Francesco Savoia

Childhood Allergic Contact Dermatitis from Henna Tattoo

Abstract: Henna is a shrub cultivated in India, Sri Lanka, and North Africa; it is used, mixed with other substances, as a hair and body dye. Several cases are reported in the literature of sensitization to para‐phenylenediamine (PPD) contained in the henna tincture, but few of these are pediatric cases. We report two instances of allergic contact dermatitis due to temporary tattoos in children. In one case a patch test was positive for PPD. We suggest that the fashion of temporary henna tattoos in children is to be discouraged due to the serious consequences that a sensitization to PPD could have in their future.

Neutrophilic Figurate Erythema of Infancy

Abstract:  We report here a new case of neutrophilic figurate erythema of infancy in a 1‐year and 9‐month‐old white boy. Neutrophilic figurate erythema of infancy is a rare inflammatory dermatosis which is part of the figurate inflammatory dermatoses of infancy and is considered a variant of annular erythema of infancy. The disease is clinically characterized by annular erythematous lesions, sometimes with a polycyclic configuration, and histologically by a dermal neutrophilic infiltration with leukocytoclasia. Differential diagnosis mainly includes clear‐cut severe diseases with a well‐known etiology, such as neonatal lupus erythematosus and its variant erythema gyratum atrophicans transiens neonatale, erythema chronicum migrans and erythema marginatum rheumaticum, and diseases of unknown origin and with less clear limits, such as erythema annulare centrifugum and its variant familial annular erythema. Anamnesis, laboratory findings, clinical features, and histology allow the correct diagnosis and therefore, having excluded severe diseases, parents should be reassured as neutrophilic figurate erythema of infancy, as the annular erythema of infancy, is a benign disease, in most cases unassociated with other conditions and usually self‐limiting over a few months, even though a chronic course may rarely occur. Our case was characterized by a chronic persistent course and by a complete resolution of the lesions only during febrile episodes.

Purpura after application of EMLA cream in two children.

Abstract:  The eutectic mixture of local anesthetic cream, a 1 : 1 mixture of prilocaine and lidocaine, 2.5% each, is frequently used in pediatric and dermatologic practice to obtain local anesthesia. Side effects include transient skin blanching, erythema, urticaria, allergic contact dermatitis, irritant contact dermatitis, hyperpigmentation, and purpura. We report two children with a purpuric reaction after application of this mixture cream. Purpura after application of this anesthetic cream is a rare nonallergic reaction and only 17 occurrences have been reported, to our knowledge, in the literature. Patch tests could not be performed in our two patients because of lack of parental consent but we suggest that the purpuric reactions were most probably of toxic origin. The pathogenesis of purpura after application of eutectic mixture of local anesthetics cream, which resolves within 2 weeks without dermatologic sequelae and without any specific therapy, is complex. The lesions are probably caused by the direct effect of the cream components on the vessels but many other factors, such as atopic dermatitis, prematurity, subjective predisposition to purpura, trauma, and thrombocytopenia may play important pathogenetic roles.

Recurrent Toxin-Mediated Perineal Erythema: Eleven Pediatric Cases

BACKGROUND Recurrent toxin-mediated perineal erythema is a cutaneous disease mediated by superantigens made by staphylococci and streptococci, which, to our knowledge, has only been reported in young adults. We describe recurrent toxin-mediated perineal erythema in 11 children and outline the differences between recurrent toxin-mediated perineal erythema and Kawasaki disease in this age range. OBSERVATIONS Eleven children (7 male and 4 female) presented with the sudden appearance of asymptomatic erythema, which was salmonlike in color and rapidly desquamating, involving the perineum in 10 patients and extending to the perianal area in 1 patient. At the onset of the rash, all patients were in good health, although 9 had mild fever for 1 to 2 days before its appearance. Physical examination also revealed an erythema of the hands and feet in 4 patients and strawberry tongue in 7. Two patients had a facial impetigo, and another showed a perianal streptococcal dermatitis. A group A beta-hemolytic streptococcus was isolated from the throat in 10 cases and from a perianal culture in 1 case. In 8 cases, resolution was spontaneous, but all patients were treated with systemic antimicrobial therapy for 10 days. Three patients had a personal history of cutaneous rashes on the perineal area during the last years before consultation. Rash recurrence was observed in 3 of the 11 patients at the follow-up examination. Conclusion Recurrent toxin-mediated perineal erythema can be observed not only in young adults but also in childhood.

Usefulness of dermatoscopy for the early diagnosis of sebaceous naevus and differentiation from aplasia cutis congenita

In early infancy, a congenital area of alopecia of the scalp may be the clinical presentation of various diseases, with the two most common being sebaceous naevus and aplasia cutis congenita. Typical lesions are easily diagnosed, but soon after birth, the differential diagnosis may be difficult if the clinical features of the lesion are not distinctive. In this paper, we report the usefulness of dermatoscopy in such cases.

Tattoo-associated Pseudolymphomatous Reaction and its Successful Treatment with Hydroxychloroquine

Tattooing has become increasingly popular in today’s society, although it has been practiced for over 8000 years (1). Following this new fashion trend, physicians have documented an increasing number of tattoo-associated skin disorders.The most common dermatological tattoo compli-cations concern hypersensitivity reactions to tattoo pigments, for example, irritant and allergic contact dermatitis (2), development of lichenoid areas (1, 3–5), and granulomatous responses such as sarcoid granulo-mas or foreign body granulomas (1). Less frequently patients developing discoid lupus erythematosus have been reported (2).Pseudolymphoma confined to the tattoo area is an unusual tattoo reaction that, to the best of our knowledge, has been described in only seven cases in the literature (6–10). We report here a new case of pseudolymphoma developing in the green portion of a multicoloured tattoo, which was treated with a systemic anti-malarial drug.CASE REPORT

Two cases of Zoon's balanitis treated with pimecrolimus 1% cream

Background  Plasma cell balanitis is a disorder of the middle‐aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy.

Retronychia in children, adolescents, and young adults: A case series

Turkey, and New Zealand reported an overall survival rate of 56% (25 of 45 patients). Eighty-three percent ofHI neonates treatedwith systemic retinoids survived, whereas the long-term survival was only 24% for those who were not given oral retinoids. Here we report the outcomes for HI in the Japan population. For a clinical survey of HI in Japan, we distributed questionnaires to 904 dermatologic or pediatrics institutes or hospitals throughout Japan in 2010 and received responses from 564 institutes or hospitals (62.4%). Clinical data between 2005 and 2010 were obtained for 16 HI patients. In total, there were 13 survivors (81.3%) and 3 deceased (18.7%). The patient’s sex was reported for 14 patients: 8 male and 6 female. Systemic retinoids were administered to 12 patients, 11 of whom survived (91.7%), whereas only 2 of the 4 patients (50%) who did not receive oral retinoids survived. Ten of 16 patients (62.5%) received intensive care in a neonatal intensive care unit (NICU). Systemic retinoids and administration in the NICU were considered to contribute to relatively good outcomes for HI patients in the Japanese population. The effects of oral retinoids in HI remains unproven, and as suggested in the commentary by Milstone and Choate, the early introduction of overall intensive therapy might have contributed to the better outcomes of the HI babies whowere given oral retinoids. In conclusion, we consider that, due to intensive neonatal care and, probably, to the early introduction of oral retinoids, HI outcomes have improved also in the Japanese population. In long-term HI survivors, epidermal keratinocytes might regain normal differentiation, and this restoration of differentiation is likely to be associated with the improvement of the skin symptoms in HI survivors. From this fact and the results of our clinical survey, we agree with the commentary by Milstone and Choate on the point that recognition of spontaneous improvement of the HI phenotype lowers the psychological hurdle and provides justification for intensive neonatal care that can improve the outcomes of HI patients. Akitaka Shibata, MD, Yasushi Ogawa, MD, PhD, Kazumitsu Sugiura, MD, PhD, Yoshinao Muro, MD, PhD, Riichiro Abe, MD, PhD, Tamio Suzuki, MD, PhD, and Masashi Akiyama, MD, PhD Department of Dermatology, Nagoya University Graduate School of Medicine; Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo; Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan

Telogen effluvium caused by magnesium valproate and lamotrigine.

Annalisa Patrizi, Francesco Savoia, Francesca Negosanti, Annio Posar, Margherita Santucci and Iria Neri Department of Specialistic and Experimental Clinical Medicine Section of Dermatology and Child Neurology and Psychiatry Unit, Department of Neurological Sciences, University of Bologna, Clinica Dermatologica, via Massarenti 1, CAP 40138, Bologna, Italy. E-mail: annalisa.patrizi@unibo.it Accepted June 7, 2004.

Discoid chronic lupus erythematosus at the site of a previously healed cutaneous leishmaniasis: an example of isotopic response

The term “isotopic response” describes the occurrence of a new skin disorder at the site of another, unrelated and already healed one. We report here the case of a 38‐year‐old woman who referred to us for an infiltrated, red‐brownish plaque localized on her left cheek. The patient had been treated for a cutaneous leishmaniasis, confirmed by the histologic examination, localized at the same site. She was completely healed after an appropriate local and systemic treatment. She experienced the occurrence of the new plaque at the site of the previously healed cutaneous leishmaniasis three month later. Histologic examination and laboratory tests were consistent with a diagnosis of discoid cutaneous chronic lupus erythematosus. Treatment with hydroxychloroquine, topical clobetasol and topical tretinoin resulted in flattening and clearing of the lesion. Our case is the first case of isotopic response where a discoid chronic lupus erythematosus had occurred at the site of an already healed cutaneous leishmaniasis. We speculate that the activation of type‐1 interferon system may be involved in the pathogenesis of our case.