Pediatric Dennatology Voi, 9 No, 4 397-406 Proceedings of the Concurrent Sessions Amy S. Paller, M.D., Bernard Cohen, M.D., Ronald Hansen, M.D., Adelaide A. Hebert, M.D., Anne Lucky, M.D., Moise Levy, M.D., Elaine Siegfried, M.D., and Andrew Truhan, M.D. A group of reporters attempted to attend most of the concurrent sessions and note exciting new infor- mation. We apologize if occasional sessions are not included herein and if important topics inadvertent- ly are not mentioned. ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, AND TEN Dr. William Weston from Denver, Colorado, em- phasized that erythema multiforme (EM) minor and erythema muitiforme major (Stevens-Johnson syn- drome) are different disorders. Although drugs most frequently have been associated with EM ma- jor, herpes simplex virus (HSV) is the most com- mon cause of EM minor. Fifty percent of patients with EM minor have a labial herpes infection 3 to 21 days before the EM, and HSV genomic DNA has been detected by in situ hybridization in mucocuta- neous tissue of the majority of patients. Treatment of EM minor should be systemic acyclovir, Cortico- steroids are contraindicated. Dr. Neil Shear from Toronto, Canada, noted a genetic predisposition to severe drug reactions, in- cluding EM major, such as by slow acetylation of certain drugs. The alteration in drug metabolism may explain why 69% of patients react to phenyt- oin, phenobarbital, and carbamazepine. He advised that 50% of patients with EM major have hepatitis, nephritis, and other internal organ involvement. NEONATAL DERMATOLOGY Dr. Alfred Lane from Stanford, Caiifomia, dis- cussed routine care of neonates less than 32 weeks' gestation as it relates to decreased epidermal barrier function and increased local and systemic toxicity of topically applied medications, particularly given itrfants' increased body surface area:weight ratio. Dr. Lane investigated pHisoDerm versus Cetaphil for bathing. The infants were bathed twice a week for three weeks with one of these products. Both groups experienced an unacceptable drop of axil- lary temperature greater than 0.5°C, despite at- tempts to increase or maintain ambient tempera- ture. The mean oxygen saturation during bathing dropped to 87°F for Cetaphii and 84°F for pHiso- Derm. Cultures grew a predominance of Staphylo- coccus epidermidis, with equal numbers before and after bathing. These results raise the question of whether it is necessary to bathe the very premature infant. There was no difference in bacteria or yeast counts in neonates treated with Eucerin versus no treatment, yet the overall appearance of the skin was better in the emollient-treated group. The use of Biocclusive was associated with a 67% decrease in transepidermal water loss (TEWL), as measured by evaporimeter on days 3 and 7, but had no signif- icant effect on TEWL by day 14. There was no in- crease in infection in the treatment group and no ef- fect on bacterial colonization. Of interest, the bacteria cultured from areas outside of the occluded sites were ultimately found under the occluded sites during the treatment interval. Two questions to be resolved are whether such semipermeable dressings should be used on injured premature skin, and the exact indications for their use. Dr, John Harper from London, England, de- scribed clinical findings of erythroderma in infants, and listed a differential diagnosis to include Leiner disease, ichthyosiform erythroderma, infantile seb- orrhea, atopic dermatitis, psoriasis, primary immu- nodeficiency, diffuse mastocytosis, and multiple carboxylase deficiency. The entity known as Leiner disease causes infantile erythroderma, failure to thrive, diarrhea, and a wide range of immunodefi- ciency disorders. The literature has noted decreases of C3, C4, and C5, as weli as decreased IgG Eind polymorphonuciear leukocyte chemotaxis. A defect in yeast opsonization, which was thought to be a specific feature of Leiner disease, occurs in approx- imately 20% of the general population. Other disor- 397