Excellence in Pediatrics Conference 2015
Introduction and case report: Erythema multiforme (EM) is a rare, acute and self-limited condition, characterized by a hypersensitivity reaction to certain infections or medications. It presents with typical cutaneous lesions associated to mucous membrane involvement, within a wide spectrum of severity. We report a case of an 8 year-old girl with previous history of oral aphthous eruptions, hospitalized for pneumonia associated with respiratory distress and vomits, treated with iv ampicillin. On the 2nd day of hospitalization presented with swelling, blistering and ulcerations of oral mucosa progressing to epithelial necrosis, conjunctival hyperaemia progressively worsening, and skin macular, rounded, well-defined, target-like lesions on the face, abdomen and extensor surfaces of inferior limbs. One vesicle on genital area was also observed. Due to persistent fever and suspicion of atypical agent infection, ampicillin was replaced by clarithromycin, gradually improving the respiratory symptoms. Topical treatment of the oral and skin lesions was instituted, with regression of these in 3 weeks. Thereafter, she had several herpetic reactivations of the oral mucosa, with progressive decrease in severity and frequency, which were treated with oral valacyclovir. Laboratory tests showed: seroconversion to Mycoplasma pneumoniae 4 weeks after infection; positive HSV1 IgM and IgG and negative HSV2 IgM and IgG; negative RAST, prick and intradermoreaction tests for amoxicillin; negative pathergy test; negative primary immunodeficiency research.
Discussion: Of the three etiologic factors considered as a possible cause of EM in this case (Mycoplasma, HSV and amoxicillin), we admit that Mycoplasma infection is the most likely, regarding the clinical presentation and well documented seroconversion associated with the negative tests for amoxicillin hypersensitivity. A certain degree of immunosuppression caused by Mycoplasma infection could explain the herpes reactivations.
Hospital de Santarém, EPE, Portugal
Excellence in Pediatrics Conference 2015
Introduction: The use of certain topical oils for the prevention or treatment of baby dry skin or massage may affect skin barrier function. Adverse effects may contribute to the development of childhood atopic eczema. Prevalence of atopic eczema has increased substantially since the 1940s, which could be linked to environmental factors, including increased use of oils and other baby skincare products.
Purpose: Maternity service health professionals commonly recommend topical olive oil or sunflower oil to new parents for their newborn baby’s skin. Study aims included providing proof of concept that topical oils have some effect on baby skin barrier function, and data to inform optimal trial design.
Materials and Methods: A pilot, assessor-blinded, RCT was conducted. 115 healthy, full-term babies aged <72 hours were recruited at a large hospital in North West England between September 2013 and June 2014. Babies were randomly assigned to using topical olive oil, topical sunflower oil or no oil, twice a day for 4 weeks, stratified by family history of atopic eczema. Change in spectral profile of lipid lamellae, transepidermal water loss, stratum corneum hydration, skin surface pH and clinical observations were measured on the forearm, abdomen and thigh, within 72 hours, and at 4 weeks post-birth. Mothers completed weekly questionnaires to record skincare practices and medical treatments.
Results: Recruitment rate was 11.1%, with completion of 80%. Protocol adherence was 79-93%, 83-94% and 100% for olive oil, sunflower oil and no oil groups respectively. At 4 weeks lipid lamellae in both oil groups was significantly less ordered compared to the no oil group, suggesting that both oils impede development of lipid lamellae structures of the skin barrier from birth. Both oil groups had significantly improved hydration, with no significant differences for other parameters across groups.
Conclusions: Proof of concept was achieved. Novel baseline data and information on trial parameters and processes to guide future study design were obtained. Observational and mechanistic studies are recommended to examine the link between using topical oils from birth and the development of atopic eczema, prior to conducting a definitive RCT. This pilot study was not powered to detect clinical significance, but, findings suggest caution when recommending topical oils for term newborn skin.
1The University of Manchester, United Kingdom; 2The University of Sheffield, United Kingdom; 3Sidra Medical and Research Center, Doha Qatar