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Dear Editor, A 50-year-old Caucasian male presented with a 30-year history of facial vitiligo, primarily affecting the chin and the perioral and periorbital regions. He had undergone multiple treatments over the years, including targeted phototherapy, topical corticosteroids, and calcineurin inhibitors, with limited success. [...]

SARS-CoV-2 infection has spread all over the world in the last year, causing millions of COVID-19 cases among humans with a large variability of symptoms and signs, including those on the skin. Among these, a contemporary cluster of chilblain-like lesions with no certain relationship with the infection has been reported. The aim of this paper is to delineate a profile of chilblain-like lesions and to establish the state-of-the-art knowledge about this new phenomenon.

Dear Editor, Dermatitis artefacta (DA) is a condition on the border of psychiatry and dermatology, characterized by patients intentionally causing skin lesions to pretend that they are ill. DA is a very challenging entity to diagnose, as it can mimic many other disorders and is usually recognized only after exclusion of all other diseases. Herein, we report three cases of a novel cutaneous condition that could fall into the spectrum of DA. [...]

Introduction Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.

[...]we again underline that careful follow-up visits always carried out with the aid of dermatoscopy should be considered a key point of the control of scabies. [...]our survey shows that, in accordance with all published guidelines, the majority of Italian dermatologists prescribes permethrin 5% cream as the first line therapy while only a minority use Benzyl benzoate. 94 55 First line therapy (%) 5%-permethrin Benzyl-benzoate Others 80 13 6 Schemes for 5%-permethrin (%) 1 + 1 one WA 2 + 2 one WA 3 + 3 one WA other 47 33 13 1,5 Schemes for Benzyl-benzoate 3 + 3 one WA 3 applications/week 51 23 Experience with oral ivermectin (%) Yes Not 22 88 Use of oral ivermectin (%) Monotherapy Combined with topical medications 48 52 Combination of topical treatment (%) Yes Not 6 94 Follow up after treatment (%) <1 week 1 week 2 week 1 month None 5 36 39 11 9 Treatment of family members (%) Yes Not 93 7 Hygienic measures (%) Yes Not 97 3 Perception of resistance of scabies to treatments (%) Yes Not 50 50 Treatments to which resistance was observed (%) 5% permethrin Benzyl benzoate 92 15 Table 2 Summary of the most relevant points of the survey.

Since 2021 we have been witnessing an increase in cases of permethrin-resistant scabies, as confirmed by different studies [3–6]. According to our experience the latter is currently the best therapeutic strategy to effectively treat scabies. [...]there is a lack of validated diagnostic test able to identify permethrin resistance. [...]first is necessary to clarify the definition of permethrin resistance and then randomized controlled trial comparing different regiments are needed in order to address the best therapeutic approach for these patients.Funding source None.Declaration of competing interest All the authors have no financial obligations or conflict of interest to declare.

A total of 227 patients (mean age 41.3 years, 52% females) with at least one second-degree superficial cutaneous burn of thermal origin of a smallest transverse diameter ≥20 mm and a largest transverse diameter ≤90 mm were randomised to receive the topical application of aqueous extract of Triticum vulgare (Fitostimoline) in two different forms (soaked gauzes and cream) or catalase of horse origin in form of gel (Citrizan Gel), given up to healing or to a maximum of 20 days. The rate of lesion healing at end of study was significantly higher in patients treated with Fitostimoline (gauzes 97.3%, cream 91.5%) than in those receiving catalase (84.5%). The pooled Fitostimoline groups were also significantly more effective than catalase gel in reducing total symptoms score, pain at medication, pain at rest, and burning at end of study. Both formulations of Fitostimoline and catalase gel were well tolerated in terms of adverse effects in the site of application.

This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment’s approval by the European Medicines Agency for childhood psoriasis and the experts’ opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. Conclusion : A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts’ opinions.

On the end of July 2022, the World Health Organization defined the H-MPXV a public health emergency of international concern (PHEIC) [4]. [6], who included 528 cases of confirmed H-MPXV from 5 continents,16 countries and 43 clinical sites, reported that all patients were men with homosexual orientation, prevalent of a white ethnic group (75%) with a median age of 38 years and half of them lived with a concomitant HIV infection under retroviral therapy. Patient Sex Age Systemic symptoms Swelled lymphnodes Skin site involved Associated HIV infection Recent foreign trips Diagnosis confirmed by PCR Positive throat swab 1 M-MSM 45 Fever Y Genital, leg and face (no oral mucosa) NA N N NA 2 M MSM Partner of patient 1 40 Headache, muscle aches Y Genital only N N Y Y 3 M MSM 35 Fever Y Genital only N N Y NA 4 M MSM 24 Muscle aches, flu-like symptoms Y Genital only Y N Y NA 5 M MSM 46 Fever Y Genital and perianal Y N Y Y Table 1 Summarization of the data about the 5 patients affected by H-MPXV.

Background Families of children affected with atopic dermatitis (AD) often report fear and anxiety regarding treatment with topical corticosteroids (TCS), which may lead to reduced compliance. The objective of our study was to measure, through a standardized questionnaire, fear of TCS in families of pediatric patients with AD and to identify items associated with fear. Methods Families of pediatric patients with AD were enrolled in 9 Italian centers of pediatric dermatology. Enrolled parents were invited to fill in a questionnaire including questions on sociodemographic and clinical characteristics and 3 sets of questions on corticosteroid phobia (general fear, specific fears, behaviours regarding TCS). Determinants of the level of general fear were investigated through multivariable analysis. Results A total of 300 outpatients with AD were enrolled. Most parents (80%) had a high instruction level. Eighty-one percent reported to have a certain amount of fear of TCS. At the multivariable analysis, fear of TCS was associated with the following items: believing that TCS treatment advantages do not overweight disadvantages ( P  = 0.011); believing that TCS may be dangerous independently from the specific side effect ( P  < 0.001). Moreover, TCS fear was associated with fear of applying too much cream ( P  = 0.001). Conclusion TCS phobia is widespread among Italian families of children with AD. Fear of TCS is associated with fear of applying too much cream, thus increasing the risk of poor compliance and treatment failure. Therapeutic education of families on the use of TCS should be implemented.