Tollefson, Megha M.

AbstractBackground/ObjectivesLittle is known about acne incidence in preadolescents and its potential association with body mass index (BMI). Our study aims to determine acne incidence in preadolescents and its association with BMI.MethodsA population‐based retrospective cohort study identified 7‐ to ≤12 year‐olds with an initial acne diagnosis during 2010–2018, and incidence was calculated. Two age‐ and sex‐matched controls without acne were randomly selected per case, and BMI was recorded.ResultsA total of 643 acne patients were identified. Annual age‐ and sex‐adjusted incidence rate was 58.0 per 10,000 person‐years, higher in females vs. males (89.2 vs. 28.2 per 10,000 person‐years, p < .001), and increased with age (4.3, 24.4, and 144.3 per 10,000 person‐years among 7–8, 9–10, and 11–12 year‐olds, respectively, p < .001). Systemic medication use was associated with increasing BMI (odds ratio = 1.43 per 5 kg/m2 increase in BMI, 95% CI 1.07–1.92, p = .015). Median BMI percentile was higher among acne cases vs. controls (75.0 vs. 65.0, p < .001), as was the proportion with BMI ≥95th percentile (16.7% vs. 12.2%, p = .01).ConclusionAcne incidence is higher in preadolescent girls than boys and increases with age. Preadolescents with acne are more likely to be obese than those without acne. Those with higher BMIs are more likely to be given systemic treatment.

AbstractBackgroundA new trend includes taking a dedicated year away from medical school to complete a research fellowship. There is minimal data on the benefit of a gap year. We aimed to identify if a gap year makes a dermatology applicant more successful in The Match.MethodsDermatology applicants who applied to Mayo Clinic Arizona for the 2018–2019 application cycle and Mayo Clinic Rochester, Arizona, and Florida for the 2019–2020 application cycle were surveyed.ResultsIn total, 291 dermatology applicants completed the initial survey, and 236 completed the follow‐up survey. Ninety applicants took a gap year, 198 applicants did not. There was no significant difference in match rates. When comparing match rates at top dermatology residency programs, 40.6% of gap‐year applicants matched to these residencies versus 19.0% of no gap‐year applicants (P < 0.01).ConclusionApplicants should weigh the opportunity costs before pursuing research gap years as they may not be universally helpful. Applicants who want to match at a top dermatology program may benefit from a research gap year. This data may have limited generalizability outside of the United States.

AbstractBackground/ObjectiveCurrent knowledge about usage of effective, but non‐first‐line topical acne medications in the United States is limited. We aimed to investigate utilization patterns and temporal trends for such acne medications in the US ambulatory care.MethodsPediatric (≤18 years old) and adult (>18 years old) data from the 2012 to 2016 (inclusive) cycles of the US National Ambulatory Medical Care Survey were extracted. Utilization patterns of six non‐first‐line topical acne medications (ie, azelaic acid, salicylic acid, glycolic acid, sulfur, resorcinol, and zinc) were compared and followed over time.ResultsData from 218 410 US office–based sampled visits during 2012‐2016 were included in the analysis. Across all acne visits (n = 1542), salicylic acid (1.58%), azelaic acid (1.22%), and glycolic acid (0.52%) were the most frequently used agents, while zinc and resorcinol were not used. Sulfur (0.52%) and salicylic acid (0.33%) were the only medications used in preadolescents, and none of these medications were used in the neonatal or infantile group. Temporal trends for using at least one of these medications were insignificant among both pediatric and adult age groups (P = .825 and .136, respectively).ConclusionsSalicylic acid and azelaic acid are the most frequently used of the studied second‐line medications to treat acne, although the use of these and the other non‐first‐line topical medications overall is uncommon, especially among younger groups of US pediatric patients.

AbstractSpitzoid melanocytic lesions describe a spectrum of pediatric melanocytic proliferations ranging from benign Spitz nevi to malignant spitzoid melanomas typically arising within the first two decades of life. Atypical spitzoid neoplasm (ASN) is a poorly defined category within this spectrum that poses a unique diagnostic challenge due to histologic findings with insufficient atypical characteristics to make the diagnosis of melanoma. This report presents an exceptionally rare case of an ulcerative atypical spitzoid neoplasm mimicking an infantile hemangioma in a two‐month‐old girl treated with pulse dyed laser (PDL) and surgical excision. Our patient ultimately underwent five excisions over a 2‐year period, with successful maintenance of function and dexterity of the affected fingers.

AbstractBackground/ObjectivesTrisomy 21 has known associated clinical phenotypes, including skin and soft tissue concerns. However, the overall prevalence and types of findings are largely unclear.MethodsA retrospective review of children with trisomy 21 and one or more dermatologic diagnoses, seen from 1/1/1994 to 7/1/2016, was performed to record dermatologic diagnoses. If one or more diagnoses were confirmed, further data were collected, including demographics, medical specialty, referrals to dermatology, treatment, complications, and follow‐up.ResultsOne hundred and seventy‐four patients with a diagnosis of trisomy 21 aged 18 years or younger were confirmed to have one or more dermatologic diagnoses. In a total of 479 dermatologic diagnoses, superficial mycoses (12%), skin and soft tissue infections (10%), dermatitis (8%), and folliculitis (8%) were most common. Diagnoses were most commonly made as an outpatient (91%) and by general pediatrics (45%) or dermatology (25%). A significant difference (P < .05) in the frequency of various diagnoses made by different specialties was observed. A significant difference (P < .05) in the treatments recommended by different specialties was also observed. Referrals to dermatology were infrequent (6%). However, a frequent change in diagnosis (61%) or treatment (68%) for patients referred to dermatology was observed.ConclusionsChildren with trisomy 21 are most commonly diagnosed with superficial mycoses, skin and soft tissue infections, dermatitis, and folliculitis. The majority of diagnoses were made by general pediatricians and although dermatology referral was rarely necessary, consultations often resulted in change of diagnosis and/or treatment, supporting consideration of early and frequent dermatology referral.

AbstractMucous membrane pemphigoid (MMP) is a rare chronic immunobullous disease that involves the mucous membranes and may result in significant scarring and complications if diagnosis is delayed. MMP typically occurs in elderly patients, with very few cases reported in children. Here, we present a 12‐year‐old female patient with childhood‐onset oral and genital MMP, clinically suspected to be lichen sclerosus, but eventually diagnosed as MMP after multiple supportive biopsies and confirmatory direct immunofluorescence. Although treatment was challenging, the combined use of systemic corticosteroids, dapsone, and mycophenolate mofetil was ultimately successful in achieving disease control.

AbstractBackground/ObjectiveThere are few studies examining pediatric scarring alopecia. The objective of this study is to characterize the clinicopathologic findings, comorbidities, and treatment outcomes of pediatric patients with scarring alopecia.MethodsRetrospective review of patients under age 18 diagnosed with scarring alopecia at Mayo Clinic from 01/01/1992 through 02/05/2019.Results27 patients met inclusion criteria with a mean age of 11.2 years and a racial breakdown of 85.2% (23) White, 11.1% (3) Black, and 3.7% (1) Multiracial. Clinical scarring was noted in most (23, 85.2%). Biopsy confirmed the diagnosis in most (24, 88.9%). The most common diagnoses were folliculitis decalvans (6, 22.2%), lichen planopilaris (6, 22.2%), aplasia cutis congenita (4, 14.8%), tinea capitis (4, 14.8%), and morphea (3, 11.1%). Comorbid depression (6, 22.2%) and anxiety (6, 22.2%) were prevalent. Of the patients who received follow‐up, most who pursued treatment achieved stabilization (55.5%) or slowing of progression (27.8%), with 44.4% of those treated experiencing regrowth. Mean time to stabilization in the treated population was 19.6 months. Two patients did not pursue treatment, but received follow‐up and these untreated patients did not experience hair regrowth.ConclusionsMost patients presented with clinically evident primary scarring alopecia. Biopsy may confirm the diagnosis. Active treatment should be pursued, and successful treatment often requires combination therapies. Time to stabilization often takes years. Screening for depression and anxiety should be pursued.

AbstractA 10‐year‐old Guatemalan girl with past medical history of Epstein‐Barr virus‐associated smooth muscle tumors (EBV‐SMT) and combined immunodeficiency presented for evaluation of painful intraoral lesions. On examination, she was noted to have multiple, white to flesh‐colored, soft, flat‐topped papules, and plaques on the buccal and labial mucosa. Human papillomavirus type 13 was detected on PCR with PGMY primers of previously biopsied buccal tissue, confirming a diagnosis of Heck's disease (multifocal epithelial hyperplasia). We present an immunosuppressed, pediatric patient with two rare, virus‐associated neoplastic disorders that have not been previously reported to occur in the same individual.

AbstractBackground/ObjectivesThough maculopapular cutaneous mastocytosis is the most common form of pediatric mastocytosis, it remains unclear which patients will experience severe symptoms. We sought to better define the presentation and the cutaneous and systemic signs and symptoms in patients with maculopapular cutaneous mastocytosis.MethodsWe analyzed retrospective data on 227 patients diagnosed with maculopapular cutaneous mastocytosis prior to age 15 years from five US clinical sites. We collected data on signs, symptoms, age of onset, and laboratory testing.ResultsMedian age of onset of maculopapular cutaneous mastocytosis was 3 months, with 94% of patients presenting prior to age 2 (range 0‐15 years). Patients presenting before age 2 had significantly lower serum tryptase level (P = .019). Greater number of skin lesions (P = .006), number of reported skin signs and symptoms (P < .001), and higher tryptase levels (P < .001) were associated with more systemic symptoms.ConclusionChildren with maculopapular cutaneous mastocytosis, who have greater skin involvement, higher serum tryptase level, and more skin signs and symptoms, are more likely to have systemic symptoms.