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Background Scabies are a significant health issue for institutions and represent a health burden in children. Topical treatments such as permethrin 5% are usually effective but lately, a loss of efficacy has been observed. Objectives To describe demographic data, topical treatment schemes (permethrin 5%; benzyl benzoate 25%) and outcomes in children with scabies over the past 2 years. Methods We retrospectively evaluated records of children aged 0 to 14 years with scabies treated in our outpatient clinic from 1 January 2021 to 31 December 2022. Results Two hundred and thirty‐one records were evaluated. Permethrin 5% (P5%) was used as first‐line treatment in 103 children with a success rate of 81.5%; benzyl benzoate 25% (BB25%) was successful in 94.3% of 123 patients. Three patients were lost for follow up and two received other therapies. Mean days of application using P5% increased from 4.1 to 6.8 in 2 years, whereas BB25% showed an opposite trend, from 10 days to 4.7. With the same days of application, the success rate with BB25% was higher (repeated cycle of 2 treatment days, 7 days apart [2 + 2]: 93.3% for BB25% vs. 82.9% for P5%; 3 + 3‐day regime: 91.9% for BB25% vs. 83% for P5%). Twenty‐three out of 26 patients who still had active scabies after the first cycle cleared with a second treatment cycle, with the same topical treatment, or with a different agent. Mild to moderate skin irritation was the only side effect observed (18.4%), more frequently associated with BB25% (81%). Conclusions During the observational period, the use of permethrin decreased while regimen duration increased, probably due to a perceived lack of efficacy. Conversely the use of benzyl benzoate both as first‐line treatment and after permethrin failure increased, despite being more correlated to local inflammation. Both 2 + 2 and 3 + 3 regimes for P5% and BB25% may be considered as suitable first‐line treatment of scabies in children. Records of 231 children 0‐14 years treated for scabies with permethrin 5% and benzyl benzoate 25% were analyzed. During the study period (Jan 2021 ‐ Dec 2022) the use of permethrin decreased while regimen duration increased, due to lack of efficacy; conversely the use of benzyl benzoate increased, despite being more correlated to local inflammation. The overall success rate of a first line 2+2 days or 3+3 days regimen was 81.5% for permethrin 5% and 92.7% for benzyl benzoate 25%.

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.

Introduction It has been almost 2 years since the first reports on cutaneous manifestations of COVID‐19. Those reported in children are different and include macular, papular, lichenoid, vesicular, urticarial, and vascular morphologies, among others. The prognosis of isolated cutaneous involvement in COVID‐19 in children is usually self‐limiting but the extreme variety of clinical presentations complicates the clinical approach. Methods Numerous reviews have been systematically drafted and edited giving the clinicians a future direction for skin presentations during pandemics. Results and Discussion Hereby we report the rare and common manifestations of COVID‐19 in children and question the recurrence phenomena and age‐related distribution of the eruptions. Age distribution of SARS‐Cov‐2 positive or suspected paediatric patients (0−18 years) observed in our centre during the first pandemic spread categorized by cutaneous manifestations. In the lower part of the figure, boxes correspond to the highest frequency rate of patients with the clinical characteristics mentioned. Lateral strings include all the sample spans. CLLs, chilblain‐like lesions (COVID toes); EM‐like, erythema multiforme‐like; MIS‐C, multisystem inflammatory syndrome; PLEVA‐like, papular‐purpuric dermatitis of childhood.

Background: The central nervous system originates ontogenetically from the ectoderm and therefore numerous neurocutaneous syndromes exist. Objective: We describe a novel neurocutaneous syndrome with characteristic epidermal papules and plaques associated with mild psychomotor retardation and epilepsy with a good prognosis. Methods: We investigated history, clinical features, laboratory parameters including karyotype, histopathological and immunohistological examination, electron microscopy, HPV infection, EEG and neurologic imaging in patients with an unusual symptom complex. Results: Six children are reported with characteristic keratotic papules and plaques of ‘gem-like’ appearance, randomly distributed on the trunk and the proximal part of the limbs. Four patients were unrelated and two were siblings. The cutaneous lesions appeared congenitally or developed soon after birth. The skin lesions were rounded or of an irregularly polycyclic shape, ranging from 0.5 to 1.5 cm in diameter. A few to eighteen lesions were present. The lesional surface was rough and of white or yellowish color. Histopathological examination showed acanthokeratosis, but immunostaining for keratins and melanocytes, electron microscopy and laboratory results were within normal range. During the natural course of the disease the lesions were stable and asymptomatic. All but one of our six patients developed neurologic signs and symptoms during the first year of life, in the form of epilepsy and psychomotor delay. Five children had low intellectual performance together with EEG abnormalities and some had MRI changes of the brain. One patient had marked language impairment. The central nervous system involvement had a peculiar benign and self-limiting course and total normalization occurred in one case. Limitations: We present only a small series of patients. Conclusion: Cutaneous lesions showing identical clinical and microscopical features, but without any extracutaneous abnormalities, have recently been described by Torrelo et al. [J Am Acad Dermatol 2011;64:888–892] under the designation ‘papular epidermal nevus with “skyline” basal cell layer (PENS)’. An association of such nevi with neurologic abnormalities had so far only been published in the ‘Atlas of Genodermatoses’ edited by Caputo and Tadini. We believe that this unique and otherwise undescribed symptom complex is a new neurocutaneous phenotype that may be called PENS syndrome. Whether this new syndrome can be categorized as a distinct phenotype within the group of epidermal nevus syndromes remains speculative and has to be clarified by further investigations.