Mastocytosis (M) represents a systemic pathology characterized by increased accumulation and clonal proliferation of mast cells in the skin and/or different organs. Broadly, M is classified into two categories: Cutaneous mastocytosis (CM) and systemic mastocytosis (SM). In children, CM is the most frequent form. Unfortunately, pathogenesis is still unclear. It is thought that genetic factors are involved, but further studies are necessary. As for features of CM, the lesions differ in clinical forms. The most important fact is evaluating a pediatric patient with CM. It must comprise laboratory exams (with baseline dosing of total serum tryptase), a skin biopsy (with a pathological exam and, if the diagnosis is unclear, immunohistochemical tests), and a complete clinical evaluation. It is also defining to distinguish between CM and other diseases with cutaneous involvement. As for the management of CM in children, the first intervention implies eliminating trigger factors. The available cures are oral H1 and/or H2 antihistamines, oral cromolyn sodium, oral methoxypsoralen therapy with long-wave psoralen plus ultraviolet A radiation, potent dermatocorticoid, and calcineurin inhibitors. In children, the prognosis of CM is excellent, especially if the disease’s onset is in the first or second years of life.

Isotretinoin is an oral derivate of vitamin A that has been used since 1982 for the treatment of multiple dermatologic conditions such as severe acne, rosacea, scarring alopecia, ichthyosis or non-melanoma skin cancer prophylaxis. The recommended dose is 0.5-1 mg/kg/day for a period of 4-6 months in sebaceous gland pathologies. There are many adverse effects caused by isotretinoin but by far the most important is the teratogenicity induced by this drug which is estimated to have a 20-35% risk to infants that are exposed to isotretinoin in utero and includes numerous congenital defects such as craniofacial defects, cardiovascular and neurological malformations or thymic disorders. Isotretinoin induces apoptosis and cell cycle arrest in human sebocytes, emphasizing these as processes associated with its teratogenic effect. The aim of this review is to analyze the latest literature data regarding the teratogenic effect of isotretinoin for both fertile females and males and its biological effects underlying the occurrence of congenital malformations under the influence of isotretinoin.

Morphea is an inflammatory skin disease with self-limited evolution, presenting as localized sclerosis of the skin and/or underlying tissues. The incidence is not exactly known; the disease occurs more frequently in women, and there is no sex prevalence. Pathogenesis of morphea remains still controversial. Several theories exist and the Borrelia burgdorferi infection is not yet elucidated. The aim of this report is to present the main mechanisms involved in the etiophatogenesis of morphea and also the thepapeutic options. A case of a 60-year-old woman is presented, who was referred to the clinic for an erythematous-violaceus, asymptomatic eruption, located on the trunk and legs, for appoximately 2 months. The patient's medical history revealed an infection with Borrelia 1 year previously. After diagnosis of morphea was established, and with systemic therapy (corticosteroids and methotrexate), the evolution was favorable.

Diagnosis, tratament and follow-up of patients with melanoma during COVID-19 pandemic is quite challenging. These patients are often immunocompromised, but, on the other hand, management of this malignant skin cancer should not be delayed. It is necessary to diagnose and stage the melanoma as soon as possible, in an attempt to provide a better prognosis. There are few data regarding the treatament of melanoma during COVID-19 pandemia. However, the general recommandations suggest testing all cancer patients prior administration of the therapy. The European Society for Medical Oncology (ESMO) provided guidelines regarding therapy of this skin cancer during COVID-19 pandemic. Every patient is different, and it is always important to evaluate the risks and benefi ts.

REzumatGranulomul inelar (GI) reprezintă o patologie cutanată benignă, de etiologie necunoscută. Se poate manifesta sub mai multe forme clinice: localizat, generalizat, subcutanat sau perforant. Asocierea dintre GI și diabetul zaharat, dislipidemie sau neoplasme nu este încă elucidată. Deși diagnosticul este în mare parte clinic, uneori poate fi necesar examenul histopatologic. Prezentăm cazul unei paciente în vârstă de 52 de ani, diabetică, hipertensivă, care a dezvoltat o erupție maculă-papuloasă, pruriginoasă, localizată pe membrele inferioare și abdomen, în evoluție de 6 luni. Am efectuat biopisie cutanată cu examen histopatologic, care a relevat infiltrate nodulare dermice alcătuite din histiocite palisadate în jurul unor colecții de mucine și însoțite de limfocite cu dispoziție perivasculară, modificări tipice pentru o leziune de granulom inelar. Am inițiat tratament sistemic cu isotretinoin, asociat cu dermatocorticoizi, cu evoluție favorabilă. Atât diagnosticul, cât și managementul unei pacient cu GI generalizat pot fi uneori dificile. Examenul histopatologic, în asociere cu un tablou clinic sugestiv, tranșează diagnosticul. Tratamentul se indică în cazurile severe, cu leziuni multiple, simptomatice, persistente.Cuvinte cheie: granulom inelar, isotretinoin, dermatocorticoizi, dapsonă aBStRaCt Granuloma annulare (GA) is a benign skin condition of unknown etiology. It can manifest itself in several clinical forms: localized, generalized, subcutaneous or perforating. The association between GI and diabetes, dyslipidemia or neoplasms is not yet elucidated. Although the diagnosis is clinical in most cases, a histopathological examination may be necessary. We presented the case of a 52 years old patient, diabetic, hypertensive, who reffered to our clinic, with a rash or macular-papular, pruritic, eruption, localization on the lower limbs and abdomen, in the evolution of 6 months. We performed skin biopsy with histopathological examination, which revealed: dermal nodular infiltrates consisting of palisadiate histiocytes, in several mucin collections and signified by lymphocytes with perivascular arrangement, typical modifications for an annular granuloma lesion. We have initiated systemic treatment with isotretinoin, associated with dermatocorticoids, with favorable evolution. Diagnosis, aș well aș the management of a patient with generalized GI, can sometimes be difficult. The histopathological examination, in combination with a suggestive clinical picture, makes the diagnosis. Treatment is indicated in severe cases, with multiple, symptomatic, persistent lesions.