Summary The current COVID‐19 pandemic is caused by the SARS‐CoV‐2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS‐CoV‐2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID‐19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID‐19, chilblain‐like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease‐like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID‐19 manifestations, and the testing and management of infected children for both COVID‐19 and any other pre‐existing conditions.

The recurrence of low-fluence 1064-nm QS-Nd:YAG laser rates in melasma was high when the long-term results were considered. This result may be attributed to certain patient and treatment-related factors.

The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search.

Granular parakeratosis (GP) is a benign disorder of keratinization presenting with unilateral or bilateral red to brown hyperkeratotic plaques and papules at the intertriginous areas. The first pediatric case of GP was reported in 2002, and only a few cases have been reported since. Although the exact etiology of GP is unknown, it is thought that certain environmental factors compromise the epidermal barrier and lead to proliferation and altered maturation of the epidermis in predisposed individuals. The histopathology is diagnostic and reveals parakeratosis together with retention of keratohyalin granules within a disproportionately thickened stratum corneum and usually the preservation of stratum granulosum. Herein we report seven cases of infantile GP, six of which also had atopic dermatitis. Cytologic examination confirmed our clinical diagnosis by demonstrating the retention of keratohyalin granules and preservation of the nuclei from the superficial scrapings of the lesions, which we propose as a novel diagnostic technique. In all seven cases the lesions developed after the overuse of topical products and resolved with avoidance of their excessive use. We propose that atopic skin may be more prone to develop GP because the epidermal barrier is disrupted, resulting in the enhanced transepidermal penetration of topical products. In conclusion, GP should be included in the differential diagnosis of diaper area eruptions, especially in atopic children. Cytologic examination of superficial scrapings of the lesions can easily confirm the diagnosis of GP.

Kindler syndrome (KS) is a rare genodertnatosis characterized by acral skin blistering and photosensitivity. followed by diffuse progressive poikiloderma, and various degrees of mucosal involvement (1). Mutations in the KIND! gene (20pl2.3) have been disclosed in tiiost patients w ith clinical signs consistent witb KS (2-4). The gene product, kindlin-1, is a 78-kDa phospbo-protein expressed in skin in the basal keratinocytes (5). It fonns complexes with [31 and p3 integrin subunits and. accordingly, kindIin-1-deficient keratinocytes have adhesion, proliferation, polarization and migration defects (6, 5). This report examines the genetic basis of KS in one Albanian and one Turkish patient with KS with severe involvement ofthe digestive and genitourinary mucosa, and discusses genotype/phenotype correlations. CASE REPORTSPatient I. A 16-year-old Albanian female, born lo non-consanguineous parents, developed acral blistering during infancy, followedby progressive skin atrophy and poikiloderma (Fig. IA). Al 13 years of age. surgical repair of a severe acquired vaginal stenosis had been performed. One year later, she lost all of her teeth due to severe periodontilis and started lo suffer from dysphagia, Oesophagoscopy and a barium oesophagogram confirmed oesophageal stenosis and web formation. Her body weight was 29 kg, height L5X m and she had profound anaemia. She had proximal webbing ofthe fingers and toes, pseudo-syndaeiily, coniraciurcs of the fingers, palmoplantar keraioderma. loss of dcrmaioglyphics, and nail dystrophy (Fig. 1B). There was complete eiTacement ofthe external female genitalia; the labia majora, labia minora. clitoris and introitus were absent, and only one 4-5 mm orifice, supposed to be the vestibulum. was present. As she had been menstruating regularly, it is thought ihal ber vagina and urethra terminated at the same orifice. The results olabdominal, urinary system and pelvic ullrasonography were normal. Pelvic magnetic resonance imaging showed normal organs. The eonfigurations ofthe uterus, cervix and vaginal eanal were normal on T2-weighied sagittal images, except for the visible end-point ofthe vagina, which was located at the level ofthe symphysis pubis. X-rays of her hands showed difTusc osteoporosis, dctbrnied tips ofthe phalanges wiih peri-plialangeal soft tissue nol exlending to the melaearpal area, Histopalhology of a skin specimen from ihe patient's neck showed epidermal atrophy with dilYuse fiattening ofthe rete ridges, telangieclatic vessels, melanophages, and minimal sclerosis of the dermis. Since she had insutlkieni oral intake, a balanced nulritional oral solution containing protein, lipid. carbohydrates, mineral and vitamins, and 5% de.xtiose 1000 cc iv infusion per day was slarled. She has been scheduled to undergo a series of oesophageal dilatation sessions, following temporal parenteral nutrition to improve her general condition.Patient 2. A 25-year-old Turkish man born lo non-consanguineous, but geograpbieally-linked parents. Family history revealed three mildly affected young...

Bathing suit ichthyosis (BSI) is a rare congenital disorder of keratinization characterized by restriction of scale to sites of relatively higher temperature such as the trunk, with cooler areas remaining unaffected. Fewer than 40 cases have been reported in the literature. Bathing suit ichthyosis is caused by recessive, temperature-sensitive mutations in the transglutaminase-1 gene (TGM1). Clear genotype-phenotype correlations have been difficult to establish because several of the same TGM1 mutations have been reported in BSI and other forms of congenital ichthyosis. We identify novel and recurrent mutations in 16 participants with BSI. OBJECTIVE To expand the genotypic spectrum of BSI, identifying novel TGM1 mutations in patients with BSI, and to use BSI genotypes to draw inferences about the temperature sensitivity of TGM1 mutations. DESIGN, SETTING, AND PARTICIPANTS A total of 16 participants with BSI from 13 kindreds were identified from 6 academic medical centers. A detailed clinical history was obtained from each participant, including phenotypic presentation at birth and disease course. Each participant underwent targeted sequencing of TGM1. MAIN OUTCOMES AND MEASURES Phenotypic and genotypic characteristics in these patients from birth onward. RESULTS Of the 16 participants, 7 were male, and 9 were female (mean age, 12.6 years; range, 1-39 years). We found 1 novel TGM1 indel mutation (Ile469_Cys471delinsMetLeu) and 8 TGM1 missense mutations that to our knowledge have not been previously reported in BSI: 5 have been previously described in non-temperature-sensitive forms of congenital ichthyosis (Arg143Cys, Gly218Ser, Gly278Arg, Arg286Gln, and Ser358Arg), and 3 (Tyr374Cys, Phe495Leu, and Ser772Arg) are novel mutations. Three probands were homozygous for Arg264Trp, Arg286Gln, or Arg315Leu, indicating that these mutations are temperature sensitive. Seven of 10 probands with a compound heterozygous TGM1 genotype had a mutation at either arginine 307 or 315, providing evidence that mutations at these sites are temperature sensitive and highlighting the importance of these residues in the pathogenesis of BSI. CONCLUSIONS AND RELEVANCE Our findings expand the genotypic spectrum of BSI and the understanding of temperature sensitivity of TGM1 mutations. Increased awareness of temperature-sensitive TGM1 genotypes should aid in genetic counseling and provide insights into the pathophysiology of TGM1 ichthyoses, transglutaminase-1 enzymatic activity, and potential therapeutic approaches.

Basal cell carcinoma (BCC) is the most common malignancy of the skin. It is most frequently seen on the sun-exposed areas of the head and neck region. Occurrence of BCC on the nipple is extremely rare, though the number of the reported cases has been increasing steadily. It has metastatic potential to regional lymph nodes; therefore a more aggressive course can be expected when compared to BCCs located at other sites. Hence, early diagnosis and treatment of BCCs located on this region is of importance. There are 39 reported cases of BCC of nipple-areola complex (NAC) in the English literature. We present an additional case of BCC located on the nipple, presenting with enlargement of the nipple as a sole clinical finding in a 60-year-old man.

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