Palmoplantar Region Research Articles

Epidermal Inclusion Cyst Presenting as Prepatellar Bursitis

An epidermal inclusion cyst is one of the rare benign lesions that can occur around the knee and can mimic prepatellar bursitis. They can occur anywhere in the body, but more prevalent sites are the face, neck, trunk, behind the ears, and palmoplantar region. In the present case, a 52-year-old man with epidermal inclusion cyst presented to the surgery outpatient department (OPD) with symptoms clinically mimicking as prepatellar bursitis, occurring at a rather unusual site, ie; the anterior aspect of the left knee. The possibility of an epidermal inclusion cyst should always be considered in an atypical soft tissue mass when presenting around the knee. Histopathological examination confirms the diagnosis.

Psoriasis with Leg Involvement as the New Difficult-To-Treat Area: A Cohort Study of Patients Treated With Risankizumab.

Historically, difficult-to-treat areas in psoriasis included face, scalp, folds, genitalia, nails, and palmoplantar region. Recent studies have found that lower limbs behave like a "new" difficult-to-treat area as they can be the only site of residual disease even in patients undergoing biologic therapies. We aimed to evaluate whether legs had different response rates and response times to treatment with a new biologic drug, risankizumab, compared to other body sites. We conducted a real-life, observational, retrospective, multicenter study including patients affected by moderate-to-severe psoriasis with leg involvement and undergoing biological therapy with risankizumab for more than 16 weeks. The Psoriasis Area Severity Index (PASI) and Leg-PASI were collected at T0 and at weeks 16, 28, 40, 52, 64, and 76. Statistical analysis using Student's t test and linear regression analysis were performed. A total of 124 patients were included. The difference between the improvement percentage compared to baseline was statistically significant at weeks 16 and 28, demonstrating that Leg-PASI improved less than PASI. From the linear regression it was deduced that the slope is statistically less steep for Leg-PASI than for overall PASI, confirming that this site responds more slowly to the therapy. Leg response to risankizumab appears to differ significantly from other body sites in the first weeks of treatment, even if after 28 weeks, statistical significance is lost. Our preliminary finding suggests that risankizumab can be considered an effective treatment for leg psoriasis but with longer response times than other areas, demonstrating the relative nature of resistance to treatment of this district.

Long-Term Efficacy and Safety of Guselkumab in Psoriasis Patients Who Failed Anti-IL17: A Two-Year Real-Life Study.

Guselkumab is the first approved human IgG1λ monoclonal antibody selectively targeting the p19 subunit of interleukin (IL)-23. Despite its effectiveness and safety, which have been widely reported by clinical trials and real-life experiences, data regarding its use on patients who previously failed anti-IL17 are limited or characterized by a reduced follow-up period. These data are essential to guide clinicians in biologic switching, considering that anti-IL23 and anti-IL17 partially share their therapeutic targets, as well as some patients who may have to interrupt treatment with anti-IL17 for loss of efficacy over time or the development of adverse events (AEs). In this context, we performed a retrospective study with the aim of evaluating the long-term use (2 years) of guselkumab in psoriasis patients who previously failed at least one anti-IL17 in a real-life setting, also focusing attention on psoriasis located in difficult-to-treat areas (the scalp, palms or soles, fingernails, genitals). A total of 61 patients (35 male, 57.4%; mean age 57.6 ± 8.8 years) were enrolled. Of these, 30 (49.2%) patients failed secukinumab, 21 (34.4%) failed ixekizumab, 7 (11.5%) failed brodalumab, and 3 (4.9%) failed both secukinumab and ixekizumab. At the baseline, the mean PASI and BSA were 12.8 ± 8.4 and 24.5 ± 26.6, respectively. During week 16, PASI90 and PASI100 responses were achieved by 60.7% and 37.7% of patients, respectively, which continued to improve up to week 104 (PASI90: 73.8%, PASI100: 59.0%). Clinical improvement in difficult-to-treat areas was detected as well. In particular, a slower improvement for fingernails and the palmoplantar region was reported compared to scalp and genital psoriasis at week 16. However, no differences were found following 28 weeks of therapy. Primary and secondary inefficacy were reported by 1 (1.6%) and 5 (8.2%) patients. As regards safety, no severe AEs were collected.

Keratoderma climactericum: an under-reported condition successfully treated with an estriol cream

Climacteric keratoderma is a specific cutaneous disorder often underreported, potentially misdiagnosed, or undervalued. Although the pathogenesis remains undetermined, hormonal changes during menopause heavily affect the trophism and normal cellular function of the epidermis and dermis of the palmoplantar regions. We present the case of a 55-year-old woman referred to the Dermatological Clinic of Cagliari for acquired bilateral palmoplantar hyperkeratosis not responding to common topical treatments. Based on the medical history, clinical appearance of the lesions, and laboratory tests, keratoderma climactericum was diagnosed, as confirmed by histopathological examination. An overlap with allergic contact dermatitis was also detected through patch testing, and its synergic effect contributed to the perpetuation of the dermatosis on the hands. A daily high-potency corticosteroidal topical therapy, combined with a 50% urea-based cream at night, was only partially effective. However, adding estriol-based cream at a concentration of 0.125% led to a significant clinical improvement. Climacteric keratoderma is an acquired condition that deserves further clinical trials to assess topical hormonal treatment protocols, as the current approach is largely empirical.

Gorlin Syndrome: A Comprehensive Evaluation of Skin Findings.

Although Gorlin syndrome has rich skin findings, there is limited information about their subtypes, features specific to this genodermatosis, and relationships with each other. The demographic characteristics as well as cutaneous and extracutaneous findings of consecutive Gorlin syndrome patients diagnosed during 23 years were evaluated retrospectively. The relationship between palmoplantar pitting and basal cell carcinoma (BCC) in this localization and the relationship between odontogenic keratocysts (OKCs) and epidermoid cysts were investigated. A total of 30 patients were diagnosed with Gorlin syndrome of whom 36.7% were children. BCC was the most common finding (90%) followed by OKCs (83.3%), skeletal system anomalies (76.7%), and palmoplantar pitting (76.7%). While classical BCC (63.3%) lesions were the predominant clinical subtype among all patients, acrochordon-like or small-sized papular BCCs were seen in 45.4% of pediatric patients. Three patients, 2 of whom were children, had BCC lesions in the palmoplantar region in association with palmoplantar pitting. Epidermoid cysts presenting clinically as solitary (n = 12) or a few nodules (n = 4) without punctum, located more commonly in acral areas (n = 10) were seen in 16 (53.3%) patients of whom 7 were children. Epidermoid cysts were seen in 60% of patients with OKCs, and the relationship between epidermoid cysts and OKCs was not statistically significant (P = .15). Extracutaneous tumors such as medulloblastoma (n = 3), cardiac fibroma (n = 1), and ameloblastoma (n = 1) were also recorded. The awareness of papular or acrochordon-like BCCs, palmoplantar BCCs, and acral epidermoid cysts without punctum may facilitate early diagnosis of Gorlin syndrome in children.

Secondary Syphilis Reinfection with Suspected Asymptomatic Neurosyphilis

Syphilis, a sexually transmitted disease caused by Treponema pallidum, poses a significant global health threat, with an annual incidence of around 12 million cases, predominantly affecting individuals aged 15-49. Reinfection occurs in 11 out of 120 patients, underscoring the importance of effective management. If untreated, 4-9% of cases may progress to early neurosyphilis, often presenting asymptomatically. We present the case of a 22-year-old male with reddish-brown patches on the face, palms, and soles, along with erythematous papules on the genital region, following a history of recent promiscuity. Physical examination revealed distinctive manifestations, including nickels and dimes on the face, syphilitic roseola, Biett's collarette on the palmoplantar region, and erythematous papules-plaques on the scrotal and penile areas. The VDRL test indicated a titer of 1:32, TPHA test >1:5120, and a non-reactive HIV rapid test. Initiating treatment with a single intramuscular injection of benzyl benzathine penicillin G (2.4 million IU) resulted in successful symptom resolution, accompanied by a four-fold decrease in VDRL titer to 1:8 by the third month. However, a subsequent increase to 1:32, following sexual intercourse in the sixth month, indicated reinfection and raised suspicions of asymptomatic neurosyphilis. The patient received oral doxycycline (100 mg twice daily) for 30 days. Unfortunately, treatment success could not be determined as the patient was lost to follow-up. This case report highlights that elevated VDRL titers signify reinfection, treatment failure, or neurosyphilis. Asymptomatic reinfection is common due to lead-time bias and partial immunity, especially with multiple episodes of syphilis. Early neurosyphilis may coexist with primary or secondary syphilis and is frequently asymptomatic. Continued efforts in monitoring and treatment adherence are crucial for effective syphilis management on a global scale.

Race-Specific and Skin of Color Dermatoscopic Characteristics of Skin Cancer: A Literature Review.

Individuals with melanin-rich skin account for the majority of the world's population. However, literature data regarding dermatoscopic characteristics of skin cancer in skin of color (SoC) are scarce. The dermatoscopic characteristics of cutaneous tumors might differ among skin types due to heterogeneity in composition and pigmentation. To summarize literature data on the dermatoscopic findings of skin neoplasms, according to the skin color and race. The literature search was performed using PubMed database up to December 30, 2022 and was conducted with the use of terms referring to dermatoscopy, race (Caucasians, Hispanics, Asians, and Black/African) and skin cancer types (BCC, SCC, keratoacanthoma, Bowen's disease and melanoma). In total, 30 race-specific records were included. 9 SoC records for BCCs (2 BCC studies in Hispanics, 1 BCC study in Black individuals and 6 BCC studies in Asians ), 9 SoC records for SCCs ( 1 SCC study in Hispanics, 1 SCC study in Black individuals and 7 SCCs in Asian population) and 8 SoC records for melanoma (2 melanoma studies in Hispanics, 1 melanoma study in Blacks and 5 melanoma studies in Asians) were compared with 4 records that involved only Caucasian population, according to their participant section as well as with studies on dermatoscopy characteristics without focusing on race origins and phototype of the patient. In Hispanics and in both fair and dark-skinned Asians, BCCs were more often pigmented or at least with pigmented structures on dermoscopy. Squamous cell carcinoma (SCC) and keratoacanthoma were the least studied in SoC patients. Bowen's disease in SoC patients can be pigmented in a higher frequency compared to Caucasians, with glomerular vessels and a squamous surface being the most common dermatoscopic findings. The most frequent pattern of melanomas in SoC individuals were the parallel ridge pattern in palmoplantar region. Based on a review of studies including Caucasians, Hispanics, Asians and Blacks /Africans, SoC patients present with more frequent and unique dermatoscopy features of skin cancers.

Effectiveness of Brodalumab in Patients with Moderate-to-Severe Plaque Psoriasis Located in Difficult-to-Treat Areas.

Recent knowledge of psoriasis pathogenesis has led to the development of selective drugs. Among these, brodalumab is a monoclonal antibody targeting the interleukin (IL)-17A receptor approved for the treatment of moderate-to-severe plaque psoriasis. Biologics may be considered in patients with milder diseases in case of active psoriatic arthritis, severe impact on patient's quality of life, and involvement of sensitive and difficult-to-treat areas. These skin locations commonly require systemic drugs. Recently, psoriasis severity monitoring has also changed. Indeed, the clinical evaluation by means of specific efficacy scores was combined with serological evaluation by means of the assay of specific inflammatory biomarkers. An observational study enrolled patients affected by moderate-to-severe plaque psoriasis involving difficult-to-treat areas, undergoing treatment with brodalumab to evaluate the effectiveness and safety of brodalumab in patients with psoriasis affecting difficult-to-treat areas (scalp and palmoplantar regions). Secondary outcomes were the assessment of the development of serum markers of inflammation during the treatment period as well as the evaluation of the dermoscopic features of the affected sites to quantify disease activity and response to treatment. Twenty-five patients were included in the study. A statistically significant reduction from baseline in PASI, PSSI, ppPASI and DLQI values as early as week 24 was observed, with further improvement up to week 52. Plasma levels of MMP-3, VEGF-A, and hs-PCR decreased during treatment from week 0 to week 52. Our real-life experience suggests brodalumab as a valuable option for the management of psoriasis located in difficult-to-treat areas. Moreover, our study highlights that the use of brodalumab reduces the plasmatic levels of inflammatory biomarkers (MMP-3, VEGF-A and hs-PCR), showing how the drug modulates the skin inflammatory response by reducing systemic inflammation.

Clinical effectiveness of IL-17 and IL-23 inhibitors on difficult-to-treat psoriasis areas (scalp, genital, and palmoplantar sites): a retrospective, observational, single-center, real-life study

ABSTRACT Introduction Psoriasis affecting the genital, palmoplantar, and scalp regions is recognized as difficult-to-treat, and data on the efficacy of biologics in these areas remains limited. Research design and methods This single-center study evaluated the effectiveness of anti-IL-17 and anti-IL-23 agents on scalp, genital, and palmoplantar psoriasis. We retrospectively analyzed data from all patients with psoriasis being treated with IL inhibitors at our clinic. Effectiveness was evaluated at 16, 28, and 52 weeks, according to the achievement of relative and mean PSSI, PGA-G, and ppPASI. Results In all, 308 patients showed involvement of the scalp, 136 in the genital area, and 94 in the palmoplantar regions. On scalp psoriasis, anti-IL-17 agents demonstrated superiority in disease control compared to anti-IL-23 agents. PSSI100 at week 16 was reached by 59% of patients on an anti-IL17 vs 39.8% on an anti-IL-23 (p < 0.003). At genital sites, no significant differences between anti-IL-17 and anti-IL-23 agents were observed, and all classes achieved PGA-G 0/1. No significant differences between anti-IL-17 and anti-IL-23 agents were observed in palmoplantar areas. Conclusions The present data support the utility of both anti-IL-17 and anti-IL-23 agents for the treatment of difficult-to-treat areas in patients with psoriasis. Anti-IL-17 agents achieved better control of scalp psoriasis.

Ayurvedic Management of Vipadika (Palmoplantar psoriasis): A Case Report

Vipadika is one among the Kshudra Kushta. It features with Panipada sphutana, Teevravedana. Its symptoms can be correlated with palmoplantar psoriasis, which is a form of psoriasis and is chronic and recurring in nature that affects the palms and soles of the feet and is characterized by hyperkeratosis, fissures, erythema and occasionally inflammation and pustules. This disease not only affects person physically but also affects the mental and social health of the patient. Since there is no satisfactory treatment for psoriasis in conventional medicine. Ayurvedic treatment can provide promising results in this condition. In this article a case of 50 years old female with a complaints of Peeling of the palmoplantar skin and Itching with occasional burning sensation in the palmoplantar region since 3-4 months is presented which was successfully treated with Shamanoushadis like Manjishtadi Kashaya, Nimbadi Guggulu, Navayasa Loha, Kamaduga Rasa and external application of Jeevantyadi Yamaka lepam for a period of one month. This is an effort to show the brighter side of Ayurvedic interventions not just in alleviating the symptoms but also in improving the immune strength and causing no recurrence of disease.

Effect of the age of onset on epidemiology, clinical features, and comorbidity of geriatric psoriasis.

Psoriasis is an immune-mediated chronic, relapsing, inflammatory, systemic disease induced by a combination of genetics and environment. Currently, there are limited reports on the epidemiological and clinical characteristics of geriatric psoriatic patients in mainland China. This study analyzed the epidemiological characteristics, clinical features, and comorbidity rates of geriatric patients with psoriasis and evaluated the influence of age of onset on disease characteristics. This retrospective study enrolled 1259 geriatric patients with psoriasis in hospitals affiliated with the National Standardized Psoriasis Diagnosis and Treatment Center in China from September 2011 to July 2020 to analyze the epidemiological characteristics, clinical features, and prevalence of comorbidity in geriatric psoriasis. The cases were classified according to the age of onset into two groups to compare differences: early-onset psoriasis (EOP) and late-onset psoriasis (LOP). The mean age of geriatric patients with psoriasis was 67, with a 1.8:1 male-to-female ratio and 10.7% positive family history. The clinical manifestations of plaque psoriasis accounted for a high proportion (82.0%) and 85.1% of patients had moderate to severe disease. Overweight (27.8%), hypertension (18.0%), joint involvement (15.8%), diabetes (13.7%), and coronary heart disease (4.0%) were the first five common comorbidities. The LOP group had significantly more patients (79.9%) than the EOP group (20.1%). Positive family history was significantly associated with the EOP group (21.7%) than the LOP group (7.9%). The scalp (60.2%) was the most affected area, followed by the nails (25.3%), palmoplantar region (25.0%), and genitals (12.7%). This study analyzed the epidemiological and clinical characteristics of geriatric psoriasis in China and found that age of onset had no effect on disease characteristics or other comorbidities, except for toenail involvement, diabetes, and joint damage.

Effectiveness of Brodalumab on Scalp, Palmoplantar, and Genital Psoriasis: A Descriptive Pilot Study

Introduction. Psoriasis of the scalp, genital areas, and palms and soles represents a treatment challenge in clinical practice. Randomized clinical trials and real‐life studies investigating the efficacy of biological drugs in these sites are scarce. The present is a descriptive retrospective real‐life study with the aim to evaluate the efficacy and safety of brodalumab in these difficult‐to‐treat areas. Materials and Methods. 158 psoriatic patients with scalp involvement, 69 with genital involvement, and 54 with palmoplantar involvement being treated with brodalumab were assessed at weeks 16, 28, and 48 using PSSI (Psoriasis Scalp Severity Index), sPGA‐G (Physician Global Assessment of Genitalia), and ppPASI (Palmoplantar Psoriasis Area and Severity Index). Results. The achievement of relative PSSIs (75%, 90%, and 100%) was already observed in week 16. 86% achieved PSSI75, 80% PSSI90, and 75% PSSI100. The sPGA‐g 0/1 was achieved by 83% of patients at week 16 and 100% at week 24 and 48. At week 16 ppPASI75, 90, and 100 were all reached by 76.9% of patients; at week 24, 84.6% of patients reached all relative ppPASI. Conclusions. Brodalumab proved to be effective and safe in the treatment of scalp, genital, and palmoplantar regions.

Recurrent cutaneous eosinophilic vasculitis characterized by annular purpuric lesions: A case report

A 71-year-old woman presented with a persistent, intensely pruritic cutaneous eruption localized on the palmoplantar regions, lips and palate. The histological findings allowed to make the diagnosis of recurrent cutaneous eosinophilic vasculitis, a very rare cutaneous vasculitis characterized clinically by multiple erythematous or purpuric erythematous papules or plaques or angioedema with a relapsing course in the absence of systemic involvement and histologically by a necrotizing vasculitis of the dermal small vessels with a dominant eosinophilic infiltration. The patient was treated with oral methylprednisolone and pentoxifylline which led to a rapid resolution of the cutaneous lesions.

Clinicopathologic features of epidermoid cysts in the upper and lower extremities, including a case of malignant transformation in the palmoplantar region

Purpose: Epidermoid cysts are common benign skin neoplasms derived from the pilosebaceous apparatus that usually develop in hair-bearing regions such as the head and neck. Epidermal cysts rarely occur in the extremities, especially in the palmoplantar region. Therefore, they can be easily misdiagnosed as warts or calluses. Here, we present our experience treating epidermal cysts in the extremities, including a very rare case of malignant transformation into squamous cell carcinoma. Methods: This retrospective study enrolled all patients who underwent excision of epidermoid cysts in the upper and lower extremities from March 2006 to April 2021.Results: Among 249 patients, there were 10 (seven male and three female patients) who had epidermal cysts in the extremities (4.0%). All four plantar cysts were located in weight-bearing areas. One palmar epidermal cyst occurred 33 years after the trauma. There was one case of a highly recurrent epidermal cyst on the heel that was eventually diagnosed as squamous cell carcinoma arising from the cyst lining on excisional biopsy. After wide excision with a margin of 2 cm, the resulting defect was reconstructed using a free thoracodorsal artery perforator flap. Conclusion: Epidermoid cysts in the extremities, especially the palmoplantar region, are rare. Detailed history taking, including underlying diseases and trauma history, is helpful for diagnosis. Complete excision is necessary to avoid relapse and to confirm the final diagnosis, especially in cases suspected of malignant transformation arising from epidermoid cysts.

Dermatologic manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic

Objectivesmulti-system ınflammatory syndrome in children (MIS-C) is an immune-mediated process that develops after infections like SARS-CoV-2. The authors aimed to reveal the mucocutaneous findings of patients diagnosed with MIS-C at presentation and evaluate the frequency of these mucocutaneous findings and their possible relationship with the severity of the disease. MethodsA prospective study was conducted of 43 children admitted to a tertiary hospitals between January 2021 and January 2022 who met Centers for Disease Control and Prevention criteria for MIS-C. Results43 children (25 [58.1%] male); median age, 7.5 years [range 0.5‒15 years]) met the criteria for MIS-C. The most common symptom was cutaneous rash 81.4%, followed by gastrointestinal symptoms 67.4%, oral mucosal changes 65.1%, and conjunctival hyperemia 58.1%. The most common mucosal finding was fissured lips at 27.9%, diffuse hyperemia of the oral mucosa at 18.6%, and strawberry tongue at 13.9%. Urticaria (48.8%) was the most common type of cutaneous rash in the present study’s patients. The most common rash initiation sites were the trunk (32.6%) and the palmoplantar region (20.9%). The presence or absence of mucocutaneous findings was not significantly associated with disease severity. Study limitationsThe number of patients in the this study was small. ConclusionsThe present study’s prospective analysis detected mucocutaneous symptoms in almost 9 out of 10 patients in children diagnosed with MIS-C. Due to the prospective character of the present research, the authors think that the characteristic features of cutaneous and mucosal lesions the authors obtained will contribute to the literature on the diagnosis and prognosis of MIS-C.

RSPO1-mutated keratinocytes from palmoplantar keratoderma display impaired differentiation, alteration of cell–cell adhesion, EMT-like phenotype and invasiveness properties: implications for squamous cell carcinoma susceptibility in patients with 46XX disorder of sexual development

BackgroundSecreted R-spondin (RSPO) proteins play a key role in reproductive organ development, epithelial stem cell renewal and cancer induction by reinforcing canonical Wnt signaling. We have previously reported that palmoplantar keratoderma (PPK), predisposition to cutaneous squamous cell carcinoma (SCC) development and sex reversal segregate as autosomal recessive trait in patients carrying RSPO1-mutations.Although our previous findings suggested that RSPO1 secreted from fibroblasts regulates keratinocyte growth or differentiation, the role of this protein in the epidermis remains largely unexplored. Our study was aimed at expanding the phenotypic, molecular and functional characterization of RSPO1-mutated skin and keratinocytes.ResultsCultured primary keratinocytes from PPK skin of a RSPO1-mutated XX-sex reversed patient displayed highly impaired differentiation and epithelial-mesenchymal transition (EMT)-like phenotype. Interestingly, RSPO1-mutated PPK skin expressed markers of increased proliferation, dedifferentiation and altered cell–cell adhesion. Furthermore, all these signs were more evident in SCC specimens of the patient. Cultured PPK patient’s keratinocytes exhibited increased expression of cell‒matrix adhesion proteins and extracellular matrix remodeling enzymes. Moreover, they showed invasiveness properties in an organotypic skin model in presence of PPK fibroblasts, which behave like cancer-associated fibroblasts. However, the co-culture with normal fibroblasts or treatment with the recombinant RSPO1 protein did not revert or reduce the EMT-like phenotype and invasion capability of PPK keratinocytes. Notably, RSPO1-mutated PPK fibroblasts induced a hyperproliferative and dedifferentiated phenotype of age-matched normal control plantar keratinocytes. Wnt signaling has a key role in both PPK promotion and SCC development. Accordingly, Wnt mediators were differentially expressed in both PPK keratinocytes and skin specimens of RSPO1-mutated patient compared to control.ConclusionsAltogether our data indicate that the absence of RSPO1 in patients with 46XX disorder of sexual development affects the skin microenvironment and epidermal integrity, thus contributing to the risk of SCC tumorigenesis in palmoplantar regions exposed to major frictional stresses.

A Neglected Disease: Scabies a Retrospective Study On Children

Objective: Scabies is one of the diseases that can be minimized with preventive health measures. Accurate diagnosis of scabies is important for both patient and public health. Diagnosis of scabies in children can be challenging, since the clinical features in children may differ from those of adults. The aim of the present study was to investigate the demographic and clinical characteristics of the patients with scabies in childhood. Material and Methods : The patients aged 0-18 years, who were diagnosed with scabies and presented to the dermatology outpatient clinic of our hospital, were included in the study. The demographic characteristics of the patients, time of admission, duration of symptoms, family history, the presence of specific lesions, and any lesions on the scalp, face, palmoplantar region, laboratory findings (if any), previous hospital admissions, treatment, and complications were recorded retrospectively. Results: Fifty six of the 104 patients were male (53.8%) and 48 were female (46.2%). The mean age was 5.82±5.21 years. The mean duration of symptoms was 2.41±2.24 months. Eighty four patients had a family history of scabies (80.7%). Seventy patients (67.3%) had at least one specific lesion of scabies. Atypical sites of involvement were palmoplantar region (33.6%), head (6.7%), and face (2.8%). The most commonly used diagnostic tool was dermatoscopy. Forty-one patients were treated with permethrin 5% lotion (39.4%) and 63 with sulfur ointment (60.5%). Of all admissions to the hospital, admissions were highest in fall (40.4%), followed by winter (30.8%), summer (18.2%), and spring (10.6%). Eight patients developed complications (7.6%), including 5 with impetigo and 3 with paronychia. Conclusion: Scabies is an important health issue that can be treated with an accurate and prompt diagnosis. It was observed that the head, face, palms, and soles often are involved in infants and very young children, unlike adults. Therefore, clinicians should consider the clinical differences between adults and children in the management of scabies in children. Also, dermatoscopy is a practical and effective diagnostic tool especially in infants and young children with scabies.

Angioedème isolé récurrent : pensez à l’urticaire chronique

Isolated histamine-mediated angioedema is an uncommon form of chronic urticaria. Herein we report a case of recurrent isolated angioedema in a setting of chronic urticaria. A 33-year-old male patient presented with isolated and recurrent angioedema of the lips, external genitalia and palmoplantar regions that had been present for two years. The occurrence of recurrent isolated angioedema may in itself be sufficient to establish a diagnosis of chronic urticaria.

EARLY DIAGNOSIS OF COWDEN’S SYNDROME: CASE REPORT IN CHILD

A melanoderma 11-year-old male patient, sought care complaining of tongue lesions that did not heal. During anamnesis, the patient's father reported that he suffered from stomach problems and was using Digesil®, and since his childhood he presented papular mucocutaneous lesions. An extraoral physical examination, it was observed that the patient had flat hyperkeratotic papules in the palmoplantar regions. The intraoral examination revealed whitish and asymptomatic papules, restricted to the tongue dorsum that coalesced acquiring aspect of “paving stones.” The brain magnetic resonance did not show abnormalities. Based on clinical findings, the patient was diagnosed with Cowden’s syndrome. The intraoral lesions were treated with application of 60% trichloroacetic acid. The early diagnosis of Cowden’s syndrome requires careful monitoring of the patient to detect early malignant neoplasms commonly associated with this pathological entity.

Dyshidrotic Eczema and Its Relationship to Metal Allergy.

Dyshidrotic eczema, also known as dyshidrotic dermatitis or pompholyx, is characterized by pruritic, small tense vesicles mainly on the palmoplantar region and lateral and ventral surfaces of the fingers. While its etiology appears to be related to sweating, as dyshidrotic eczema often occurs in an individual with hyperhidrosis, and the spring allergy season, histologic examination shows an eczematous reaction around the sweat ducts which is not associated with abnormalities of the sweat ducts. More recently, the nomenclature of 'acute and recurrent vesicular hand dermatitis' has been proposed to reflect clinical features of dyshidrotic eczema. Although the exact etiology of dyshidrotic eczema remains unknown, given the presence of metal allergy in patients with dyshidrotic eczema and the improvement of the symptoms by removing metal allergen, metal allergy is regarded as one of the important potential etiologic factors for dyshidrotic eczema.