Among the acquired diseases which are distributed along Blaschko’s lines there are linear psoriasis and lichen striatus: in addition to the same distribution, which is linked to a condition of mosaicism, they are both acquired inflammatory diseases and usually asymptomatic, sometimes creating problems of differential diagnosis.

Neonatal Herpes simplex virus (HSV) infection is a potentially life threatening disease. We describe a case series of 4 neonates who demonstrate variable presentations of neonatal cutaneous HSV and the difficulties that can occur in diagnosis. Our aim is to increase awareness of the clinical variation in neonatal HSV to facilitate early diagnosis, prompt treatment and improved outcomes.

Background. Epidermal cysts are common benign intradermal or subcutaneous tumors that can also occur in oral mucosa and internal organs. The clinical presentation is variable, so the diagnosis of epidermal cysts needs histopathological confirmation. Methods. A retrospective case-series study of histologically proven epidermal cysts of the head and neck presenting from January 2017 to January 2020 at the Department of Dermatology, the Third Affiliated Hospital of Soochow University in China was carried out. Clinical details, including age, gender, sites and histopathological results, were noted. Results. The highest incidence of epidermal cysts was observed in the age group of 31–40 years (20.5%, 23/112) and the most commonly affected site of the head was the ear (15.4%, 10/65). Histopathological findings included rupture of epidermal cysts with giant cell reactions (15 cases) and infections (28 cases). Conclusion. Epidermal cysts are common benign lesions of hair-bearing skin. An epidermal punctum is a hallmark of the clinical diagnosis; however, epidermal cysts can have unusual presentations. Early diagnosis and treatment are needed to avoid cosmetic damage, since epidermal cysts are mostly located in the head region.

Background. Nail lichen planus is considered to be rare in children. Information about its prognosis is lacking. Objectives. To review the epidemiological and clinical features, response to treatment and follow-up of 12 children with nail lichen planus. Methods. Retrospective study involving 12 children younger than 16 years with a clinical and histopathological diagnosis of nail lichen planus, seen from April 2006 to December 2019 at outpatient consultation for nail disorders of the Department of Dermatology of the University Hassan II of Casablanca, Morocco. Results. Data on 12 children were collected, with an average age of 10.6 years (8-16 years). A male preponderance was observed (7/12). The mean duration of the disease was about 16 months. None of the children had skin or mucosal lesions of lichen planus. In all nail lichen planus cases, nail bed involvement was associated with nail matrix damage. In all cases nail biopsy confirmed the diagnosis. Intramuscular triamcinolone acetonide was used in all patients. Apart from the patients with pterygium, most of the children improved. Conclusions. Because of the risk of permanent scarring in nail lichen planus, early diagnosis is essential. Nail biopsy is a relatively simple, safe and useful procedure with a minimal scarring risk, even in children. Treatment should be implemented immediately.

Pachydermodactyly is a rare digital fibromatosis which presents with asymptomatic soft tissue swelling of the proximal interphalangeal joints. Its etiology remains unknown and only few cases have been reported in the literature. We report a new case of a 22-year-old male with typical lesions to raise awareness of the importance of an adequate diagnosis and to avoid unnecessary procedures as it can mimic inflammatory joint diseases.

Lupus erythematosus (LE) is a group of autoimmune disorders with a clinical spectrum ranging from localized discoid lesions (DLE) to life-threatening systemic manifestations (1). Lupus erythematosus panniculitis is a rare variant that may occur as a separate disease or coexist with DLE or SLE (2). The incidence is estimated between 1-3% of LE cases, more prevalent (2:1) among females (5), especially at a young age. It is characterized by persistent, tender, and hard nodules localized on the face, arms, shoulders, breasts, and buttocks. Healing of lesions is associated with scarring, lipoatrophy, and rarely ulceration (7). The diagnosis is based on the clinical-pathological correlation. Histopathological features are lymphocytic panniculitis, hyaline degeneration and calcification, allowing the diagnosis (6). There is non consensus on the therapeutic approach. Local treatment with corticosteroids (topical or injectable) is used (4). Antimalarial drugs seem to be beneficial in mild cases of isolated LP (8).

Skin picking disorder (SPD) is not a dermatological problem but a clinical picture causing a damage on the skin tissue and characterized by picking the skin intensely and repetitively. Psychiatric disorders such as depression, bipolar disorder and obsessive-compulsive disorder can play a role in its etiology. Neurodermatitis is included in the skin picking disorder spectrum and can be considered its synonym. Clinically, it is characterized by single or multiple lichenified plaques, which are often hyperpigmented and excoriated, and accompanied by prominent skin lines. The psychiatric factors play a role also in nodular prurigo, which is characterized by severely itchy nodules. A 5-year-old male patient, who had been diagnosed with atopic dermatitis, was brought to our outpatient clinic by his family with the complaints of compulsive scratching, which was responsible for severe bleeding. The patient was diagnosed with nodular prurigo/neurodermatitis with SPD. The rarity in the pediatric literature of case reports discussing the association with SPD in a frequently encountered clinical picture such as atopic dermatitis creates a concern that SPD cases are not diagnosed in children. This case has been presented to attract attention to the fact that atopic dermatitis and SPD can be observed together although they are two different clinical pictures and to underline that there should be no delay in diagnosis of SPD since there are also psychiatric disorders in the background.

Erythema dyschromicum perstans (EDP) is a pigmentary disorder characterized by blue-brown or gray macules in dark-skinned individuals, that are distributed symmetrically on the trunk and proximal extremities. Generalized EDP is relatively rare. Its etiology has remained obscure and no effective treatment is currently available. Here, we report a Chinese female with generalized EDP, presumably caused by the oral antifungal drug griseofulvin, that affected more than 90% of her body surface area.

Discussion. In 1923, Tauber first described hyperkeratosis of the nipple and areola, which was characterized by a slowly growing thickening and pigmentation of the nipple and areola (5). In 1938, Levy-Frankel further classified the condition into three types: (i) nevoid form (NHNA) or idiopathic type; (ii) in conjunction with other skin disorders; (iii) extension of an epidermal nevus (2). Considering this classification, our patient has the nevoid form or idiopathic type of hyperkeratosis. This type is usually bilateral, presenting as persistent verrucous thickening and dark pigmentation in the involved areas (6). The lesions are generally asymptomatic but are occasionally itchy. The etiology of NHNA is not known. Realizing that this condition usually occurs in females in their second and third decades of life, it was speculated that the occurrence of NHNA is related to sharp hormonal changes as menarche or pregnancy (3). The diagnosis of NHNA is always by exclusion and needs confirmation by histologic examination. The specific pathological features include hyperkeratosis, acanthosis and papillomatosis and mild perivascular lymphocytic infiltrates, occasionally with keratotic plugging (4). Our patient refused our request for a biopsy and the diagnosis of unilateral NHNA was based on the clinical features. Despite being a benign disease, NHNA is distressing for patients, since the thickened skin shows an esthetically disturbing appearance. For clinicians it is therapeutically challenging, because there is no effective treatment for this condition. Mismanagement may threaten breast function or could lead to a bad esthetic result. Various modalities have been tried, but the results varied widely. Topical application of corticosteroids, tretinoin, keratolytics, calcipotriol and etretinate have been reported. Some Authors described treatment with radiofrequency, surgery and shave excision (1).

In DSM-5 (5th edition of the Diagnostic and Statistical Manual of Mental Disorders) obsessive compulsive disorder (OCD) is no longer part of anxiety disorders but becomes a separate chapter along with related disorders, such as compulsive excoriation of the skin, trichotillomania, nail biting, etc. OCD is characterized by obsessions, that is thoughts that are perceived as unpleasant by the subject, and by compulsions, that is, repetitive actions implemented by the subject to alleviate the discomfort caused by the obsessions. However, the compulsions do not eliminate the obsessions that are repeated on time. Compulsive actions are preceded by a feeling of progressive excitement, agitation and followed by a feeling of momentary relief or pleasure but also by a sense of guilt. It should be noted that obsessive-compulsive disorder has a very different severity: it ranges from mild, very frequent (2) forms of onychophagy, often familial and therefore due to imitation of what the subject sees a parent doing, to severe forms with repercussions on social life and quality of life, which therefore require treatment. The most commonly used drugs in this field are selective serotonin reuptake inhibitors, clomipramine and N-acetylcysteine (1, 3, 4). However, these drugs have yielded clinical results below their theoretical expectations (4). Cognitive behavioral therapy seems more effective and in particular habit reversal therapy (5), which includes several stages, in particular awareness, stimulus control, competitive response, relaxation exercises and social support. In the first stage, the patient must become aware of his/her problem and of the stimuli that generate the repetitive reaction; in this stage the patient also learns to monitor and record the moments of his/her repetitive behavior. Then the patient must learn to avoid and control the stimuli that cause his/her repetitive actions. He/she must then learn to perform relaxation exercises that reduce agitation and stress. It is then necessary to suggest to the patient competitive responses to stimuli capable of provoking compulsive actions: for example, squeeze the fists keeping the arms extended at the sides, clap hands, sit on top of his/her hands, etc.; finally, the presence of a support person is required who rewards the subject when he correctly performs the listed stages and who discusses with him/her any failures in carrying them out. We have presented this case because we have not found compulsive actions in the literature such as those implemented by our patient and to highlight the important psycho-social consequences of such actions.