European Journal of Pediatric Dermatology

Plantar fibrolipomatous hamartoma in a patient with neurofibromatosis type 1.

Singh S., Kowe P., Sawatkar G., Meshram N. — Mon, 10 Nov 2025 00:00:00 +0000

A female in her early teens presented with freckles over her face and axilla, dental pits, and a progressive swelling over the medial aspect of the right foot. The swelling looked like a plexiform neurofibroma, but histopathology revealed a rare variant of lipoma, a fibro-lipomatous hamartoma of the median plantar nerve.

Recurrent toxin-mediated erythema in a 6-year-old boy.

Molka Ben Salem, Anissa Zaouak, Houda Hammami, Samy Fenniche — Mon, 10 Nov 2025 00:00:00 +0000

Toxin-mediated erythema is an uncommon cutaneous manifestation of group A β-hemolytic streptococcal (GAS) infection, resulting from the systemic action of streptococcal pyrogenic exotoxins rather than local bacterial invasion.
We describe a 6-year-old boy with recurrent pharyngitis who developed sharply demarcated erythema of the perineal region, extending to the thighs and inguinal folds. Throat culture grew GAS, while perineal swabs were sterile. Both pharyngitis and rash resolved rapidly after oral amoxicillin therapy. This was the third recurrence.
Differential diagnoses included Kawasaki disease, scarlet fever, and perianal streptococcal dermatitis. The temporal association with pharyngitis, negative local culture, and rapid antibiotic response supported a toxin-mediated mechanism.
This is, to our knowledge, the first documented Tunisian case of recurrent toxin-mediated erythema. Recognition of this entity is essential to ensure prompt treatment and to avoid unnecessary investigations in children presenting with perineal erythema.

Nipple hyperkeratosis in a 15-year-old girl.

Maheshwari R., Phiske M., Someshwar S. — Mon, 10 Nov 2025 00:00:00 +0000

Hyperkeratosis of the nipple and areola (HNA) is a benign condition characterized by warty thickening and pigmentation of the nipple, areola, or both. This disorder is rare, about 150 cases have been reported till september 2022. Nevertheless, the prevalence of this condition is likely underestimated because the skin lesions are usually asymptomatic and subsequently, there may not be sufficient motivation for affected persons to seek medical care. Pathophysiology of HNA is unclear. It is either unilateral or bilateral, strictly limited to the nipple and areola. Clinically, it is characterized by hyperpigmented, hyperkeratotic verrucous plaques, without induration, erythema or discharge. Diagnosis is clinical, aided by dermoscopy and histopathology. Several therapeutic options, both medical and surgical have been tried for cosmetic improvement with variable success. A 15-year-old female child, presented for evaluation of hyperpigmented to flesh coloured plaque with finger like projections over the surface, involving the both nipples since 2 years. She had prior crusting over nipples, with subsequent shedding. She had applied lanolin ointment for 1 year, without improvement. There was no history of prior pre-existing dermatosis, similar lesions in the past or family. The dermoscopy revealed papillated growth, white clods, linear vessels, brownish crust on surface and peripheral brown pigmentation which allowed clinic-dermoscopic diagnosis of HNA. She was initially treated with topical retinoids with subsequent addition of cryotherapy with significant clinico-dermoscopic improvement at end of three months. HNA, though rare, has to be kept as a differential diagnosis for lesions restricted to nipples. Dermoscopy can prove to be a diagnostic as well as prognostic tool for nipple hyperkeratosis.

Unilateral micronychia associated with yellow nail.

Uwe Wollina — Mon, 10 Nov 2025 00:00:00 +0000

We present an 8 months-old otherwise healthy infant with a unilateral congenital micronychia combined with an acquired yellow nail on the neighboring digit of her right foot. The various associations of both nail conditions to syndromic and other underlying disorders are discussed. In our case, fortunately syndromic disorders could be excluded.

Congenital onychodysplasia of the index finger in a newborn.

Arias Linthon Stephany, Giraldo Parra Maria Jose, Valderrama Ávila Alix Jessika — Mon, 10 Nov 2025 00:00:00 +0000

Congenital onychodysplasia of the index finger (COIF), also known as Iso-Kikuchi syndrome, is a rare and often underdiagnosed condition. While most cases are sporadic, a hereditary component has also been described. Its pathophysiology remains unclear but is associated with maternal medication use during pregnancy, alterations in the Wnt signaling pathway, and intrauterine ischemic events. Clinically, it is characterized by micronychia, polyonychia, anonychia, and irregular lunulae, predominantly affecting the index fingers and, less commonly, the toes. Currently, there are no standardized treatment options.

Occipital fibrous nodules leading to late diagnosis of tuberous sclerosis complex.

Jindal Alok, Singla Isha, Aditi, Goel Shitij — Mon, 10 Nov 2025 00:00:00 +0000

Tuberous sclerosis complex (TSC) is a multisystem genetic disorder often first suspected based on cutaneous findings. We report the case of a 16-year-old boy with facial angiofibromas and asymptomatic nodules on the occipital scalp. Cutaneous examination revealed a fibrous plaque on the occipital region, a rare lesion but recognized as a major diagnostic criterion for TSC. Its unusual location prompted further diagnostic evaluation, which confirmed the diagnosis of TSC. This case highlights the importance of a thorough examination of the skin and scalp in children with subtle or resolved neurologic signs. Recognizing atypical presentations of classical lesions, such as occipital fibrous plaques, can facilitate timely diagnosis and guide appropriate systemic screening in TSC.

Efficacy of sirolimus in Klippel-Trenaunay syndrome.

Gueroum S., Elfatoiki F.Z., Hali F., Chiheb S. — Mon, 10 Nov 2025 00:00:00 +0000

Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular malformation involving capillary, venous, and lymphatic anomalies with limb hypertrophy. Management has traditionally been palliative. Sirolimus, an mTOR inhibitor, offers new therapeutic perspectives. We report the case of a 5-month-old female infant with KTS who presented with a large angiomatous lesion of the right lower limb, complicated by recurrent bleeding, anemia, elevated D-dimer, and coagulopathy whose condition improved with sirolimus.

Value of Doppler ultrasound in the management of infantile hemangioma.

Jebbouje S., Hali F., Moubine I., Chebani W., Chiheb S. — Mon, 10 Nov 2025 00:00:00 +0000

Oral propranolol (Pr) is the standard treatment for infantile hemangioma (IH), the most common vascular tumor of childhood. Therapy must be continued until the end of the proliferative phase, whose clinical assessment can be challenging, particularly in subcutaneous forms. Doppler ultrasound (DUS) is a valuable tool that can guide clinicians in making appropriate therapeutic decisions. In this retrospective, observational, single-center study, we enrolled all children with IH treated with Pr for 6-12 months who also underwent DUS. We evaluated the contribution of DUS in guiding the decision to discontinue Pr at the end of the proliferative phase or to restart treatment in the event of suspected recurrence.
A total of 332 children were included, of whom 220 underwent DUS after 6 months of Pr. Among these, 182 showed reduced vascular activity, suggesting discontinuation of propranolol, while 38 had persistent vascular activity, warranting continuation of therapy. After a median follow-up of 36 months, the clinical findings indicated regression in all cases, while Doppler ultrasound confirmed regression in 108/220 cases, but indicated recurrence in 112/220 cases, thus leading to the resumption of propranolol treatment. Recurrent IHs were characterized by mixed or deep forms, with very low vascular activity. After another 18 months, the 112 patients who had resumed propranolol underwent another DUS: in 75 cases, the DUS did not reveal VA, which was still present in 37 cases; in these latter cases, too, PR was not resumed, as the clinical judgment indicating regression of IH prevailed.
To our knowledge, there are only two small-series studies on the use of DUS in IH treated with propranolol, one of which did not evaluate distant recurrence. In our study, Doppler ultrasound proved useful in conjunction with clinical examination in the therapeutic management of infantile hemangiomas.

Biochemical markers in psoriasis: vitamin D, oxidative stress, vegf, and homocysteine. Literature review.

Khan-Khodjaeva Sohibahon Anvarovna, Babadjanov Oybek Abdujabbarovich — Mon, 10 Nov 2025 00:00:00 +0000

Psoriasis is a chronic inflammatory skin disease characterized by complex dysregulation of the immune system. Biomarkers may be useful for assessing disease activity and therapeutic response.
The objective of the current study is to examine biochemical markers with potential clinical relevance in psoriasis, with particular attention to vitamin D, malondialdehyde (MDA), vascular endothelial growth factor (VEGF), and homocysteine.
Therefore, a literature review was conducted using PubMed, Scopus, and Web of Science databases with relevant keywords.
Low vitamin D levels, elevated oxidative stress markers such as MDA, high VEGF expression, and increased homocysteine have been consistently associated with disease severity and systemic comorbidities. However, evidence regarding vitamin D supplementation and oxidative markers remains inconsistent.
These biomarkers may be useful in prognosis, risk assessment, and therapeutic monitoring of psoriasis. Additional longitudinal and interventional studies are needed to clarify their role and clinical applicability.

Ewing sarcoma of distal phalanx of the great toe in a 10-year-old boy: case report and review of the literature

Mon, 10 Nov 2025 00:00:00 +0000

Ewing sarcoma (ES) is a malignant tumor that arises in bone or soft tissue, and usually affects the pelvis and proximal long bones, although it can occur in any part of the body. ES of the foot is extremely rare, and its clinical presentation can mimic that of more common diseases. We present a case of ES of the distal phalanx of the great toe in a 10-year-old boy. Only 12 cases involving the toes have been reported in the literature, with only 4 affecting the distal phalanges. This case is a valuable addition to the literature and highlights the importance of including ES in the differential diagnosis to minimize delay in diagnosis.

A chameleon virus: EBV-induced PLEVA-like eruption in a child with neuroblastoma.

Salve S., Joshi V.D., Bhoite K.S., Chikhalkar S.B., Kharkar V.D. — Mon, 10 Nov 2025 00:00:00 +0000

Cutaneous eruptions in pediatric oncology may arise as secondary effects of chemotherapy, infections, or the tumor itself (paraneoplastic eruptions); Epstein–Barr virus (EBV) reactivation is a less well-known cause. EBV usually persists in a latent form, but in immunocompromised hosts it can induce either reactive or cytopathic cutaneous lesions. EBV-induced PLEVA-like eruptions are extremely rare, especially in children with cancer. We report the case of a 5-year-old boy with cervical neuroblastoma undergoing chemotherapy who developed sequential polymorphic lesions. The initial papulovesicular lesions mimicked varicella but proved resistant to acyclovir. Subsequently, verrucous lesions appeared, resembling epidermodysplasia verruciformis or generalized verrucosis, although HPV studies were negative. Later, papulonecrotic lesions, clinically resembling PLEVA, demonstrated EBV DNA and focal immunohistochemical positivity for LMP1. Taken together, these findings established the diagnosis of an EBV-induced PLEVA-like eruption, likely favored by immunosuppression. This case highlights the potential of EBV to induce atypical and recalcitrant eruptions in pediatric oncology, underscoring the importance of clinico-pathological correlation and molecular confirmation for accurate diagnosis.

Systemic-onset juvenile idiopathic arthritis: a challenge for the dermatologist.

Mon, 10 Nov 2025 00:00:00 +0000

Systemic-onset juvenile idiopathic arthritis (sJIA) is a rare but potentially life-threatening inflammatory condition affecting children. Its evanescent skin eruption may represent a crucial diagnostic clue. We report the case of a 2-year-old boy presenting with daily high spiking fevers, arthralgia, and a transient salmon-colored maculopapular rash coinciding with febrile episodes. Physical examination and laboratory findings – including leukocytosis, elevated inflammatory markers, and hyperferritinemia – supported the diagnosis of systemic-onset juvenile idiopathic arthritis associated with partial macrophage activation syndrome (MAS). Ultrasound confirmed arthritis in multiple joints. Initial treatment with systemic corticosteroids and methotrexate was later escalated with the addition of cyclosporine and tocilizumab, resulting in clinical improvement. This case highlights the importance of recognizing the subtle and fleeting cutaneous signs of this disease, which may precede or accompany systemic symptoms. Dermatologists play a key role in the early recognition and referral of such cases to pediatric rheumatologists.

Childhood cellular neurothekeoma: diagnostic challenges in a rare benign neoplasm.

Mon, 10 Nov 2025 00:00:00 +0000

Neurothekeoma is a rare benign cutaneous tumor, particularly uncommon in pediatric patients. Histologically, it is classified into three variants – myxoid, cellular, and mixed –based on the proportion of myxoid matrix. The cellular variant, more frequently observed in children, is characterized by a dermal proliferation of epithelioid or spindle-shaped cells with little or no myxoid matrix and a distinct immunohistochemical profile. We report the case of a 10-year-old girl diagnosed with cellular neurothekeoma, highlighting the clinical presentation, histopathological and immunohistochemical findings, along with a review of the recent literature.

Multiple endocrine neoplasia syndrome in a 6-year-old child.

Mun A.V., Kuddusova K.K.q. — Mon, 10 Nov 2025 00:00:00 +0000

Multiple endocrine neoplasia (MEN) syndromes comprise a group of autosomal dominant hereditary disorders characterized by specific clinical features driven by excessive hormonal secretion. The parathyroid glands, thyroid, adrenal glands, pituitary, and pancreatic islet cells may be involved. The most serious complication is the development of potentially life-threatening neoplasms of these glands, which can be diagnosed early – and in some cases prevented – thanks to subtle cutaneous and mucosal manifestations, as illustrated in the case of a 6-year-old child described herein.

Basidiobolomycosis in a 14-year-old girl.

Mon, 10 Nov 2025 00:00:00 +0000

Basidiobolomycosis is a rare subcutaneous fungal infection caused by Basidiobolus ranarum, typically affecting children and young males in tropical regions. Its clinical presentation is nonspecific and often mimics other granulomatous or infectious conditions, leading to frequent misdiagnosis. We report the case of a 14-year-old girl who presented with a firm, erythematous mass on the right thigh that progressively increased in size. Histopathological examination revealed fungal hyphae surrounded by the Splendore-Hoeppli phenomenon, and fungal culture confirmed the presence of B. ranarum. This case highlights the importance of considering basidiobolomycosis in the differential diagnosis of chronic subcutaneous lesions in endemic areas.

Unilateral erythema nodosum in a 17-year-old girl.

Ventura Lourenco J., Mazeda I. , Oliveira J., Martins A., Ramos S. — Mon, 10 Nov 2025 00:00:00 +0000

Erythema nodosum, the most prevalent form of panniculitis, usually affects women in their 3^rd and 4^th decades of life, presenting as tender, erythematous nodules on the legs. It arises from delayed hypersensitivity reactions, often triggered by various factors, including infections, especially those caused by Streptococcus. Unilateral erythema nodosum in pediatric patients is exceedingly rare, with only one previously documented case.
We present the case of a 17-year-old girl that initially presented with a painful, erythematous induration of her left leg, mimicking cellulitis. Despite initial treatment with antibiotics, further evaluation revealed elevated antistreptolysin O titres and imaging findings consistent with erythema nodosum. Dermatological consultation confirmed the diagnosis, and the lesions resolved within 8 weeks.
This case underscores the importance of a thorough evaluation and consideration of atypical presentations in diagnosing erythema nodosum, particularly in pediatric patients. A comprehensive approach to patient care is essential to ensure accurate diagnosis and appropriate management.

European Journal of Pediatric Dermatology, issue 4, vol. 35, 2025

STAFF STAFF — Mon, 10 Nov 2025 00:00:00 +0000

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Contents, issue 4, vol. 35, 2025

STAFF STAFF — Mon, 10 Nov 2025 00:00:00 +0000

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