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Rash and fever are some of the most common chief complaints present in paediatric dermatology emergencies. The spectrum of differential diagnosis is broad, including many different infectious and some non-infectious agents. A systematic approach involving detailed history taking, careful clinical examination along with particular attention to epidemiological features are the most important factors to make a diagnosis. This article reviews the morphological patterns of various causes of fever with rash in children, including infectious as well as non-infectious causes, with special emphasis on the Indian scenario. We intend to highlight the clinical characteristics of each cause, which will not only help make a clinical diagnosis but also distinguish benign versus life-threatening causes of skin rash in febrile paediatric patients and provide early medical intervention. [ABSTRACT FROM AUTHOR]

Gianotti-Crosti syndrome (GCS) is characterized by the sudden onset of a papular or papulovesicular rash with a symmetrical distribution. This rash mainly appears on the extensor surfaces of the limbs, buttocks, and face. GCS is most frequently observed in children aged 1 to 6 years. In this case, we present the diagnosis of GCS in an 8-month-old male patient who also has a history of atopic dermatitis. Symmetrical, multiple, monomorphic, raised, red, and itchy lesions were identified on the patient's face, trunk, arms, and legs. The presence of atopic dermatitis was notably more common in individuals with GCS, suggesting a significant association with a family history of atopy. GCS is a syndrome that demands a high degree of clinical suspicion as it can be mistaken for other childhood exanthematous diseases. [ABSTRACT FROM AUTHOR]

Introduction: Immune checkpoint inhibitors are new drugs approved for the treatment of many types of malignancies. Despite their wide use and unquestionable clinical benefits, these agents have also been associated with a unique spectrum of side effects known as immune-related adverse events. In this study, we report the first case of atezolizumab-induced pustular psoriasis and acrodermatitis. Case Presentation: A 61-year-old woman presented to our department with erythematous-desquamative and pustular lesions involving all hands and feet fingers, inguinal region, and trunk, associated to severe psoriatic onychodystrophy. She was affected by non-small-cell lung carcinoma from 12 years, and 7 months before admission, she started a treatment with atezolizumab. Conclusion: Immune checkpoint inhibitors such as atezolizumab are linked to a plethora of adverse events. Identifying and treating certain adverse skin events, particularly in cancer patients, can be a challenge, leading oncologists to discontinue immunotherapy. Our case shows how it is necessary to have a shared therapeutic algorithm in order to manage serious skin reactions in cancer patients and avoid disruption of the oncotherapy.

Introduction: Immune checkpoint inhibitors are new drugs approved for the treatment of many types of malignancies. Despite their wide use and unquestionable clinical benefits, these agents have also been associated with a unique spectrum of side effects known as immune-related adverse events. In this study, we report the first case of atezolizumab-induced pustular psoriasis and acrodermatitis. Case Presentation: A 61-year-old woman presented to our department with erythematous-desquamative and pustular lesions involving all hands and feet fingers, inguinal region, and trunk, associated to severe psoriatic onychodystrophy. She was affected by non-small-cell lung carcinoma from 12 years, and 7 months before admission, she started a treatment with atezolizumab. Conclusion: Immune checkpoint inhibitors such as atezolizumab are linked to a plethora of adverse events. Identifying and treating certain adverse skin events, particularly in cancer patients, can be a challenge, leading oncologists to discontinue immunotherapy. Our case shows how it is necessary to have a shared therapeutic algorithm in order to manage serious skin reactions in cancer patients and avoid disruption of the oncotherapy. [ABSTRACT FROM AUTHOR]

Background: To determine the composition of skin pigmentation in chronic venous insufficiency (CVI) and other less common vascular conditions of lower limbs. Methods: Forty-five skin biopsies were obtained from 17 patients. Samples were taken from pigmented regions and compared with control non-lesional samples from the same patient. Perl's Prussian Blue was used to identify haemosiderin and Schmorl's for melanin. Results: Seven patients presented with CVI, one with concurrent livedo vasculopathy (LV). One patient had LV only. Two patients had acroangiodermatitis (AAD). Six patients had post-sclerotherapy pigmentation (PSP), one with concurrent post-inflammatory hyperpigmentation (PIH). One patient had PIH only. The predominant pigment in CVI samples was haemosiderin. C5-C6 patients showed increased epidermal melanin. LV, AAD, and PSP samples showed dermal haemosiderin but no increase in epidermal melanin. PIH samples showed prominent epidermal melanin whilst no haemosiderin was detected. Conclusion: The predominant pigment in CVI and other vascular conditions was haemosiderin. Melanin was present in later stages of CVI (C5-C6) and in PIH. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Acrodermatitis Enteropathica (AE) is a rare disease that can be transmitted by autosomal recessive inheritance, it can be related to parenteral nutrition without zinc, or it can be secondary to malabsorptive syndromes. Clinically, it is characterized by the triad of acral and periorificial dermatitis, alopecia and diarrhea, accompanied by growth restriction. The condition can be fatal if left untreated. METHODS: We describe the case of a child with AE and Crohns Disease (CD), with AE being a known complication, secondary to malabsorption caused by CD. RESULTS: Treatment for CD was started with systemic steroids, Azathioprine and Mesalazine, and local care with the diaper area. Oral zinc replacement was also started. The child showed significant clinical and dermatological improvement within a few weeks. CONCLUSIONS: The diagnosis of AE is made with serum zinc levels lower than 70 ug/dL. Treatment involves zinc supplementation, at a dose ranging from 1 to 3 mg/kg/day. In the case described, the zinc value was 65 ug/dL. In this case, we started replacement with 2mg/kg/day, with rapid clinical improvement. Zinc deficiency AE is a well-known complication of CD, secondary to malabsorption. In the case described, the cutaneous condition came after the intestinal condition, with the deficiency in the absorption of zinc being secondary to Crohns Disease, leading to a condition with extensive lesions, but with a quick response to the treatment and with an important improvement of the condition.

Introduction: dysmetabolic acrodermatitis can occur in patients with inborn errors of metabolism, such as maple syrup urine disease (MSUD). Case description: this is a male patient who, at eight days of age, presented hypotonia, lethargy, anorexia, apneas and cyanosis. Due to the neurological manifestations, an inborn error of metabolism is suspected, requesting metabolic screening. Due to elevated plasma levels of leucine, isoleucine and valine, a diagnosis of MSUD was established, starting a diet free of these amino acids. At five months of age, he was identified with disseminated dermatosis: confluent erythematosquamous plaques, poorly delimited, considered as dysmetabolic acrodermatitis; after seven days of adjusting therapy, improvement of the dermatological lesions was observed. He remained stable until 2 years of age, when he was readmitted for dermatosis exacerbation and metabolic acidosis; however, the patient died despite intensive care management. Conclusions: in dysmetabolic acrodermatitis, skin lesions can be a marker of decompensation of a metabolic disease. Early identification of this complication can help offer timely treatment. [ABSTRACT FROM AUTHOR]

Trace elements (microminerals) play a role in many physiological functions, including hormone production and cellular growth. However, their importance in diagnosing and treating dermatologic disease has not been well examined. In this review, we discuss the functions, sources, and recommended requirements of each micromineral. In addition, we analyze the systemic and dermatologic manifestations associated with micromineral imbalances. The pathogenesis of genodermatoses, such as Wilson disease, Menkes disease, acrodermatitis enteropathica, and allergic dermatitis, are also discussed. Included are studies examining the potential therapeutic role of zinc, selenium, and copper in inflammatory diseases, skin cancer, and photoaging. [ABSTRACT FROM AUTHOR]

Abstract A second‐born breastfed infant presented with zinc deficiency. His mother had a novel heterozygous mutation in SLC30A2. A previous baby did not have zinc deficiency but the mother had taken a proton pump inhibitor (PPI) during the second pregnancy. Antenatal PPI exposure may plausibly contribute to transient infantile zinc deficiency.

Psoriasis is a chronic multisystemic disease that can take on different clinical morphologies and can present both in classic locations and in less frequently affected areas. With this paper we aim to describe the forms of psoriasis with particular locations: palpebral, of the ear lobe, of the tip of the nasal pyramid, psoriasis gyrata, Blaschko-linear psoriasis, as well as psoriasis with particular involvement: Hallopeau acrodermatitis, reactive arthritis and psoriatic onycho-pachydermo-periostitis of the hallux. [ABSTRACT FROM AUTHOR]

Abstract Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.

A second‐born breastfed infant presented with zinc deficiency. His mother had a novel heterozygous mutation in SLC30A2. A previous baby did not have zinc deficiency but the mother had taken a proton pump inhibitor (PPI) during the second pregnancy. Antenatal PPI exposure may plausibly contribute to transient infantile zinc deficiency. [ABSTRACT FROM AUTHOR]

This case study takes you through the timeline from clinical presentation to diagnosis of acquired zinc deficiency for a four-month-old boy seen in the paediatric clinic following referral. [ABSTRACT FROM AUTHOR]

Gianotti-Crosti syndrome is a cutaneous eruption that occurs rarely in adults. It mostly concerns pediatric population and immunocompromised patients. Cytomegalovirus has already been described as one etiology of Gianotti-Crosti acrodermatitis in children and bone-marrow transplanted patients. Here, we present a Cytomegalovirus-associated Gianotti-Crosti syndrome in a 28-year-old immunocompetent female patient diagnosed in CHU Amiens-Picardie (Amiens, France). This type of case has never been shared in literature before. This rare complication of Cytomegalovirus infection indirectly led to disruption of anticoagulant treatment and thromboembolic incident that could have been fatal.

Byline: Binodini. Behera, Liza. Mohapatra, Bharati. Sahu, Monali. Patnaik Acrodermatitis enteropathica (AE) is a rare inherited form of defective zinc absorption usually manifesting as eczematous and erosive dermatitis preferably over [...]

Gianotti–Crosti syndrome (GCS) is a self-limited benign dermatosis, clinically characterized by a monomorphic papular or papulovesicular eruption symmetrically distributed on the limbs and face of children. Various viral and vaccine triggers have been associated with GCS. Recurrences are uncommon but have been reported. We report a case of recurrent vaccine-triggered GCS.

Dermatitis as an initial manifestation of cystic fibrosis (CF) is unusual. The eruption is usually first noted in the perineum anywhere from several days to few months after birth. It subsequently spreads to the extremities and trunk. We report a 2-month-old male baby who presented with failure to thrive, hypoproteinemia, anemia, and a cutaneous eruption resembling acrodermatitis enteropathica. Oral zinc supplementation resulted in temporary resolution of the dermatitis. A further workup revealed the diagnosis of CF. The rash was responsive to nutritional and pancreatic enzyme supplementation. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of acquired acro­dermatitis enteropathica involves zinc supple­mentation; however, further research is required to establsih the optimal dose and duration of the supplementation. Case presentation: Female patient with a history of gastric bypass, intestinal resection, and 2 months of skin rash that required biopsy with histological findings compatible with der­matitis associated to nutritional deficiency. She received elemental zinc supplementation for 11 days, achieving improvement in skin le­sions. She was later readmitted twice due to reactivation of the disease with the need to restart zinc supplementation. At the time of this study, she had been receiving oral elemental zinc treatment for 3 years, at doses of up to 240 mg/day. Discussion: In patients with gastric bypass and intestinal malabsorption, the usual zinc dose of 8-11 mg/day may be insufficient and put patients at risk for acquired acrodermatitis enteropathica. In similar case reports, the sup­plementation dose ranges from 2 mg/kg/day of venous elemental zinc to 300 mg/day orally, while the duration of supplementation has not been established. Conclusions: Oral supplementation for 3 years with a maximum dose of 240 mg/day has been adequate for controlling the disease. Monitoring blood zinc levels and physical examination of the skin have been key factors for adjusting the dose to be supplied.

Introduction. Acrodermatitis continua Hallopeau (ACH) is a rare form of psoriasis. Sterile pustules are usually located in the area of the fingertips and nails at the site of injury or infection. Nail lesions are always present. Case report. A 65-year-old man was admitted to the Department of Dermatology for diagnostics and treatment of lesions of the skin and fingernails that developed as a consequence of an injury. Initially, he was treated on an outpatient basis with topical glucocorticoids, without improvement. On admission, numerous pustules, maceration of the epidermis, severe hyperkeratosis of the skin in distal parts of fingers and soles, and swollen, red nail folds with dystrophy of many finger and toe nail plates were observed. Acitretin was introduced. An improvement in the condition of the skin was observed during the hospitalisation. An outpatient follow-up was recommended, during which further improvement was noted. Conclusions. Acrodermatitis continua Hallopeau is a chronic and progressive dermatosis that can lead to irreversible complications. The nail apparatus becomes affected early. Untreated acrodermatitis continua Hallopeau may lead to onychodystrophy or anonychia, and even to osteolysis of distal phalanges. So far, no specific guidelines for the treatment of acrodermatitis continua Hallopeau have been developed. [ABSTRACT FROM AUTHOR]

This review provides a concise overview of the cellular and clinical aspects of the role of zinc, an essential micronutrient, in human physiology and discusses zinc-related pathological states. Zinc cannot be stored in significant amounts, so regular dietary intake is essential. ZIP4 and/or ZnT5B transport dietary zinc ions from the duodenum into the enterocyte, ZnT1 transports zinc ions from the enterocyte into the circulation, and ZnT5B (bidirectional zinc transporter) facilitates endogenous zinc secretion into the intestinal lumen. Putative promoters of zinc absorption that increase its bioavailability include amino acids released from protein digestion and citrate, whereas dietary phytates, casein and calcium can reduce zinc bioavailability. In circulation, 70% of zinc is bound to albumin, and the majority in the body is found in skeletal muscle and bone. Zinc excretion is via faeces (predominantly), urine, sweat, menstrual flow and semen. Excessive zinc intake can inhibit the absorption of copper and iron, leading to copper deficiency and anaemia, respectively. Zinc toxicity can adversely affect the lipid profile and immune system, and its treatment depends on the mode of zinc acquisition. Acquired zinc deficiency usually presents later in life alongside risk factors like malabsorption syndromes, but medications like diuretics and angiotensin-receptor blockers can also cause zinc deficiency. Inherited zinc deficiency condition acrodermatitis enteropathica, which occurs due to mutation in the SLC39A4 gene (encoding ZIP4), presents from birth. Treatment involves zinc supplementation via zinc gluconate, zinc sulphate or zinc chloride. Notably, oral zinc supplementation may decrease the absorption of drugs like ciprofloxacin, doxycycline and risedronate., (© 2024. The Author(s).)

A 44-year-old man, previously healthy, consulted for a three-month history of asymmetrical polyarthralgia with inflammatory features involving small and large joints. A few days later, he developed erythema covered by pustules in the nail folds and progressive degeneration of the nail plate of the left thumb, with severe functional limitation. The physical exam showed well-defined erythematous scaly and pustular plaques in the first and third fingers of the left hand, with severe onychodystrophy, which was a key aspect in the diagnosis of acrodermatitis continua of Hallopeau. Other signs of the psoriatic spectrum were observed: erythematous patches of the scrotum, erythematous scaly plaques with hemorrhagic crusts on both knees, and dactylitis. The diagnosis of inverse psoriasis, plaque psoriasis, and pustular psoriasis, respectively, were confirmed by histopathology and, with the CASPAR criteria, psoriatic arthritis. This case is of particular dermatological interest due to the variety of psoriatic manifestations recognized in a single patient and because of the poorly described association between acrodermatitis continua of Hallopeau with psoriatic arthritis.

A 45-day-old female infant was brought to a tertiary care center with the chief complaints of skin lesions over both hands and feet and perianal area since birth. Associated systemic complaints included rhinitis and diarrhea. Clinical examination revealed erosions with moist, erythematous base in an acral distribution, cheilitis, and perianal moist erythematous lesion. Based on the history and clinical examination findings of a congenital bullous rash, acrodermatitis, and periorificial moist lesion, rapid plasma reagin test was advised which came 1:512, thus confirming the diagnosis of congenital syphilis.

Palmoplantar pustulosis is disease that manifests with grouped sterile pustules on the palms and soles. The disease manifests itself with recurrent grouped sterile pustules on a erythematous and keratotic basis, located on the palms and soles. The lesions may extend to the dorsum or the lateral aspects of the feet and hands. Various diseases can be considered in the differential diagnosis of the disease including pomphylox, dermatophyte infectios, scabies, insect bite, gonococcal infection, syphilis, palmoplantar psoriasis and acrodermatitis continua hallopeau. Treatment of the disease starts with general measures which are smoking cessation, use of emoillients and avoiding irritants. First line treatment modalities are topical corticosteroids, oral retinoids and phototherapy. [ABSTRACT FROM AUTHOR]

The article describes the case of a 23-year-old female patient with palmoplantar erythematosquamous plaques and intermittent erythematous painful swelling of the distal interphalangeal (IP) joints. Topics discussed include combination therapy started in the patient, clinical features of acrodermatitis continua suppurativa of Hallopeau (ACH), and significance of future interdisciplinary research of ACH in multiple centres treating ACH patients.

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Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea due to zinc deficiency. We report a case of a 9-month-old baby boy with hair loss for 2 months, diarrhea for 1.5 months, skin peeling starting around mouth, nose, anus, gradually spreading all over body over 1 month, and fever for 10 days. Due to superadded bacterial infections and altered clinical picture, he was diagnosed as a case of staphylococcal scalded skin syndrome. With low serum zinc levels and improvement of skin lesions and diarrhea within 8 days of starting oral zinc therapy, it was confirmed to be a case of acrodermatitis enteropathica. It is important to consider AE as one of the differential diagnoses in pediatric chronic diarrhea cases with acral and/or periorificial skin lesions to prevent delay in the zinc supplementation treatment and mortality. [ABSTRACT FROM AUTHOR]

Byline: Filiz. Demir, Ceyda. Çaytemel, Nazli. Caf, Zafer. Türkoglu, Mesut. Ayer, Nesimi. Büyükbabani Olmsted syndrome is a rare genodermatosis. Palmoplantar keratoderma and periorificial keratodermic plaques are the most important clinical [...]

Abstract: We report the case of a male 22-month-old child, with atypical presentation of Gianotti-Crosti syndrome after infection with Epstein-Barr virus.

Aim: To analyse postnatal characteristics, clinical and laboratory findings, results of investigations in the newborn (25 gestational weeks; Apgar score: 6/9 points; born per caesarean section; birth weight: 600 g; birth length: 31 cm; head circumference: 21 cm) from the first high-risk pregnancy with acquired form of acrodermatitis enteropathica., Results: After summarizing the clinical picture with laboratory findings, we analysed the components of parenteral nutrition with regard to the deficiency of trace elements and vitamins. The zinc depletion dominated., Conclusion: The diagnosis is clinical, based on the presence of a typical clinical picture together with a low serum zinc concentration. Standard preparations with elementary elements do not sufficiently cover the daily needs of children, other possibilities of supplementation in intravenous form are not available. It is necessary to supplement zinc in premature children, in children with high losses of zinc (with diarrhoea, in patients with a stoma, in patients with severe skin disease) (Fig. 4, Ref. 15).