Babies born four months before the peak cold and flu season have a 30 percent higher risk of developing asthma, U.S. researchers said on Friday, suggesting that these common infections may trigger asthma.

Without ample opportunity for forms of play that foster innovation and creative thinking, America’s children will be at a disadvantage in the global economy, psychologist argues.

Should preschool be more about ABCs or learning to play with others? With the help of Twiggle the Turtle, scientists found out that youngsters do better if they do both.

A safe haven law in Nebraska has stressed-out parents abandoning children as old as 17 without fear of prosecution. Has the law gone awfully wrong, or is it terribly right?

Children who study a musical instrument for at least three years outperform children with no instrumental training on non-musical tests of vocabulary and non-verbal reasoning.

Scientists using ultrasound imaging detected fatty deposits in arteries of obese children and teens more typical of middle-aged adults, raising fears about accelerated heart disease.

Objective  To investigate the prevalence of autoimmune disease and circulating autoantibodies in women with lichen sclerosus (LS) and erosive lichen planus (LP) of the vulva and to compare these with a control population.

Design  Age- and sex-matched controlled study.

Setting  The vulval clinics in Oxfordshire, England, for patients with LS and LP. Healthy controls were recruited from the hospital and community.

Patients  A total of 190 women with the typical features of adult-onset LS of the vulva, 126 women with adult-onset erosive LP of the vulva, and 922 female controls (of whom 230 were examined).

Interventions  Personal history of autoimmune disorder for patients and controls, family history of autoimmune disorder for vulval LS and LP cohorts, and an autoantibody screen.

Main Outcome Measures  The presence or absence of a personal or family history of autoimmune disorder, and the presence or absence of 1 or more circulating autoantibodies.

Results  The mean ages of patients with LS, patients with erosive LP, and control patients were 63, 61, and 61 years, respectively. The mean age of the 230 controls examined (including those who had serum autoantibodies assayed) was 62 years. Autoimmune disorders were more frequent in patients with erosive LP compared with controls (29% vs 9%; P < .001) and in those with LS compared with controls (28% vs 9%; P < .001). Circulating autoantibodies were more frequent in those with erosive LP compared with controls (41% vs 20%; P < .001).

Conclusion  This study demonstrates an association of autoimmune disorder and autoantibodies with erosive LP of the vulva and confirms the autoimmune associations of vulval LS.

Objective  To examine the significance of eccentric hyperpigmentation (EH), central hyperpigmentation (CH), multifocal hyper/hypopigmentation (MH/HP), and the multicomponent pattern (MCP) in melanocytic lesions lacking specific dermoscopic features of melanoma.

Design  A total of 3367 benign and malignant melanocytic lesions (n = 341 melanomas, excluding lentigo maligna and lentigo maligna melanoma) were examined to identify those lesions lacking specific dermoscopic features of melanoma but having any of the global patterns of EH, CH, MH/HP, and MCP.

Setting  Dermoscopic images were collected from lesions excised or undergoing sequential digital monitoring from the Sydney Melanoma Diagnostic Centre, a tertiary referral institution located in Sydney, Australia.

Main Outcome Measure  The odds ratio (OR) for melanoma of EH, CH, MH/HP, and MCP.

Results  While EH (OR, 3.3; 95% confidence interval [CI], 2.5-4.6) and MCP (OR, 15.4; 95% CI, 11.9-19.9) were significant predictors of melanoma when total melanomas vs nevi were analyzed, there was no significant difference between the frequency of any of the global patterns in melanomas vs benign nevi lacking specific dermoscopic features of melanoma.

Conclusion  Based on our study results and previous prevalence data on these global patterns in benign nevi, we do not believe that lesions with EH or MCP require closer observation than other benign nevi lacking specific dermoscopic features of melanoma.

Objective  To conduct an assessment of levels of UV radiation (UVR) exposure and the range of sun protection behaviors of beachgoers at a popular vacation destination.

Design  Participants completed the sun habits survey prior to entry to the beach and completed an exit survey on leaving regarding their sun protection practices while at the beach. Ambient UVR was monitored using polysulfone dosimeters.

Setting  A popular beach for vacationers in Honolulu, Hawaii.

Main Outcome Measures  Sun protection practices and UVR.

Results  Participants spent an average of 3 hours at the beach and received an estimated UVR dose of 10.4 standard erythemal doses. Latent class analysis identified 3 homogeneous classes with distinct characteristics and sun protection behaviors. Those in class 1 (unconcerned and at low risk) were at least risk of skin cancer, intended to tan, and used the least amount of sun protection. Those in class 2 (tan seekers) had the second highest risk of skin cancer, had the highest proportion of women, became sunburned easily, intended to tan, had used tanning beds in past 30 days, and had the highest proportion of sunscreen coverage and the least clothing coverage. Those in class 3 (concerned and protected) had the highest skin cancer risk, the highest proportion of clothing coverage and shade use, and were more likely to be residents of Hawaii.

Conclusions  Beachgoers were exposed to 5 times the UVR dose required to result in erythema among unprotected fair-skinned populations. Latent class analysis was effective in identifying subgroups of beachgoers who would benefit from targeted, population-based interventions aimed at reducing skin cancer risks while enjoying outdoor leisure-time activities.

Objective  To evaluate the efficacy and safety of treatment with indigo naturalis in patients with recalcitrant plaque-type psoriasis.

Design  Randomized, observer-blind, vehicle-controlled, intrapatient comparison study.

Setting  Ambulatory department of a hospital.

Participants  Forty-two outpatients with chronic plaque psoriasis were enrolled in the study from May 1, 2004, to April 30, 2005.

Intervention  The patients applied either indigo naturalis ointment or vehicle ointment topically to each of 2 bilaterally symmetrical psoriatic plaque lesions for 12 weeks (depending on the date of enrollment in the study).

Main Outcome Measures  The outcomes were assessed using the following criteria: the sum of erythema, scaling, and induration scores and the clearing percentage of the target plaque lesion assessed by 2 blinded observers.

Results  Significant reductions in the sum of scaling, erythema, and induration scores (P < .001) (mean score, 6.3 after indigo naturalis treatment vs 12.8 in control subjects) and plaque area percentage (P < .001) (mean percentage, 38.5% after indigo naturalis treatment vs 90% in controls) were achieved with topical application of indigo naturalis ointment. Approximately 31 of 42 patients (74%) experienced clearance or near clearance of their psoriasis in the indigo ointment–treated lesion.

Conclusion  Topical indigo naturalis ointment was a novel, safe, and effective therapy for plaque-type psoriasis.

Objective  To assess physician, patient, and skin lesion characteristics that affect the number of benign skin lesions excised by primary care physicians for each skin cancer.

Design  Prospective study collecting clinical, patient, and histopathologic details of excisions or biopsies of skin lesions by random samples of primary care physicians.

Setting  Southeast Queensland involving traditional family medicine physicians (n = 104; response rate, 53.9%) and family medicine physicians working in 27 primary care skin cancer clinics (n = 50; response rate, 75.0%).

Participants  Of 28 755 skin examinations recorded during the study, 11 403 skin lesions were excised or biopsied; 97.5% of the excised lesions had clinical and histologic diagnoses recorded.

Main Outcome Measures  Number of lesions needed to excise or biopsy (NNE) for 1 melanoma (pigmented lesions only) and NNE for 1 nonmelanoma skin cancer (nonpigmented lesions only).

Results  The NNE for nonpigmented lesions (n = 8139) was 1.5 (95% confidence interval, 1.4-1.6) and for pigmented lesions (n = 2977) was 19.6 (16.2-22.9). The NNE estimates were up to 8 times lower if the physician thought the lesion was likely to be malignant and up to 2.5 times higher if there was strong patient pressure to excise. The NNE estimates varied by other physician-, patient-, and lesion-related variables.

Conclusions  Clinical impressions of excised skin lesions were strongly associated with NNE estimates. By focusing on pigmented skin lesions and by addressing the physician- and patient-specific factors identified, the effectiveness of future training for primary care physicians in the clinical management of skin cancer could be improved.

Background  The treatment of skin ulcers frequently presents a management challenge. Nonhealing wounds with poor response to conventional wound management therapy represent a significant cause of disability, affecting approximately 1% of the global population. Activated protein C is a serine protease with anticoagulant, angiogenic, and anti-inflammatory properties that has shown efficacy in patients for the treatment of severe sepsis. We report 4 cases of nonhealing lower limb skin ulcers that were treated with activated protein C.

Observations  The study included 4 patients whose wounds were not improving despite standard wound treatment for 4 months or more. Activated protein C was applied topically to their wounds once weekly for 4 weeks. All 4 patients showed a rapid positive response to treatment that was maintained during a 4-month follow-up period. The treatment was well tolerated, with no remarkable adverse effects or complications.

Conclusions  Activated protein C can stimulate wound healing in patients with skin ulcers that are refractory to conventional wound-healing therapies. The likely mechanism of action is its recognized ability to stimulate angiogenesis and reepithelialization and to inhibit inflammation. Activated protein C has potential as a therapeutic option for patients with chronic skin ulcers.

Background  The neutrophilic dermatoses comprise a group of cutaneous disorders that are characterized histopathologically by infiltration of the dermis with mature neutrophils with or without vessel wall destruction. Neutrophilic dermatoses have been reported in association with a variety of autoimmune diseases, most recently as a manifestation of lupus erythematosus.

Observations  We describe 2 patients with photodistributed violaceous plaques: one with associated heliotrope rash and malar erythema, and the other with scalp involvement and Gottron-like papules. In each case, the biopsy specimen revealed changes compatible with a neutrophilic dermatosis as opposed to an interface dermatitis. The first patient also had a history of Graves disease and primary biliary cirrhosis, while second patient had Wegener granulomatosis. The 2 patients responded to therapy with oral dapsone and prednisone, respectively.

Conclusions  The atypical presentation of neutrophilic dermatosis in 2 patients with clinical features of dermatomyositis and intercurrent autoimmune-mediated illnesses may suggest an expansion in the clinical spectrum of parainflammatory neutrophilic dermatoses. The finding of a neutrophilic dermatosis in a biopsy specimen from a patient without a classic clinical presentation should invoke a thoughtful search for underlying immune complex–mediated systemic disease.

Background  Nonbullous neutrophilic dermatoses are seen infrequently in association with lupus erythematosus (LE). A recently described histopathologic variant of Sweet syndrome, to our knowledge, histiocytoid Sweet syndrome (HSS) has not been described in either pediatric or adult patients with LE.

Observations  We describe 2 pediatric patients with nonbullous histiocytoid neutrophilic dermatitis in the setting of LE. One case represents the initial presentation of subacute cutaneous LE, while the other case represents a manifestation of established systemic LE. Both cases demonstrate histopathologic findings of HSS.

Conclusions  We believe that the dermatosis observed in these 2 patients represents a nonbullous histiocytoid neutrophilic dermatosis that is best termed HSS. This entity may represent a distinct and important cutaneous manifestation of LE. Additional study is needed to further elucidate the relationship between neutrophilic dermatitis and LE.