Background and objectives
Head and neck dermatitis (HND) is a clinical variant of atopic dermatitis (AD), presenting in adolescence or adulthood and characterized by involvement of the head, neck, ...and superior part of the trunk. The role of Malassezia spp has been advocated in the pathogenesis of HND, and antifungal agents represent the treatment of choice.
Methods
A retrospective single‐center study was performed to define the clinical features and treatment response of HND among adolescent and adult patients.
Results
Thirty‐one patients were identified, 17 with "adolescent‐onset" and 14 with "adult‐onset" HND. Adolescent‐onset HND positively correlated with a past history of AD and presented with exclusive head and neck involvement (P < .05). Adult‐onset HND was associated with concomitant widespread atopic eczema, involving the flexural areas of the upper and lower limbs, trunk, nipples, or hands (P < .05). A positive response to itraconazole in combination with topical treatments was observed in both groups.
Conclusions
This study delineates two HND clinical phenotypes: adolescent vs adult onset. Different characteristics were observed in terms of relationship to AD and eczema localization. A history of AD in childhood and presentation with exclusive involvement of head and neck regions was observed predominantly in the adolescent‐onset form, while adult‐onset HND often occurred in association with diffuse dermatitis and a past history of AD was less frequent than in the adolescent group. The study is limited by the single‐center retrospective nature, which may lead to diagnostic and selection biases, and the small cohort of patients.
Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by ...delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever, lymphadenopathy, visceral involvement, and laboratory abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes). It is more frequently triggered by anticonvulsants, sulphonamides, or antibiotics, the latter being responsible for up to 30% of pediatric cases. The disease typically develops 2-8 weeks after exposure to the culprit medication, with fever and widespread skin eruption; mild viral prodromes are possible. Unfortunately, diagnosis is challenging due to the absence of a reliable test; however, a score by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) allows to classify suspect patients into no, possible, probable, or definite DRESS cases. Moreover, rapid-onset DRESS syndrome has been described in recent years. It affects children more often than adults and differs from the most common form because it appears ≤15 days vs. >15 days after starting the drug, it is usually triggered by antibiotics or iodinated contrast media rather than by anticonvulsants and has a higher presence of lymphadenopathy. Differential diagnosis between rapid-onset antibiotic-driven DRESS syndrome, viral exanthems, or other drug eruptions may be challenging, but it is mandatory to define it as early as possible to start adequate treatment and monitor possible complications. The present review reports the latest evidence about the diagnosis and treatment of pediatric DRESS syndrome.
Dear Editor, Cold urticaria (CU), the second most frequent type of chronic inducible urticaria, is characterized by skin lesions and/or angioedeina developing upon contact with cold air, liquids or ...solids, subsequent to the release of proinflammatory mast cell mediators on exposure to low temperatures. CU can be subdivided into familial or acquired forms. The latter can be classified as primary or secondary to an underlying cause, such as infections (mainly viral pathogens), cryoglobulinemia, hypersensitivity vasculitis, drugs, neoplasms. Certain acquired CU (ACU), called atypical ACU syndromes, could not exhibit wheal formation after standard cold contact stimulation tests, and consequently their diagnosis must depend on history and other diagnostic procedures. Among them, have been included the systemic ACU, the cold-dependent dermatographism, the cold-induced cholinergic urticaria, the delayed cold urticaria, the localized cold reflex urticaria and the localized cold urticaria (LCU).
Autosomal recessive congenital ichthyoses (ARCI) are a genetically heterogeneous group of rare and chronic disorders characterized by generalized skin scaling and hyperkeratosis, erythroderma, and ...palmoplantar keratoderma. Additional features include ectropion, eclabium, ear deformities, foul-smell, joints contractures and walking problems, recurrent infections, as well as pruritus and pain. No curative therapy is available and disease care mainly relies on daily application of topical emollients and keratolytics to the whole-body surface. Altogether, disease signs and symptoms and treatment modalities have a major impact on quality of life of patients and their caregivers. However, very few studies have evaluated the family disease burden in ARCI. We have performed an Italian multicenter cross-sectional study to assess the secondary disease impact on family members of pediatric and adult patients with ARCI, using a validated dermatology-specific questionnaire, the family dermatology life quality index (FDLQI). Disease severity was assessed by the dermatologist in each center. Seventy-eight out of 82 patients who were accompanied by at least one family member filled the FDLQI. Forty-eight (61.5%) patients were aged less than 18 years. The mean FDLQI score was 10.3 (median 10), and the most affected dimensions were (1) time needed for care, (2) extra-housework, and (3) household expenditure. Higher total FDLQI score significantly correlated with more severe disease score (P = 0.003). Features associated with greater family burden included recurrent infections (P = 0.004), foul-smell (P = 0.009), palmoplantar keratoderma (P = 0.041), but also presence of scales on the face (P = 0.039) and ear deformities (P = 0.016). Our findings highlight the major socio-economic and psychological burden imposed by ARCI on the QoL of family caregivers. In addition, they show that global evaluation of disease impact also on family members is an essential part of patient-reported outcomes. Finally, our data underline the need to develop specific measures for family support.
SARS-CoV-2 infection has spread all over the world in the last year, causing millions of COVID-19 cases among humans with a large variability of symptoms and signs, including those on the skin. Among ...these, a contemporary cluster of chilblain-like lesions with no certain relationship with the infection has been reported. The aim of this paper is to delineate a profile of chilblain-like lesions and to establish the state-of-the-art knowledge about this new phenomenon.
Introduction: Infantile hemangioma with minimal or arrested growth (IHMAG) is an unusual subset of infantile hemangioma, difficult to recognize because they are often mistaken with capillary ...malformation or other entities. Dermoscopic features of IHMAG have been described only in small case series so far. Objectives: The aim of our study is to evaluate epidemiological, clinical and dermoscopic features in 79 cases of IHMAG with a specific focus on neonates and toddlers with segmental complicated IHMAG and to provide a remarkable dermoscopic criteria to achieve diagnosis. Methods: This case series collected all the cases of IHMAG recorded in our Clinical Registry from January 2012 to March 2022. Results: A total of 79 cases of IHMAG were identified in our study; 53 (67.1%) were localized and 26 (32.9 %) were segmental. Patients showed any complications during the follow up, as ulceration and soft tissue anomalies. One PHACE syndrome and 2 LUMBAR syndromes were included. Our study highlights the main dermoscopic features differentiating IHMAG from infantile hemangiomas and capillary malformations in neonatal patients, highlighting the presence of enlarged, unfocused telangiectatic vessels as remarkable clues. Conclusions: This is a large case series described in literature about this rare entity. We emphasize that segmental IHMAG may be associated with structural abnormalities and may pose a diagnostic challenge especially in its rare facial segmental localization. The use of dermoscopy has allowed us to find typical signs for IHMAG, thus avoiding the execution of invasive methods and ensuring a prompt suspect of a syndrome on segmental neonatal cases.
Basal Cell Nevus Syndrome (BCNS) is an autosomal dominant inherited disease caused by PTCH1 (9q22.3‐q31) germline mutations. Skin manifestations are mainly characterized by hyperkeratosis of the ...palms and soles, palmoplantar pits and a strong predisposition to develop multiple basal cell carcinomas (BCCs). Recently, it has been hypothesized that basaloid follicular hamartomas (BFH) could be included in BCNS skin features. We present three pediatric cases of GS with BCCs and BFHs. Clinical, dermoscopic and immunohistochemical tools are reported.
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