Assembly Edition -- FP Report

ASSEMBLY EDITION • ORLANDO, FLA

Lecture delves into treatment of skin conditions in youngsters

By Toni Lapp

Family physicians are often asked to diagnose skin conditions such as this case of contact dermatitis.

Parents have brought children with warts into his practice, determined to have the bothersome growths removed, recalled Daniel Van Durme, M.D., of Tallahassee, Fla., during a two-hour seminar yesterday.

"They'll ask about cutting, freezing or burning, and offer to hold their children down," said Van Durme, presenting "Skin Conditions in Infants and Children."

"It's bothering you a whole lot more than it's bothering the child," he said he tells the parents. "I don't want to give the child a complex about doctors because we were so aggressive about treating warts when they were young."

Van Durme repeats his two-hour seminar today at 8:30 a.m. and 1:30 p.m. Check on ticket availability in the registration area; the seminar location is printed on the ticket.

A recent small study using duct tape on warts found efficacy comparable to cryotherapy, Van Durme said yesterday, but no treatment for warts is more than 90 percent effective, and in the majority of cases, warts spontaneously resolve, giving food for thought to the FP dealing with anxious parents.

But then there are the conditions that have the potential to turn malignant, and benign neglect may not be the best option, said Van Durme. Other conditions cause anguish because of their appearance on what used to be a "perfect" child, he said.

Here's a sampling of some of the conditions he discussed:

Port-wine stain, or nevus flammeus, caused by vascular change, is a condition for which physicians may consider offering pulsed laser treatment.
Cavernous hemangioma, a deeper version of nevus flammeus, is found in up to 10 percent of infants, more commonly in girls. About half of cases spontaneously heal by age 5, but sometimes they get worse.
Mongolian spots are usually found in Asian and African-American children. They can be mistaken for bruises, sometimes leading to accusations of child abuse. Since they usually fade, a watchful waiting approach is advisable.
Congenital pigmented nevi, when occurring with frequency, may be associated with malignancy, prompting the physician to ask about history of melanoma.
Giant congenital melanocytic nevi, or giant hairy nevi, clearly carry higher risk of malignancy. Cases like these are appropriate for referral.

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