Warning - this story won't be nearly as interesting to those of you who aren't in the medical field, but I think you will still enjoy how it ends. For those of you who treat kids, this is something you will definitely want to read - I learned and you will too I would be willing to bet!!!
I had a 8 1/2 year old white girl come to see me a couple of weeks ago. She complained about a brown spot in her suprasternal notch that appeared about a month prior and had spread to circle halfway around her neck. Also started to appear in her navel. Mom thought it was dirt and made her get back in the shower and try again to get it off. When she couldn't, mom tried and succeeded only in turning the poor kid's neck red from all the scrubbing. On exam, it looked exactly like acanthosis except that it was in the front instead of the back. Well, I thought this was weird because she is white and skinny (BMI ~5%). My partner examined and completely agree with me - so we looked it up.
According to up-to-date, acanthosis is caused either by insulin resistance or malignancy, nothing else is even mentioned. I did a fasting insulin which was normal. So, then I was starting to get a little worried. I even consulted, by phone, Hem-Onc at Childrens. They were just as confused as I was, as acanthosis usually only comes with adult-type malignancies such as lung and colon cancers. They suggested that I send her to derm for a biopsy to make sure this is what we were dealing with. I called the dermatologist, explained what was going on, and made an appt.
So, last week she went to see dermatology. The dermatologist examined it closely . . . then started laughing. She got a makeup remover pad, soaked it in alcohol and wiped off the "acanthosis". I was shocked!! Apparently this is something this dermatologist sees at least once a week in kids. She said that no amount of scrubbing with soap and water will get it off, you have to use alcohol.
So, lesson learned for me - before diagnosing a kid with acanthosis, try treating with Alcohol!!
The mom and I got a good laugh out of this, although we were both embarrassed that we didn't recognize dirt!!!!
Fettucini Alfredo
13 years ago
1 comment:
I had a similar thing happen to me. Little girl with a greenish discoloration on her chest. Had a history of congenital heart disease and had some kind of device implanted just under where the spot was. Mom reported scrubbing it with soap with no change. Had my partner look at it and she was sure it was some kind of stain. Sure enough, when I wiped with an alcohol pad instead of just water it came right off!
Post a Comment