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In recent decades, despite being well-known, dermatophytosis has seen a resurgence and an increase in the incidence of infections, with dermatophytes such as Trichophyton rubrum being the most common agents. Dermatophytosis pathogenesis involves complex interactions between the host, agent, and environment. In many cases, dermatophytosis can be mistaken for other pathologies, which leads to incorrect therapies and the consequent non-recovery of the patient. In this paper, we describe five previously undiagnosed cases of diffuse T. rubrum dermatophytosis because they represent the clinical manifestations that affect several sites at the same time and that, if not properly diagnosed and treated, can lead to severe, widespread, chronic, and difficult-to-treat dermatophytosis. This case series of five instances of misdiagnosed T. rubrum dermatophytosis was later accurately diagnosed and successfully treated with systemic terbinafine hydrochloride 250 mg/die for at least four weeks up to twelve or sixteen, and topical azoles (sertaconazole nitrate 2%) as well. This case series highlights the need to make an accurate diagnosis and avoid misidentifications while offering insightful information about the clinical presentation and treatment of these illnesses.

Background Tinea capitis is a cutaneous fungal infection common among 3 to 7 year old children but it is rare in the first year of life. Case presentation We present a case of a 12-month-old infant with erythematous scalp lesions combined with hair loss. He was suspected of dermatophytosis and mycological analysis of all suspected lesions was performed. Clinical features and culture results confirmed tinea capitis caused by Microsporum canis. The infant patient was treated with griseofulvin for 2 months. However, 15 days later at the end of treatment he presented with a single vesicle positive for M. canis. Griseofulvin therapy continued for another month. After 3 months of follow-up, no recurrence was observed. Conclusions In infant, sometimes tinea capitis is misdiagnosed and underreported because it is similar to other scalp pathologies. Therefore, if erythematous scalp lesions are present, they must be examined from a mycological point of view to inform the differential diagnosis. Once diagnosed, treatment of tinea capitis can pose a dilemma because different factors may influence the choice between equally effective therapies (i.e. safety, age, formulation, cost). This case report suggests that it is important to establish an accurate diagnosis and  treatment for this dermatophytosis to avoid recurrences or therapeutic failures, especially in infants.

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.

Many adalimumab biosimilars have been approved for the same indications as their originator (Humira ). However, data on their efficacy and safety in children with psoriasis are scarce. To assess the effectiveness and safety of adalimumab biosimilars in a group of adalimumab-naïve patients and another group of patients who switched from originator adalimumab to biosimilars. The co-primary endpoints were the PASI absolute mean, PASI 75, and PASI 90 at 16, 24 and 52 weeks. In this 52-week, multi-center, non-interventional, observational, retrospective study, patients starting biosimilars in routine practice after January 2022 were enrolled at 10 sites across Italy, Portugal, and France. Disease activity scores such as the Psoriasis Area Severity Index (PASI) and safety data were captured during 12 months following adalimumab biosimilar initiation. A total of 102 pediatric patients with psoriasis receiving adalimumab biosimilar therapy either as naïve (n = 72) or switching from originator adalimumab (n = 30) were enrolled. Median absolute PASI remained low at weeks 16, 24, and 52 in both groups (naïve 5.4, 4.3, 2.8; switching 2.6; 2.0; 1.4 respectively). PASI 75 response at weeks 16, 24, and 52 was observed in 41.7, 55.0, and 77.8% of patients in the naive group and 82.8%, 86.2%, and 92.6% of patients in the switch group. PASI 90 response at weeks 16, 24, and 52 was achieved by 23.3%, 26.7%, and 46.3% of patients in the naïve group and 58.6%, 65.5%, and 55.6% of patients in the switch group. Three patients discontinued biosimilars after the switch due to loss of efficacy. No emergency room visits or hospitalizations were observed during the study period and none of the patients experienced serious adverse effects. Adalimumab biosimilars showed a favorable effectiveness/safety profile in childhood psoriasis. Switching from reference adalimumab to biosimilars did not impact effectiveness and safety. A likelihood of discontinuation was noted in patients who switched from Humira to biosimilars.