Psoriasis dermatitis, a common phenotype of early forms of both psoriasis and atopic dermatitis in children: A prospective multicenter study.

BACKGROUND: Psoriasis (Ps) and atopic dermatitis (AD) are chronic systemic immune-mediated diseases that can coexist in an overlapping condition called psoriasis dermatitis (PD). PD patients have intermediate lesions with characteristics of both Ps and AD. PD is very rare in adults but much more frequent in children. Little is known, however, about the course of PD in the pediatric population. The aim of this study was to evaluate the percentage of PD cases in children that evolved to a definite form of Ps or AD and to identify any clinical or epidemiological variables that could predict the course of the disease. METHODS: We performed a prospective multicenter cohort study of children diagnosed with PD between January 2018 and December 2020. We collected participants' clinical and epidemiological characteristics, and pediatric dermatologists determined the percentage of participants who developed Ps or AD. RESULTS: The study included 24 children with PD, with a median age of 7.0 years. After a median follow-up period of 31 months, 83.3% of cases had evolved to a definite form of Ps or AD (44.4% to Ps and 38.9% to AD). Younger age and family history of Ps were associated with progression to AD. Participants who progressed to AD or Ps had a longer follow-up than those with an unchanged PD diagnosis. CONCLUSIONS: Given sufficient time, a large percentage of PD cases in children will evolve into Ps or AD. Long-term clinical follow-up is necessary for a correct diagnosis.

Topical 15% Resorcinol Is Associated with High Treatment Satisfaction in Patients with Mild to Moderate Hidradenitis Suppurativa.

BACKGROUND: Topical 15% resorcinol is commonly used in clinical practice for the treatment of nodules and abscesses in patients with hidradenitis suppurativa (HS). It has been shown to be clinically effective in some small studies, but data on satisfaction perceived by patients are lacking. The Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 is a validated measure of patient satisfaction, evaluating four domains: effectiveness, side effects, convenience, and global satisfaction. Our objective was to obtain data from HS patients regarding resorcinol treatment satisfaction and its relationship with clinical and epidemiological variables. METHODS: We performed a cross-sectional study providing TSQM version 1.4 questionnaires to HS patients who had been prescribed topical resorcinol during the previous 24 months. RESULTS: Ninety-two patients answered the questionnaire. Eighty-five out of 92 (92.4%) were Hurley II and 7 Hurley I. The mean total score was 317.5 out of 400 (71.0 points in effectiveness, 93.6 in side effects, 79.3 in convenience, and 73.2 in global satisfaction). Total score was higher in men than in women (329.7 vs. 311.6, p = 0.026) and higher scores on convenience were seen in patients who were not overweight or obese (86.9 vs. 77.1, p = 0.016). Most patients (65, 70.6%) denied having any side effect. 78 (84.8%) of the patients would recommend the treatment. CONCLUSION: The results of this study suggest that HS patients treated with resorcinol 15% are very satisfied with this treatment.

Herpes Simplex Virus Infection in Neonates Born to Asymptomatic Mothers: A Case Series.

Neonatal herpes is a rare condition and it is normally acquired through vertical transmission in the peripartum period. Delayed diagnosis and treatment of this condition are associated with high morbidity and mortality. We present five cases of neonatal herpes in infants born to asymptomatic mothers. Three of these infants were girls, three were born preterm, three were born after prolonged rupture of membranes, three had herpes simplex virus (HSV) type 2, and one had central nervous system (CNS) involvement. In all cases, the dermatologist played a key role in establishing an early diagnosis. Given the absence of a vaccine or a cost-effective method of screening for HSV infection in asymptomatic mothers, the current management strategies focus on the prevention of maternal infection and mother-to-child transmission, as well as early diagnosis and treatment of neonatal infection.

Hidradenitis Suppurativa is Associated with Non-alcoholic Fatty Liver Disease: A Cross-sectional Study.

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of end-stage liver disease. The aim of this controlled cross-sectional study was to assess the association between NAFLD and hidradenitis suppurativa. NAFLD was assessed using hepatic ultrasound. A total of 125 patients with hidradenitis suppurativa and 120 patients without hidradenitis suppurativa were recruited, matched for age, sex and body mass index (< 25 or ≥ 25 kg/m2), a risk factor related to NAFLD. Both groups presented similar proportions of overweight or obesity (89.6% vs 90%). Patients with hidradenitis suppurativa presented significantly higher prevalence of NAFLD compared with those with non- hidradenitis suppurativa (57.6% vs 31.7%, p < 0.001). Multivariable analysis confirmed independent association between hidradenitis suppurativa and NAFLD (odds ratio 2.79, 95% confidence interval 1.48-5.25; p = 0.001) besides age, body mass index, hypertension and hypertransaminasaemia. Hidradenitis suppurativa is significantly associated with the development of NALFD regardless of the presence of classic metabolic risk factors.

Identification of bacterial DNA in the peripheral blood of patients with active hidradenitis suppurativa.

Bacterial translocation may have a role in the pathogenesis of several inflammatory conditions. A prospective analytical case-control study was designed to assess the presence of bacterial DNA in the peripheral blood of patients with hidradenitis suppurativa (HS). An age- and gender-matched control population was recruited from healthy blood donors. Demographic and HS-related data were also collected. We took fasting blood samples from each participant and determined the presence of bacterial DNA (including bacterial species identification) and levels TNF-α, IL-1ß, and IL-17A. We included 50 patients with HS and 50 healthy controls. Bacterial DNA was present in 17 (34.0%) cases vs. 2 (4.0%) controls (P < 0.001); 14/17 (82.4%) bacterial species identified in HS patients were Gram-negative bacilli, especially Escherichia coli. The presence of bacterial DNA in patients with HS was associated with elevated levels of TNF-α (P < 0.001), IL-1ß (P = 0.01) and IL-17 (P < 0.001); however, it was not associated with disease severity or disease location. BactDNA in the peripheral blood of patients with active HS is more common that in healthy controls, and it is associated with higher levels of proinflammatory cytokines. We hypothesized that BT from the skin/intestinal lumen may play a relevant role in the pathogenesis of HS.

Subacute cutaneous lupus erythematosus starting as linear lupus erythematosus.

BACKGROUND: Cutaneous lupus in childhood is usually associated with systemic lupus erythematosus (LE). Linear cutaneous LE (LCLE) is an unusual presentation mostly seen in children and young adults. METHODS: We report a rare case of cutaneous subacute LE with a segmentary pattern following the lines of Blaschko in an 18-month-old girl with a 2-month history of persistent, linear, asymptomatic, erythematous lesions along the right arm. The clinical diagnosis at presentation was lichen striatus. RESULTS: A biopsy showed an intense, band-like, inflammatory cell infiltrate with perivascular and periadnexal involvement associated with basal cell liquefactive degeneration. The lesions were treated with topical corticosteroids and healed without scarring. Two months later, new lesions manifested as multiple erythematous, edematous, polycyclic plaques. A new biopsy showed a periadnexal infiltrate, a large amount of mucin, and a thickened basement membrane. Direct immunofluorescence was negative. Our definitive diagnosis was subacute cutaneous LE starting as linear LE. The lesions responded slowly to oral corticosteroids. Six months later, only a mild livedoid skin pattern remained on the patient's legs. CONCLUSIONS: Linear cutaneous LE usually presents with erythematous, atrophic, hyperkeratotic, dyschromic circular lesions arranged in a linear pattern; the main differential diagnosis is lichen striatum. In general, LCLE can be considered as discoid lupus following Blaschko's lines, which correspond to the direction of growth in clones of cutaneous cells that arise during embryogenesis. The present patient represents the first pediatric case of subacute cutaneous LE following Blaschko's lines, with posterior progression to a generalized form of subacute LE.

Tinea capitis in schoolchildren in a rural area in southern Ethiopia.

OBJECTIVES: Skin diseases, especially tinea capitis, represent some of the most frequent causes of morbidity in developing countries. The aim of this study was to examine the prevalences of fungal infections in schoolchildren in a primary school located in a rural area in southern Ethiopia and to perform an analysis of the risk factors associated with tinea capitis. METHODS: This school-based, prospective cross-sectional study was conducted in October 2012 in Gambo School, Kore, West Arsi, Oromya Region, Ethiopia. Detailed interviews and dermatological examinations were performed. No laboratory examinations were conducted. RESULTS: A total of 647 students were interviewed and examined. The mean age of these children was 10 years (range: 4-14 years). Of the children examined, 236 had some type of dermatophytosis (prevalence: 36.5%, 95% confidence interval [CI] 32.8-40.3), which represented the most frequent type of skin problem. The prevalence of dermatophytoses was more common in males than in females (42.2% and 30.5%, respectively; P = 0.002), and among pupils aged 5-7 years (46.9%; P < 0.001). A total of 159 (prevalence: 24.6%, 95% CI 21.3-28.1) children had tinea capitis, 56 (8.7%) had tinea pedis, 50 (7.7%) had tinea corporis, and six (0.9%) had tinea unguium. In multivariate analysis, the risk factors for tinea capitis were: age (odds ratio [OR] 0.75, 95% CI 0.69-0.84; P < 0.001), and male gender (OR 2.56, 95% CI 1.69-13.39; P = 0.002). CONCLUSIONS: Fungal dermatoses, especially tinea capitis, are common in primary schoolchildren in rural areas of southern Ethiopia, especially in young boys.

Recovery of the response to biological treatments using narrow band ultraviolet-B in patients with moderate to severe psoriasis: a retrospective study of 17 patients.

BACKGROUND/PURPOSE: Biological therapy has demonstrated a very satisfactory anti-psoriatic effect; however, the loss of response with time has been reported. OBJECTIVE: To evaluate the efficacy of the narrow band ultraviolet-B phototherapy (NB-UVB) as a rescue in patients with moderate to severe psoriasis who have lost efficacy in their biological treatment. METHODS: A retrospective chart review study was conducted on patients with moderate to severe psoriasis receiving treatment with a biologic, with a good initial response that subsequently had lost efficacy. All the patients received combined treatment with NB-UVB. RESULTS: Seventeen patients were included, with a mean age of 44 years. The biologics were: 8 etanercept, 4 adalimumab, 3 ustekinumab, 1 efalizumab, and 1 infliximab. The mean NB-UVB sessions was 25 (7-48 sessions), with a mean accumulated dose of 31.12 J/cm(2) (5.2-94.6 J/cm(2) ). Sixteen patients had the following results: 44% PASI 90-100, 31.3% PASI 75-89, and 25% PASI 50-74 response. CONCLUSION: According to this study on clinical practice, it could be considered that the use of NB-UVB along with biological drugs that have lost efficacy in controlling moderate to severe psoriasis in adults could contribute to the recovery of the initial response.

Extramammary Paget disease successfully treated with topical imiquimod 5% and tazarotene.

Extramammary Paget disease (EMPD) is an intraepithelial adenocarcinoma usually localized in areas rich in apocrine sweat glands. Surgery remains the treatment of choice for EMPD. However, several nonsurgical treatments have been also described. Around 40 cases of EMPD treated with imiquimod 5% have been published; of these, only six correspond to nonresponses. We describe a recurrent vulvar EMPD with failure to respond to topical imiquimod 5% in monotherapy but a favorable response to its association with tazarotene.

"Cauliflower ear" in a teenager: a possible sign of child abuse.

"Cauliflower ear" is a perichondritis of the auricular pavilion, usually caused by infection or repeated trauma. In children, this entity is considered infrequent. We present the case of a 10-year-old girl living in a child care institution with "cauliflower ear" that was interpreted as a possible sign of child abuse.

Kabuki syndrome: a new case associated with Becker nevus.

Kabuki syndrome or Kabuki makeup syndrome was first described in 1981 in Japan by two different groups of authors. These investigators described a group of patients sharing typical facial features, skeletal anomalies, mental retardation, short stature, and dermatoglyphic anomalies. The term Kabuki makeup syndrome was coined because the peculiar facial features of the patients were reminiscent of the Japanese Kabuki theater masks. In 1988, Niikawa et al, after studying 62 patients, proposed five diagnostic criteria for this disease: peculiar facies (in 100% of all patients), skeletal anomalies (92%), dermatoglyphic anomalies (93%), medium to moderate mental retardation (92%), and short stature (83% of all cases). In addition to these findings, a variety of anomalies have been associated with this syndrome - the most serious being cardiac, renal, and urogenital abnormalities. We present a case of Kabuki syndrome in a 6-year-old boy who, in addition to the various features typical of the disease, also exhibited a Becker nevus - a condition not previously associated with this syndrome. The usefulness of dermoscopy in studying alterations in the dermatoglyphic patterns is also discussed.

Congenital lower limb enlargement in a newborn.

A full-term newborn presented with swelling of his right leg soon after birth. There was no alteration in Doppler. The grandmother and other relatives were said to have shown a similar history at birth. Milroy's disease was then diagnosed and compressive massage was advised.