Pediatric skin conditions, both congenital and acquired, encompass a broad spectrum of dermatological disorders that vary in etiology, clinical presentation, and prognosis. Congenital skin conditions, such as congenital melanocytic nevi, hemangiomas, epidermal nevi, and congenital ichthyosis, are present at birth or develop in early infancy. These conditions often have genetic or developmental origins and may require long-term monitoring or intervention depending on their severity. In contrast, acquired skin diseases, including atopic dermatitis, psoriasis, viral exanthems, and impetigo, develop postnatally due to environmental, infectious, or immunological factors and generally respond more favorably to medical treatment.

Accurate diagnosis is critical for effective management and prognosis determination. While clinical evaluation remains the primary diagnostic approach, advanced radiological techniques such as ultrasound, magnetic resonance imaging (MRI), and X-ray have become valuable adjuncts in assessing the extent of dermatological involvement, particularly in conditions affecting deeper skin structures. These imaging modalities assist in differentiating benign from malignant lesions, guiding treatment decisions, and monitoring disease progression.

Despite the growing use of radiological and dermatological techniques, there is limited research on their comparative efficacy in diagnosing congenital versus acquired pediatric skin conditions. This study aims to evaluate the demographic distribution, radiological findings, and treatment responses in pediatric patients with congenital and acquired skin diseases. Additionally, it explores the statistical differences in treatment outcomes between the two groups, providing insights into optimizing diagnostic and therapeutic strategies.

This cross-sectional study was conducted at RVM Institute of Medical Sciences, Laxmakkapally, Telangana, India, from January 2023 to December 2024. The study aimed to evaluate the effectiveness of advanced dermatological and radiological techniques in diagnosing congenital and acquired pediatric skin conditions.

Study Population

A total of 100 pediatric participants aged 1 month to 18 years were enrolled. The participants were recruited from dermatology and pediatric outpatient clinics. The inclusion and exclusion criteria were as follows:

Inclusion Criteria:

Pediatric patients (aged 1 month–18 years) diagnosed with congenital or acquired skin conditions.

Patients who underwent dermatological and radiological assessments.

Those with complete medical records and parental consent.

Exclusion Criteria:

Patients with incomplete medical records.

Those with systemic diseases affecting the skin.

Patients with contraindications to radiological imaging.

Data Collection

Demographic and clinical data were collected, including age, gender, diagnosis, and disease duration. The study classified patients into two groups:

Congenital skin conditions (present at birth or developing in infancy).

Acquired skin conditions (developing postnatally due to infections, allergies, or autoimmune causes).

Diagnostic Techniques

Each patient underwent dermatological examination and radiological imaging as needed:

Clinical Dermatological Evaluation: Conducted by board-certified dermatologists to diagnose and classify skin conditions.

Radiological Assessment:

Ultrasound

Used for hemangiomas and epidermal nevi (70% of cases).

MRI

Applied in cases requiring deeper tissue analysis, such as congenital melanocytic nevi and extensive hemangiomas (15% of cases).

X-ray

Used for conditions with suspected bony involvement, such as osteoma cutis and dermatofibromas (5% of cases).

Treatment and Follow-Up

Patients received appropriate treatment based on their diagnosis, including:

Conservative management (topical and systemic therapy).

Surgical intervention (for selected congenital cases).

Follow-up assessments were conducted to monitor treatment response.

Outcome Measures

Primary Outcome

Treatment response, classified as full resolution, partial resolution, or no significant improvement.

Secondary Outcome

The effectiveness of different diagnostic techniques in confirming skin conditions.

Statistical Analysis:

Data were analyzed using SPSS version 26.0. Chi-square test was applied to compare treatment outcomes between congenital and acquired conditions. A p-value < 0.05 was considered statistically significant.

The study evaluated the demographic and clinical characteristics of 100 pediatric participants, ranging in age from 1 month to 18 years, with a mean age of 7.5 years. Among the total sample, 45% were male and 55% were female. Of the participants, 60% had congenital skin conditions, while 40% had acquired conditions.

Table 1: Demographic Characteristics of Study Participants

Dermatological Findings

Among the congenital skin conditions, the most common diagnosis was congenital melanocytic nevi, accounting for 35% of cases (Table 2). Hemangiomas followed closely with 28%, while epidermal nevi and congenital ichthyosis were seen in 17% and 15% of cases, respectively. Other rare congenital skin conditions represented 5% of the sample.

Table 2: Dermatological Findings of Congenital Skin Conditions

In the acquired skin conditions group, atopic dermatitis was the most prevalent, affecting 30% of patients (Table 3). Psoriasis was the second most common, seen in 20% of cases. Viral exanthems and impetigo were diagnosed in 18% and 15% of participants, respectively. Tinea corporis and other

Table 3: Dermatological Findings of Acquired Skin Conditions

Radiological Findings and Diagnostic Techniques

Regarding diagnostic techniques, ultrasound was used in 70% of cases to diagnose hemangiomas and epidermal nevi (Table 4). MRI was employed in 15% of cases to assess deep skin involvement in congenital melanocytic nevi and hemangiomas. X-ray was utilized in 5% of cases, primarily for osteoma cutis and dermatofibromas with bony involvement.

Table 4: Radiological Findings and Diagnostic Techniques

Treatment Response

For congenital skin conditions, the majority of patients (65%) showed no significant improvement and required follow-up (Table 5). A smaller proportion (20%) experienced full resolution with conservative management, while 15% underwent surgical intervention (excision or debulking).

Table 5: Treatment Response for Congenital Skin Conditions

In contrast, acquired skin conditions responded more favorably to treatment, with 40% of patients showing significant improvement with pharmacological treatment. Combination dermatological and systemic treatments were effective in 30% of cases, while 30% of patients showed moderate response (partial resolution) (Table 6).

Table 6: Treatment Response for Acquired Skin Conditions

Statistical Analysis

Statistical analysis revealed that congenital conditions had a higher rate of complete resolution (20%) compared to acquired conditions (15%), with a p-value of 0.04, indicating a statistically significant difference in treatment outcomes between the two groups (Table 7).

Table 7: Statistical Analysis of Treatment Outcome Based on Skin Condition Type

Pediatric skin conditions, both congenital and acquired, present significant diagnostic and therapeutic challenges. This study highlights the role of advanced dermatological and radiological techniques in the accurate diagnosis and management of these conditions. The findings provide insights into the prevalence, diagnostic approaches, and treatment responses among pediatric patients with skin disorders.

Prevalence and Clinical Patterns

Our study revealed that 60% of cases were congenital skin conditions, with congenital melanocytic nevi (35%) and hemangiomas (28%) being the most common. These findings align with previous studies that emphasize the high incidence of congenital melanocytic nevi and hemangiomas in newborns and infants. The presence of epidermal nevi (17%) and congenital ichthyosis (15%) further reinforces the diversity of congenital dermatological presentations.

Among acquired skin conditions (40%), atopic dermatitis (30%) was the most prevalent, followed by psoriasis (20%), viral exanthems (18%), and impetigo (15%). These conditions are often associated with environmental, allergic, or infectious triggers, making early diagnosis essential for effective treatment. The prevalence patterns observed in this study are comparable to global pediatric dermatology trends.

Role of Radiological Techniques in Diagnosis

Radiological imaging played a crucial role in diagnosing deep-seated and complex dermatological conditions. Ultrasound (70%) was the primary imaging modality, particularly effective for hemangiomas and epidermal nevi due to its ability to assess vascular and soft tissue involvement. MRI (15%) was employed for cases requiring deeper structural analysis, such as congenital melanocytic nevi and extensive hemangiomas, ensuring precise evaluation of subcutaneous involvement. X-ray (5%) was limited to cases with suspected bony involvement, such as osteoma cutis and dermatofibromas, indicating its role in specific diagnostic scenarios.

The use of these imaging techniques complements clinical examination, aiding in early diagnosis, disease monitoring, and treatment planning. Our findings support previous research emphasizing the importance of imaging in pediatric dermatology, particularly for congenital conditions requiring long-term follow-up.

Treatment Responses and Outcomes

A notable difference was observed in the treatment outcomes of congenital versus acquired conditions. Congenital conditions had a lower response to treatment, with 65% requiring long-term follow-up, while only 20% showed full resolution with conservative management. Surgical intervention was necessary in 15% of cases, indicating the need for specialized interventions in some congenital conditions.

In contrast, acquired conditions demonstrated a better response to treatment, with 40% of patients achieving significant improvement through pharmacological management. Combination therapies involving systemic and dermatological treatments were effective in 30% of cases, while the remaining 30% showed partial resolution. These findings suggest that early and targeted treatment strategies are crucial for acquired dermatological conditions, which typically respond better to medical interventions than congenital conditions.

Statistical Significance in Treatment Outcomes

Our statistical analysis revealed a significant difference (p = 0.04) in treatment outcomes between congenital and acquired conditions, with acquired conditions demonstrating a higher rate of complete resolution. This finding highlights the chronic nature of congenital skin conditions, which often require long-term management, while acquired conditions benefit more from early intervention.

Clinical Implications and Future Directions

The study underscores the importance of integrating radiological techniques into routine dermatological practice for pediatric patients. Given the varying responses to treatment, individualized management plans based on disease type, severity, and imaging findings should be prioritized. Future research should explore novel therapeutic approaches for congenital skin conditions and evaluate the long-term effectiveness of imaging-guided interventions.

Additionally, larger multicenter studies are needed to confirm these findings and establish standardized guidelines for using radiological techniques in pediatric dermatology. Further investigations into genetic and immunological factors contributing to treatment resistance in congenital conditions could also improve patient outcomes.

This study highlights the significance of advanced dermatological and radiological techniques in diagnosing pediatric skin conditions. Ultrasound (70%) was the most frequently used imaging modality, particularly for hemangiomas and epidermal nevi, while MRI (15%) was valuable for assessing deep tissue involvement. Congenital conditions (60%) often required long-term monitoring (65%), with only 20% achieving full resolution, whereas acquired conditions (40%) showed a higher response to early medical management (40% significant improvement, p = 0.04). These findings emphasize the need for tailored diagnostic and treatment strategies, integrating clinical expertise with imaging tools. A multidisciplinary approach involving dermatologists, radiologists, and pediatricians is crucial to optimizing patient care and improving outcomes for pediatric dermatological disorders.

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