In the child you can observe all the forms of scleroderma from localized cutaneous to systemic sclerosis; however, the localized cutaneous is the most frequent form of scleroderma and more generally of the connective tissue diseases in the child. As with other connective tissue diseases, and more generally for many other diseases, the severity is very variable and it ranges from minimal forms that require only a topical immunosuppression to very severe forms requiring systemic immunosuppression. In addition to the skin, scleroderma can also affect the mucous membranes and in particular the oral cavity; the involvement of the oral cavity, particularly of the the tongue is more common in systemic sclerosis and in severe forms of scleroderma like facial hemiatrophy. In the two cases here described the lingual involvement occurred in the presence of minor skin lesions, especially in the second case where there was a single chin lesion.
We have already described in the past this dermatitis that can affect simultaneously several subjects attending the same pool so as to suggest an epidemic. In literature there are reports that speak of aggravation of atopic condition induced by the pool; in our patient an aggravation of atopic dermatitis seems unlikely because this never affected her hands and occurred the first time in the summer when perioral atopic dermatitis had regressed; moreover, the dermatitis of our patient had an acute recurrent clinical course that is not characteristic of atopic dermatitis. The sites involved and the severity gradient of the dermatitis in the different fingers support the role played by rubbing the fingertips against the edge of the pool, probably favored by the maceration of the skin in water; this dermatitis affects inexperienced swimming children who cling more often to the edge of the pool.
The epidermal proliferation induced by molluscum contagiosum virus gives rise to a pear-shaped epidermis lobule (Fig. 2) with the base going down in the dermis; a pear-shaped lobule corresponds to an element of molluscum contagiosum. There may be more lobules separated and isolated from each other or they can be close to each other, separated by thinned dermal papillae reduced to thin fibrous septa, giving rise to plaques composed of many agminate lobules (2, 3). In the giant molluscum contagiosum (1) many lobules or molluscum contagiosum elements can be close to each other to form a 2 cm in size nodule (Fig. 3). We hypothesize that the mammilated mass of our case was due to an endophytic development of several close to each other but non confluent elements; the pressure exerted on the side walls of the mass would have resulted in the release of the same.
Both very extensive congenital melanocytic nevi (CMN) with PAS > 20 cm (the size of a CMN is measured independently of age with PAS -predicted adult size - which is obtained by multiplying the maximum diameter at birth x3.3 for the lower limbs, x2.8 for the upper limbs and trunk, x1.7 for the head) and numerous CMN are the most common risk factor for neuro-cutaneous melanosis and prepubertal melanoma. A CMN with these characteristics should be monitored through inspection and palpation. The famous ABCDE rule in children is different from adults because the child’s melanoma (cM) is different from the adult: thus in the child remains in its original meaning only the E (Evolution) while A becomes Amelanotic because the cM is usually symmetrical and not pigmented; B becomes Bump and Bleeding because the borders of cM are usually regular, and it often occurs as a bleeding nodule; C becomes uniform Color because cM is most often monochromatic.
We describe these melanocytic nevi because we have not found anything like those in the literature, which is mainly devoted to the differential diagnosis between acral nevi and melanoma and the dermoscopic aspects of both (1, 2). The herein reported nevi are melanocytic non palpable nevi characterized by their clinical distribution along the course of dermatoglyphics. Both the two congenital and the two acquired nevi grew in proportion to the growth of the foot. The anatomical site may influence the shape of melanocytic nevi. We know for example that the compression exerted by a fold can reduce the growth of a melanocytic nevus and hemangioma; we also know that the recurrent nevus on scar tends to be distributed linearly ie perpendicularly to the suture line. It is therefore possible that the superficial melanocytic nevi are distributed linearly along the furrows of dermatoglyphics.
Melanoma in children is so rare that a dermatologist cannot diagnose any during his/her professional career. Spitz nevus can mimic melanoma both in its classical angioma-like or hypopigmented variant and in its pigmented variant that according to some Authors is indistinguishable from Reed nevus. In the actual report we examined 56 cases of pigmented variant or Spitz-Reed nevus (SRN) in children less than 13 years, we focused its morphological characteristics and its natural history in the child. The latter in the child looks like that one of the angioma-like variant of Spitz nevus and more generally to that of many benign proliferations of childhood in which an initial proliferative phase is followed by a phase with prevailing regressive phenomena.
Viral common wart is often characterized by red brownish dots due to hemorrhages of the dilated small vessels of the dermal papillae; the dots are a clue to the diagnosis in the doubtful cases. Solitary papular angiokeratoma is characterized by both hyperkeratosis and dilated vessel in the papillar dermis. Due to the presence in both the disorders of hyperkeratosis and vessel component they need to be differentiated in some cases.
Tick bite. Tick bite is always responsible for a cutaneous lesion. The latter ranges from an inflammatory papule to a granulomatous lesion, till to a gangrenous and then ulcerated lesion of various size. Other manifestations can be associated to tick bite such as those ones caused by toxic products of the tick (ascending flaccid palsy), the reactive manifestations against tick allergens and, finally, the manifestations caused by the tendency of the tick to be carrier of infectious agents of various type such as viruses, rickettsiae and spirochetae. However, we are not dealing in this chapter with the cutaneous and extracutaneous manifestations associated with tick bite. (...).
Inhibitors of tumor necrosis factor (TNF) frequently induce the formation of antinuclear antibodies and anti-native DNA; however, they can also induce clinically evident lupus-like reactions in 0.2% of cases (4). You can talk about drug-induced lupus-like reaction when the following criteria are satisfied: presence of one or more symptoms of discoid, subacute or systemic lupus erythematosus, absence of previous history of lupus, taking a drug that is known to be responsible for lupus-like reactions and disappearance of the lesions with drug discontinuation. Among anti-TNF agents infliximab causes most frequently these reactions, while etanercept is less frequently responsible for these reacions; females are affected 10 times more frequently than males, and the average age is 44.9 years (3). The anti-TNF-induced lupus-like reaction is typically characterized by joint and skin lesions and occurs on average after 11 months after initiation of therapy (3). The cutaneous manifestations consist of a macular and papular rash, sometimes annular as in our case, erythema in sun-exposed sites, alopecia. There may be general symptoms such as fever, arthralgia, fatigue or myositis symptoms with elevation of muscle enzymes (1). The symptoms do not regress immediately after the anti-TFN suspension, but improve significantly in a period ranging from three weeks to six months. At least four pathogenetic hypotheses were advanced (2) about the mechanisms of the anti-TNF-induced lupus-like reaction; the long period of time required for the regression of the reaction after discontinuation of the drug underlines the importance of genetic predisposition: the drug would probably act only as a trigger in a subject genetically predisposed. (...).