European Journal of Pediatric Dermatology

Severe psoriasis in a 3-year-old child treated with methotrexate.

Baswedan R., Hidayati A.N., Widia Y., Sawitri, Suyoso S. — Sun, 01 Feb 2026 00:00:00 +0000

Psoriasis vulgaris in early childhood is uncommon and may present diagnostic challenges, particularly when clinical features mimic other inflammatory dermatoses. We report a 3-year-old boy with widespread erythematous, scaly plaques involving the scalp, face, trunk, extremities, and inguinal region, accompanied by obesity as a relevant comorbidity. Histopathological examination confirmed psoriasis vulgaris, and methotrexate was initiated at 0.3 mg/kg/week with folic acid supplementation. Progressive clinical improvement was observed within the first month, and near-complete resolution of lesions occurred after two months, without adverse effects or laboratory abnormalities. This case highlights methotrexate as an effective and well-tolerated systemic option for moderate-to-severe pediatric psoriasis, particularly in resource-limited settings or when comorbid obesity is present.

Contents, issue 1, vol. 36, 2026

STAFF STAFF — Sun, 01 Feb 2026 00:00:00 +0000

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Megalencephaly-Capillary Malformation Syndrome: a Case Series with Expansion of Phenotype

Sun, 01 Feb 2026 00:00:00 +0000

Background/Objectives: Megalencephaly-capillary malformation polymicrogyria syndrome (MCAP) is a rare genetic disorder characterized by megalencephaly, capillary malformation and somatic overgrowth, caused by somatic variants in PIK3CA. We report a case series of 12 patients with MCAP with a focus on clinical manifestations.

Methods: Retrospective case series at tertiary referral centers.

Results: 12 patients with MCAP syndrome were identified. All patients presented with reticulated capillary malformations, 50% had a combination of reticulated and confluent capillary malformations. A fronto-facial capillary malformation was present in a majority of patients (83%), with lumbosacral involvement in 42%. Two patients developed a benign, non-specific vascular tumor on the trunk. Digital anomalies, somatic overgrowth and neurologic manifestations of variable severity were present in all patients.

Conclusions: Clinical overlap exists between MCAP and other PIK3CA-related overgrowth spectrum disorders. Cutaneous manifestations are salient features of MCAP, their recognition is critical for an early diagnosis.

mTOR inhibitors: optimizing outcomes and expectations in complex vascular anomalies.

Sun, 01 Feb 2026 00:00:00 +0000

Just as propranolol has transformed the treatment of infantile hemangiomas, mTOR inhibitors have become significant targeted therapies for non-involuting and complex vascular malformations — such as lymphatic and the PIK3CA-related malformations.
This retrospective cohort study reviewed 30 patients treated with mTOR inhibitors at Kapiolani Medical Center’s Vascular Anomalies Center (2017-2023). Included were venous malformations (VM), lymphatic malformations (LM), capillary malformations (CM), and combined malformations. Data collected included demographics, lesion characteristics, treatment duration, adverse effects, and adjunctive therapies. Treatment response was graded using a five-point scale (1=no response, 5=near-complete resolution).
Patients ranged from 4 months to 23 years of age (mean: 11 years of age) with treatment durations of 2 weeks to 6 years (mean: 24.2 months). Lesions were predominantly located on limbs (63.3%), face/neck (30%), and trunk (30%). PROS malformations (20%, n=6) showed moderate to dramatic improvements (mean treatment response score 3.3), whereas non-PROS malformations (80%, n=24), including VM, LM, CM, and isolated combined malformations, had milder responses (mean treatment response score 1.8). Over 50% of all patients required adjunct therapies, including embolization, sclerosis, debulking, or additional medications. Adverse effects (40%) included pain, oral ulcers, and viral illnesses, with no severe complications.
mTOR inhibitors offer symptom relief for vascular malformations in general, with more pronounced effects in syndromic combined malformations, such as PROS-related KTS. Pediatric dermatologists should consider mTOR therapy for cutaneous symptoms like swelling, bleeding vesicles, and microlymphatic lesions. Multimodal approaches, including sclerotherapy and debulking, remain essential for both lesion types.

Umbilical granuloma in infants: treatment modalities between the past and present.

Muhamed Jassim Fadhle, Ali Farooq Al-Mayoof — Sun, 01 Feb 2026 00:00:00 +0000

Umbilical granuloma is a common condition encountered during infancy. Several treatment modalities are available, but the optimal management strategy has not yet been clearly defined. This study aims to compare the effectiveness of five therapeutic approaches used for umbilical granuloma. A prospective cohort study was conducted at a tertiary pediatric surgery center over a 20-month period, including patients up to three months of age with umbilical granuloma. Patients were allocated into five groups according to the treatment modality chosen by their parents. They were followed for 10-45 days, and healing and failure rates were calculated for each therapeutic strategy.
A total of 158 patients were included, with a mean age of 29 days. Males were predominant, with a male-to-female ratio of 1.46:1. Low birth weight, prematurity, and delayed cord separation showed low incidence rates (7.6%, 6.3%, and 5.7%, respectively). Healing rates were 100% for silver nitrate and surgical excision, 76.7% for topical steroids, 65.8% for table salt, and 44.1% for ethanol; the differences were statistically significant (P = 0.00001).

Folliculotropic mycosis fungoides in an 11-year-old child.

Sinuco Rueda L.A., Rueda Cadena X., Dufflart Ocampo J.D., Leal Reina H.S. — Sun, 01 Feb 2026 00:00:00 +0000

Mycosis fungoides is a cutaneous T-cell lymphoma that is rare in children and may mimic various inflammatory skin conditions. We report the case of an 11-year-old boy with longstanding hypochromic and inflammatory lesions initially suggestive of dermatitis. Based on histopathologic and immunohistochemical findings, a diagnosis of folliculotropic mycosis fungoides was established. This case is presented to highlight the diagnostic challenges of this condition, which can only be overcome through histologic and immunohistochemical evaluation.
Mycosis fungoides (MF) accounts for approximately 50% of cutaneous T-cell lymphomas, with an incidence of 0.5 cases per 100,000 persons per year, and is far more frequent in adults than in children, in whom a prevalence of 5% of all T-cell lymphomas is estimated. According to the most recent World Health Organization/European Organization for Research and Treatment of Cancer classification, MF is categorized into classic, folliculotropic, pagetoid reticulosis, and granulomatous slack skin variants.
At any age, MF may have a chronic, indolent course that mimics inflammatory dermatoses. The mean age at diagnosis in children is approximately 10 years, with a male-to-female ratio of 1.1:1 that increases to 2.1:1 in adulthood, especially around 60 years of age.

Localised insulin-induced lipoatrophy in an 8-year-old girl.

Ali A., Nicholls I., Zidan A., Kanji A. — Sun, 01 Feb 2026 00:00:00 +0000

Lipoatrophy is a rare but clinically significant complication of insulin use, believed to be mediated by immune-complexes. This case describes an 8-year-old Caucasian girl, who presented with a 4-month history of asymptomatic cutaneous depressions at the sites of insulin pump attachment, used to treat her type 1 diabetes mellitus. She was diagnosed with insulin-induced lipoatrophy following ultrasound imaging and skin biopsy of the affected site. Early recognition and management of this complication is essential, not only for its cosmetic implications, but also because insulin absorption from these sites can be unpredictable, leading to poor glycaemic control. Although the incidence of lipoatrophy has markedly declined with the use of modern insulin analogues, isolated cases still occur. In our patient, gradual clinical improvement was observed following a switch in the type of insulin administered via her pump.

Acute graft-versus-host disease.

Sun, 01 Feb 2026 00:00:00 +0000

Acute graft-versus-host disease (GVHD) represents one of the leading causes of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. The skin is the earliest and most frequently affected organ, and grade IV acute cutaneous GVHD presents with a clinical picture similar to toxic epidermal necrolysis, characterized by epidermal detachment and a high risk of sepsis, multiorgan failure, and death. Early, coordinated, multidisciplinary intervention is essential for survival.
We report the case of a 9-year-old boy with early relapse of B-cell acute lymphoblastic leukemia who developed rapidly progressive grade IV acute cutaneous GVHD on day +25 post-transplant, involving 40% of the total body surface area, with epidermal loss and a positive Nikolsky sign. Initial treatment with high-dose intravenous methylprednisolone was insufficient, necessitating the use of ruxolitinib (a JAK1/2 inhibitor), intravenous immunoglobulins, and broad-spectrum antibiotics. A cytomegalovirus (CMV) reactivation was also promptly detected and treated.
Due to extensive skin barrier loss and severe pain, the patient underwent sequential surgical debridement and occlusive silver-based dressings under general anesthesia, managed similarly to a severe burn patient. Treatment was coordinated by a multidisciplinary team including pediatric plastic surgery, dermatology, ophthalmology, transplant immunology, intensive care, and rehabilitation. After three scheduled surgical procedures and optimization of immunomodulatory therapy, rapid re-epithelialization and clinical stabilization were achieved within 20 days of hospitalization. This case highlights that grade IV cutaneous GVHD can be compatible with survival when advanced therapy and burn unit–like wound management are initiated early under the supervision of an intensive multidisciplinary team.

Chronic genital ulcer in a teenager reveals orificial cutaneous tuberculosis.

Riswanto C.D., Widia Y., Sawitri S. — Sun, 01 Feb 2026 00:00:00 +0000

Tuberculosis cutis orificialis (TCO) is a rare form of cutaneous tuberculosis, accounting for approximately 2% of cases and typically involving the oral cavity, external genitalia, endometrium, or anal region. Despite its rarity, TCO presents significant diagnostic challenges due to its heterogeneous clinical and histopathological features. A case of genital ulceration in a 15-year-old boy was diagnosed as TCO through the GeneXpert integrated system. This case highlights the diagnostic complexity of TCO, particularly when routine tests and histopathology yield nonspecific findings. TCO should be considered in the differential diagnosis of chronic genital ulcers, especially in tuberculosis-endemic regions, to ensure timely and effective treatment.

Hair tourniquet syndrome localized to the labia minora.

Sun, 01 Feb 2026 00:00:00 +0000

Hair tourniquet syndrome (HTS) is a rare condition in which a hair or fiber encircles an appendage, leading to swelling, pain, and potentially ischemic necrosis. Uncommon, cases involving the female genitalia have been described.
We report a case of HTS involving the labia minora in a 6-year-old girl, initially misdiagnosed, managed surgically, and confirmed by histological exam, in the absence of any context of sexual abuse.
Early recognition of this condition is essential to prevent serious complications.

Antihypertensive therapy and hypertrichosis: a probable association.

Siva Chaitanya Senapathi, Karthi Kishore — Sun, 01 Feb 2026 00:00:00 +0000

Hypertrichosis is characterized by excessive growth of terminal hair in areas of the skin where hair is normally fine, scarcely visible, or absent. The most common causes of acquired hypertrichosis include syndromic conditions, endocrine disorders, and drug exposure. Medications most frequently associated with hypertrichosis include phenytoin, minoxidil, diazoxide, cyclosporine, corticosteroids, psoralens, and acetazolamide. We report a case of acquired hypertrichosis in a 3.5-year-old child, attributed to the prolonged use of antihypertensive therapy.

Bilateral congenital triangular alopecia associated with alopecia areata: report of two cases.

Purva Lakhotiya, Het Modi, Meghana Phiske, Shylaja Someshwar — Sun, 01 Feb 2026 00:00:00 +0000

Congenital triangular alopecia (CTA), also known as temporal triangular alopecia or Brauer nevus may be present at birth or acquired during first decade of life with incidence of 0.1% . Presentation at birth and at age of 2-9 years, is seen in 36.5% and 55.8% respectively. There is no gender predilection and it affects mainly white patients. It is usually unilateral in 80%, more commonly described on the left side and rarely described bilaterally. It can present as triangular, oval, or lancet-shaped patch of alopecia. It may be misdiagnosed as traction alopecia, trichotillomania or tinea capitis. Histopathological and dermoscopic features help in its diagnosis. There is no effective treatment and, in most cases, there is no need for therapeutic intervention. Treatment modalities include topical Minoxidil, surgical excision, and hair transplantation. Eyebrow and eyelash alopecia is characterized by either complete or partial loss of eyebrow or eyelash hair. Prevalence of eyebrow and eyelash involvement is not precisely known. Etiologies are varied, and diagnosis is confirmed by dermoscopy and histopathology. Treatment modalities include topical and intralesional steroids, JAK inhibitors, and prostaglandin analogues.
A 8 year old girl presented with well-demarcated, 13 × 12 × 10 cm, triangular patch of alopecia occupying bilaterally temporo-parieto-vertex region of scalp since birth, with patchy loss of hair in mid portion of both eyebrows and complete loss of eyelashes in both lower eyelid since 2 years. There was alopecia areata (AA) over scalp in mother. Dermoscopy confirmed the diagnosis of CTA and AA. A 9-year-old girl presented with well demarcated, oval, 5x5 cm patch of hair loss on occipital scalp since 1 month, triangular patch of hair loss bilaterally on temporo-parietal scalp since birth with scanty eyebrows and eyelashes. No similar family history. Dermoscopy confirmed CTA with AA. Both cases were given Minoxidil for CTA and topical corticosteroids for all AA lesions.
Both CTA and eyebrow, eyelash alopecia are rare condition, with bilateral presentation of CTA being rarer. Co-existence of both these is hitherto unreported. Trichoscopy aids in diagnosis of both. Prompt treatment helps prevent/reverse progression of hair loss in both.

Hypopigmentation in dark skin: a diagnostic challenge.

Silva J.S., Pereira M.I., Gorito V., Quaresma M. — Sun, 01 Feb 2026 00:00:00 +0000

We report a 4-month-old dark-skinned male infant who presented with generalized pruritic, hypochromic, and scaly lesions initially suspected to represent depigmentation of unknown origin. Dermatologic evaluation revealed atopic dermatitis (AD) with post-inflammatory hypopigmentation. The infant responded favorably to topical corticosteroids and emollients. This case illustrates the diagnostic challenges of AD in infants with dark skin, where atypical color changes may mask underlying inflammation, leading to delayed recognition and treatment.

European Journal of Pediatric Dermatology, issue 1, vol. 36, 2026

STAFF STAFF — Sun, 01 Feb 2026 00:00:00 +0000

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