To determine the frequency of skin disorders encountered in a paediatric emergency care unit and to evaluate the benefits of advice from a dermatologist, we prospectively recorded data of children admitted with skin disorders to the emergency care unit during a 5-month period. Diagnostic agreement between paediatricians and dermatologists evaluating the patients separately was assessed. Three hundred and ninety-five children (median age 3 years; interquartile 1-6) were included. Skin disorders represented 4% of all paediatric emergency care unit visits. Visits were considered as appropriate in 19-30% of cases according to different criteria. Six diseases accounted for 57% of cases: viral exanthema, urticaria, atopic dermatitis, varicella, diaper dermatitis and herpetic gingivostomatitis. The dermatologist modified the diagnosis in 42% of cases and the treatment in 30%. Greater emphasis on teaching the skin disorders encountered in this setting and efforts to provide easy access to advice from dermatologist would improve the quality of care.

British Journal of DermatologyVolume 150, Issue 2 p. 396-397 Asymmetric periflexural exanthem of childhood in a child with axonal Guillain–Barré syndrome S. Auvin, S. Auvin Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorA. Imiela, A. Imiela Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorJ.C. Cuvellier, J.C. Cuvellier Paediatric Neurology Unit, Hôpital Jeanne de Flandre, 2 Avenue Oscar Lambret, 59037 Lille cedex, FranceSearch for more papers by this authorB. Catteau, B. Catteau Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorL. Vallée, L. Vallée Paediatric Neurology Unit, Hôpital Jeanne de Flandre, 2 Avenue Oscar Lambret, 59037 Lille cedex, FranceSearch for more papers by this authorA. Martinot, A. Martinot Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this author S. Auvin, S. Auvin Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorA. Imiela, A. Imiela Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorJ.C. Cuvellier, J.C. Cuvellier Paediatric Neurology Unit, Hôpital Jeanne de Flandre, 2 Avenue Oscar Lambret, 59037 Lille cedex, FranceSearch for more papers by this authorB. Catteau, B. Catteau Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this authorL. Vallée, L. Vallée Paediatric Neurology Unit, Hôpital Jeanne de Flandre, 2 Avenue Oscar Lambret, 59037 Lille cedex, FranceSearch for more papers by this authorA. Martinot, A. Martinot Paediatric Emergency Care Unit, Department of DermatologySearch for more papers by this author First published: 19 February 2004 https://doi.org/10.1111/j.1365-2133.2003.05798.xCitations: 3 A. Martinot, E-mail: amartinot@chru-lille.fr Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume150, Issue2February 2004Pages 396-397 RelatedInformation

Juvenile xanthogranuloma is the most common non-Langerhans cell histiocytosis of infancy and childhood. It is a benign disorder that usually regresses spontaneously, more often without or with limited skin changes. The clinical features are very pleomorphic and recognition of the atypical presentations should facilitate the diagnosis. We report a 9-month-old boy who had an extensive, atrophic lesion on the proximal thigh that followed the course of the congenital giant form. The large size of the lesion does not alter the clinical course or result in extracutaneous involvement, which remains rare. However, uncommon clinical presentations raise the problem of differential diagnosis, requiring biopsy to eliminate other tumors with a less favorable prognosis.

L’activité de consultation des dermatologues libéraux français a été récemment étudiée.Nous avons évalué dans cette etude l ’activité de consultation de trois services de dermatologie hospitalo-universitaires français.L’étude a été réalisée prospectivement pendant une période de deux mois de l ’année 2003,dans les services de dermatologie des CHU d ’Amiens,Lille et Rouen.Un questionnaire était rempli pour chaque consultant pendant la durée de l ’étude.Les données recueillies étaient :date de la consultation,fonction du consultant,center hospitalier,type de consultation,type de pathologie,éventuelle hospitalisation à l ’issue de la consultation.Au cours de cette étude,7 296 fiches ont été recueillies. Trente-huit pour cent des consultations étaient réalisées par des médecins attachés,29 p.100 par des internes de spécialité,18 p.100 par des praticiens hospitaliers, 9 p.100 par des professeurs des universities et 6 p.100 par des chefs de clinique assistants.Les groupes de pathologies le plus fréquemment rencontrés étaient l ’allergologie (17 p.100),la cancérologie (16 p.100),l ’angéiologie (15 p.100)et l ’infectiologie (11 p.100).Trois types de consultations ont été identifiés : consultations d ’urgence sans rendez-vous,consultations à thème et consultations sans thème sur rendez-vous.Le nombre d ’hospitalisations générées variait de 2 à 10 p.100 des consultants,selon le type de consultation et la fonction du consultant.Cette étude montre qu ’en France,l ’activité de consultation des services de dermatologie est très différente de celle des dermatologues libéraux.Les principales pathologies rencontrées (cancérologie,angéiologie,allergologie,dermatoses infectieuses) recouvrent largement le recrutement d ’hospitalisation de ces services. L ’organisation actuelle des consultations hospitalières évolue,d ’une part vers la prise en charge de pathologies très spécialisées par des consultations à thème,et,d ’autre part,vers la prise en charge en urgence de certaines dermatoses aiguës.We recently carried out a study concerning consultations by French dermatologists in private practice.We evaluated consultations at the dermatology departments of 3 university teaching hospitals in France.This was a 2-month prospective study conducted in 2003 at the dermatology departments of the university teaching hospitals of Amiens,Lille and Rouen.Each consultant completed a questionnaire covering the duration of the study. The following data were recorded:consultation date,function of the consultant,study centre,type of consultation,type of disease, and whether or not the patient was hospitalised after the consultation.7296 files were examined during the study.38%of the consultations were performed by part-time hospital consultants, 29%by dermatology interns,18%by hospital practitioners,9%by university professors and 6%by clinical heads or assistant heads. The most commonly encountered diseases were allergies (17%),cancer (16%),arteriovenous disease (15%)and infectious disease (11%). Three types of consultation were identified:emergency consultations without an appointment,consultations by appointment for a specific problem and consultations by appointment without a specific problem. The number of resulting hospital admissions ranged from 2 to 10%of consultations,depending on the type of consultation and the role of the consultant in question.This study shows that in France,consultations at hospital dermatology departments differ greatly from those of dermatologists in private practice.The main diseases seen (cancer,arteriovenous disease,allergy,infectious dermatosis)accounted for the majority of hospitalisations in these departments.The organisation of hospital consultations is increasingly tending both towards treatment of highly specialised diseases through specifically oriented consultations and also towards the emergency treatment of certain forms of acute dermatosis.

The case of a newborn girl with a rare, giant, congenital, tissue lymphangioma giving rise to elephantiasis of the right lower limb is presented. The different imaging methods, especially magnetic resonance imaging, showed no extension of the lesions into the deep structures. At the age of 2 years, the child underwent a roentgenographic skeletal survey, which revealed osteolytic lesions in the femurs and the right tibia. There was no clinical evidence of systemic involvement. The place of this affection among the different lymphatic malformations was discussed and the diagnosis of elephantiasis-like lymphangiomatosis of the limb, an extremely rare disorder, has been retained. Early surgical reduction was performed, followed by application of a pressure dressing. Five years later the result remains satisfactory, but the excision of a persistent fluid-filled pouch around the knee will probably be necessary in the future.

The frequency and the gravity of allergic reactions to insulin have decreased substantially with the availability of recombinant DNA-human insulins. Today, the frequency of immediate reactions is estimated to be on the order of 10%. Most of these allergic reactions are related to components of these preparations other than insulin. The manifestations are usually benign and localized to the injection site. True insulin allergies are very rare. We report three cases of patients who presented generalized immediate allergic manifestations after insulin injections. Intradermal skin tests with a panel of recombinant DNA-human insulins were negative in nonallergic diabetic controls and non-diabetic controls but positive in our three patients, suggesting the occurrence of IgE-dependant systemic allergy to recombinant DNA-human insulin. (C) 2003 Editions scientifiques et medicales Elsevier SAS. All rights reserved.