Highlights from the literature

A study in the Department of Dermatology at the Great Ormond Street Hospital for Children, London (Br J Dermatol 2011;165:1308–13) has led to the conclusion that localised scleroderma (morphoea) in children is often misdiagnosed or diagnosed late. The retrospective study included 50 children who developed localised scleroderma (LS) at a median age of 5.2 years (range 0.1–14.4 years). The time to diagnosis was 11.1 months (1.8–79 months). At the onset the children's families most commonly suspected that the lesion was a bruise or eczema. The child was first seen by a doctor after 1.2 (0.2–48.7) months. These doctors were general practitioners (46), paediatricians (2), a dermatologist, and a dentist. By parental report, none made a correct diagnosis: 22 offered no diagnosis, 10 diagnosed eczema, four melanocytic naevus, and the rest proffered nine different diagnoses. On referral to a specialist (dermatologist, paediatrician, vascular surgeon, or other) after an average disease duration of 7.5 (1.0–70.9) months the correct diagnosis was made in 32 cases but 10 children still had no diagnosis and eight remained misdiagnosed, the most common misdiagnosis at this stage being a port wine stain. The correct diagnosis was made by a dermatologist in 46 cases, maxillofacial …