Latanya Benjamin, MD, FAAD, FAAP

Ichthyosis Scoring System (ISS) is a standard for Ichthyosis severity analysis with high inter- and intra- rater reliability. We have found it to be a reliable measure of global and regional ichthyosis severity during in-person evaluations at the 2022 F.I.R.S.T. Conference

Topical and systemic retinoids are often used long term for the treatment of ichthyoses and other disorders of cornification. The Pediatric Dermatology Research Alliance Use of Retinoids in Ichthyosis Work Group was formed to address the numerous clinical concerns with the use of these medications in children and adolescents and to establish best practices regarding the use of retinoids. A consensus was achieved using the Delphi process, with recommendations based on the best available evidence… Show more

Topical and systemic retinoids are often used long term for the treatment of ichthyoses and other disorders of cornification. The Pediatric Dermatology Research Alliance Use of Retinoids in Ichthyosis Work Group was formed to address the numerous clinical concerns with the use of these medications in children and adolescents and to establish best practices regarding the use of retinoids. A consensus was achieved using the Delphi process, with recommendations based on the best available evidence and expert opinion. Show less

Photodocumentation is an important tool utilized across medical specialties and plays an especially pivotal role in dermatology given the visual nature of the field. Although it has been well-established that dermatologic diseases manifest differently in dark skin compared to light skin, there is under-representation of images of dark skin in dermatology textbooks and other educational resources. It is essential for dermatologists to work toward increasing the availability of images of… Show more

Photodocumentation is an important tool utilized across medical specialties and plays an especially pivotal role in dermatology given the visual nature of the field. Although it has been well-established that dermatologic diseases manifest differently in dark skin compared to light skin, there is under-representation of images of dark skin in dermatology textbooks and other educational resources. It is essential for dermatologists to work toward increasing the availability of images of dermatologic disease in dark skin by improving their own ability to successfully photograph dark-skinned patients. In this article, we describe our nuanced approach to photographing skin of color in regards to the ideal background type, lighting, and camera settings. Show less

Group members composed of academic pediatric dermatologists with teaching responsibilities including skin of color topics for dermatology residents and medical students. Learning objectives were developed for an educational lecture on basic science, and clinical conditions affecting PSOC were grouped by age-infantile, pediatric, and adolescent skin conditions affecting the PSOC population were identified for inclusion with rank score based on specific parameters including greater frequency in… Show more

Group members composed of academic pediatric dermatologists with teaching responsibilities including skin of color topics for dermatology residents and medical students. Learning objectives were developed for an educational lecture on basic science, and clinical conditions affecting PSOC were grouped by age-infantile, pediatric, and adolescent skin conditions affecting the PSOC population were identified for inclusion with rank score based on specific parameters including greater frequency in skin of color, nuances in skin of color, and need for medical workup. Show less

In 2020, PeDRA formed an Equity, Diversity, and Inclusion Task Force to address its current and future operational efforts to diversify the pediatric dermatology workforce. A review of PeDRA's membership, leadership, grant awardees, and research topics was conducted. As a training pipeline for future pediatric dermatologists and steward of research in the field, recommendations are proposed as a call to action for the community.

An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics.

The Pediatric Dermatology Research Alliance (PeDRA) Use of Retinoids in Ichthyosis Work Group was formed to address these issues and to establish best practices regarding the use of retinoids in ichthyoses based on available evidence and expert opinion.

Results from an expert panel were summarized and discussed to provide updated recommendations for the treatment and maintenance of AD.

An expert panel of pediatric dermatologists and dermatologists discussed information from systematic literature searches, coupled with expert opinion and experience of the panel, to adopt eight statements. Taking into consideration the maturation process of neonatal and infant skin, the application of moisturizers and cleansers containing barrier lipids may help maintain the protective skin barrier and soothe with long-term moisturizing benefits.

An expert group of panel members reached unanimous consensus on seven statements addressing the various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; mid-childhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls.

Thirteen consensus statements were developed addressing clinical challenges, existing treatment options and their limitations, and new therapeutic alternatives for the most common bacterial infection in children.

Dry skin conditions during infancy may predict the subsequent development of AD. Parental education and the application of moisturizers are recommended as an integral part of AD prevention, treatment, and maintenance.

Venolymphatic malformations (vlms) are vascular anomalies consisting of both veins and lymph vessels. a 2-week-old newborn presented with large vlms on the left forehead, temple, preauricular area, and orbit. patient was at imminent risk for permanent vision loss due to a localized mass effect. surgical excision or debulking was contraindicated due to its complexity and proximity to the left eye, and the patient failed to respond to the sildenafil treatment and sclerotherapy. patient was… Show more

Venolymphatic malformations (vlms) are vascular anomalies consisting of both veins and lymph vessels. a 2-week-old newborn presented with large vlms on the left forehead, temple, preauricular area, and orbit. patient was at imminent risk for permanent vision loss due to a localized mass effect. surgical excision or debulking was contraindicated due to its complexity and proximity to the left eye, and the patient failed to respond to the sildenafil treatment and sclerotherapy. patient was subsequently started on oral sirolimus 0.8 mg/m(2) twice daily in combination with prednisolone 2 mg/kg daily. the patient had an excellent therapeutic outcome for 7 months with complete preservation of vision before treatment was discontinued. however, 2 months after the medical treatments were discontinued, her vlm rebounded. she responded to the combination therapy again after a failed treatment with the mtor inhibitor alone. this case demonstrates that the sirolimus and prednisolone combination therapy could be beneficial for treatment of complex vlm intractable to other treatments. Show less

Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited. This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma. (Funded by Pierre Fabre Dermatologie; ClinicalTrials.gov number, NCT01056341. opens in new tab.)

In our pilot study, being overweight or obese preceded psoriasis by at least 2 years in 93% of children with psoriasis. We also demonstrate that children with psoriasis with increased adiposity have a high percentage of immediate family members with obesity (48%) and psoriasis (41%), which occurs in 34% and 30%, respectively, of children overall with psoriasis. We recommend early lifestyle counseling of families with psoriasis (especially those with obesity). Whether weight control reduces… Show more

In our pilot study, being overweight or obese preceded psoriasis by at least 2 years in 93% of children with psoriasis. We also demonstrate that children with psoriasis with increased adiposity have a high percentage of immediate family members with obesity (48%) and psoriasis (41%), which occurs in 34% and 30%, respectively, of children overall with psoriasis. We recommend early lifestyle counseling of families with psoriasis (especially those with obesity). Whether weight control reduces pediatric psoriasis severity also deserves investigation. Show less

Nevus sebaceus (NS) is a common congenital cutaneous hamartoma that typically presents on the scalp and face at birth or in early childhood. Occasionally NS can be associated with the Schimmelpenning-Feuerstein-Mims syndrome, which presents with concomitant severe neurologic, skeletal, cardiovascular, ophthalmic, and genitourologic disorders. In a previous study, maternal transmission of the human papillomavirus (HPV) and infection of ectodermal stem cells by HPV was postulated to result in the… Show more

Nevus sebaceus (NS) is a common congenital cutaneous hamartoma that typically presents on the scalp and face at birth or in early childhood. Occasionally NS can be associated with the Schimmelpenning-Feuerstein-Mims syndrome, which presents with concomitant severe neurologic, skeletal, cardiovascular, ophthalmic, and genitourologic disorders. In a previous study, maternal transmission of the human papillomavirus (HPV) and infection of ectodermal stem cells by HPV was postulated to result in the development of NS. In this study we aimed to determine the incidence of HPV infection in pediatric NS samples to further clarify the potential link between HPV and the pathogenesis of NS. NS tissue samples (N = 16) were analyzed for HPV DNA using type-specific, real-time polymerase chain reaction (PCR) targeting HPV 6, 11, 16, and 18 and conventional PCR with modified general primers designed for broad-range HPV detection. The tissues were also histologically evaluated for evidence of HPV infection. HPV DNA was not detected in any of the NS tissue samples using PCR and HPV-associated histopathologic changes were absent in all 16 NS tissues. HPV infection is an unlikely etiologic cause of NS. Show less

Lymphatic malformations can be challenging to treat. Mainstay interventions including surgery and sclerotherapy are invasive and can result in local recurrence and complications. We sought to assess the effect of 20 weeks of oral sildenafil on reducing lymphatic malformation volume and symptoms in children. Four subjects had a lymphatic malformation volume decrease (1.0%-31.7%). In 2 subjects, despite a lymphatic malformation volume increase (1.1%-3.7%), clinical improvement was noted while on… Show more

Lymphatic malformations can be challenging to treat. Mainstay interventions including surgery and sclerotherapy are invasive and can result in local recurrence and complications. We sought to assess the effect of 20 weeks of oral sildenafil on reducing lymphatic malformation volume and symptoms in children. Four subjects had a lymphatic malformation volume decrease (1.0%-31.7%). In 2 subjects, despite a lymphatic malformation volume increase (1.1%-3.7%), clinical improvement was noted while on sildenafil. One subject had a 29.6% increase in lymphatic malformation volume and no therapeutic response. Lymphatic malformations of all 6 subjects who experienced a therapeutic response on sildenafil softened and became easily compressible. Adverse events were minimal. Sildenafil can reduce lymphatic malformation volume and symptoms in some children. Show less

Salivary gland choristoma (heterotopic salivary gland tissue) is a rare condition typically seen in the newborn period. This developmental heterotopia is generally nonprogressive, with little risk of malignant transformation. We present the second known reported case of a salivary gland choristoma located on the anterior chest wall. Knowledge of this rare entity will allow for accurate diagnosis and management of this benign anatomic variant.

Birthmarks are commonplace and most pose no significant detriment to health. It is usual for some ‘birthmarks’ to manifest within the first weeks to months of life and are not necessarily seen at birth. This is attributed in large part to the maturation of neonatal skin and the deepening of skin color over time. With time, increased pigment production in the skin by melanocytes eventually highlight the differences between normal and abnormal hypopigmented and hyperpigmented anomalies of the… Show more

Birthmarks are commonplace and most pose no significant detriment to health. It is usual for some ‘birthmarks’ to manifest within the first weeks to months of life and are not necessarily seen at birth. This is attributed in large part to the maturation of neonatal skin and the deepening of skin color over time. With time, increased pigment production in the skin by melanocytes eventually highlight the differences between normal and abnormal hypopigmented and hyperpigmented anomalies of the skin. Birthmarks can be seen as an isolated skin condition or serve as an important diagnostic aid for other more significant disorders. This review details four of the most common birthmarks regularly encountered in the neonatal period by perinatologists, obstetricians and pediatricians. This review emphasizes their medical significance and highlights any associated underlying systemic disease or genetic syndrome. Show less

We describe a case of an 8-year-old girl with large irregular café au lait macules on the right cheek and right lower extremity presenting with sudden onset vision loss and found to have polyostotic fibrous dysplasia on imaging. The classic triad of McCune-Albright syndrome is discussed along with the importance of recognition in patients with partial presentation. This case also highlights a rare and potentially devastating neurologic complication of McCune-Albright syndrome, as well as the… Show more

We describe a case of an 8-year-old girl with large irregular café au lait macules on the right cheek and right lower extremity presenting with sudden onset vision loss and found to have polyostotic fibrous dysplasia on imaging. The classic triad of McCune-Albright syndrome is discussed along with the importance of recognition in patients with partial presentation. This case also highlights a rare and potentially devastating neurologic complication of McCune-Albright syndrome, as well as the need for early diagnosis and continual surveillance in these patients. Show less

Rapidly involuting congenital hemangioma (RICH) is an uncommon, often high-flow vascular tumor that presents at birth and involutes within the first year of life. It is clinically and histologically distinct from infantile hemangioma, kaposiform hemangioendothelioma, and tufted angioma, the latter two being associated with Kasabach-Merritt phenomenon. We present a female infant with RICH and profound, transient thrombocytopenia and review the extent and clinical course of thrombocytopenia in… Show more

Rapidly involuting congenital hemangioma (RICH) is an uncommon, often high-flow vascular tumor that presents at birth and involutes within the first year of life. It is clinically and histologically distinct from infantile hemangioma, kaposiform hemangioendothelioma, and tufted angioma, the latter two being associated with Kasabach-Merritt phenomenon. We present a female infant with RICH and profound, transient thrombocytopenia and review the extent and clinical course of thrombocytopenia in the context of congenital vascular tumors. Show less

We describe a case of multiple, discrete, hypopigmented macules in the suprapubic and axillary region in a healthy 3-year-old girl. The lesions first appeared at approximately 9 months of age and increased in number over time. Initial histopathologic examination by an outside dermatopathologist at 1 year of age was reported as showing nonspecific histologic changes. A repeat biopsy at 3 years of age showed large intraepidermal clear cells that expressed CKAE1/CAM5.2, CK7, and BRST2. These… Show more

We describe a case of multiple, discrete, hypopigmented macules in the suprapubic and axillary region in a healthy 3-year-old girl. The lesions first appeared at approximately 9 months of age and increased in number over time. Initial histopathologic examination by an outside dermatopathologist at 1 year of age was reported as showing nonspecific histologic changes. A repeat biopsy at 3 years of age showed large intraepidermal clear cells that expressed CKAE1/CAM5.2, CK7, and BRST2. These findings are diagnostic for clear-cell papulosis, a rare condition that primarily affects children. Without great clinical and pathologic suspicion, this is a diagnosis that can often be overlooked because the histologic findings are virtually identical to those of normal skin. Show less

Leprosy, or Hansen disease, is an infection that affects the mucous membranes of the respiratory tract and may manifest with nasal symptoms of chronic rhinitis, including nasal congestion, rhinorrhea, and intermittent epistaxis. We present a case of a woman diagnosed with leprosy as an incidental finding from a biopsy obtained during endoscopic sinus surgery for the management of chronic rhinitis. The diagnosis of leprosy should be considered in patients with nasal symptoms and presumptive… Show more

Leprosy, or Hansen disease, is an infection that affects the mucous membranes of the respiratory tract and may manifest with nasal symptoms of chronic rhinitis, including nasal congestion, rhinorrhea, and intermittent epistaxis. We present a case of a woman diagnosed with leprosy as an incidental finding from a biopsy obtained during endoscopic sinus surgery for the management of chronic rhinitis. The diagnosis of leprosy should be considered in patients with nasal symptoms and presumptive chronic rhinitis who do not respond adequately to standard therapies. Show less

Delineating the extent of capillary malformations in the operating suite can be challenging because of a variety of physiologic modifiers, including vasodilatation induced by anesthesia, reactive erythema, and filtering of colors with protective laser eyewear. The use of traditional surgical pens to mark the treatment field has limitations; we have found the use of a white eyeliner pencil to delineate lesions a contemporary technique that assists in identifying the target tissue… Show more

Delineating the extent of capillary malformations in the operating suite can be challenging because of a variety of physiologic modifiers, including vasodilatation induced by anesthesia, reactive erythema, and filtering of colors with protective laser eyewear. The use of traditional surgical pens to mark the treatment field has limitations; we have found the use of a white eyeliner pencil to delineate lesions a contemporary technique that assists in identifying the target tissue intraoperatively. Show less

Epidermolysis bullosa acquisita (EBA) is a rare, chronic, autoimmune bullous dermatosis that is caused by autoantibodies against the noncollagenous terminus of the α chain of type VII collagen, resulting in decreased anchoring fibrils in the lamina densa. Autoimmune neonatal bullous skin disease caused by placental transfer of maternal IgG autoantibodies is rare. It has been reported in neonates born to mothers with pemphigus vulgaris, pemphigus foliaceus, and gestational pemphigoid. To our… Show more

Epidermolysis bullosa acquisita (EBA) is a rare, chronic, autoimmune bullous dermatosis that is caused by autoantibodies against the noncollagenous terminus of the α chain of type VII collagen, resulting in decreased anchoring fibrils in the lamina densa. Autoimmune neonatal bullous skin disease caused by placental transfer of maternal IgG autoantibodies is rare. It has been reported in neonates born to mothers with pemphigus vulgaris, pemphigus foliaceus, and gestational pemphigoid. To our knowledge, congenital EBA has not been previously reported. Vertically acquired congenital autoimmune blistering disorders appear to be self-limited and resolve with supportive therapy, concomitant with the presumed clearance of maternal autoantibodies from the neonate's circulation. We describe a newborn with transient EBA due to the passive transfer of maternal autoantibodies. Show less

Sinus pericranii is a rare finding that has not, to our knowledge, been previously associated with PHACE syndrome. Central nervous system, not only posterior fossa, abnormalities are frequently encountered in PHACE syndrome. Endovascular embolization of the facial hemangioma in our patient was a useful therapy.

Apert syndrome, or acrocephalosyndactyly, is characterized by craniosynostosis and early epiphyseal closure resulting in various deformities of the skull, hands, and feet. Typically a sporadic condition, autosomal dominant inheritance with complete penetrance has been known to occur. Most adolescents with the disorder are prone to the development of severe pustular facial and truncal acne, with extension to the upper arms and forearm. We report twin brothers with Apert syndrome who, after 2… Show more

Apert syndrome, or acrocephalosyndactyly, is characterized by craniosynostosis and early epiphyseal closure resulting in various deformities of the skull, hands, and feet. Typically a sporadic condition, autosomal dominant inheritance with complete penetrance has been known to occur. Most adolescents with the disorder are prone to the development of severe pustular facial and truncal acne, with extension to the upper arms and forearm. We report twin brothers with Apert syndrome who, after 2 years of standard management by their pediatrician, were referred for management of complicated acne. In our patients there were a constellation of findings consistent with the disorder and, of importance to this report, significant dermatological manifestations. On presentation, each brother was found to have acne vulgaris of a different stage. Our patients were refractory to conventional treatment for acne but one required and had a significant response to isotretinoin. The risk/benefit ratio in treating acne lesions with isotretinoin in a teenager with Apert syndrome is reviewed. Show less

Aplasia cutis congenita is a congenital condition in which skin, bone, and dura can be absent. The condition can present in isolation or with associated conditions such as limb anomalies or embryologic malformations. The majority of cases affect the scalp and are limited to the dermis and epidermis. Vertex aplasia cutis typically range in size from 0.5 to 3 cm. The rare larger scalp defects are prone to complications of hemorrhage and infection, and subsequently patients are at risk for death… Show more

Aplasia cutis congenita is a congenital condition in which skin, bone, and dura can be absent. The condition can present in isolation or with associated conditions such as limb anomalies or embryologic malformations. The majority of cases affect the scalp and are limited to the dermis and epidermis. Vertex aplasia cutis typically range in size from 0.5 to 3 cm. The rare larger scalp defects are prone to complications of hemorrhage and infection, and subsequently patients are at risk for death. For these reasons, surgical intervention for large defects may be required. We report the case of a 12-month-old Haitian boy who presented with aplasia cutis congenita of the scalp involving 10 cm of skin and 9 cm of underlying bone. There were no other associated anomalies. Show less