Case 1. A 10-month-old little girl had since birth a band-like pigmented lesion affecting the lateral third of the nail plate of the 5th left finger and most of the distal and lateral perinychium of the same finger (Fig. 1); the dermoscopic examination (Fig. 2) showed a parallel pattern on the skin and irregular longitudinal striae on the lamina: these findings led to the diagnosis of congenital melanocytic nevus. Case 2. A 18-month-old child presented since birth a pigmented band of the thumb, which had remained unchanged over time (Fig. 3, note the pseudo-Hutchinson, namely the pigmentation of the cuticle due to the transparency of the underlying nevus). These data led to the diagnosis of congenital longitudinal melanonychia. Case 3. This 8-year-old boy presented for 2 months a blackish pigmentation of the right thumb. The physical examination showed a triangular pigmentation with base on the cuticle and apex located 2 mm from the distal edge (Fig. 4, courtesy Dr. Furnari): these data led to the diagnosis of melanonychia probably due to recent acquired melanocytic nevus of the nail matrix, which began in the middle of the base and then extended laterally to the sides where the deposition of melanin in the nail plate began late.
A 20-day-old baby was first observed for the presence since birth of reddish lesions of the right hemiface. The physical examination showed flat red lesions on the right forehead-eyelid region and under the right ear (Fig. 1) leading to diagnose port-wine stain of the first and third trigeminal branch and to recommend 595 nm dye laser. When the child presented in the second month for the first session of dye laser, we noticed that the lesion of the first trigeminal branch had remained unchanged, while on the patch of the third trigeminal branch proliferative micropapules had appeared (Fig. 2); the dermoscopic observation of the red lesion under the ear showed irregularly dilated vessels with structures similar to microaneurysms, sometimes reminiscent of a rosary; a more careful observation in the crease behind the ear put in evidence an obvious hemangioma in plaque (Fig. 3). These clinical features led to the final diagnosis of port-wine stain of the first trigeminal branch associated with hemangioma under the right ear.
Propranolol is the drug of first choice in the treatment of problematic hemangioma. How-ever, it remains to deal with the problem of its recurrence after drug discontinuation. The recurrence, usually negligible, is significant in about one fifth of the cases. We then made a retrospective study of cases treated up to 2009 and a prospective study for the cases treated from 2010 onwards, aimed at identifying the factors responsible for the rebound and trying to avoid it. 99 children who had started the treatment within 2012 and had discontinued it from at least six months, 69 females and 30 males, ranging in age between 1 and 19 months at the beginning of the treatment, with a median age of 4.3 months entered the study. The regression of hemangioma was complete in 49 children (RE group), while in 21 children there was a rebound more than 20% (RI20 group). We compared the clinical data and treatment modalities in the two groups. Risk factors for a significant rebound in the hemangioma after discontinuation of propranolol were female sex, duration of treatment with propranolol less than 10 months, localization to the cheek and less than 30% improvement after the first month of treatment. To prevent the rebound we propose to increase the initial 2 mg/kg per day dosage of the drug up to 3 mg in cases with less than 30% improvement after the first month of therapy and increase the duration of treatment with propranolol especially in females and in hemangioma of the cheek. To treat the rebound we propose a 4-month second cycle of propranolol, possibly associated in the case of ocular and subglottic hemangioma with deflazacort 1 mg/kg/ day in the first month, tapered and then suspended in the next two months.
Neonatal subcutaneous fat necrosis (NSFN) is a transient, self-healing skin disorder, characterized by nodules and plaques caused by subcutaneous necrosis. NSFN is rarely observed in full-term newborns infants with perinatal problems, especially asphyxia. The most important NSFN complication is hypercalcemia, a common condition that can have serious consequences leading to death. In this paper we describe a case of persistent nephrocalcinosis caused by an extensive neonatal subcutaneous fat necrosis, emphasizing the symptoms to suspect hypercalcemia. We also discuss the therapeutic interventions to restore the levels of serum calcium and prevent the deposition of calcium salts.
The term cutis marmorata is used to indicate both a physiological reaction to the cold occurring in many babies and sometimes even in older children and a persistent capillary-venous malformation. The latter is mostly visible at birth, when necrotic and ulcerative lesions can be associated, and then improves in decades. The different prognosis calls for a differential diagnosis between the two conditions.