Common Lumps and Bumps in Children: A Colour-coded Differential

Shahana Nathwani, BHK, Faculty of Medicine, University of British Columbia, Vancouver, BC.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC.

Abstract
Many conditions present as 'lumps and bumps' in the pediatric population. Some follow a benign course and can be safely observed with parental education and reassurance. Others require definitive therapy or carry the potential for serious complications. Understanding and recognizing the different lesions will help guide the care, counseling and management of patients with these common 'lumps and bumps'. This review presents and categorizes common pediatric cutaneous lesions according to colours as a tool to help the general practitioner recognize and remember these lesions.
Keywords: benign; pediatric; tumours; vascular; hemangioma; nevus.

Thoughts on the WHO's Dementia Report

It is a positive step for all of us trying to care for those living with dementia and their families to learn that the World Health Organization (WHO) has produced a far-reaching report outlining the world-wide challenge faced by nations whose populations will be affected by increasing numbers of those afflicted with Alzheimer's disease and other causes of dementia. The report entitled, "Dementia: A Public Health Priority",  gives a world-wide perspective and reiterates the already known Canadian statistics which estimates about half a million people living with some sort of dementia in 2010 with an estimated increase to 1.1 million by 2025 if nothing dramatic happens in terms of preventative treatments over the coming years.

One of the comments that caught the eye of the media about Canada's approach is that unlike Australia, Denmark, France, Japan, Korea, the Netherlands, Norway and the United Kingdom which all have some sort of a national strategy for dementia, Canada does not.  This apparent lack by the Canadian federal government became a focus for criticism by many Canadian organizations including the Alzheimer Society of Canada which used the term, "a wake up call" to the federal government to take action.

The problem in Canada with expecting the federal government to embark on a national strategy is that unlike the nations cited as having national strategies which in fact have national health services, Canada does not really have a national health service. Rather it has a nationally mandated framework for provincially run-health care systems under the umbrella legislation known as the Canada Health Act, often referred to as Canadian Medicare. In essence what Canada has are provincial health care systems, all of which share commonalities, but which differ enormously in the spectrum of services provided beyond the federally mandated (through the Canada Health Act) physician and hospital services. Therefore each province has its own approach to home care, long-term care, pharmacare, and family support systems for those experiencing a wide range of ailments of which dementia is just one of many that can have a devastating effect on individuals and their families.

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This means that for there to be a meaningful and robust approach to the challenges of dementia from original and basic research to the clinical domains of care through the spectrum of stages and venues where care will be provided to the very late stages of dementia where palliative and end-of-life considerations become paramount, it will likely be at the individual provincial level. This will take place with local organizations including universities and their affiliated research centres and individual health care settings from acute to long-term care that will ultimately define, explore and experiment with the range of interventions that might be useful in either thwarting the disease or providing appropriate care and support to patients and their families.

The federal government can be of great assistance whether through a formal national 'strategy' or through extensions of already existing mechanisms by promoting and encouraging (which usually means funding) research across many domains of dementia scientific enquiry, from the basic science aspects, to pharmaceutical research to health care systems and delivery studies. It can also find ways to support the range of care provision aspects at the individual and organizational approaches again through funding, grants, tax incentives, and other levels that work at the federal level that augment, but do not conflict with the provincial mandates of providing care in the local jurisdictional level.

That dementia is a "ticking time bomb" is clear from the current statistics and the projections should nothing dramatic occur. But that can change with a combination of concerted effort, use of best brains and technologies and a modicum of good fortune in the world of research endeavors which often comes up with solutions either from expected or unexpected sources.

Canada and each of the provinces cannot ignore the implications of the WHO report and the impact that the factors outlined in the report will have on the populations living in the country. All ways possible must be found to support each of the provinces as they try to cope with the local challenges of their populations affected by the "ticking time bomb" through their own provincial initiatives along with close scrutiny of the world-wide evidence on novel approaches along with cooperation across all the provinces and the sectors within the country. Canadians deserve no less from their federal and provincial governments.

Michael Gordon, MD, MSc, FRCPC
Editor-in-Chief, Dementia Educational Resource
www.healthplexus.net and the Journal of Clinical Care

About Health Plexus:
Comprised of 1000s of clinical reviews, CMEs, bio-medical illustrations and animations and other resources, all organized in the 34 condition zones, our vision is to provide physicians and allied healthcare professionals with access to credible, timely and multi-disciplinary continuing medical education from anywhere and on any media consumption device. The Dementia Educational Resource is the compilation of high quality clinical reviews, online CME programs, library of original visual aids, interviews, roundtable discussions and related conference reports.

The Launch of the Dementia Educational Resource: Interview With the Editor-in-Chief Dr. Michael Gordon

Key Topics for Your Adult Patients

It is my pleasure to introduce the latest issue of The Journal Of Current Clinical Care. This current issue has a number of key articles, for the primary care physician and specialist, alike that summarize a practical approach to important issues in daily practice.

From Dr. Shabbir Alibhai, we have an update on cancer screening in the older adult. Cancer remains a major cause of morbidity and mortality in older adults—as more than half of all new cancers and over 70% of cancer deaths occur in the over -65 age group. Cancer screening is an important tool to decrease the incidence and mortality from cancer in older adults. Dr. Alibhai reviews the evidence and the screening recommendations for this population.

Dr. James Wright reviews the choice of first line anti-hypertensive agents in the older adult. This article examines the evidence for the different classes of first-line antihypertensive drugs in the context of four important treatment goals: reduction in mortality and morbidity; efficacy in lowering blood pressure; ensuring tolerability; and minimizing cost.

Many may consider Parkinson’s disease as primarily a motor disorder. However, it has important effects on cognition and personality. Important neuropsychiatric sequelae of Parkinson’s, known as impulse-control disorders, can have significant negative effects on patients and their families. Examples are pathological gambling and hypersexuality. Dr. Andrew Johnson reviews the treatment options for this condition, including dopamine agonist dose reduction or cessation, the use of psychosocial strategies, and deep-brain stimulation of the subthalamic nucleus.

Proteinuria is frequently a marker of unsuspected kidney disease, progressive atherosclerosis, or a systemic disease. A strong correlation exists between urinary protein excretion and the progression of renal failure. Proteinuria is also a strong and independent predictor of increased risk for cardiovascular disease and death, especially in people with diabetes, hypertension, and chronic kidney disease. Dr. Fatemeh Akbarian et al. review the diagnosis and treatment of proteinuria in the adult.

Dr. Michael Gordon’s article discusses the sensitive issue of conflict among family members in the context of substitute decision making for patients with dementia. The article emphasizes that physicians must use the art of medicine, including their communication skills and sensitivities, to help families resolve their differences so that the best possible care can be provided to their family members.

I hope you enjoy the issue. As always your comments are welcome.

The Canadian Conference on Dementia: Past, Present and Future

Optimizing Acne Care

Publication of THE LATEST IN ACNE CARE supplement was made possible by an unrestricted educational grant from Galderma Canada Inc.

Maha Theresa Dutil, MD, M.Ed, FRCPC, Assistant Professor of Medicine, Division of Dermatology, University of Toronto, Toronto, ON.

One of the marked changes in the practice of dermatology over the past thirty years has been the increased focus on acne. What was once considered a universal rite of passage that occasionally caused deeply disturbing scars is now considered—by patients and doctors alike—an insufferable condition that must be treated. Perhaps as a sign that available treatments are increasingly successful, acne is showing signs of affecting popular culture. Kid Acne, a British artist (not his real name!), decided to make his affliction his signature so as to stand out in the crowded hip-hop scene. The Uruguayan movie Acné (as you would have guessed, about a thirteen-year-old boy coming of age while enduring acne outbreaks) was a hit of Spanish-speaking cinema in 2008. Acne for Dummies by Dr. Herbert P. Goodheart (a remarkably good book!) ranks a respectable 76th in skin care/ beauty books on Amazon.ca.

Success has bred the desire for even more success. This supplemental publication to Dermatology Times on "Innovations in Acne Care: The Latest Guidelines and Treatment Options" sheds light on new approaches that will be helpful to specialists and GPs alike. Dr. Neil Shear's "Newest Guidelines for the Treatment of Acne" discusses the acne guidelines...

Newest Guidelines for the Treatment of Acne

Neil H. Shear, MD, FRCPC, FACP,

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Abstract: This article summarizes key statements from the 2009 Global Alliance to Improve Outcomes in Acne Group's therapeutic guidelines, published as a supplement in the Journal of the American Academy of Dermatology (JAAD). It offers an algorithm for acne treatment, as well as addresses important statements from the committee on acne pathophysiology, epidemiology, and the latest research findings, as they pertain to the guidelines.

Key Words: acne, treatment guidelines, adherence, antibiotic resistance, maintenance.

Dermatologists should be actively contributing to educating other clinicians that acne is a chronic disease.

Despite many extensive educational programs, the committee sees an ongoing need to urgently reduce the use of antimicrobial therapies, especially as single agents.

A combination of a topical retinoid plus an antimicrobial agent is first-line therapy for most patients with acne (a finding based on clinical trials with over 16,000 total subject participants in studies of Level I evidence quality), as it targets multiple pathogenic features and both inflammatory and noninflammatory acne lesions.

The Global Alliance 2009 update affirms that topical retinoids should be fundamentally a core component of an acne therapy regimen for stages I to III. The committee's consensus is that early and appropriate treatment, continued for as long as necessary, is the best approach to mitigating scarring for acne patients.

Implement strategies to improve adherence to therapy (e.g., medication reminders, self-monitoring with diaries, support groups, telephone follow-up) to ensure success.

Treat acne as quickly and as efficiently as possible to achieve the best therapeutic outcomes, and to improve patient satisfaction, limit treatment expenses, and mitigate scarring.

To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.