Exanthema Research Articles

Cutaneous Manifestations of NAXD or NAXE Deficiency: A Literature Review for the Dermatologist.

Nicotinamide adenine dinucleotide phosphate hydrate dehydratase (NAXD) and nicotinamide adenine dinucleotide phosphate hydrate epimerase (NAXE) deficiencies are rare autosomal recessive metabolic disorders characterized by severe neurological manifestations during infancy. In affected individuals, febrile illnesses can trigger progressive encephalopathy often accompanied by distinctive skin eruptions, resulting in high mortality rates. This study reviews the literature on NAXD/NAXE deficiencies, focusing on dermatological manifestations and their correlation with genotypic variations and treatment responses. A comprehensive literature search identified 45 patients with 31 pathogenic/likely pathogenic mutations, and a median age of onset at 1.16 years. Patients with NAXE deficiency exhibited a broader range of age of symptom onset compared to those affected with NAXD deficiency. Fever or infections were identified as the most common triggers for decompensation episodes. Skin manifestations were observed in 31% of patients with whole cell NAXD and NAXE deficiencies. The characteristic skin eruption comprises well-demarcated erythematous and erosive plaques progressing to blistering and necrosis, predominantly affecting flexural surfaces. The mortality rate was 78%, with survivors experiencing varying degrees of neurological sequelae. Niacin/nicotinamide supplementation resulted in improvements in skin lesions and survival rates. The review underscores the critical role of dermatologists in early diagnosis and intervention of NAXE and NAXD deficiencies. Recognizing characteristic skin manifestations is essential, particularly in patients with acute neurological decline following infections or vaccinations. Early intervention with specific supplements shows promise; however, further research is needed to establish standardized treatment protocols and enhance patient outcomes.

Skin Eruption and Nerve Impairment: Eosinophil Activation Link.

Skin Eruption and Nerve Impairment: Eosinophil Activation Link.

Progress of varicella prevalence and immunization strategies in adolescents and adults

Varicella, often referred to as chickenpox, is a widespread acute infectious condition triggered by the varicella-zoster virus (VZV). It manifests with systemic symptoms and distinct skin and mucosal eruptions, including macules, papules, and vesicles. Although it mainly affects children, the disease is typically more severe in teenagers and adults. Following the adoption of vaccine-based control measures in China, there has been a noticeable trend of varicella affecting older demographics, leading to an uptick in cases among teenagers and adults. This review synthesizes the latest research on the clinical symptoms, epidemiological trends, and immunization strategies for varicella in these age groups, both domestic and aboard. The goal is to enhance strategies for prevention and control, support the development of tailored immunization policies, and underscore the critical role of the varicella vaccine in comprehensive health management across all ages.

Pruritic Urticarial Papules and Plaques of Pregnancy Case Study

ABSTRACT A primiparous patient, 30 days postpartum, presented to the clinic with a chief complaint of an itchy red rash on her mid to lower abdomen. It started 2 days ago. The rash had spread to her upper thighs. Past medical history was negative for skin disease or atopy. Her examination exposed pruritic erythematous polymorphous papules, with subsequent coalescence of larger urticarial plaques on the mid to lower abdomen and upper thighs. The patient was diagnosed with pruritic urticarial papules and plaques of pregnancy (PUPPP). PUPPP is the most common dermatosis affecting about one in 200 pregnant women. It has no tendency to recur in subsequent pregnancies. The elevated differential diagnosis included pemphigoid gestationis and eczema. Drug eruptions, urticaria, and viral exanthems were also considered. The primary goal of PUPPP treatment is to alleviate pruritus and discomfort. Antihistamines and topical corticosteroids are often prescribed along with skin care recommendations. Patients frequently have limited relief from topical treatments or skin care strategies. The extent of patient discomfort mandates competent evaluation because treatment is symptomatic and PUPPP can be difficult to manage. Despite the discomfort related to severe pruritus, PUPPP is not harmful to the mother or baby.

Detecting Monkeypox Virus by Immunohistochemistry.

Mpox (formerly known as monkeypox), a zoonotic disease caused by Monkeypox virus (MPXV), has become an international outbreak since May 2022. Mpox often presents with a mild systemic illness and a characteristic vesiculopustular skin eruption. In addition to molecular testing, histopathology of cutaneous lesions usually showsdistinctive findings, such as epidermal necrosis, balloon degeneration, papillary dermal edema, and focal dermal necrosis, which have proven helpful in the diagnosis of mpox. Viral cytopathic changes with areas of multinucleation, smudging of the nuclei, and intracytoplasmic inclusions have also been described. Although useful, these features are relatively nonspecific. The use of a monoclonal antibody for immunohistochemical (IHC) staining of MPXV may be a useful tool in confirming mpox infection. Three cases of PCR-confirmed mpox were biopsied and subjected to IHC staining with a monoclonal MPXV-specific antibody targeting viral envelope protein A29. As controls, cell lines transduced to express other MPXV viral antigens and samples of cutaneous viral infections involving Molluscum contagiosum, Herpes simplex, Herpes zoster, or Cytomegalovirus were also subjected to IHC staining with this antibody. All three mpox patient biopsies performed on lesional skin subjected to MPXV IHC staining reliably detected viral infection in lesional skin with a diffuse cytoplasmic and focally nuclear staining pattern. No staining was seen in transduced cell lines expressing off-target MPXV viral antigens and in lesional skin of other common viral infections listed above. The monoclonal MPXV-specific antibody may be used as an adjunct tool to confirm mpox infection.

Blaschkitis del adulto como fenómeno paraneoplásico. A propósito de un caso

Blaschkitis is an inflammatory skin eruption that that can manifest following the lines of Blaschko. Clinically, it manifests as a recurrent papulovesicular inflammatory dermatitis with a linear distribution. The lesions may appear as narrow lines, though more frequently as broad bands, affecting the trunk either unilaterally or bilaterally. This condition is typically observed in middle-aged individuals. We present the case of an 81-year-old male with a one-year history of an inflammatory plaque in the abdominal region. Histopathological examination of the lesion revealed features consistent with a paraneoplastic syndrome.

Cytotoxic effects of the standardized extract from Curcuma aromatica Salisb. rhizomes via induction of mitochondria-mediated caspase-dependent apoptotic pathway and p21-mediated G0/G1 cell cycle arrest on human gastric cancer AGS cells

ABSTRACT Curcuma aromatica Salisb. (C. aromatica) is one of the traditional herbs used to treat microbial infection, skin eruption, coronary heart disease, and other diseases, including cancer. However, the inhibitory effects and underlying mechanisms of action of C. aromatica on gastric cancer cells have not yet been fully elucidated. Our study aimed to examine the possible molecular mechanisms underlying the cytotoxic effects attributed to C. aromatica rhizome standardized extract against gastric cancer cells. The components of two major active compounds in C. aromatica rhizome extract were quantitatively analyzed using a simple and validated HPLC method. Cytotoxicity was determined in different gastric cancer and non-cancer cell lines. The biological activities of the extract targeting apoptosis and cell cycle-related genes on gastric cancer AGS cells were also investigated to elucidate the mechanisms relating to the anti-proliferative effect of C. aromatica rhizomes. The two major active compounds curdione and germacrone, in the C. aromatica extract were standardized to 0.64% and 1.12% w/w, respectively. The standardized extract (CAE) exerted cytotoxic effects on various cancer cells, whereas minimal effects at equivalent doses were noted for normal cells. CAE concentration-dependently suppressed growth of gastric cancer AGS cells via induction of apoptosis. Further studies revealed that CAE treatment disrupted mitochondrial membrane potential (ΔΨm), increased Bax/Bcl-2 ratio, and cytochrome c release, resulting in activation of caspase-9/-3 and subsequent cleavage of PARP. Further, the inhibitory effects of caspase-9/-3 expression by a synthetic pan-caspase inhibitor partially protected cells against apoptosis following CAE treatment. In addition, CAE significantly promoted cell death in AGS cells via an accumulation of cells in the G0/G1 phase. This effect was associated with upregulation of the CDK inhibitor p21 and downregulation of cyclin D1, cyclin E, CDK4, and CDK2 expression. Our data indicated that CAE exerted anti-proliferative activity by activating the mitochondria-mediated caspase-dependent apoptotic pathway and arresting the p21-mediated G0/G1 cell cycle on human gastric cancer AGS cells.

Severe Hypersensitivity Reactions with Oral Manifestations: Case Reports on Stevens-Johnson Syndrome and DRESS Syndrome

ABSTRACT Stevens-Johnson syndrome (SJS) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome are rare conditions, representing severe hypersensitivity reactions with significant oral presentations. SJS is an uncommon but severe variant of erythema multiforme, presenting skin and mucosal eruptions that can be potentially fatal. DRESS syndrome, similarly, involves a severe hypersensitivity reaction characterized by fever, rash, and organ involvement. DRESS syndrome is a rare but severe drug-induced hypersensitivity reaction characterized by fever, rash, eosinophilia, and internal organ involvement. The condition often presents with elevated liver enzymes and systemic symptoms that necessitate prompt diagnosis and treatment. This report discusses a case of DRESS syndrome in a 41-year-old patient, highlighting the clinical presentation, investigations, differential diagnosis, and treatment approach. Both conditions require prompt diagnosis and treatment, often involving hospitalization. This report discusses two cases of severe hypersensitivity reactions with oral manifestations.

Dermatology-Related Emergency Department Visits in Tertiary Care Center in Riyadh, Saudi Arabia: A Descriptive Study.

Background/Objectives: Dermatological complaints are commonly seen in the emergency department (ED) setting and may be attributed to infectious, inflammatory, allergic, hypersensitivity, or traumatic processes, yet few studies have been carried out in Saudi Arabia addressing this topic. This study, therefore, aimed to explore this issue by investigating the most common dermatology-related ED encounters in a large tertiary care center in Riyadh, Saudi Arabia, and estimating the incidence of these encounters. Methods: This was a retrospective cohort study conducted in the ED of King Abdulaziz Medical City, a tertiary care center in Riyadh, Saudi Arabia. Data included all patients with dermatology-related ED visits during the period of 2022-2023. Demographic information including, for example, age and sex was collected. The International Classification of Diseases, 10th Revision (ICD-10) was used for the classification of diagnoses. Results: A total of 11,443 patients were included in the study, with male patients making up the majority (54.9%). The mean age upon diagnosis was 22.4 ± 23.2 years. More than half of the patients (55.3%) were diagnosed during childhood (<18), while proportions of older ages declined gradually. Average monthly presentations ranged from 400 to 560. Rash and non-specific skin eruptions (16%), cellulitis (13.6%), and urticaria (12.2%) were the most frequent dermatological emergencies. Conclusions: This study examined the dermatological conditions commonly seen in the emergency department. The findings highlighted a range of dermatology diseases that are typically seen in the ED. Addressing these prevalent disorders in the future will enhance ER physicians' understanding and management of such common dermatological problems.

A cross-sectional study to characterise the topical steroid dependent face by dermoscopy at a tertiary care centre

The occurrence of topical steroid dependent face (TSDF) in India has become widespread because of the abuse of creams containing steroids. Of late, many studies have been undertaken about topical steroid dependent face. Only few studies have demonstrated the dermoscopic features of this condition. Hence, we undertake a research to study the characteristic features of topical steroid dependent face by dermoscopy.A total of 398 patients who have applied topical steroid creams for more than one month and with symptoms indicative of topical steroid dependent face like redness, itching, burning, increased hair growth, acne were included in the study. The demographic, clinical and dermoscopic features were noted in such patients. These dermoscopic features were correlated with the clinical features and potency of steroid creams using Chi- square test. Statistical analysis was done using standard statistical software, ‘p’ value less than 0.05 was considered statistically significant.398 cases were included in the study. The mean age of the patients was 30.22 ± 5.7 years. The duration of topical corticosteroid application was 1-3 months in 30.15% patients, 3-6 months in 32.66% patients. Melasma and other hyperpigmentary causes was the most common cause of steroid usage in 32.16% patients. The most prevalent steroid used was 0.1% Betamethasone valerate. The most common presenting complaints were with itching (70.35%) and redness (69.84%). The dermoscopic features included mainly diffuse red areas (93.96%), terminal hair (75.87%), telangiectasias (74.87%) and brown globules (73.86%). Terminal hair, telangiectasias, focal white areas, white hair were seen on dermoscopy in statistically higher proportion of cases.Atrophy of skin, telangiectasias, red skin, hypertrichosis, easy bruisability and acneiform eruptions are the common clinical features of TSDF in our cohort. Dermoscopic findings along with these clinical features aid in meticulous diagnosis, differentiating it from other dermatological disorders. Hence, dermoscopic evaluation of TSDF provides an easy, diagnostic and time saving procedure that aids in quick detection and helps in management of such cases.

Emerging and re-emerging viral exanthems among children: what a physician should know.

Viral exanthems can present with diverse morphologies of rash, including macular, maculopapular, papular, urticarial and vesicular, or sometimes a combination of these. There has been an increasing trend towards emerging and re-emerging viral exanthems in recent years, the cause of which is multifactorial, including changing environmental conditions and altered host-vector-agent interaction. The significant temperature variations brought on by climate change and ever-increasing international travel has modified the host-agent interactions, and many re-emerging viral illnesses are now presenting with atypical presentations, including an increased frequency of affliction across broader age groups and heightened manifestations often posing as 'great imitators' mimicking a myriad of other dermatoses. Although final diagnosis often relies on serological and molecular tests, certain cutaneous clues can help arrive at a probable clinical diagnosis and help the clinicians order specific and relevant investigations, especially in resource-poor settings where access to laboratory diagnostic tests is likely to be limited. In this review we explore the changing disease dynamics of common viral infections, especially in resource-poor settings, including coronavirus disease 2019, chikungunya, hand-foot-and-mouth disease and some newly emerging ones like mpox (previously referred to as monkeypox), and highlight recent developments in our understanding of the clinical variations seen in their presentations.

Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results - American Samoa, March-July 2023.

On April 24, 2023, the American Samoa Department of Health (ASDoH) declared a public health emergency amid concern about a possible measles outbreak given low 2-dose vaccination coverage at the time. ASDoH had received two positive measles immunoglobulin (Ig) M test results after Flag Day festivities 1 week earlier from vaccinated children. ASDoH performed active case finding, took actions to mitigate transmission, and requested technical assistance from CDC. ASDoH implemented a vaccination campaign to improve suboptimal coverage. Confirmatory molecular testing of specimens from these initial persons under investigation (PUIs) was not possible, but subsequent testing of specimens from additional PUIs by Hawaii State Laboratories Division and CDC ruled out measles. In settings with low measles prevalence, measles antibody testing results have low positive predictive value and can lead to difficulties with interpreting results. Testing for additional pathogens revealed a variety of viruses known to cause common childhood viral exanthems. Both molecular and serologic testing should be performed for all suspected measles cases. To decrease the probability of false-positive IgM results, testing should be reserved for cases that meet the Council of State and Territorial Epidemiologists measles case definition, especially those in persons with no evidence of immunity and with a history of recent international travel. In addition, maintaining high measles vaccination coverage can prevent future outbreaks.

Pathophysiological Mechanisms of the Onset, Development, and Disappearance Phases of Skin Eruptions in Chronic Spontaneous Urticaria

Chronic spontaneous urticaria (CSU) is a typical example of an intractable skin disease with no clear cause and significantly affects daily life of patients. Because CSU is a human-specific disease and lacks proper animal model, there are many questions regarding its pathophysiological dynamics. On the other hand, most clinical symptoms of urticaria are notable as dynamic appearance of skin eruptions called wheals. In this study, we explored dynamics of wheal by dividing it into three phases using a mathematical model: onset, development, and disappearance. Our results suggest that CSU onset is critically associated with endovascular dynamics triggered by basophils positive feedback. In contrast, the development phase is regulated by mast cell dynamics via vascular gap formation. We also suggest a disappearance mechanism of skin eruptions in CSU through an extension of the mathematical model using qualitative and quantitative comparisons of wheal expansion data of real patients with urticaria. Our results suggest that the wheal dynamics of the three phases and CSU development are hierarchically related to endovascular and extravascular pathophysiological networks.

Neonatal Miliaria Pustulosa-A Case Series.

Miliaria pustulosa is a noninfectious, transient skin eruption of pustules overlying erythematous plaques secondary to obstruction of eccrine glands. There are very few case reports in the literature detailing miliaria pustulosa in neonates. When presenting in neonates, its similarity to life-threatening infections may cause diagnostic confusion. By differentiating this condition from similar presentations, unnecessary treatments and tests in this population may be avoided. Retrospective review of the medical records of nine neonates presenting with a pustular eruption diagnosed as miliaria pustulosa. Patients were seen at a children's hospital in Chicago, IL, USA; cases were selected by investigator recall. In this case series, miliaria pustulosa presents in nine neonates as clusters of eruptive pustules with resolution or significant improvement noted after an average of 2.6 days (range 1-5 days). The average age was 4.6 days (range 1-10 days old) and the average gestational age was 34.7 weeks (range 26.3-40.1 weeks). All patients had pustular outbreaks in areas occluded by swaddling, clothes, or adhesive. Seven patients had geometric lesions that were underlying sites of intravenous (IV) site adhesive or electrocardiogram (EKG) leads. The consistent morphological features of this pustular eruption at sites of skin occlusion and the transient course in the setting of an otherwise well-appearing infant are strongly suggestive of the diagnosis of miliaria pustulosa. It is important for clinicians to be familiar with this benign presentation and to differentiate it from other neonatal pustular eruptions to minimize invasive tests and treatments in this vulnerable population.

A case of indeterminate cell histiocytosis with ETV3-NCOA2 translocation.

Indeterminate cell histiocytosis (ICH) is a rare histiocytic disorder characterized by a proliferation of CD1a+ and CD207/langerin- cells. Recent molecular analyses have identified ETV3-NCOA2 translocation as a possible aetiopathogenesis of ICH. Herein, we describe the first Japanese case of ICH with ETV3-NCOA2 translocation. A 79-year-old Japanese man presented with a 1-year history of pruritic erythematous papules and nodules on his trunk and extremities. Histological examination revealed a dense and diffuse sheets-like infiltration of medium-sized histiocyte-like cells from the epidermis to the deep dermis. Immunohistochemically, the atypical cells were positive for CD1a but negative for CD207/langerin. Fluorescence insitu hybridization using NCOA2 break-apart probes confirmed a chromosomal break occurring on NCOA2 monoallele in the tumor cells. Furthermore, ETV3 exon 4-NCOA2 exon 14 translocation was identified in formalin-fixed paraffin-embedded skin samples using reverse transcription polymerase chain reaction and subsequent direct DNA sequencing. He also presented with interspersed eczematous plaques on his trunk and reactive dermatopathic lymphoadenopathy without any infiltration of ICH. He was treated with topical corticosteroids and narrowband UVB phototherapy. Four months later, his ICH skin eruptions, eczematous plaques, and lymphoadenopathy gradually regressed. Our case supports the notion that the detection of ETV3-NCOA2 translocation can be useful for diagnosis of ICH.

Appreciation of hematological and serological of IL-1a, IL-10 and DHEA- S hormone levels in serum of patients with Acne

There were eleven cytokines in the interleukin-1(IL) bunch. Similarly, it's an essential part. Interleukin-1α (IL-1α) is the most extensively studied of them all, and it is arguably the most widely used cytokine in the pathophysiology of skin eruptions. In the ongoing review, the patients in the Thi-Qar region will have their levels of IL-1α and IL-10 assessed. In the Al-Hussein Instructional Clinic in Iraq, we were in charge of the review. The review contained 100 blood tests from patients who had breakouts on their skin; there were 39 male and 61 female patients, ages ranging from 10 to 35. Depending on their age ranges, our patients were divided into three groups. The most prevalent age group (10–20) was 52/100 (52%) and was followed by the other groups.

Juvenile Spring Eruption: A Report on an Outbreak and 2 Sporadic Cases in French Military Personnel.

Juvenile spring eruption is a sun-related skin eruption primarily affecting boys or young adult males. The pathophysiology is unknown, but there appears to be a link with sun exposure in cold weather. It can cause small outbreaks, particularly in groups of children or young adults. The primary lesions can be pruritic erythema, with or without associated papules, vesicles, or bullae. They are notable for almost exclusively affecting the ears. Spontaneous healing occurs within a few days without leaving scars. We report an outbreak and 2 sporadic cases that occurred at the Valdahon military camp in France between 2021 and 2024 among military personnel.

Paederus Dermatitis: Two Outbreaks of an Entomologic Disease in Austere Expeditionary Care.

Paederus dermatitis, also known as dermatitis linearis, is an acute cutaneous condition caused by contact with the potent vesicant toxin paederin, produced by endosymbiotic Pseudomonas-like bacteria within Paederus spp. beetles. Paederin is a protein synthesis inhibitor that halts cell division, leading to vesiculation and necrotic breakdown of the epidermis. The resultant damage facilitates secondary infection, especially in austere conditions. Between October 2022 and July 2023, several US special operations teams forward deployed to various countries in East Africa reported over 17 cases of painful, blistering skin eruptions consistent with Paederus dermatitis, 2 of which are summarized in this report. To confirm the best treatment approach, 1 team's medic reached back to a deployed infectious disease physician in the same Combatant Command as well as through the DoD ADVISOR line to a dermatologist in the United States. All cases were managed with irrigation, followed by a combination of topical steroid and antibacterial ointments, with resolution occurring after 3 to 7 days, whereas 38% of the cases in July 2023 developed secondary cellulitis by day 7, requiring oral antibiotic treatment. Strict preventative measures were implemented to limit exposure while carefully observing each case, as this was critical to optimize medical readiness of the team. Ultimately, we seek to highlight the identification of beetles specific to East Africa, seasonal prevalence, and the importance of preventative measures as they vary depending on specific beetle characteristics. Additionally, we reiterate classic presentation features that help avoid misdiagnosis for cases that occur outside of the typical epidemiologic criteria.

Two new flavonoids from the leaves of Garcinia smeathmannii, in vitro and in silico anti-inflammatory potentials

Garcinia smeathmannii is a well-known plant for its uses in the effective treatment of intestinal parasites, skin eruptions and skin burns. The dichloromethane-methanol (2:3) crude extract of the leaves of G. smeathmannii led to the isolation and characterization of twenty compounds (1−20) using chromatographic and spectroscopic techniques. Extracts and compounds were screened in vitro for their anti-inflammatory (ROS), antiglycation and antileishmanial (L. tropica) activities. Compounds were also screened for their in silico anti-inflammatory activities using Maestro 4.2.1 software with the co-crystal complex structures of the ovine oCOX-1: meloxicam (PDB Id: 4O1Z) and murine mCOX-2: meloxicam (PDB Id: 4M11) proteins. An unprecedented flavonol (1) and a flavone dimer (2) together with eighteen known compounds (3−20) were characterized. All the tested samples in vitro revealed no antiglycation and antileishmanial activities. Beside, extracts revealed moderate anti-inflammatory activities (IC50 ranging from 24.1 ± 2.0 to 34.7 ± 0.8 μg/mL). Only compound (13) revealed an anti-inflammatory activity which was 9.33 times more active than the reference (Ibuprofen, IC50 = 11.2 ± 1.9 μg/mL) with IC50 of 1.2 ± 0.0 μg/mL. Compounds (2–9, 11–13 and 19–20) were docked and the docking scores were ranging from −10.178 to −6.119 (kcal/mol) which were in agreement with the experimental anti-inflammatory activity. These results are in agreement with the traditional uses of the leave of G. smeathmannii as cataplasm for skin eruption and as analgesic agent.

Paradoxical Psoriasiform Skin Eruption in Pediatric Patients with Inflammatory Bowel Disease Treated with TNFα Inhibitors.

Tumor necrosis factor α inhibitors (TNFαI)-induced psoriasiform eruptions are a well-known phenomenon among adults. However, data are limited regarding this reaction in children. To describe in pediatric patients with inflammatory bowel diseases (IBD), the clinical characteristics of TNFαI-induced psoriasiform eruptions and the outcomes of various therapeutic options. We reviewed the medical charts of pediatric patients (aged <18 years old) with IBD who developed TNFαI-induced psoriasiform eruptions during 2006-2022. Among 454 patients with IBD treated with TNFαI, 58 (12.8%) were diagnosed with TNFαI-induced psoriasiform eruptions, of whom 51 were included in the study. The female to male ratio was 1:1.3. The median age at skin eruption was 14.1 [interquartile range, 12.11-16.05] years. The median elapsed time to eruption appearance was 15 [interquartile range, 7-24] months after initiation of the treatment. All the patients were treated with topical steroids and 17 (33%) needed systemic treatment (phototherapy, methotrexate or acitretin). Sixteen patients (31%) needed to stop TNFαI treatment due to an intractable eruption. Female patients, patients with inflammatory alopecia and patients who were treated with methotrexate or phototherapy were more prone to stop TNFαI. TNFαI-induced psoriasiform eruptions are common in pediatric patients with IBD. The eruption may appear months or even years after treatment initiation. Almost one-third of the described patients had to replace their treatment due to a recalcitrant cutaneous eruption. This indicates that a multidisciplinary approach is required for effective management.