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Summary: Background: Tinea capitis is the most common dermatophyte infection in children. Pathogens differ between populations. During the past few decades pathogen shifts have been reported in many countries around the world. This study aimed to characterize the pathogens involved in tinea capitis in a large tertiary paediatric medical centre in Israel. Methods: The electronic medical records of the dermatology unit were searched for patients diagnosed with tinea capitis from 2010 to 2019, and demographic, clinical and mycological data were retrieved. A stepwise logistic regression was performed to determine the variables most significantly associated with positive cultures. Results: The prevalence of Trichophyton tonsurans isolates was found to be significantly increased during 2019. In the logistic regression analysis, alopecia was most significantly associated with a positive culture (OR = 8.72, 95% CI 4.29–17.7, P < 0.001) while positive culture was also associated with age (OR = 1.11 per year of age, 95% CI 1.02–1.22, P = 0.01) and Ethiopian ethnicity (OR = 3.67, 95% CI 1.42–9.45, P = 0.01). The presentation of alopecia was significantly related to having a positive culture. This symptom was more prevalent in boys than in girls, and the diagnosis of tinea capitis was delayed by an average of 2 months in girls. Conclusion: The results of this study may herald a pathogen shift in Israel. Physicians should be aware that rates of alopecia are lower in girls and this can result in delayed diagnosis and the development of complications, including chronicity, scarring alopecia and kerion formation. [ABSTRACT FROM AUTHOR]

Background: Unilesional folliculotropic mycosis fungoides (UFMF) has been rarely reported. Objective: The aim of this study was to describe our experience with UFMF. Methods: Data were collected on all patients with clinicopathological UFMF who attended the Department of Dermatology of a tertiary university-affiliated medical centre in 1996-2013 and were followed prospectively. Results: The sample included seven patients (five male, two female) of mean age 38 years at diagnosis; two were aged <18 years. The lesion presented as a solitary patch/plaque with follicular accentuation in five patients, an infiltrated plaque devoid of hair in one and with follicular nodules in one. Four patients had alopecia, and one, secondary anetoderma. The lesion was located on a limb in four patients, the trunk in two, and the face in one. In all cases, the atypical folliculotropic lymphocytes expressed mainly surface CD4+. Monoclonality was detected in three of the six patients analysed. Treatment consisted of localized electron beam in five patients, all of whom had a complete response (CR), and excision in one patient. The remaining patient, a 9-year-old boy, was treated with topical psoralen and UVA with CR. The duration of follow-up was 0.5-10 years (mean 4). There were no recurrences in six patients and local recurrence in one. Conclusion: UFMF presents at a young age, usually with early disease clinical morphology. The treatment goal should be cure. Our experience indicates an excellent prognosis of early UFMF with no multifocal/internal spread. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the effect of combined intralesional and sub-Tenon's administration of corticosteroids for the treatment of refractory periocular and orbital capillary haemangioma in a retrospective, non-comparative study.MethodsSeven infants with resistant periorbital and orbital capillary haemangioma who attended our tertiary centre from 2000 to 2005 were treated with an intralesional injection of a mixture of betamethasone 6 mg/cc and triamcinolone 10 mg/cc, by body weight, together with sub-Tenon's infusion of betamethasone 6 mg/cc and triamcinolone 40 mg/cc of a volume of 1 cc, close to the orbital lesion, in the same session. Visual axis, proptosis, pre- and post-treatment changes in four refractive parameters, and parental satisfaction were evaluated.ResultsNone of the babies had proptosis or visual axis obstruction after treatment. Mean spherical power decreased by 22.7% (P=0.06). Mean spherical equivalent decreased in 34%, but the difference was not statistically significant (P=0.09). No early or late ocular side effects were observed. Mean intraocular pressure results were normal before and immediately after treatment, and during the follow-up period. Parental satisfaction score during follow-up was 9/10. Mean time to improvement was 96.43±58.3 days.ConclusionsCombined local corticosteroid administration by posterior sub-Tenon’s infusion and intralesional injection in babies with extensive capillary haemangioma is associated with a satisfactory anatomical and functional outcome and there were no ophthalmic side effects.Eye (2009) 23, 1302–1307; doi:10.1038/eye.2008.300; published online 7 November 2008 [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the effect of AS-101, a known immunomodulator, on the pattern of cytokine production in children with patchy alopecia areata (PAA). Ten previously untreated children with PAA were compared to 10 healthy age- and sex-matched controls. Peripheral blood mononuclear cells (PBMC) were isolated from all participants. Unstimulated and phytohaemagglutinin (PHA)-stimulated PBMC were tested with and without the addition of AS-101. The production of interferon gamma (IFNγ), soluble interleukin (IL)-2 receptor (IL-2R), IL-10, IL-5 and IL-6 was determined. The levels of soluble IL-2R, IL-5 and IL-6 were significantly higher in the PAA patients than the controls. AS-101 inhibited the production of IL-10, IFNγ, IL-2R and IL-5 in both PAA patients and controls, but there was a greater inhibitory effect in children with PAA. [ABSTRACT FROM AUTHOR]

Background: Pediatric pemphigus is a rare bullous disease that represents a diagnostic and therapeutic challenge;  evidence on patients' response to various treatments and long-term surveillance data are lacking. We aimed to investigate pediatric pemphigus patients' characteristics, diagnosis, therapeutics, response, and long-term follow-up., Methods: This is a retrospective study of all pemphigus patients aged <18 years, diagnosed between 2000 and 2023, from three tertiary medical centers in Israel. The diagnosis was confirmed by positive immunofluorescence., Results: Twelve pediatric pemphigus patients were included (mean age 10.7 ± 4.3 years, male:female ratio 1:1). Mean diagnostic delay was 11.1 ± 12.6 months (range 1.8-36 months). Most patients had pemphigus vulgaris with mucosal involvement (58.3%). First-line treatment for all patients included systemic corticosteroids (sCS), with a treatment duration (including tapering down) of 28 ± 18.4 months. Hospitalization did not yield better outcomes. Only three patients achieved sustained complete response with sCS treatment (25.0%), and the rest required additional therapeutics, most commonly rituximab. Rituximab showed a good safety profile and therapeutic response. Follow-up was recorded up to 18.1 years after diagnosis (mean: 5.6 years). Three of five patients with information available more than 5 years after the pemphigus diagnosis still exhibited disease symptoms., Conclusions: Pediatric pemphigus is associated with a significant diagnostic delay. While sCS can induce remission in most patients as a first-line treatment, long-term disease control requires additional immunomodulators. Long-term follow-up reveals a chronic yet mostly benign disease course in this population and advocates for the use of rituximab in pediatric pemphigus patients., (© 2024 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: Common cutaneous non-genital viral warts are a common skin infection with significant morbidity in the pediatric population. Although various therapeutics are available, many of them necessitate recurrent patient visits and may be associated with significant irritation and pain. Verrulyse Methionine ® (VM), a nutritional supplement, was previously suggested as a non-invasive treatment option for the disease., Objective: To assess the response to oral VM supplement as a monotherapy in a cohort of children and adolescents with multiple, non-genital viral warts after failing previous treatments., Methods: We reviewed medical records of pediatric patients (<18 y/o) with viral warts treated with VM between 2010 and 2021., Results: Among 25 patients with multiple verrucae vulgaris lesions who failed previous treatments, 14 (56%) had complete or almost-complete response to VM within 4 months, after an average of 18 months of active disease prior to VM treatment initiation. None of the 4 patients with verruca plana had response to VM treatment. Favourable cosmetic results were found in responders, and no adverse events were recorded., Conclusion: Response rates in our cohort are comparable to those reported in the literature for destructive local therapeutics for viral warts. Thus, our data suggest that VM may be considered for children with multiple verrucae vulgaris, providing a painless and non-invasive therapeutic option for this common disease., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Conflicts of interest None declared.