Varicella-zoster virus infection: herpes zoster in T8 to T10 dermatomes. Typical grouped vesicles and pustules with erythema and edema of three contiguous thoracic dermatomes on the posterior chest wall.
Trachyonychia (twenty nail dystrophy of childhood). Any skin disease that affects the nail matrix may result in an abnormal nail plate. There are children, though, who only manifest dystrophy of the nail without any other cutaneous lesions, a condition that has been termed twenty nail dystrophy of childhood. The nails have a rough, sandpaper-like quality as well as longitudinal ridging and occasional splitting at the distal nail edge. Similar nail changes can be seen in lichen planus and alopecia areata. In many patients the condition spontaneously regresses.
Sucking blister. The oval blister pictured here was present at birth and is a result of normal sucking behavior in utero. Sucking blisters are fairly common and are usually located on the forearm, wrist, or hand. They are most often solitary and involve only one upper extremity. However, lesions involving both hands, or even involving a foot, are sometimes seen. The sucking blister resolves spontaneously as soon as bottle or breast is offered as a dietary substitute.
Xerosis. The accentuation of skin markings and fine scale illustrated here are typical of xerosis. The tendency toward dry skin tends to be inherited and is more common in families with a history of atopy. Low humidity, usually related to dry heat during the winter months, is an aggravating factor. Treatment of xerosis is aimed at rehydrating the stratum corneum. Emollients containing urea or alpha-hydroxy acids are particularly effective. Excessive bathing and the use of alkaline soaps must be avoided.
Vitiligo. These are more illustrations of fairly extensive cases of vitiligo. The condition tends to progress and may even become universal. A variety of treatment modalities are commonly employed, with varying degrees of success. The patient and family should be made aware of the sophisticated cover-up cosmetics that are now available. The use of broad-spectrum sunscreen lotions during the summer months minimizes the con- trast between normal and involved skin. For some patients, the application of topical corticosteroids alone or with brief natural sunlight exposure early in the course of the disease may induce repigmentation. Narrowband UUB is also an effective treatment. Varying combinations of topical or oral psoralens and ultraviolet A light (PUVA) are used in the treatment of vitiligo.