No abstract

The annual incidence of child abuse was estimated to be 2.8 million by the national incidence study conducted in the USA in 1993, which is a two-fold increase compared to 1986. Awareness of child abuse has been increasing since the 1960s. Although most victims of child abuse present with cutaneous lesions, many genuine skin diseases may appear as non-accidental injuries which, if not recognized, may lead to misdiagnosis of child abuse. Here, we review the most common cutaneous mimickers of child abuse in order to increase awareness of these disorders and reduce erroneous diagnosis of child abuse.

Generalized pustular psoriasis is a rare form of psoriasis that is characterized by the eruption of sterile pustules. Because of the concern of the long term teratogenetic effect of acitretin in females of childbearing age, we treated a 16-year-old girl with pustular psoriasis with isotretinoin with excellent outcome.

Netherton's syndrome (NS) is a rare autosomal recessive disease comprised of ichthyosis in the form of ichthyosis linearis circumflexa, hair shaft defects and atopic manifestations with an elevated IgE level. Various therapeutic options have been used in NS with variable success. Tacrolimus and pimecrolimus belong to the family of calcineurin inhibitors. They bind cytoplasmic proteins and the resulting complex binds calcineurin, inhibiting its ability to dephosphorylate the nuclear factor of activated T cells, thus suppressing gene transcription. There have been conflicting reports of the usefulness of tacrolimus in NS patients, with systemic absorption being the main adverse outcome. Here we report four Saudi siblings (two boys and two girls) with NS who were treated with topical tacrolimus and pimecrolimus with good control of their skin disease without any toxic effect. To our knowledge, this is the second report of the use of topical pimecrolimus in NS in the English literature.

Ulcerative lichen planus of the sole is a rare variant of lichen planus, characterized by chronic painful disabling ulceration of the soles. Despite many treatment modalities used to treat ulcerative lichen planus, it is still considered a resistant disease. We report a Saudi female patient with ulcerative lichen planus of the soles resistant to many systemic and topical agents. We used topical tacrolimus 0.1% ointment with excellent response and complete healing in a few weeks as well as good maintenance during a follow-up period of more than 2 years.