La fréquence de la gale est en augmentation en France. La gale hyperkératosique (ou norvégienne) est une forme de gale très contagieuse en raison d’un nombre important de parasites présents dans la peau. Elle survient sur un terrain d’immunodépression, de déficit sensitif ou moteur ou de retard mental. Sa présentation clinique, en dehors des signes classiques de la gale, se caractérise par des lésions hyperkératosiques. Son traitement est difficile et nécessite une hospitalisation. Les dermocorticoïdes sont fréquemment utilisés en pathologie dermatologique de l’enfant. Nous rapportons le cas d’un garçon de 8ans présentant une gale hyperkératosique induite par l’application de dermocorticoïdes et discutons des aspects thérapeutiques de cette forme sévère de gale.

Infectious factors contribute to sudden infant death in about 1 case out of 3. We report 3 children less than 4-years-old who died suddenly of bacterial infection due to Neisseria meningitidis, Streptococcus pneumoniae, and Staphylococcus aureus. The bacteria were isolated from central and peripheral samples. A bacterial origin should be sought in all cases of sudden death in children. When a bacterial origin is confirmed, the question of immunodeficiency should be raised.

OBJECTIVES:To assess the prevalence in children with sickle cell disease of low bone mineral density (BMD), a feature found in up to 82% of adults but not well known in children. METHODS:In 53 children (45 SS, 4 SC, 4 Sbeta-thalassemia) with a mean age of 12.8 +/- 2.4 years, we assessed height; weight; sexual maturation; number of hospitalizations, painful crises, and transfusions in the last 3 years; calcium intake; steady-state hemoglobin and leukocyte count; calcaemia, phosphataemia, and calciuria/creatinuria; serum 25-(OH)D and PTH concentrations; and osteocalcin, urinary deoxypyridinoline, and the C-terminal component of pro-collagen type I. BMD was assessed using dual X-ray absorptiometry. RESULTS:Mean lumbar spine Z-score was -1.1 +/- 1.3 (-3.9 to +1.8). The Z score was significantly lower in girls than in boys in the prepubertal subgroup (-1.74 +/- 0.27 vs. -0.53 +/- 0.31) (P = 0.0169), but not in the pubertal group (-1.15 +/- 0.41 vs. -1.33 +/- 0.70). BMD was not associated with any of the disease-severity markers in girls but was unexpectedly associated with fewer vaso-occlusive crises and hospitalizations in boys. BMD did not correlate with hemoglobin or leukocyte counts. Vitamin D deficiency [25-(OH)D < 12 ng/mL] was found in 76% of patients and secondary hyperparathyroidism (PTH > 46 pg/mL) in 38%. BMD was not related to calcium intake, vitamin D status, osteocalcin, or bone resorption markers. CONCLUSION:A slight BMD decrease was found in SCD children, starting before puberty and being more marked in females. The decrease was unrelated to disease severity, vitamin D deficiency, or bone hyperresorption, suggesting abnormal bone formation as the underlying mechanism.

Evaluar la densidad mineral ósea (DMO) en niños con enfermedad de células falciformes (ECF) de la Comunidad de Madrid.Se valora la DMO en un total de 40 niños con ECF y rango de edad entre 3-16 años, mediante densitometría (DEXA) siguiendo las recomendaciones de la Sociedad Internacional de Densitometría Clínica (ISCD).La edad media en el momento del estudio fue de 7,97 ± 3,95 años; el valor medio de la DEXA expresado en Z-score es de -0,91 ± 1,46 con un rango de valores mínimo de -5,30 y máximo de 2,30. Un 57,5% de los niños tiene DMO normal (Z > -1), un 25% tienen DMO baja (Z entre -1 y -2) y un 17,5% presentan Z-score patológico con valores de osteoporosis (Z-score < -2). Los estudios de correlación solo encuentran una correlación lineal de Pearson significativa estadísticamente entre valor de Z-score y valor de Hb (r = 0,368, p = 0,019), no encontrando correlación con los niveles de 25 (OH) D.Se necesitan estudios prospectivos, con mayor número de enfermos para conocer las implicaciones futuras de la densitometría alterada y los factores de riesgo asociados.To evaluate bone mineral density (BMD) in children with sickle cell disease (SCD) in the Community of Madrid.The BMD was estimated in 40 children with SCD, and with an age range between 3 and 16 years, using densitometry (DXA), as recommended by the International Society for Clinical Densitometry (ISCD).The mean age at the time of the study was 7.97 ± 3.95 years, the mean value of the DXA expressed in Z -score was -0.91 ± 1.46 with a range of minimum values - 5.30 and 2.30 maximum. More than half (57.5%) of all the children had normal BMD (Z > -1), 25% had low BMD (Z between -1 and -2), and 17.5% showed an abnormal Z -score values of osteoporosis (Z -score < -2). The Pearson linear correlation was statistically significant between Z -score value and the haemoglobin level (r = 0.368, p = .019), finding no correlation with the levels of 25 (OH) vitamin D.Prospective studies are needed with a larger number of patients to understand the future implications of bone densitometry changes and associated risk factors.

L’alcool pendant la grossesse est un problème majeur de santé publique. Il représente la première cause de déficit intellectuel d’origine non génétique dans les pays occidentaux. Le syndrome d’alcoolisation fœtale (SAF) est principalement caractérisé par un retard de croissance pré- et postnatal, des troubles neurocognitifs et une dysmorphie faciale. Il menace le pronostic intellectuel et comportemental de l’enfant à long terme. Des outils de prévention primaire et secondaire existent et passent par une meilleure information des professionnels de santé, pour une prise en charge optimale des patientes à risque avant, pendant et après la grossesse, ce qui devrait permettre de constater une diminution de l’incidence du SAF dans les années à venir.

Alcohol consumption during pregnancy is a major cause of mental retardation in Western countries. Fetal alcohol syndrome (FAS) is mainly characterized by pre- and postnatal stunted growth, neuro-cognitive disorders, and facial dysmorphism. It compromises the intellectual and behavioral prognosis of the child. Prevention tools exist, through better information of health professionals, for optimal care of high-risk women before, during, and after pregnancy, which would decrease the incidence of SAF in the future. (C) 2009 Elsevier Masson SAS All rights reserved.