Bari B. Cunningham

Infantile myofibromatosis (IM) is a nonmetastasizing locally invasive neoplasm. The behavior of the tumor is more hamartomatous than tumoral, and it is unclear whether the cell of origin is a fibroblast or a smooth muscle myocyte. Lesions typically present during infancy and range in size from a few millimeters to several centimeters. We present an unusual case of a patient with an atrophic variant of IM.

Research from JAMA Dermatology — General Anesthesia for Pediatric Dermatologic Procedures — Risks and Complications

Abstract:  Infantile acne is a rare occurrence. It is more common in boys and predominately occurs on the cheeks in infants between the ages of 1 and 16 months. Clinically, the lesions range from comedones to inflammatory papulopustules to cysts. Successful therapies include topical tretinoin, benzoyl peroxide and topical and oral erythromycin. For more serious cases, oral isotretinoin (Accutane) has been reported to successfully treat recalcitrant infantile cystic acne. We describe two additional patients with infantile cystic acne treated successfully with oral isotretinoin. The dose of isotretinoin used ranged from 0.2 mg/kg/day to 1.5 mg/kg/day. The treatment duration varied from 5 to 14 months. Careful monthly monitoring is recommended because of the many side effects reported with isotretinoin. Practical tips for the administration of oral isotretinoin in infants are reviewed.

Dyskeratosis congenita is a rare, progressive, degenerative disorder characterized by cutaneous and mucosal involvement in the first decade of life with malignant changes and bone marrow failure in the second and third decades. The primary inheritance pattern is X-linked recessive, with the majority of cases presenting in boys. We report dyskeratosis congenita in an adolescent girl with choanal atresia, a previously unreported association.

THE CYANOACRYLATE group of tissue adhesives has been studied for use in surgical procedures for over 40 years.^1,2 These adhesives work by polymerizing in an exothermic reaction when contacting a fluid or basic medium, thereby forming a strong bond when applied to moist skin. For a number of years, the first widely used variety, N-butyl-2-cyanoacrylate, has been used safely throughout countries other than the United States.² This particular adhesive is significantly less strong than conventional monofilament sutures and is not particularly flexible.^3,4 More recently, a new tissue adhesive designed to address the limitations of the butyl-2-cyanoacrylate group, 2-octyl cyanoacrylate (Dermabond; Ethicon Inc, Norwood, Mass), has been approved by the Food and Drug Administration. Along with increased flexibility, 2-octyl cyanoacrylate has 4 times the breaking strength of N-buytl-2-cyanoacrylate, and it may therefore be indicated for use on a wider variety of wound types.⁵ In the United States, it is currently being used on children for the repair of lacerations, most often in the emergency department setting. Tissue adhesive is less time-consuming to apply than suture, leading to shorter, more efficient patient encounters with less need for nursing, monitoring, and sedation, resulting in lower costs to deliver care. In large studies, N-butyl-2-cyanoacrylate–repaired laceration wounds have been judged comparable to suture-repaired wounds in cosmetic outcome.^6-8 In large studies, octyl cyanoacrylate has been shown to be a good alternative to conventional sutures for use on selected lacerations and incisions in both children and adults. Studies have taken place primarily in the emergency department, where octyl cyanoacrylate has been used primarily in elective head and neck procedures.^9-11 To date, there have been no formal reports on the use of this tissue adhesive for the closure of excisional wounds in children. We compared the cosmetic outcome and complication rates of cutaneous excisional biopsy wounds closed using tissue adhesive with those closed using conventional monofilament sutures.