malignant melanoma) prompt surgical excision is done in our office surgery suite.

Infantile Eczema

The terms eczema or dermatitis describe inflammatory skin conditions that include allergic contact dermatitis and nummular dermatitis. Eczema presents with red, blistered, oozing, scaly, brown, or thickened skin and usually itches severely. A special type is called atopic dermatitis or atopic eczema. Hughes Dermatology can successfully diagnose and treat this miserable malady.

Treatment options for Eczema