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The article discusses the potential link between napkin psoriasis (NP) in infants and the development of psoriasis in adulthood. A retrospective study conducted over 32 years found that infants diagnosed with NP had a higher risk of developing psoriasis later in life, with a prevalence of 41% and an odds ratio of 23.44. However, factors traditionally considered predictive of psoriasis development, such as the duration of NP, presence of distant lesions, and family history, did not show significant correlations. The study highlights the importance of long-term monitoring and early intervention strategies for NP and suggests further research to explore the underlying mechanisms connecting NP to psoriasis in later life. [Extracted from the article]

This article discusses a study on the dermoscopy of idiopathic facial aseptic granuloma (IFAG), a benign condition that affects the face of young children. The study aimed to characterize the dermoscopic findings of IFAG and compare them with other clinical mimickers. The main dermoscopic clue of IFAG was found to be the combination of focal orange and white structureless areas. However, these features were not present in all cases, so their absence does not rule out a diagnosis of IFAG. The study acknowledges its limitations, including a limited sample size and the exclusion of other possible differential diagnoses. [Extracted from the article]

Bullous pemphigoid (BP) is an autoimmune bullous disease and is a rare condition in childhood. Acquired tense acral bullae and fixed urticarial annular lesions on the trunk are diagnostic clues of infantile BP. Diagnosis is supported by immunosorbent assay (IgG anti-BP180 and BP230) and direct immunofluorescence (linear deposition of IgG at the dermo-epidermal junction). Topical and/or systemic corticosteroids are the first-line treatment. The prognosis is good with a self-limited clinical course. Differential diagnoses include impetigo and other bullous diseases in children, such as dermatitis herpetiformis, linear IgA bullous dermatosis and erythema multiforme. The etiopathogenesis is still unknown, and the role of antigen stimuli such as infections, drugs and vaccination is still debated. [ABSTRACT FROM AUTHOR]

Background: The hair whorl denotes the spiral disposition of hairs around an axis, which is determined by the follicle growing direction. Atypical variants of scalp hair patterns, identified by abnormally placed or multiple whorls, have been associated with early brain developmental disorders and several dysmorphic syndromes. Materials and Methods: A 6-month case-control, prospective monocentric study included an overall number of 557 children. A logistic regression analysis was performed to evaluate the relationship between localization, the number of scalp hair whorls, and their association with neurofibromatosis type 1 (NF1). Results: NF1 positively correlates with a frontal localization, whereas a negative association was found with a parietal whorl pattern (P < 0.001). Conclusion: Evaluation of scalp whorls gains importance in the neonatal settings and may contribute to suspect the early diagnosis of NF1, as the related National Institutes of Health diagnostic criteria cannot be usually observed at an early age. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pyogenic granuloma (PG) is a common, acquired, benign vascular neoplasm of the skin and mucous membranes. It occurs most often in children and adolescents. First‐line treatment options for PG are based on destructive approaches. Pain, permanent scarring, and pigmentation are potential complications of these therapies. Methods: This single‐arm, open‐label, prospective study evaluated the efficacy of topical propranolol for treatment of PGs in children. All patients clinically diagnosed with cutaneous PG consecutively at the Dermatology Pediatric Outpatient Service of the University of Bologna from January 2010 to December 2010 received a compounded formulation of propranolol ointment 1%. Results: We found propranolol ointment to be effective in consecutive patients; 59.0% completely regressed in a mean of 66 days, 18.2% remained stable, and 22.7% did not respond. No side effects (eg, skin irritation, allergy, bleeding) were observed. Conclusion: Topical propranolol ointment 1% with occlusion appears to be an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome. [ABSTRACT FROM AUTHOR]

Background Atypical forms of hand, foot, and mouth disease ( HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated. Methods All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas). Results Data from 47 patients were analyzed (median age 22 months [range 4-84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases. Conclusion Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications. [ABSTRACT FROM AUTHOR]

A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information re- garding their appropriate use and prescription that should be considered in clinical practice for impetigo management. A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information regarding their appropriate use and prescription that should be considered in clinical practice for impetigo management. A consensus on ideal features of antibiotic therapy for the treatment of impetigo was appraised by an online Delphi-based method, based on a panel of 61 infectious disease specialists, pediatricians, and dermatologists coordinated by a scientific committee of 5 experts specializing in impetigo management. Full or very high consensus was reached on the 10 statements identified to describe the characteristics of the best hypothetic antibiotic therapy for impetigo together with indications for appropriate antibiotics use. Several criteria have to be considered when selecting topical antibacterial therapy for impetigo. Beyond efficacy and safety, antimicrobial susceptibility and pharmacological characteristics of the agent are essential points. Formulation of the antimicrobial product is fundamental, as well as patient and caregiver preference, to facilitate therapeutic adherence, to achieve the infection control, and to obtain the best benefit from treatment (Curr Ther Res Clin Exp. 2023; 84:XXXXXX). [ABSTRACT FROM AUTHOR]

Objective: To determine periextubation practices in extremely preterm infants (<28 weeks gestation). Design: A survey consisting of 13 questions related to weaning from mechanical ventilation, assessment of extubation readiness and postextubation respiratory support was developed and sent to clinical directors of level III NICUs in Australia, Canada, Ireland, New Zealand and USA. A descriptive analysis of the results was performed. Results: 112/162 (69%) units responded; 36% reported having a guideline (31%) or written protocol (5%) for ventilator weaning. Extubation readiness was assessed based on ventilatory settings (98%), blood gases (92%) and the presence of clinical stability (86%). Only 54% ensured that infants received caffeine ≤24 h prior to extubation. 16% of units systematically extubated infants on the premise that they passed a Spontaneous Breathing Test with a duration ranging from 3 min (25%) to more than 10 min (35%). Nasal continuous positive airway pressure was the most common type of respiratory support used (84%) followed by nasal intermittent positive pressure ventilation (55%) and high-flow nasal cannula (33%). Reintubation was mainly based on clinical judgement of the responsible physician (88%). There was a lack of consensus on the time frame for definition of extubation failure (EF), the majority proposing a period between 24 and 72 h; 43% believed that EF is an independent risk factor for increased mortality and morbidity. Conclusions: Periextubation practices vary considerably; decisions are frequently physician dependent and not evidence based. The definition of EF is variable and welldefined criteria for reintubation are rarely used. Highquality trials are required to inform guidelines and standardise periextubation practices. [ABSTRACT FROM AUTHOR]

Infantile hemangiomas ( IHs) are the most common tumors of infancy and are usually characterized by a pattern of rapid proliferation, followed by a slower period of involution. In most cases, IHs do not require any treatment because they spontaneously regress over the years. However, in a minority of patients, a therapy is mandatory and should be started early to avoid functional and esthetic impairment or even severe systemic complications. Currently, no medications exist that are specifically labeled to treat his; however, because the serendipitous discovery of the efficacy of propranolol in the treatment of IHs at the Dermatologic Department of the University of Bologna, β-blocker therapy has become the first-line therapy in severe and/or complicated hemangiomas. This is a practical review reporting our approach to IHs in our daily practice. [ABSTRACT FROM AUTHOR]

Chilblain-like lesions during the COVID-19 pandemic: should we really worry? Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has spread worldwide in a few months.1,2 In the emerging literature, skin seemed to be involved in only 0.2% of patients, and notations of cutaneous findings have been generically described as "rash".3 During the rapid spread of SARS-CoV-2 infection in Italy, pediatric dermatologists received pictures from pediatricians reporting young patients with pernio-like lesions.4 The clinical features appeared to be stereotypical, with the sudden onset of slightly painful or pruritic violaceous plaques and nodules, sometimes bullous, on the fingers and toes (Figs. Because of the quarantine in Italy, initially testing all patients with chilblain-like lesion for SARS-CoV-2 infection was not possible, but with the lifting of the lockdown, we started to perform screening. [Extracted from the article]

Transient reactive papulotranslucent acrokeratoderma is a rare palmoplantar keratoderma seen predominantly in adolescent and young adult women. Clinically it is characterized by translucent white papules generally involving the palmar surfaces after exposure to water. The typical “hands-in-the-bucket” sign, which is not clearly visible until the hand is submerged in water, is indispensable for the diagnosis. Histologic examination shows a mild orthokeratotic hyperkeratosis and dilated eccrine ducts. We propose the term “transient aquagenic palmar hyperwrinkling” to describe this condition. Until now, a total of 12 patients have been reported in the literature, all female, with an age of onset from 9 to 33 years. We present the first reported instance of this condition in a young boy. [ABSTRACT FROM AUTHOR]

To analyze the clinical features, response to treatment, and follow-up of lichen striatus and any associated symptoms or disease, we designed a retrospective study involving 115 affected children at the Pediatric Dermatology Unit of the Department of Dermatology of the University of Bologna, Bologna, Italy. Between January 1989 and January 2000 we diagnosed lichen striatus in 37 boys and 78 girls (mean age 4 years 5 months). We studied their family history and the season of onset, morphology, distribution, extent, duration, histopathology, and treatment of their lichen striatus. We found that family history was negative in all our patients except for two pairs of siblings. The majority of children had the disease in the cold seasons; precipitating factors were found in only five cases. The most frequently involved sites were the limbs, with no substantial difference between upper and lower limb involvement. When lichen striatus was located on the trunk and face, it always followed Blaschko lines; in seven children the bands on the limbs appeared to be along the axial lines of Sherrington. In 70 cases, lichen striatus was associated with atopy. The mean duration of the disease was 6 months and relapses were observed in five children, and in one instance the disease had a prolonged course. Only a few case study series of lichen striatus in children have been reported and ours is the largest to date. The etiology of lichen striatus remains unknown in the majority of our patients. The confirmed association with atopy observed in our patients may be a predisposing factor. It has generally been accepted that lichen striatus follows the lines of Blaschko, and this distribution is a sign of both a topographic and a pathogenetic concept. In patients where lichen striatus is along axial lines, a locus minoris resistentiae, we suppose that this distribution may only be an illusory phenomenon in instances in which the trigger factor prefers this route, consisting of several successive Blaschko lines, but appearing as a single band. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the presence of inflammatory phenomena and elastic fiber phagocytosis in mid-dermal elastolysis. The pathological and ultrastructural features of 5 Caucasian female patients (ranging from 26 to 40 years) with acquired diffuse asymptomatic areas of skin wrinkling have been reviewed. The clinical features of all cases were characteristic of this condition and only in one patient were characteristic of this condition and only in one patient were erythematous urticaria-like, non pruriginous patches also observed. In 4 cases a history of prolonged sun bathing was present and in 3 cases there was a short history of oral contraception. The pathological study confirmed the typical absence of elastic fibers in the midreticular dermis. In two cases elastic fibers were still detectable in the periadnexal dermis. Hematoxylin and eosin sections showed a mild perivascular infiltrate in two cases, while in three patients histiocytes were scattered among collagen bundles. Multinucleated giant cells containing fragmented elastic fibers were detectable in one patient. Ultrastructural analysis revealed large mononuclear cells with phagocytic aspects toward elastic fibers in all cases. [ABSTRACT FROM AUTHOR]

Background: The management of paediatric atopic dermatitis (AD) is challenging, mostly relying on emollients and topical corticosteroids. Dupilumab, a fully human monoclonal antibody, has been recently approved for the treatment of children aged 6–11 years with moderate-to-severe AD not adequately controlled with topical therapies or when those therapies are not advisable. Objectives: The aim of this study was to evaluate in real life the effectiveness and safety of dupilumab in the treatment of children aged from 6 to 11 years. Methods: Demographic and clinical data of children aged 6–11 years, affected by moderate-to-severe AD and treated with dupilumab, were retrospectively collected from 24 dermatological and paediatric referral centres. Dupilumab was administered subcutaneously at an induction dose of 300 mg on day (D) 1, followed by 300 mg on D15 and 300 mg every 4 weeks. Disease severity was assessed at baseline and after week 2 (W2), W4 and W16 of dupilumab therapy using Eczema Area Severity Index (EASI), Pruritus Numerical Rating Scale (P-NRS) and Sleep NRS (S-NRS) and Children's Dermatology Life Quality Index (c-DLQI) score. Results: A total of 55 AD children (24 males [43.64%], 31 females [56.36%]; mean age 9.35 ± 1.75 years) were included. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to W16 of treatment with dupilumab. In particular, at W16 the proportion of patients achieving EASI75 was 74.54%. Moreover, at the same timepoint a significant mean percentage reduction for P-NRS, S-NRS and c-DLQI was also observed (68.39%, 70.22% and 79.03%, respectively). Conclusions: Our real-life data seem to confirm the effectiveness of dupilumab in paediatric patients on all disease aspects, including extent and severity of signs, intensity of symptoms, sleep and QoL, with a good safety profile. [ABSTRACT FROM AUTHOR]

Baboon syndrome is a combination of diffuse symmetrical erythema on the major flexural areas and V-shaped erythema on both upper anteromedial thighs. Infectious agents have been described as possible triggers. We describe for the first time baboon syndrome in a child induced by a coinfection with Epstein-Barr virus and cytomegalovirus. [ABSTRACT FROM AUTHOR]

Median raphe cysts (MRCs) of the male genitalia are benign and usually asymptomatic; therefore, they are rarely diagnosed or treated in children. Median raphe cysts (MRCs) are uncommon benign lesions of the male genitalia that develop from the median raphe. Close follow-up of multiple and large paediatric MRCs is desirable; we recommend surgical excision as the first-choice treatment for complicated lesions, even in younger patients. [Extracted from the article]

A letter to the editor is presented concerning a case of facial eruption of viral warts with a predominantly digitate aspect in a 12-year-old boy treated with topical tacrolimus ointment for atopic dermatitis.

The eutectic mixture of local anesthetic cream, a 1 : 1 mixture of prilocaine and lidocaine, 2.5% each, is frequently used in pediatric and dermatologic practice to obtain local anesthesia. Side effects include transient skin blanching, erythema, urticaria, allergic contact dermatitis, irritant contact dermatitis, hyperpigmentation, and purpura. We report two children with a purpuric reaction after application of this mixture cream. Purpura after application of this anesthetic cream is a rare nonallergic reaction and only 17 occurrences have been reported, to our knowledge, in the literature. Patch tests could not be performed in our two patients because of lack of parental consent but we suggest that the purpuric reactions were most probably of toxic origin. The pathogenesis of purpura after application of eutectic mixture of local anesthetics cream, which resolves within 2 weeks without dermatologic sequelae and without any specific therapy, is complex. The lesions are probably caused by the direct effect of the cream components on the vessels but many other factors, such as atopic dermatitis, prematurity, subjective predisposition to purpura, trauma, and thrombocytopenia may play important pathogenetic roles. [ABSTRACT FROM AUTHOR]

Abstract: Nevus comedonicus is a rare, benign hamartoma of the pilosebaceous unit that may be isolated or part of the nevus comedonicus syndrome. Although rare in children, complication by hidradenitis suppurativa‐like lesions has been described. We present a report of a 9‐year‐old girl in whom surgical excision was curative, with a review of the relevant literature. [ABSTRACT FROM AUTHOR]

ACE2 is a mono-carboxypeptidase with remarkable vasculo-protective properties, and its expression in the human placenta plays a central role in blood pressure homeostasis and fetal perfusion. Therefore, an alteration in the placental expression of ACE2 could be responsible for reduced placental perfusion and infantile hemangioma (IH) development. Study placentae were collected from patients affected by IHs who were referred to our Dermatology Clinic from 2016 to 2022, while control placentae were randomly collected while matching cases for gestational age. Immunohistochemical investigations were performed with a recombinant anti-ACE2 rabbit monoclonal antibody. A total of 47 placentae were examined, including 20 study placentae and 27 control ones. The mean placental weight was significantly lower in the study group (380.6 g vs. 502.3 g; p = 0.005), while subclinical chorioamnionitis occurred more frequently in the study group (20% vs. 0%, p = 0.03). The mean ACE2 expression was dramatically lower in the study group (χ2 = 42.1 p < 0.001), and the mean placental weight was significantly lower when ACE2 was not expressed compared to the 25–75% and >75% classes of expression (p < 0.05). This study demonstrated that ACE2, as a marker for tissue hypoxia, is dramatically hypo-expressed in placentae belonging to mothers who delivered one or more babies with IH compared to the controls. [ABSTRACT FROM AUTHOR]

Examines the nevus comedonicus syndrome (NCS). Description of NCS; Association of the nevus with noncutaneous abnormalities; Performance of a complete skeletal radiograph.

The article presents a case study of a 1-year-old girl with small painless papules on the scalp. Topics discussed include several translucent, glossy and dome-shaped papules revealed by physical examination on the parietal, temporal region and on her left eyelid, diagnosis of molluscum contagiosum (MC) suggested by clinical examination, and chances of MC infection being congenital and need for a timely treatment.

An 8-month-old Caucasian infant with neurofibromatosis type 1 presented with a congenital plexiform neurofibroma and multiple café au lait spots. A pale area surrounded one of the café au lait spots located on the left gluteus in the area of dermal melanocytosis. This halolike phenomenon results from the disappearance of the Mongolian spot around the café au lait spots, revealing normal pigmented skin. This sign has been described rarely in the literature and the pathogenic mechanism is unclear. [ABSTRACT FROM AUTHOR]

Imiquimod is an immune-response modifier acting as a toll-like receptor (TLR)-7/8 agonist, stimulating the innate cutaneous immunity and the cellular arm of the adaptive immune response (Badavanis, Pasmatzi, Monastirli, Georgiou, & Tsambaos, [1]). Regarding the pediatric population, imiquimod has been used off-label for a variety of skin disorders (molluscum contagiosum [MC], trichoepithelioma, verrucae, infantile hemangiomas [IH], morphea, cutaneous Langerhans cell histiocytosis, and pyogenic granuloma). Based on the RCTs, Katz (Katz, [3]) discouraged the use of imiquimod in the pediatric population for the treatment of MC. [Extracted from the article]

This narrative review aims to summarise the classification of vascular anomalies, their clinical presentation, and their radiological features to propose a diagnostic algorithm to approach patients with suspected soft tissue vascular anomalies of the extremities. The management of vascular anomalies necessitates a multidisciplinary approach. Clinical presentation and physical examination are sufficient in most cases to achieve a correct diagnosis. This is especially true for small congenital lesions of the skin and subcutaneous tissue. Imaging is used for accurate characterization of these lesions, especially in cases of atypical or vague clinical presentation, and to assess extension in cases of lesions that are larger and localized in deeper tissues. [ABSTRACT FROM AUTHOR]

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID‐19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life‐threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID‐19 outbreak. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Diagnosis and Treatment of Post-ceasarean Scar Endometriosis," that was published in the February 5, 2007 issue.

A letter to the editor is presented in response to the article about streptococcal intertrigo published within the issue.

Juglone is the active ingredient of the green flesh of walnuts and is known to be a strong irritant. We report the first two paediatric cases of contact pigmentation and acute irritant contact dermatitis due to the juice of green walnut husks in two young nursery-school playmates. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the cutaneous Pili migrans in a 3 year old child.

The article discusses a case of granular parakeratosis (GP) in a 3-year-old female with skin lesions on her hips. The dermoscopic findings revealed brownish papules with a rough surface and small circles of pigment around a central area. GP is a rare dermatological condition with distinct histological features, often occurring in women over 40 in areas prone to friction. The article emphasizes the importance of dermoscopy in diagnosing GP, especially in pediatric cases, and highlights the need for further research on dermoscopic findings of GP. [Extracted from the article]

A case study is presented of a 2-year-old girl with a 3-month history of small painless papules, growing on the surface of an abdominal congenital melanocytic naevus (MN). Dermoscopic examination suggested molluscum contagiosum (MC), which is a common viral skin infection. It relates the occurrence of viral lesions on an MN with the Meyerson's phenomenon, which is an eczematous reaction occurring in MN.

This article describes the case of a two-year old female patient with molluscum contagiosum (MC). It discusses the patient's medical history, results of the patient's medical examinations, diseases associated with MC and the reasons behind the occurrence of viral lesions on an intermediate melanocytic naevus.

The article presents a case study of a nine year old child who was referred to pediatric dermatology unit for a temporary walking impairment due to painful lesions on the soles of both his feet. Several laboratory tests such as erythrocyte sedimentation rate, serum reactive protein, and antinuclear antibody. The article discusses diagnosis of palmoplantar eccrine hidradenitis (PEH), pathogenesis of PEH, and erythematous violaceous papules in PEH.

The article describes the case of a nine-year old boy with painful lesions on the sole of both his fee. The patient was diagnosed with palmoplantat eccrine hidradenitis (PEH) following histological examination of the neutrophilic infiltrate around and within the eccrine cells. Characteristics of PEF include erythematous violaceous papules and nodules on the soles of children. Risk factors to PEH development include physical activity and hyperhidrosis.

The article presents a case study of a six-month-old infant with itching erythema. It informs that diffuse cutaneous mastocytosis (DCM) diagnosis revealed vesicle-bullous eruption, skin infiltration and dermographism. It also mentions that skin prick tests may induce an anaphilaxis in infants and tryptase levels were consistently high in the infant.

Idiopathic facial aseptic granuloma (IFAG), or pyodermite froide du visage, is a skin disease reported only in children and characterized by painless red nodules usually located on the cheeks. Its etiology is still unclear, but some authors considered the possibility that IFAG might be included in the spectrum of granulomatous rosacea (GR). The histopathological features of IFAG and GR are quite similar, showing perifolliculitis, granulomas, folliculitis, and lymphocytes and plasmacells around epithelioid histiocytes. In the present article, we discuss three cases in which an association between a facial nodule, compatible with both IFAG and GR, and recurrent chalazia make us support the hypothesis that IFAG should be considered as GR. [ABSTRACT FROM AUTHOR]

Background: After decades of use, methotrexate displays an established safety and efficacy profile in both in-hospital and outpatient settings. Despite its widespread use, there is surprisingly little clinical evidence to guide daily practice with methotrexate in dermatology. Objectives: To provide guidance for clinicians in daily practice for areas in which there is limited guidance. Methods: A Delphi consensus exercise on 23 statements was carried out on the use of methotrexate in dermatological routine settings. Results: Consensus was reached on statements that cover six main areas: (1) pre-screening exams and monitoring of therapy; (2) dosing and administration in patients naïve to methotrexate; (3) optimal strategy for patients in remission; (4) use of folic acid; (5) safety; and (6) predictors of toxicity and efficacy. Specific recommendations are provided for all 23 statements. Conclusions: In order to optimize methotrexate efficacy, it is essential to optimize treatment using appropriate dosages, carrying out a rapid drug-based step-up on a treat-to-target strategy and preferably using the subcutaneous formulation. To manage safety aspects appropriately, it is essential to evaluate patients' risk factors and carry out proper monitoring during the course of treatment. [ABSTRACT FROM AUTHOR]

The article presents a reprint of the article "Hydroa vacciniforme," by Dr. Riccardo Balestri and Dr. Iria Neri, which appeared in www.cmaj.ca. It presents the case of a 10-year-old boy who had repeated lesions for three years. It states that initial differential diagnosis include lupus erythematosus, actinic prurigo, and hydroa vacciniforme. The patient was diagnosed with hydroa vacciniforme, an idiopathic photodermatosis, via histologic examination and a provocation test for ultraviolet A.

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, and must not exceed two pages of text including references. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided. [ABSTRACT FROM AUTHOR]

This article discusses a dermatological condition called annular lichenoid dermatitis of youth (ALDY), which primarily affects young individuals and commonly appears on the groin and flanks. ALDY is often misdiagnosed due to its similarity to other dermatoses, leading to delays in diagnosis and treatment. This study aimed to characterize the dermoscopic findings of ALDY and compare them to other similar dermatoses. The main dermoscopic clue of ALDY was the presence of brown-grey dots, which were more common in hyperpigmented and hypopigmented lesions. However, the absence of this finding does not rule out ALDY. The study had limitations due to the rarity of ALDY and the small sample size. [Extracted from the article]

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome causing hamartomatous growths in multiple organs. Facial angiofibromas occur in up to 80% of patients and can be highly disfiguring. Treatment for these lesions is challenging. Recently, topical rapamycin has been proposed as an effective option to treat angiofibromas but a commercially available compound has not yet been developed in Europe. We conducted a retrospective review with the aim to update the current data on the use of topical rapamycin in the treatment of angiofibromas in TSC, focusing on the optimal concentration and trying to establish which vehicle should be preferred. Thirty‐nine reports describing the use of topical rapamycin in the treatment of angiofibromas in TSC were considered, involving a total of 483 patients. An improvement of the lesions has been shown in over 90% of subjects, particularly if the treatment was started at early stages. Several different formulations (ointment, gel, solution and cream) with a wide range of concentrations (0.003%–1%) were proposed, of which a pharmacological analysis has also been performed. Topical rapamycin can be considered an effective and safe option for the treatment and the prevention of facial angiofibromas in younger patients, but the best formulation has yet to be established. Our review demonstrates that ointment and gel should be preferred, but it is not clear which concentration is optimal. However, according to this study, the 0.1% concentration represents the first choice. Long‐term and comparative studies between topical rapamycin formulations are required in order to establish which treatment has a better outcome and lower recurrence rate. [ABSTRACT FROM AUTHOR]

Background: Dupilumab has been shown to be a safe and effective drug for the treatment of atopic dermatitis (AD) in children from 6 months to 11 years in randomized clinical trials. Aim: The aim of this real-life study was to determine the effectiveness in disease control and safety of dupilumab at W52 in moderate-to-severe AD children aged 6-11 years. Methods: All data were collected from 36 Italian dermatological or paediatric referral centres. Dupilumab was administered at label dosage with an induction dose of 300 mg on day 1 (D1), followed by 300 mg on D15 and 300 mg every 4 weeks (Q4W). Treatment effect was determined as overall disease severity, using EASI, P-NRS, S-NRS and c-DLQI at baseline, W16, W24, and W52. Ninety-six AD children diagnosed with moderate-to-severe AD and treated with dupilumab were enrolled. Results: Ninety-one (94.8%) patients completed the 52-week treatment period and were included in the study. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to weeks 16, 24 and 52. Conclusions: Our real-life data seem to confirm dupilumab effectiveness and safety in paediatric patients. Moreover, our experience highlighted that patients achieving clinical improvement at W16 preserved this condition over time. [ABSTRACT FROM AUTHOR]

Introduction: This mono-center randomized, controlled, double-blind study evaluates the safety and efficacy of MD2011001 cream versus placebo, in mild-to-moderate atopic dermatitis (AD). MD2011001 is a nonsteroidal topical cream containing vitamin E, epigallocatechin gallate and grape seed procyanidins. Methods: Patients with AD (corresponding to an IGA score of 2 or 3), involving the face, the perioral/periocular area and/or the neck, were enrolled. Patients were randomized 1:1 ratio to receive MD2011001 or placebo before the start of the study (D0), then evaluated after 7 days, and after 28 days. The study was approved by the Local Independent Ethics Committee and conducted according to the Declaration of Helsinki and local regulations. The statistical tests used were the Wilcoxon test and the Mann–Whitney U-test. Results: Forty-four patients (29F and 15M) were enrolled. The IGA values showed a statistically significant reduction during the treatment period obtaining a favorable safety profile and local tolerance for both the products. The reduction in the surface area affected by AD was significantly faster with MD2011001. Discussion: This study focuses on very sensitive areas known to be particularly susceptible to local complications. Conclusions: These results suggest the usefulness of an emollient treatment for mild/moderate AD. [ABSTRACT FROM PUBLISHER]

Investigates the treatment of psoriasis in children with calcipotriol ointment. Application of urea-based cream; Use of score system considering morphology and number of lesions in the clinical assessment; Efficacy of calcipotriol ointment.