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Hintergrund: Die Symptome der Coronavirus-Infektion 2019 (COronaVIrus Disease 2019, COVID-19) fallen bei Kindern weniger schwer aus als bei Erwachsenen. Allerdings liegen zunehmend Berichte über schwere pädiatrische COVID-19-Fälle vor, darunter Patienten mit Kawasaki-Syndrom (KS) oder einem multisystemischen Entzündungssyndrom (multisystem inflammatory syndrome in children, MIS-C), das KS-ähnliche Merkmale aufweisen kann. Zusammenfassung: MIS-C ist ein neuartiges schweres pädiatrisches Syndrom, das mit COVID-19 in Zusammenhang steht, und bei dem Überschneidungen mit KS, KS-Schocksyndrom und toxischem Schocksyndrom bestehen können. Möglicherweise handelt es sich bei MIS-C um eine entzündliche Erkrankung, die sich vom KS unterscheidet und Folge einer überschießenden Immunreaktion ist. Neben einer gastrointestinalen und kardiovaskulären Beteiligung wurde bei MIS-C auch eine hohe Prävalenz von mukokutanen Manifestationen beobachtet. Die häufigsten mukokutanen Befunde waren Konjunktivitis und Exanthem, das oft als makulös und/oder papulös oder polymorph beschrieben wurde. In der vorliegenden Arbeit geben wir einen kurzen Überblick über MIS-C mit besonderem Augenmerk auf mukokutanen Befunden und dem Zusammenhang mit KS.

The coexistence of psoriasis with autoimmune bullous diseases (AIBDs), particularly bullous pemphigoid (BP), has been documented in case reports and series, as well as in epidemiological studies. The onset of psoriasis precedes that of BP in the majority of cases. Patients with concomitant BP and psoriasis are generally younger at the onset of BP and present with fewer erosions and blisters as compared with patients suffering from isolated BP. Intriguingly, it has been speculated that some BP cases with comorbid psoriasis can actually correspond to anti-laminin gamma-1 pemphigoid, a rare form that was recently recognized as a distinct entity and which can mimic BP and/or other subepidermal AIBDs. The pathomechanisms underlying the BP–psoriasis association have not yet been identified, although several hypotheses have been proposed. The most credited among such hypotheses involves the so-called “epitope spreading” phenomenon, with tissue injury secondary to a primary inflammatory process (i.e., psoriasis) leading to the exposure of sequestered antigens evoking a secondary autoimmune disease (i.e., bullous pemphigoid). This narrative review aims to give a brief overview of the association between psoriasis and BP, examining epidemiological, clinical, and immunopathological features, the pathomechanisms underlying this association, the treatments for psoriasis incriminated as potential triggers of BP, and the therapeutic management of patients with psoriasis and BP.

Omalizumab is a monoclonal anti-IgE antibody which is effective in chronic spontaneous urticaria (CSU), although clinical response appears to be variable in the real-life setting. The aim of this study was to evaluate whether the response of CSU to omalizumab and disease relapse are associated with individual and/or clinical characteristics of patients. We retrospectively evaluated the clinical records of 124 patients treated with omalizumab for moderate to severe CSU refractory to antihistamines. Disease activity was assessed using the urticaria activity score over the last 7 days (UAS7). After 24 weeks of treatment, 91% of patients showed complete remission (UAS7 = 0) or good control (UAS7 7) of CSU. Omalizumab was re-administered in 45 patients because of recurrence of moderate to severe symptoms at week 8 after treatment discontinuation or later, and clinical results achieved with retreatment were similar to those observed in the first course. Among the parameters included in our analysis (age and sex of patients, documented history of atopy or autoimmune thyroid disease, CSU duration and baseline severity, concurrent angioedema, and association with chronic inducible urticaria), none was associated with response to omalizumab in our study population. Similarly, these parameters did not significantly differ between patients who experienced CSU relapse and those without relapse. Predictors of response to omalizumab treatment in CSU patients are still unclear, and further studies are needed to evaluate the presence of baseline factors that can influence treatment outcome.

The international EAACI/GALEN/EDF/WAO guideline suggests a stepwise approach for the therapeutic management of chronic spontaneous urticaria (CSU), outlined in an algorithm. The aim of this article is to summarize and review the evidence available on alternative treatment options for CSU outside of this algorithm.Although CSU is a common disease, there are a limited number of high-quality studies, and only antihistamines and omalizumab are licensed for its treatment. Most studies regarding alternative therapies for CSU show methodological limitations and a high risk of bias. For many therapies, only case reports and uncontrolled studies exist. Recent publications on alternative treatments for chronic urticaria/CSU include reports on the use of adalimumab, rituximab, vitamin D, probiotics, histaglobulin, injection of autologous whole blood or serum, and phototherapy.Numerous treatments beyond the guideline algorithm have been evaluated in patients with refractory CSU. The global level of evidence to support their efficacy in CSU is low or very low. Further research is needed to assess the efficacy and safety of alternative therapies of CSU to manage adequately those patients who do not respond to the treatments included in the algorithm.

Actinic cheilitis (AC) is a common premalignant condition that requires an effective treatment to reduce the risk of malignant transformation. Photodynamic therapy (PDT) has been recently added to the armamentarium available for AC treatment. Daylight PDT (D-PDT) is a novel PDT modality in which the activation of the topical photosensitizer is induced by the exposure to natural daylight instead of artificial light sources without preliminary occlusion. This simplified procedure was found to be more tolerated as compared to conventional PDT. We report our preliminary experience on the use of D-PDT using methyl-aminolevulinate cream in 10 patients with refractory AC of the lower lip. Patients received two consecutive D-PDT sessions with an interval of 7-14 days. At 3 months after therapy, a complete response was observed in seven patients, with sustained results in five patients over an observational period of 6-12 months. Treatment was well tolerated.

L’orticaria e una risposta infiammatoria della cute e delle mucose a stimoli di vario tipo (Henz et al., 1998; Cassano e D’Argento, 1999; Patrizi et al., 2001). Da un punto di vista clinico e caratterizzata dalla presenza di pomfi, rilievi solidi circoscritti, di colorito dal rosa pallido al rosso acceso, che possono comparire in qualsiasi sede cutanea e avere numero, forma e dimensioni variabili. Nei bambini hanno una maggiore tendenza ad assumere morfologia bizzarra e figurata. I pomfi si associano a sintomatologia pruriginosa, che e talora assente nei bambini, soprattutto nei primi mesi di vita. Tipicamente i pomfi sono fugaci, risolvendo in genere in poche ore (comunque non oltre le 24), senza lasciare alcun reliquato. E tuttavia possibile nei bambini molto piccoli osservare esiti lievemente ipercromici legati a modesto stravaso ematico.

Cutaneous lymphangioma circumscriptum (CLC) is clinically characterized by clusters of translucent vesicles that may be filled by blood.To evaluate the dermoscopic features of CLC.Dermoscopic examination was performed in two cases presenting with discrete translucent and blood-tinged lesions.Lesions filled with clear fluid were dermoscopically characterized by light brown lacunas surrounded by paler septa. Lesions tinged with blood were associated with different dermoscopic features depending on the amount of blood content: focal reddish areas inside the lagoons, pink diffuse coloration, reddish to violaceous lacunar structures.On dermoscopy, CLC was characterized by a lacunar pattern. Lesions with a marked hematic content show dermoscopic findings indistinguishable from those of hemangioma.

Radiation therapy can cause acute and chronic damage of the skin.A 71-year-old woman presented with an atrophic and sclerotic plaque at a site previously treated with radiotherapy because of lung cancer. Inside the area affected by chronic radiodermatitis, she reported that a preexisting pigmentary lesion had gradually undergone morphologic changes after radiation therapy.On dermoscopy, the lesion showed features highly suspicious for malignant melanoma. The lesion was excised and examined histopathologically.The histopathologic diagnosis was compound congenital melanocytic nevus associated with prominent dermal sclerosis and epidermal atrophy.The existence of melanocytes within an atrophic and fibrotic area is a finding typically associated with recurrent or persistent melanocytic lesions. It is likely that the "pseudomelanoma" features of the lesion observed in our patient might have been secondary to the skin changes induced by radiation therapy.

The study of specific differences between women and men is arousing huge interests in various fields of medicine, including dermatology. The available data on gender medicine applied to common skin diseases are unfortunately still scanty. Psoriasis is a chronic immunemediated skin disease which affects 1%-3% of most populations worldwide and can involve also the joints and entheses. The pathogenesis of the disease is very complex, resulting from the interaction between genetic predisposition and several environmental triggers. The pathogenic role of sex hormones has also been hypothesized. The analysis of gender-specific differences in psoriasis seems to suggest some interesting findings, such as an earlier age of disease onset in females, a higher probability of severe disease in men, or different tendencies in care utilization, adherence to treatment, development of psychological distress, and coping strategies. Moreover, sex-related differences have been recently described in some epidemiological and clinical features among patients with psoriatic arthritis. The objective of this article is to review briefly the available evidence regarding gender differences in various aspects of psoriasis, such as epidemiology, genetics, risk factors, associated conditions, quality of life, clinical and therapeutic aspects.