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Pediatric teledermatology rapidly expanded with the COVID‐19 pandemic, and the impacts of this expansion on patients' access to care have not yet been entirely defined. In this retrospective study of 3027 patients in an academic pediatric dermatology practice, patients who identified as having a primary language other than English were less likely to access pediatric dermatology care during the COVID lockdown. This study did not identify a significant or meaningful difference in age, geography, socioeconomic status, ethnicity, or race between patients who were offered pediatric dermatology care that was either in‐person or via synchronous telehealth. These findings are overall reassuring that there were not major disparities in telehealth utilization during the COVID shelter‐in‐place mandate, although highlight the need for institutions to ensure systems are in place to enhance telehealth access for patients with non‐English primary language. [ABSTRACT FROM AUTHOR]

Self‐induced trauma is a rare cause of panniculitis in adolescents and may be associated with undiagnosed underlying psychological conditions. The condition often poses a diagnostic challenge as patients usually present with non‐specific signs and symptoms, and often a concealed history of self‐induced trauma. Here, we present three adolescent patients with self‐induced traumatic panniculitis. All three patients were repeatedly admitted with non‐specific cutaneous lesions as well as multiple somatic complaints. After extensive evaluation to exclude organic causes, psychiatric assessment eventually revealed underlying psychosomatic disorders as a cause of the self‐induced trauma. [ABSTRACT FROM AUTHOR]

Background: Low‐flow malformations (LFMs) are rare diseases with a significant impact on health‐related quality of life (HRQoL), especially in children. No disease‐specific questionnaire is available for children with LFMs. Objective: To develop and validate a specific HRQoL questionnaire for children from 11 to 15 years old suffering from LFMs. Methods: A preliminary questionnaire based on a verbatim from focus groups was created and sent to children from 11 to 15 years old suffering from LFMs, together with a dermatology‐specific and a generic HRQoL questionnaire (cDLQI and EQ‐5D‐Y). Results: A total of 75 from 201 included children responded to the questionnaires. The final version of the questionnaire (cLFM‐QoL) included 15 questions and was not divisible into subscales. It demonstrated excellent internal consistency (cronbach 0.89), convergent validity and readability (SMOG 6.04). cLFM‐QoL mean score (± SD) was 12.9/45 (8.03) for all grades of severity, for mild 8.22/45 (7.5), moderate 14.03/45 (8.35), severe 12.35/45 (6.59) or very severe patients 20.7/45 (3.39) (p 0.006). Conclusion: cLFM‐QoL is a validated short and easy to use specific questionnaire with excellent psychometric capacities. It will be suitable for any children aged 11–15 with LFMs, in daily practice or clinical trials. [ABSTRACT FROM AUTHOR]

Congenital cutaneous candidiasis (CCC) is a rare condition in neonates, mainly in term neonates, that develops in the 1st week of life. Its broad clinical spectrum makes it challenging to differentiate it from other exanthemas in the newborn. The involvement of palms and soles and the presence of pustules are important clinical clues for the differential diagnosis, with cultural examination confirming the diagnosis by identification of Candida spp. Treatment of clinically stable term neonates without evidence of invasive disease is currently controversial. We report a case of CCC in a term newborn with no evidence of invasive disease that evolved into a clinical cure after systemic and topical antifungal treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited. Objective: Our objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies. Methods: We surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA). Results: Fifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy. Conclusions: This is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management. [ABSTRACT FROM AUTHOR]

Background: Cutaneous manifestations associated with celiac disease (CD), other than dermatitis herpetiformis, are poorly known. The aim of the present study was to study the spectrum of dermatological disorders in children with CD. Methodology: A total of 100 cases of biopsy-confirmed CD (both new and old) were recruited after taking written informed consent/assent from the child/guardians. The patient's demographic details, history, vitals, general physical examination, systemic examination, and cutaneous examination findings were recorded. Relevant investigations were carried out, depending on the clinical findings of the cutaneous examination. Results: A total of 100 patients comprising 62 girls and 38 boys were studied, with the average age being 8.08 ± 3.67 years. Seventy patients showed the presence of dermatological findings. Cutaneous, mucosal, nail, and hair findings were seen in 35%, 7%, 14%, and 14% of patients, respectively. A higher incidence of dermatological findings was found in females (39%) compared to males (18%). The most common cutaneous conditions seen were atopic dermatitis (17%) and xerosis (10%). The most common mucosal finding was oral aphthae (4%). The most common nail changes were leukonychia and ragged cuticles (4% each). There was no statistical correlation between the presence of dermatological findings with the duration of the disease or with the duration of a gluten-free diet. Conclusion: Mucocutaneous manifestations are present in a significant proportion of patients with CD. Further studies with a larger sample size are needed to determine whether these findings are true associations or coincidental. [ABSTRACT FROM AUTHOR]

Background. Figures and captions in medical documentation contain important information. As a result, researchers are becoming more interested in obtaining published medical figures from medical papers and utilizing the captions as a knowledge source. Methods. This work introduces a unique and successful six-fold methodology for extracting figure-caption pairs. The A-torus wavelet transform is used to retrieve the first edge from the scanned page. Then, using the maximally stable extremal regions connected component feature, text and graphical contents are isolated from the edge document, and multi-layer perceptron is used to successfully detect and retrieve figures and captions from medical records. The figure-caption pair is then extracted using the bounding box approach. The files that contain the figures and captions are saved separately and supplied to the end useras theoutput of any investigation. The proposed approach is evaluated using a self-created database based on the pages collected from five open access books: Sergey Makarov, Gregory Noetscher and Aapo Nummenmaa's book "Brain and Human Body Modelling 2021", "Healthcare and Disease Burden in Africa" by Ilha Niohuru, "All-Optical Methods to Study Neuronal Function" by Eirini Papagiakoumou, "RNA, the Epicenter of Genetic Information" by John Mattick and Paulo Amaral and "Illustrated Manual of Pediatric Dermatology" by Susan Bayliss Mallory, Alanna Bree and Peggy Chern. Results. Experiments and findings comparing the new method to earlier systems reveal a significant increase in efficiency, demonstrating the suggested technique's robustness and efficiency. [ABSTRACT FROM AUTHOR]

Social distancing requirements associated with the COVID-19 pandemic have allowed for the expansion of different healthcare delivery modalities. Namely, there has been an increase in the utilization of remote diagnostic services for both primary and specialist care. Dermatology care has traditionally been inaccessible to many pediatric patients; this is due in part to a limited number of practicing pediatric dermatologists, as well as a maldistribution of the pediatric dermatology workforce with the majority of providers located in large metropolitan areas. There is therefore a need for an accessible alternative for care to reach underserved patient populations. This commentary highlights evidence from recent studies on remote dermatology care (teledermatology) and how it has not only improved access to dermatologic care but also quality of care. Although teledermatology does not completely replace traditional in-person visits and is limited by poor broadband access in traditionally underserved areas, teledermatology can, in some instances, be a cost-effective and efficient alternative for pediatric patients otherwise lacking dermatologic care.

Background: Atopic dermatitis (AD) is a chronic, inflammatory skin disease commonly onset during infancy. Objective: We examine the association between pre-and postnatal antibiotic exposure and the development of AD. Methods: A retrospective, observational study analyzed 4106 infants at the University of Florida from June 2011 to April 2017. Results: Antibiotic exposure during the first year of life was associated with a lower risk of AD. The association was strongest for exposure during the first month of life. There were no significant differences in the rates of AD in infants with or without exposure to antibiotics in months 2 through 12, when examined by month. Antibiotic exposure during week 2 of life was associated with lower risk of AD, with weeks 1, 3, and 4 demonstrating a similar trend. Limitations: Retrospective data collection from a single center, use of electronic medical record, patient compliance with prescribed medication, and variable follow-up. Conclusions: Early life exposures, such as antibiotics, may lead to long-term changes in immunity. Murine models of atopic dermatitis demonstrate a “critical window” for the development of immune tolerance to cutaneous microbes. Our findings suggest that there may also be a “critical window” for immune tolerance in human infants, influenced by antibiotic exposure.

Background: The Infants and Toddlers Dermatology Quality of Life (InToDermQoL) questionnaire is the first dermatology-specific proxy health related QoL instrument for children from birth to 4 years. Score meaning bands and the sensitivity to successful therapeutic intervention are important to interpret the clinical meaning of an instrument. Objective: The aim of the present study was to check the sensitivity to successful therapeutic intervention and establish score bands of the InToDermQoL questionnaire. Methods: Parents or grandparents of 424 children with skin diseases from Spain, Malta, Croatia, Romania, Greece, and Ukraine filled in national language versions of the InToDermQoL questionnaire. Disease severity of children with atopic dermatitis was assessed by SCORAD (Scoring atopic dermatitis). Cohen’s d was used to assess the responsiveness of the instrument. Results: The mean total InToDermQoL scores significantly decreased after treatment. Severity grading of the SCORAD scores gave stratification of the InToDermQoL severity grades based on 95% confidence intervals. Scores below a calculated minimal important difference of 2 corresponded to no effect on patient’s health related QoL. Limitations: Score banding may be slightly different across patient population and study context. Conclusion: All 3 age-specific versions of the InToDermQoL questionnaire showed sensitivity to treatment. Score bands for the InToDermQoL questionnaire have been established.

Background: Cutaneous manifestations associated with celiac disease (CD), other than dermatitis herpetiformis, are poorly known. The aim of the present study was to study the spectrum of dermatological disorders in children with CD. Methodology: A total of 100 cases of biopsy-confirmed CD (both new and old) were recruited after taking written informed consent/assent from the child/guardians. The patient's demographic details, history, vitals, general physical examination, systemic examination, and cutaneous examination findings were recorded. Relevant investigations were carried out, depending on the clinical findings of the cutaneous examination. Results: A total of 100 patients comprising 62 girls and 38 boys were studied, with the average age being 8.08 ± 3.67 years. Seventy patients showed the presence of dermatological findings. Cutaneous, mucosal, nail, and hair findings were seen in 35%, 7%, 14%, and 14% of patients, respectively. A higher incidence of dermatological findings was found in females (39%) compared to males (18%). The most common cutaneous conditions seen were atopic dermatitis (17%) and xerosis (10%). The most common mucosal finding was oral aphthae (4%). The most common nail changes were leukonychia and ragged cuticles (4% each). There was no statistical correlation between the presence of dermatological findings with the duration of the disease or with the duration of a gluten-free diet. Conclusion: Mucocutaneous manifestations are present in a significant proportion of patients with CD. Further studies with a larger sample size are needed to determine whether these findings are true associations or coincidental.

Introduction: Data from the Levant regarding pediatric dermatoses are limited. The objective was to estimate the prevalence of pediatric dermatoses in a health-care system that allows every patient to directly reach a specialist. Patients and Methods: It is a single-center, chart review, epidemiological study of patients who consulted, between 2010 and 2022, at the general dermatology department of a tertiary care university hospital. A random draw of 10% of the files was screened. Patients aged between 0 and 18 years at the time of consultation were included and their files were analyzed. Results: The study population consisted of 151,050 files, of which 10% were manually screened. Finally, 2313 “pediatric” files were analyzed, corresponding to 15.3% of the sample, with a female-to-male ratio of 1281/1032 (1.24). Of these analyzed files, 2912 diagnoses were distributed in the age categories as follows: 464 (16%) at preschool age, 1134 (39%) at school age, and 1314 (45%) at adolescence. The most prevalent diagnoses in males were acne (19.6%), atopic dermatitis (9.7%), and molluscum contagiosum (8.1%); in females, acne (27.4%), atopic dermatitis (9.4%), and warts (5.8%). Acne was the most frequent diagnosis overall (24%) and in the adolescents' subgroup, with a female-to-male ratio of 1.77. The prevalence of atopic dermatitis decreased from 21.1% at preschool age to 10.9% at school age to 4.3% in adolescence. The most prevalent diagnoses at school age were molluscum contagiosum and warts. Conclusion: These updated percentages help configure suitable public health strategies for children in countries of approximate genetic background and similar life habits.

An 11‐year‐old female with neurofibromatosis type 1 (NF‐1) and history of optic glioma presented with a progressive cutaneous plexiform neurofibroma of the breast. The lesion was treated with topical application of a mitogen‐activated protein kinase inhibitor, trametinib, resulting in stable, non‐progression cutaneous plexiform neurofibroma for greater than 2 years. This case demonstrates the potential application of topical trametinib for NF1‐associated superficial cutaneous plexiform neurofibroma without the toxicities associated with systemic treatment. [ABSTRACT FROM AUTHOR]

This article analyzes the characteristics of superficial spreading melanoma (SSM) in pediatric patients using the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020. The study found that SSM is one of the most frequently diagnosed cutaneous neoplasms in the pediatric population in the United States. The majority of cases were identified in white females aged 15-19 years, with localized disease and primary tumors located on the trunk. There was a significant decrease in SSM incidence rates between 2000 and 2020, possibly due to efforts to reduce ultraviolet exposure in children. The study also highlighted a higher incidence of SSM in pediatric females compared to males and a significant association between gender and primary tumor site. [Extracted from the article]

This article explores the use of artificial intelligence (AI) in dermatology literature by investigating AI-generated content in abstracts of articles published in five prominent dermatology journals. The study used OpenAI's AI Text Classifier to predict the likelihood of abstracts being AI-generated. Out of 65 abstracts analyzed, none were found to be possibly or likely AI-generated. However, the study acknowledges the limitations of the AI Text Classifier and suggests that the use of AI in dermatology publishing may change over time. The research received no specific funding and the data underlying the article can be obtained upon request. [Extracted from the article]

The article discusses the potential benefits and challenges of integrating artificial intelligence (AI) into the field of dermatology. The authors highlight that AI can improve diagnostic accuracy, research capabilities, and teledermatological services. AI-powered diagnostic tools can assist dermatologists in making precise diagnoses by analyzing large amounts of medical data. However, ethical considerations, patient privacy, algorithm transparency, and responsible use of AI should be taken into account. The authors emphasize that AI should be seen as a supportive tool and not a replacement for human expertise and judgment. Further studies are needed in this area. [Extracted from the article]

This article, published in the European Journal of Pediatric Dermatology, discusses a case of recurrent herpes simplex infection in a 6-year-old girl. The girl presented with a painful erosive lesion on her right index finger, along with paronychia and pus secretion. The mother reported that the child had experienced similar episodes in the past on the same finger. The diagnosis of recurrent herpes simplex was made, and the child was treated with topical and oral acyclovir. The article emphasizes the importance of considering herpes simplex infection in cases of pustular lesions and highlights the role of personal and family history in making a diagnosis. [Extracted from the article]

Background: Plexiform neurofibromas (pNFs) are benign neoplasms, primarily originating from Schwann cells, posing challenges in patients with type 1 neurofibromatosis (NF1) due to pain, disfigurement, compression of vital structures and potential for malignancy. Selumetinib, a MEK1/2 inhibitor, has shown promising results in treating inoperable pNFs, with clinical trials demonstrating tumor volume reduction and improved patient-reported outcomes. Despite its efficacy, dermatologic toxicities may impact the quality of life and treatment adherence. Evaluating the frequency and spectrum of such effects is crucial for effective management. Methods: In a four-year retrospective and prospective study, pediatric NF1 patients with symptomatic, inoperable plexiform neurofibromas (pNFs) were treated with selumetinib. Eligibility criteria included significant morbidity, pNF size exceeding 3 cm or surgical inoperability, and performance status >70%. Hematological, liver, lung and cardiac assessments established baseline health. Selumetinib, orally administered at 25 mg/m2 twice, was administered for two years unless a response warranting extension occurred. Cutaneous AEs were documented and graded by severity according to CTCAE v5.0, with evaluations every three to six months. The impact on symptoms and pNF size was systematically recorded, and biopsies characterized histopathological features in those patients requiring surgery. Results: Twenty patients were enrolled, with an average age at therapy initiation of 11.6 years. Cutaneous side effects were common, with all patients experiencing at least one and a median of two per patient. Xerosis, paronychia and acneiform rash were prevalent. Notably, pre-pubertal individuals were more susceptible to xerosis. Acneiform rash had a higher incidence in older patients and those with skin phototypes II and III. Successful management involved tailored approaches, such as clindamycin for acneiform rash and topical agents for paronychia. Hair abnormalities, including color changes and thinning, occurred, with female patients at higher risk for the latter. Paronychia presented challenges, necessitating various interventions, including surgical approaches. AEs led to treatment suspension in 20% of patients, with tumor rebound observed in 75%. Conclusions: According to our experience, successful management of selumetinib-induced cutaneous AEs requires tailored strategies including surgery. AEs might indirectly determine pNF regrowth due to therapy suspension. We thus emphasize the pivotal role of addressing cutaneous reactions for effective selumetinib management in pediatric patients.

Cutaneous T-cell lymphoma (CTCL) is a rare disease with a low incidence rate in the United States. Patients with CTCL often have a poor understanding of their disease, which can affect their treatment compliance and follow-up. A study conducted at CTCL specialty clinics in New Orleans aimed to evaluate patients' comprehension of their disease, methods to improve understanding, and their primary healthcare provider. The majority of patients reported that they understood their disease, with dermatologists being the primary healthcare provider overseeing their care. Patients expressed a preference for educational videos to improve their understanding. The study highlights the importance of dermatologists in treating CTCL and the need for improved communication to enhance patient understanding and outcomes. However, the study's limitations include its focus on early-stage CTCL patients and the administration of surveys only at dermatology clinics. [Extracted from the article]

Pain and anxiety related to medical procedures have long been recognized as a significant healthcare concern. If a patient's procedural pain and anxiety are not addressed, long‐term physical and psychological sequelae including increased perceived pain, anxiety, disruptive behavior, trauma reactions, or refusal of future procedures can occur. The objective of our study was to assess the utility of a virtual reality (VR) headset or noise‐canceling headphones (HP) compared to treatment as usual (TAU) in reducing pain and anxiety during pediatric dermatology procedures. Results indicated a significant difference between pre‐ versus post‐procedure anxiety in the VR and HP groups but not the TAU group suggesting non‐pharmacologic technology‐based interventions such as VR and headphones may reduce patients' anxiety during pediatric dermatology procedures. [ABSTRACT FROM AUTHOR]

A retrospective chart review of 332 pediatric psoriasis patients seen at a single academic institution from 2012 to 2022 was conducted to examine the risk factors associated with palmoplantar psoriasis (PP), a painful and treatment‐resistant subtype of plaque psoriasis affecting hands and feet. Black patients have a 6.386‐fold increase in the odds of having PP compared to White patients and males have a 2.241‐fold increase in the odds of having PP. Black and Hispanic/Latino patients displayed a higher prevalence of nail and palm/sole involvement (p <.0001), whereas White patients exhibited more scalp involvement (p =.04). This study reveals the importance of considering the diagnosis of PP in Black male patients based on its demographic prevalence, which may in turn impact clinical care for these patients. [ABSTRACT FROM AUTHOR]

Educating pediatric eczema patients and caregivers on appropriate product selection and avoidance of common irritants or allergens is a crucial aspect of eczema management. This study surveyed 80 pediatric caregivers in an academic pediatric dermatology clinic to assess influential factors in caregivers' selection of pediatric eczema‐care products and identify ways to improve patient counseling on appropriate product selection and avoidance of common irritants or allergens. Caregivers frequently reported positive perceptions of commonly recommended ingredients for eczema but had inconsistent perceptions of fragrant plant oils and extracts, regardless of previous counseling on fragrance avoidance. These findings demonstrate uncertainty and misperceptions perpetuated by product labeling and a need for improved counseling strategies for avoiding fragrance and excessive product costs. [ABSTRACT FROM AUTHOR]

A case study published in Pediatric Dermatology describes a 5-month-old boy who developed a rash on his thighs after receiving routine vaccinations. The rash was diagnosed as botryomycosis, a rare bacterial infection. The patient was found to have an underlying immunodeficiency called hyper-IgE syndrome (HIES). Treatment with antibiotics resulted in significant improvement. Botryomycosis is typically associated with immunosuppression or immune dysregulation, and this is the first reported case of vaccinations causing bacterial inoculation leading to botryomycosis. Surgical debridement may be necessary in severe cases. [Extracted from the article]

This article discusses the case of a 6-year-old girl with persistent exfoliative dermatitis. The girl presented with painful rashes on her neck, chest, axillary, and abdominal region, along with abdominal pain. Despite treatment for eczema, her condition did not improve. Further investigation revealed that she had a deficiency in vitamin B3 (niacin), leading to a diagnosis of pellagra. Treatment with oral niacinamide resulted in complete resolution of the rash and abdominal pain. Pellagra is a condition that was historically characterized by dermatitis, diarrhea, dementia, and death, but is now rare in developed countries due to fortification of flour with vitamin B3. However, it is still endemic in certain areas due to poor nutrition. [Extracted from the article]

N, number of clinical trials; NR, the number of clinical trials that did not report race data for participants; S, sample size of all participants in clinical trials. REFERENCES 1 Allison K, Patel D, Kaur R. Assessing multiple factors affecting minority participation in clinical trials: development of the clinical trials participation barriers survey. Our analyses, while limited by the low level of reporting of racial and ethnic data of trial participants, shed light on a lack of inclusivity in Canada with respect to dermatology clinical trials. [Extracted from the article]

Microphthalmia, dermal aplasia, and sclerocornea (MIDAS) syndrome is a rare syndrome manifesting at birth with a wide variety of abnormalities which include microphthalmia and/or anophthalmia, sclerocornea, linear skin defects with dermal aplasia limited to the face and neck, ocular abnormalities, central nervous system involvement, cardiac anomalies, hearing impairment, and genitourinary malformations. This report describes MIDAS syndrome in a 6-day-old female neonate who presented with multiple erosions with crusted plaques over the face and neck since birth and bilateral microphthalmia with microcornea with corneal opacity. [ABSTRACT FROM AUTHOR]

AI in skin analysis and skincare The next generation of cosmetic dermatology can benefit from AI technology in skin analysis and skincare. AI plays a crucial role in cosmetic dermatology by enhancing patient satisfaction through accurate analysis of baseline and post-treatment skin conditions. How good is artificial intelligence (AI) at solving hairy problems? In order to set out the loop holes that AI can bring to cosmetic dermatology, it is of utmost significance to mark the points of attraction that AI can have for cosmetic dermatology. [Extracted from the article]

The article focuses on a case of atopic dermatitis (AD) in a 16-year-old boy that worsened after treatment with omalizumab for severe asthma, leading to the development of widespread eczematous plaques. It mentions the patient's condition improved significantly when transitioned to dupilumab, highlighting the potential for paradoxical AD flares with omalizumab and the effectiveness of dupilumab in treating AD exacerbated by omalizumab.

Abstract Phosphoglucomutase 3 (PGM3) catalyzes the glycosylation of immune system precursor proteins. Its impairment leads to severe infections and other developmental, musculoskeletal, and nervous system defects. We present a case of a 2‐month‐old female patient with recurrent infections and diffuse eczematous dermatitis recalcitrant to corticosteroids. A next‐generation sequencing NGS gene panel for inherited immune dysfunction syndromes revealed multiple variants of unknown significance in key immune regulators, specifically heterozygous mutation c.337C⟩G (p.Pro113Ala) on exon 4 of PGM3 as a novel variant in the PGM3 associated diseases. Off‐label use of dupilumab resulted in rapid improvement.

Alopecia areata (AA) is a common cause of hair loss in children. Despite numerous therapeutic options for paediatric AA, none have been found to be both effective and safe. Recent studies have demonstrated the efficacy and safety of the Janus kinase (JAK) inhibitor tofacitinib in adult patients with AA, whereas data on paediatric patients with AA in real-world practice are limited. This was a single-centre, retrospective study that included 11 pre-adolescent patients with AA treated with tofacitinib between December 2021 and September 2022. Clinical characteristics of patients, clinical response and adverse events were evaluated. Overall, 82% (9/11) of patients experienced hair regrowth and 64% (7/11) of patients experienced over 50% improvement in their Severity of Alopecia Tool (SALT) scores. Adverse events were mild. In the literature, tofacitinib has been used to treat AA in 31 children ≤12 years of age who failed to respond to prior treatments. Eighty-seven percent (27/31) of these patients showed significant responses based on changes in their SALT scores. This case series demonstrates that oral tofacitinib is an effective and safe treatment option for paediatric AA, particularly for children who have failed to respond to traditional treatments or are not suitable for such treatments.

Not available

Pemphigus vulgaris (PV) is a rare, potentially lethal blistering disease typically occurring in adulthood and characterized by autoantibodies directed against mucocutaneous desmosomal proteins. Clinically, flaccid vesicles, bullae and erosions after breakage are the main clinical features. According to the literature, the incidence of PV is rare in the pediatric population, ranging from 1 to 4% of reported cases. We describe an interesting case of a 12-year-old boy with severe PV that was referred to our university hospital for a mucocutaneous disease resistant to anti-infective therapy. Following the appearance of bullous lesions on the skin, antibody screening for autoimmune diseases showed positivity for PV and corticosteroid therapy was started. In view of the numerous adverse effects, we decided to set up biological therapy with rituximab, which was interrupted due to the onset of an urticarial reaction. Further second-line therapies were therefore attempted, with only a partial response. For this reason, a desensitizing therapy with rituximab was decided, thus allowing a clear improvement in the clinical picture and quality of life of the patient. To the best of our knowledge, this is the first report of a child with severe PV resistant to conventional therapies and with an urticarial reaction to rituximab. This case highlights that despite PV being extremely rare in the pediatric population, this diagnosis should not be entirely discounted. In case of severe clinical manifestations, rituximab represents a valid option in children and desensitization tests should be recommended in the presence of hypersensitivity to this drug. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic required a rapid expansion of teledermatology services. Objective: Analyze demographic shifts in a pediatric dermatology practice session with children of color. Methods: A retrospective chart review of pediatric dermatology patients seen in the 4 practice weeks preceding the New York COVID-19 lockdown and comparable teledermatology visits during the COVID-19 pandemic lockdown. Demographic differences (e.g., race, age, gender, and household income) were analyzed. Results: A greater proportion of patients seen were White during lockdown (59.7%), compared with pre-lockdown (43.6%), with a reduction in Asian patients seen in lockdown (6.0%) compared with pre-lockdown (24.5%). A lower proportion of no-show patients (4.3%, 3/70 scheduled) were noted in lockdown compared with pre-lockdown (16%, 18/112). Preferred provider organizations (PPO) and higher-income zip codes were more common for children seen during lockdown. Limitations: The sample addresses a limited New York pediatric dermatology practice during a short time period. Conclusions: White patients and patients with PPO were more likely to access telehealth, supporting disparity in teledermatology services. These results demonstrate reduced health care access for lower-income and Asian children during the COVID-19 pandemic lockdown. [ABSTRACT FROM AUTHOR]

Chilblain-like lesions (CLL) coinciding with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection have been described in the literature. Available reviews of the literature suggest that CLL are associated with younger age, an equal sex ratio, negative testing for SARS-CoV-2, and mild to no extracutaneous manifestations (ECM) associated with COVID-19 infection. This systematic review aims to provide a summary of reports of CLL associated with the early SARS-CoV-2 pandemic in children to clarify the prevalence, clinical characteristics, and resolution outcomes of these skin findings. Sixty-nine studies, published between May 2020 and January 2022, met inclusion criteria and were summarized in this review, representing 1,119 cases of CLL. Available data showed a slight male predominance (591/1002, 59%). Mean age was 13 years, ranging from 0 to 18 years. Most cases had no ECM (682/978, 70%). Overall, 70/507 (14%) of patients tested positive for COVID-19 using PCR and/or serology. In the majority the clinical course was benign with 355/415 (86%) of cases resolving, and 97/269 (36%) resolving without any treatment. This comprehensive summary of pediatric CLL suggests these lesions are rarely associated with COVID-19 symptoms or test positivity. [ABSTRACT FROM AUTHOR]

Background: Pigmentary mosaicism (PM) is a descriptive term encompassing a range of hyper- and hypo-pigmented phenotypes in various patterns. Information from the neurology literature initially noted neurological abnormalities (NA) in up to 90% of children with PM. The dermatology literature suggests lower associated rates (15%–30%) of NA. Variations in terminology, inclusion criteria, and small population sizes makes interpreting existing PM literature complicated. We aimed to assess rates of NA in children presenting to dermatology with PM. Methods: We included patients <19 years, diagnosed with PM, nevus depigmentosus and/or segmental café au lait macules (CALM) seen in our dermatology department between 1 January 2006 and 31 December 2020. Patients with neurofibromatosis, McCune-Albright syndrome, and non-segmental CALM were excluded. Data collected included pigmentation, pattern, site(s) affected, presence of seizures, developmental delay, and microcephaly. Results: One hundred fifty patients were included (49.3% female), with a mean age at diagnosis of 4.27 years. Patterns of mosaicism were ascertained for 149 patients and included blaschkolinear (60/149, 40.3%), blocklike (79/149, 53.0%), or a combination of both patterns (10/149, 6.7%). Patients with a combination of patterns were more likely to have NA (p < .01). Overall, 22/149 (14.8%) had NA. Nine out of twenty-two patients with NA had hypopigmented blaschkolinear lesions (40.9%). Patients with ≥4 body sites affected were more likely to have NA (p < .01). Discussion: Overall, our population had low rates of NA in PM patients. A combination of blaschkolinear and blocklike patterns, or ≥4 body sites involved were associated with higher rates of NA. [ABSTRACT FROM AUTHOR]

Background/Objectives: The emergency department (ED) is a common point of care for many pediatric hidradenitis suppurativa (HS) patients; however, ED care may not align with recommended treatment standards. The objective of this study is to describe the care pediatric HS patients receive in the ED compared to both HS management guidelines and the management of pediatric skin and soft tissue abscess (SSTA) patients. Methods: We performed a retrospective chart review of pediatric HS and SSTA patients who presented to a single pediatric ED. Demographic and ED encounter data including medications, procedures, recommendations, consults, and referrals were collected. Results: 58 HS and 175 SSTA charts were reviewed. 69.5% of patients were female and 93.6% were African American/Black. 29.3% of HS and 61.7% of SSTA encounters involved incision and drainage (I&D); 62.1% of HS and 70.1% of SSTA encounters involved the prescription or administration of oral clindamycin; 3.4% of HS and 0.6% of SSTA encounters involved dermatology consultation in the ED; and 22.4% of HS and 5.1% of SSTA encounters involved outpatient referrals to dermatology. Conclusions: Our data reveal a pediatric HS and SSTA population that is predominantly female and African American/Black. Significant differences were found in the average ages and number of lesions between HS and SSTA patients. I&D and oral clindamycin were the most common treatments across groups; however, I&D was performed significantly more frequently among SSTA encounters than HS encounters. Our results suggest that subtle knowledge gaps may exist in ED provider management of pediatric HS. [ABSTRACT FROM AUTHOR]

Background/Objectives: The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). Methods: Patients with EB ages 8–16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. Results: Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84 = PCS parent; 34.58 = PCS child; 30.87 = parent FDI; 29.77 = child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p = .04) but not disease severity. Older children reported more functional disability than their parents and younger children (p = .02). Conclusions: Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB. [ABSTRACT FROM AUTHOR]

Background/Objective: Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Methods: Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly‐selected patients. Results: 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8–1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very‐high‐risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Conclusion: Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease. [ABSTRACT FROM AUTHOR]

Early specialist evaluation during rapid proliferative growth of complicated infantile hemangiomas (IHs) is crucial. Health disparities and barriers of access to care for children with IHs have not been examined. To investigate whether socioeconomic status (SES) is associated with age at presentation to a subspecialist for IH evaluation. A retrospective cohort study of 804 children presenting to a large academic hospital. The primary outcome was age at initial presentation. Covariates included demographic, socioeconomic, geographic, and clinical characteristics. Medicaid and the Children's Health Insurance Program were proxies for lower SES. Analysis of covariance, chi-square tests, and generalized ordered logistic regressions were performed. Children with lower SES had higher odds of presenting after 3 months of age (odds ratio, 2.11; 95% confidence interval, 1.31-3.38). In the subset that qualified for the institutional care management program (ICMP), no risk factors were associated with delayed presentation. Use of insurance and economic distress as proxies for SES; exclusion of uninsured children, which may have resulted in underestimation of racioethnic effects; and examination of a single academic center, which may limit generalizability. Children with IHs and lower SES were more likely to present later to specialists, but those enrolled in an ICMP were not, suggesting that integrated ICMPs may mitigate disparities and delayed access to care for IHs among lower-SES populations. [ABSTRACT FROM AUTHOR]

Pediatric-specific studies on Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are lacking. The objective of this study was to characterize demographics, comorbidities, and outcomes of pediatric SJS and TEN patients on a national level. On average, pediatric SJS/TEN patients were hospitalized longer and had higher mortality rates compared to reports in most previous studies. Better access to dermatologic and multidisciplinary care may help improve pediatric outcomes, although these findings must be corroborated in future studies on larger pediatric populations with SJS and TEN. [ABSTRACT FROM AUTHOR]

Background: The neonatal period encompasses the initial four weeks of extra-uterine life. Skin lesions in neonates range from transient physiological, self-limiting conditions to pathological dermatoses. An awareness of the physiological skin changes in neonates is needed to differentiate them from pathological dermatoses, thereby avoiding unnecessary treatment and mental stress to the parents. Aim: The aim was to study the clinical pattern of neonatal dermatoses and their prevalence at a tertiary care center. Materials and Methods: An institutional, prospective, observational study was conducted at the outpatient department of dermatology, venereology, and leprosy. A total of 195 neonates from the postnatal ward, pediatric ward, and dermatology department of the same institution with at least one cutaneous manifestation over the period of six months were included in the study. Results: Among the 195 neonates, cutaneous manifestations were noted in 176 neonates (90.8%), among which 82 (46%) were males and 94 (54%) were females; 163(92%) were full-term and 14 (8%) were preterm; 89 (51%) were born through vaginal delivery and 87 (49%) by caesarean section. Skin manifestations may be broadly divided into physiological skin lesions accounting for 80% of cases, transient non-infective conditions (10%), eczematous eruptions (2%), birthmarks (3%), and others (5%). The most common among all was the Mongolian spot accounting for 98 (56%) cases. Conclusion: A majority of the neonatal dermatoses were transient physiological, requiring only reassurance and no medical treatment; however proper understanding and identifying the pathological conditions are critical for early diagnosis and intervention. [ABSTRACT FROM AUTHOR]