W. Lane M. Robson, MD

In children, most causes ofitching are the result of skin disease,not underlying systemic illness. The mostcommon dermatological causes of pruritusare atopic and contact dermatitis,urticaria, miliaria rubra, infections, insectbites or infestations, xerosis, and aquagenicpruritus. A careful history andphysical examination usually reveal thediagnosis. The location, chronicity, timeof occurrence, and nature of the itchingoffer important diagnostic clues, as doprecipitating factors, associated symptoms,drug use, exposure to infectious diseasesor pets, psychosocial history, past health,and family history. Treatment of the underlyingcause of itching should beaddressed whenever possible. Symptomatictreatment is essential to breakthe itch-scratch cycle.

The mother of this 5-week-old girl reports that her baby's head tilts to the right. The mother was a primigravida; unremarkable pregnancy.

Consultations & Comments: Significance of Isolated Clinodactyly?

Eight-year-old girl with mass in midline of neck.Mass first noted about 6 months earlier. Patient is otherwise well; past health unremarkable. No symptoms ofhypothyroidism.

A 4-year-old girl presented with bilateral deviation of the fifth fingers. The deformity was noted in early childhood. There was no history of trauma or family history of a similar deformity. Physical examination was normal except for incurving of the fifth fingers.

Patient delivered vaginally at term to a G2P1 24-year-old mother following an uncomplicated pregnancy. Apgar scores, 7 and 9 at 1 and 5 minutes, respectively. No history of maternal exposure to teratogens. Parents non-consanguineous. No family history of congenital or chromosomal abnormality.

Seven-month-old boy with hyperpigmented lesions on his legs. Lesions first noted at 4 months of age. His 32-year-old father and 58-year-old grandfather had similar lesions on their legs.

Six-year-old East Indian boy delivered by normal spontaneous vaginal delivery to a para 3, gravida 2, 42-year-old mother following uncomplicated, full-term pregnancy. Apgar scores: 9 and 9, at 1 and 5 minutes, respectively. Birth weight, 2.5 kg. Infant hypotonic at birth with numerous dysmorphic features. Delayed developmental milestones; IQ measured at 80.

Ten-year-old girl assessed because of limitation of neck motion. Born at term to non-consanguineous parents. No history of necktrauma. Family history andpast health unremarkable.

Seven-year-old boy with red, nonpruritic rash that appeared first on the cheeks and then spread to the trunk, extremities, and buttocks. No history of respiratory, GI, or other symptoms in the several weeks before the onset of the rash. Patient is otherwise healthy.

A 9-year-old girl presents with multiple hyperpigmented lesions, some of which have been present since birth (Figure 1). The lesions have increased in size and number. There is no history of seizures. Her 40-year-old mother has multiple skin nodules (Figure 2).

A 12-year-old boy is assessed on the same day that he passed red-colored urine. The boy had been vigorously wrestling with his older brother in the morning; he passed the abnormal-colored urine after lunch. His mother was worried that his kidneys might have been injured during the wrestling.

An 8-year-old boy is assessed on the same day that he passed red-colored urine. The boy first noted the abnormal-colored urine when he voided on awakening.

An 18-year-old girl presented with an asymptomatic nodule on the posterior aspect of the right upper arm. The lesion had developed a month after an episode of chickenpox at 11 years of age and had slowly enlarged. The lesion was 7 mm in diameter; it was firm, rubbery, reddish brown, and nontender.

A 10-month-old girl with a mass on left side of neck. Swelling first noticed by mother when child was 7 months old. The infant is eating well, thriving, and otherwise healthy.

Female infant born to a gravida II, para I, 23-year-old mother at 38 weeks' gestation. Pregnancy complicated by oligohydramnios. Cesarean delivery performed because of prolonged time after rupture of membranes and fetal distress. Apgar scores, 3 and 6 at 1 minute and 5 minutes, respectively.

A 13-year-old boy presented with an explosive eruption of numerous, small, round, erythematous, itchy plaques on his lower back and lower limbs of 2 weeks' duration (A). Some of the lesions were scaly. His nails were normal. There was no evidence of arthritis or joint deformity. He had a sore throat a month before the onset of the rash but did not seek medical attention. He was not taking any medication and had no history of joint pain or family history of skin problems.

Photo Essay: Factitious Dermatitis Lip Licker's Dermatitis Ecchymoses From Spoon Scratching Ecchymosis From Cupping