Successful treatment of paediatric generalized pustular psoriasis with secukinumab: a case series

Generalized Pustular Psoriasis (GPP) is a rare, severe, life-threatening form of psoriasis and accounts for up to 13.1% of all childhood psoriasis. Common first-line systemic treatment for pediatric patients with GPP include oral acitretin, cyclosporin and methotrexate which have varying efficacy and side effects but multiple interventions are often needed to induce remission and maintain long term control. Recently, the anti IL 17 A monoclonal antibody secukinumab have been shown to be effective in adult patients with GPP; however, there is lack of evidence of its usage in the pediatric population. We describe a case series of 4 pediatric patients with GPP who were treated with off-label use of secukinumab. All four patients had marked clearance and reduction in Generalized Pustular Psoriasis Area & Severity Score (GPPASI) within first 48 h of first injection with subsequent almost complete to complete clearance of skin lesions by 1 month follow up. In conclusion, secukinumab was found to be successful in inducing remission, with rapid clearance and maintaining remission, with or without combination with other systemic agents for pediatric GPP

Lichen Striatus with Nail Involvement in a 6-Year-Old Boy

We describe a 6-year-old boy with an asymptomatic linear eruption on the left index finger with mild erythema of the proximal nail fold, nail dystrophy, and subungual hyperkeratosis of the nail. A diagnosis of nail lichen striatus was made. The child was successfully treated with a topical corticosteroid. Because of its rarity, nail lichen striatus is often under-recognized. Physicians should be familiar with the nail involvement in individuals with lichen striatus so that an accurate diagnosis can be made and unnecessary investigations and treatment avoided

An 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome

We report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued

Pruritic Crusted Scabies in an Immunocompetent Infant

Crusted scabies (also known as Norwegian scabies) is a highly contagious variant of scabies characterized by profuse proliferation of mites in the skin and widespread, crusted, hyperkeratotic papules, plaques, and nodules. Typically, pruritus is minimal or absent. The condition usually occurs in immunocompromised individuals. Occurrence in healthy infants has rarely been reported. We report an 11-month-old healthy Malay boy who presented with crusted scabies.Peer Reviewe

A Case of Congenital Syphilis Presenting with Unusual Skin Eruptions

Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis

Extensive Aplasia Cutis Congenita Encircling the Trunk Associated with Fetus Papyraceus

Aplasia cutis congenita associated with fetus papyraceus, though rare, is well known. On the other hand, aplasia cutis congenita associated with fetus papyraceus presenting with symmetrical circumferential scarring encircling the trunk has not been previously reported. Herein, we report a 2-month-old girl with symmetrical circumferential scarring encircling the trunk associated with fetus papyraceus

Onychomadesis in a 20-Month-Old Child with Kawasaki Disease

Kawasaki disease is characterized by fever for ≥ five days, bilateral bulbar conjunctival injection without exudate, polymorphous rash changes in the extremities, oral mucosal changes, and cervical lymphadenopathy. We report a 20-month-old boy with Kawasaki disease who had onychomadesis affecting the fingernails and toenails bilaterally. To our knowledge, there were three reported cases of onychomadesis associated with Kawasaki disease, to which we add another one. We suggest keeping in mind the possibility of onychomadesis as a nail sequela of Kawasaki disease.Peer Reviewe

Successful Treatment of Recalcitrant Granuloma Gluteale Infantum with Topical Tacrolimus 0.03% Ointment

Granuloma gluteale infantum is a rare complication of irritant contact dermatitis. For the treatment of granuloma gluteale infantum, the diaper area should be kept clean and dry and the source of skin irritation should be removed or mitigated. For those infants who fail to respond to the conservative management, the use of topical calcineurin inhibitors should be considered. We report the successful treatment of a 12-month-old infant with recalcitrant granuloma gluteale infantum with the use of topical tacrolimus 0.03% ointment. To our knowledge, this is the second case reporting the use of topical calcineurin inhibitors in the treatment of recalcitrant granuloma gluteale infantum

Aplasia Cutis Congenita as a Sole Manifestation of Congenital Varicella Syndrome

Aplasia cutis congenita following maternal varicella is well known. On the other hand, aplasia cutis congenita as the sole manifestation of congenital varicella syndrome is very rare. A perusal of the literature revealed only one case. We report two infants with aplasia cutis congenita as the sole manifestation of congenital varicella syndrome

Cutis Marmorata Telangiectatica Congenita Associated with Hemiatrophy

Cutis marmorata telangiectatica congenita is characterized by the presence of a bluish-purple reticulated cutaneous vascular network on the skin intermixed with telangiectasia and occasionally prominent veins at birth. Areas of the skin within the reticulated cutaneous vascular network may be normal, erythematous, atrophic, and, at times, ulcerated. Areas of ulcerations and focal cutaneous and subcutaneous atrophy occasionally occur resulting in body asymmetry. On the other hand, cutaneous and subcutaneous atrophy, extensive and severe enough leading to hemiatrophy, of the entire limb is rare. A search of the English literature revealed only eight documented cases to which we are adding two more cases