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Introduction: Nitric-zinc complex solution (NZCS) is a topically applied solution containing nitric acid, zinc, copper, and organic acids that induce a painless caustic effect on ''difficult-to-treat'' warts, including palmoplantar and periungual locations. The objective of the present prospective clinical study was to describe the efficacy and tolerability of NZCS in the treatment of palmoplantar and periungual warts in children. Methods: Eligible patients were immunocompetent children and adolescents, with at least one palmoplantar or periungual wart. NZCS was topically applied every 2 weeks in clinic. Efficacy was recorded by clinical evaluation, and acceptability assessments were measured using a visual analogue scale (VAS). Results: Pediatric patients (N = 12) were equally distributed by gender, and the mean age was 9.60 ± 3.34 years. The youngest patient was 4 years old. A total of 31 warts were identified: 24 periungual warts (77.4%), 2 palmar warts (6.45%), and 5 plantar warts (16.12%). We observed complete resolution in 83.9% of the warts treated with NZCS, achieving total cure considered as therapy success in 87.5% of periungual warts and 71% of palmoplantar warts, with a mean of 6.0 treatment sessions. The esthetic results evaluated by the investigator were considered excellent in 83.3% of cases and good in 16.7%. In 100% of the completely resolved cases, no scars, erythema, hyperpigmentation, hypopigmentation, or hypertrophy in the area surrounding the treated warts were observed by the investigator. The esthetic results evaluated by the patients or parents/guardians were excellent. Pain and burning sensation were minimal and well tolerated. No clinically relevant adverse events were reported. Conclusion: NZCS was an effective treatment of warts in this pediatric population. The painlessness, simplicity, and twice-monthly dosing regimen of this treatment represents an advantage over standard approaches.

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Informed consent was signed by the parents of the patient to publish his photographs.

Mammalian target of rapamycin inhibitors (MTORI) have shown promising results in the treatment of some complex vascular anomalies and have recently been used in patients with Sturge-Weber syndrome (SWS). 1,2 | C A S E REP ORTAn 11-year-old girl presented for management of SWS. She had associated seizures since five months of age, well controlled on oxcarbazepine, learning disability, and congenital glaucoma that required surgical intervention and topical treatment with timolol (Figure 1).Over the previous year, a slow and progressive increase in the soft tissue was found underlying the facial capillary malformation, not associated with infection or trauma, and leading to disfigurement, impaired opening of the affected eye, and loss of two teeth (Figure 2).The multidisciplinary vascular anomalies committee recommended treatment with oral sirolimus at a dose of 0.8 mg/ m 2 /12 hours, maintaining levels lower than 5 ng/mL, which was subsequently instituted and was well tolerated without adverse effect. A significant attenuation of the color of the capillary malformation was perceived within the first month of treatment with sirolimus. Follow-up at 8 months of treatment revealed a reduction in the overgrowth of the left face (Figure 3). No adjunctive therapies such as pulsed dye laser treatments during this time were utilized.An improvement in intraocular pressure was also noted, with levels lower than previously recorded. The patient also reported less difficulty with her schoolwork since beginning treatment with sirolimus, though no improvement was detected by the Wechsler Intelligence Scale for Children, fifth edition (WISC-V), employed 8 months after the initiation of sirolimus. | D ISCUSS I ONSturge-Weber syndrome is a sporadic congenital neurocutaneous disorder caused by a somatic activating mutation in GNAQ gene and recently described in patients with a mutation in the GNA11 gene. [3][4][5] The incidence is 1 in 20 000 to 50 000 newborns. 3 It is characterized by facial capillary malformation ("port-wine birthmark") with progressive soft tissue overgrowth, leptomeningeal capillary malformations, and choroidal and episcleral vascular malformations. Patients typically develop seizures and glaucoma. 3,6 Seizures often start in the first 2 years of life, and the onset of glaucoma is thought to be bimodal, with 60% of patients developing glaucoma in infancy and 40% developing glaucoma in childhood or early adulthood. 6