invasiveness of the highly metastatic melanoma cell line

LOX(7). The overexpression of MX1 and MX2 through

a gene dosage eect in trisomy 21 could be involved in
the occurrence of melanoma.
ACKNOWLEDGMENTS
Agrant fromthe FondationJe ro me Lejeune supports the
studyontumors inpeople withDownsyndrome. Thanks
to Christiane Satge who prepared the manuscript.
REFERENCES
1. Satge D, Sommelet D, Geneix A et al. A tumor prole
in Down syndrome. Am J Med Genet 1998;78:207216.
2. Hasle H, Clemmensen IH, Mikkelsen M. Risks of leukae-
mia and solid tumours in individuals with Downs syn-
drome. Lancet 2000;355:165169.
3. Nakano J, Muto M, Arikawa K et al. Acral lentiginous
melanoma associated with Downs syndrome. J Dermatol
1993;20:5960.
4. Jafarian F, Powell J, Kokta Vet al. Malignant melanoma in
childhood and adolescence: report of 13 cases. J Am Acad
Dermatol 2005;53:816822.
5. Kuphal S, Bosserho A. Recent progress in understanding
the pathology of malignant melanoma. J Pathol 2009;
219:400409.
6. Barrett JH, Iles MM, Harland M et al. Genome-wide
association study identies three new melanoma suscepti-
bility loci. Nat Genet 2011;43:11081113.
7. Mushinski JF, Nguyen P, Stevens LM et al. Inhibition of
tumor cell motility by the interferon-inducible GTPase
MxA. J Biol Chem 2009;284:1520615214.
Daniel Satge , M.D., Ph.D.*
Guy Dimoux-Dime, M.D.
William Godard, M.D.
Be ne dicte de Fre minville, M.D.
Departments of *Pathology and Dermatology,
University Hospital, Saint Etienne, France, Institut de
Pathologie duForez, Saint Etienne, France, Department
of Genetics, University Hospital, Saint Etienne, France
False Highlighting with Woods Lamp
Abstract: Woods lamp evaluation is used to
diagnose pigmentary disorders. For example, vitiligio
typically demonstrates lesional enhancement under
Woods lamp evaluation. Numerous false positive
enhancing lesions can be noted in the skin. We describe
a 5-year-old Hispanic boy who had painted his face with
highlighter, producing enhancinglesions under Woods
lamp. Physicians who use Woods lamp should be
aware that the appearance of markers and highlighter
can mimic that of true clinical illnesses.
A Woods lamp is used to dierentiate between vitiligo
vulgaris and hypopigmenting disorders based upon the
enhancement of vitiliginous lesions with this ultraviolet
light source (1). We want to make pediatric dermatolo-
gists aware of a specic mimic of enhancement that we
see commonly in children. The following case illustrates
this issue.
CASE REPORT
A 5-year-old Hispanic boy presented with perinasal and
perioricial hypopigmentation (Fig. 1A) of a few days
duration. On Woods lamp examination (Fig. 1B), an
enhancing lesion was noted over the left eyebrow, which
resolved with alcohol swab. The child had been playing
with magic markers but denied drawing on his face.
A similar lesion was induced with pink highlighter
(Papermate W20) to the forearm of an adult volunteer
(Fig. 2). Pink highlighter glows orange, and yellow
highlighter glows yellow-green under a Woods lamp,
mimicking erythrasma and vitiligo, respectively (1). The
highlighter-induced exogenous lesions are bright and
well demarcated and will clear with alcohol swabs.
Medical usage of highlighters to outline patch test sites
A
B
Figure 1. Hispanic boy: (A) side view, (B) under Woods
lamp demonstrating lesion invisible to the naked eye.
Address correspondence to Daniel Satge , M.D., Ph.D., Service
dAnatomie et cytologie pathologique, Centre Hospitalier Uni-
versitaire, 42055 Saint Etienne Cedex, France, or e-mail:
danielsatge@orange.fr.
Brief Reports 109
has been described (2). Standard markers are usually
more noticeable on standard examination with lack of
enhancement. Table 1 lists lesions that may enhance or
alter under aWoods lamp. Practitioners shouldconsider
that marker usage is common in small children and may
need to be cleaned o when evaluating for hypopig-
mentation in childhood.
REFERENCES
1. Ducharme EE, Silverberg NB. Selected applications of
technology inthe pediatric dermatology oce. SeminCutan
Med Surg 2008;27:94100.
2. Herro EM, Cosan T, Jacob SE. Ultraviolet protective eye-
wear for Woods light use. Pediatr Dermatol 2011;28:351
352.
Jonathan I. Silverberg, M.D., Ph.D., M.P.H
Nanette B. Silverberg, M.D.
Department of Dermatology, St Lukes-Roosevelt
Hospital Center, New York, New York
Chlorhexidine-Associated Transient
Hyperchloremia in an Infant
Abstract: An infant was cleansed with 2% clor-
hexidine gluconate (CHG) because of repeated sepsis
episodes from skin colonization. Asymptomatic hyper-
chloremia ensued, most likely associated with CHG
therapy. Fourty-eight hours after CHG therapy with-
drawal, serum chloride levels returned to normal.
Hyperchloremia may be a reversible adverse effect of
extensive use of CHG.
Chlorhexidine gluconate (CHG) is used for daily bath-
ing, full-body skin cleansing, catheter-site skin prepara-
tion, umblical cord care, and Staphylococcus aureus
decolonization (1). Here, we report a low-birth-weight
infant who was cleansed using CHGbecause of repeated
sepsis supposedly acquired through the skin and experi-
enced hyperchloremia that was considered to be related
to CHG treatment and resolved spontaneously after
discontinuing CHG cleansing.
CASE REPORT
Agirl bornat 29 weeks of gestationwithabirthweight of
1,320 g had seven episodes of sepsis due to Staphylo-
coccus aureus (3 episodes), Enterococcus faecium (2 epi-
sodes), Candida spp (1 episode), and Streptococcus
sanguis (1 episode) by the age of 58 days. Because
microbes were thought to enter the bloodstreamthrough
the skin, she hadher whole body cleansed with 2%CHG
(Dicideral Wash; Babgencel, Ankara, Turkey) for
2 weeks on alternate days after the last septicemic epi-
sode. At the endof the secondweekof CHGtherapy, her
temperature was 37.4C, and she was hyperchloremic
(125 mEq L; normal range 98107 mEq L). Sepsis
examination with interleukin-6 and C-reactive protein
were negative, and renal function tests including blood
TABLE 1. Lesions That Alter with Woods Lamp
Pigmentary disorders (Blue-white uorescence)
Vitiligo
Ash leaf macules of Tuberous sclerosis
Hypopigmented Mycosis fungoides
Infection (type, color of uorescence)
Pseudomonas, Green
Corynebacterium minutissimum, Coral-red
Propionibacterium acnes, Orange-red, Yellowish-white
Pityriasis versicolor, Yellowish-white, Copper-orange
Pityrosporum folliculitis, Bluish-white follicular
Microsporum (audouinii, canis, ferrugineum, distortum),
Blue-green
M. gypseum (some variants), Dull-yellow
Porphyrias, uorescent source, usually red-pink
Erythropoietic porphyria RBC, urine, teeth
Erythropoietic protoporphyria RBC, feces, gall stones
Hepatoerythropoietic porphyria RBC, feces, urine
Porphyria cutanea tarda urine, feces
Variegate porphyria urine, feces
False positives
Colored markers, especially highlighters
Dried soap and laundry detergents with optical brighteners
Hyperkeratotic scale
Invisible ink
Lemon juice
Lint
Natural secretions: semen, serum, saliva, milk
Select cosmetics and hair dyes
Selected sunscreens and ointments
Wet ear wax
Table modied from reference (1).
Figure 2. Exogenously induced lesion created with pink
highlighter.
Address correspondence to Nanette B. Silverberg, M.D.,
Director, Pediatric and Adolescent Dermatology, Department of
Dermatology, St. Lukes-Roosevelt Hospital Center, 1090
Amsterdam Avenue, Suite 11D, New York, NY 10025, or e-mail:
nsilverb@chpnet.org.
110 Pediatric Dermatology Vol. 31 No. 1 January February 2014