Background: Alopecia areata (AA) is an autoimmune disorder characterized by nonscarring alopecia affecting scalp and body hair. Treatment of AA in pediatric age group is challenging because of unpredictable course, uncertain natural history, potential side effects of medicines, and psychological morbidity. Moreover, no clear guidelines for treatment of pediatric AA are available. Objective: The objective of this study is to assess efficacy and safety of a combination treatment of extensive and recalcitrant AA with oral and topical steroids with topical minoxidil. Materials and Methods: Sixteen children (nine girls and seven boys) aged 6–15 years with severe and recalcitrant AA were included in this study. All were prescribed the regimen of combination of oral and topical steroid with topical minoxidil 2% solution. Oral steroid was tapered over 12 weeks, and topical steroid was withdrawn at the end of 24 weeks. Patients were maintained on topical minoxidil for next 9–12 months and closely followed up. Results: The average age of participants was 10.81 years, and the duration of disease was ranged from 3 months to 30 months. Response to our regimen was good in cases of extensive AA and ophiasis, compared to alopecia totalis. The participant having alopecia universalis did not respond at all to the regimen. Participants tolerated the regimen well with mild and easy to manage side effects and only few relapses. Conclusion: Finding an effective and safe treatment regimen for AA, especially in children is difficult. Our regimen allows for more rapid lowering of oral doses with maintaining the cosmetic response and minimizing the side effects. Therefore, a trial course of this regiment would seem to be a reasonable approach for nearly hopeless but highly motivated pediatric patients of extensive and recalcitrant AA.

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Bronze baby syndrome is a dark brown pigmentation of skin occurring sometimes following phototherapy. No specific treatment is required, as the pigmentation spontaneously disappears after the discontinuation of phototherapy. A 12-day-old neonate with dark brown pigmentation of skin was referred as cyanotic heart disease with the mass in the liver for emergency surgical removal. Infant was found to have conjugated hyperbilirubinemia. Workup was performed for the possible causes. Infant was diagnosed to have extra-hepatic biliary atresia. Dark brown pigmentation should not be interpreted as cyanosis. Always rule out the underlying causative liver disease.

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The term Annular Erythema encompases a great number of entity which commonly present as annular lesions. Differention of one from another is sometimes difficult. Consideration of different aspects such as age, sex, onset, duration etc of these so called less discussed entities as well as clinic-pathological correlation is required to solve the puzzle. We brought about a concise yet lucid review of annular erythema compraising salient features of each entity. We also went through extensive literature search to highlight latest updates and scientific information of the same.

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Erythrokeratodermia variabilis (EKV) are a rare heterogeneous group of inherited cornification disorders. They are characterized by two distinct morphological types of skin lesions: Fixed hyperkeratotic plaques and sharply marginated, pruritic, and migratory erythematous lesions. We report three cases of EKV along with a review of literature.

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Ichthyosis hystrix (IH) is a rare, genetically, and clinically heterogeneous group of ichthyosiform dermatoses characterized by spiny hyperkeratotic scales. It is inherited either as an autosomal dominant or a sporadic variety. The phenotypic expression varies from a severe generalized involvement to localized and nevoid forms. The incidence of this disorder has not been reported in the literature. We report a sporadic case of IH involving neck, trunk, and extremities with increased scaling over the flexural aspects which is a rare presentation of this rare disease.

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Michelin tire baby syndrome (MTBS), is a rare genodermatosis, characterized by generalized folding of excess skin and may be associated with various phenotypic abnormalities. The pathogenesis of this condition is unclear. Various congenital anomalies can be associated with it. It may be a clinical finding associated with various syndromes. Diagnosis is mainly clinical, and skin folds gradually diminish and disappear with age without any intervention. Here, we report a case of MTBS associated with convergent squint and hydrocephaly.

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Rubella, though a mild, vaccine-preventable disease, can manifest with severe teratogenic effects in the fetus due to primary maternal rubella infection. A case of a full-term neonate with blueberry muffin lesions and classical as well as rare systemic features of Gregg syndrome is reported.

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Introduction: A variety of lesions which may be transient, physiological, or pathological may be present during the neonatal period. However, most of these conditions are benign and self-limiting. Objective: To study the hospital-based incidence and clinical pattern of dermatoses during the early neonatal period. Methods: A hospital-based, cross-sectional study was conducted in a government hospital. A total of 1260 consecutive live babies delivered over a period of 1 year at the Department of Obstetrics and Gynecology were examined up to 7 days of extrauterine life. Results: Among 1260 newborns, 1242 (98.5%) had cutaneous lesions. Among them, 700 (55.5%) were males and 560 (44.4%) were females. Of these, 1119 (88.1%) weighed >2.5 kg, whereas 141 (11.9%) weighe<2.50 kg. 1176 (93.3) were born at term, 66 (5.3%) were preterm, and 18 (1.4%) were postterm. History of consanguinity was present in 211 (16.7%) cases. 817 (64.8%) newborns were delivered by normal vaginal route and 443 (35.1%) by cesarean section. Majority, i.e., 764 (60.6%) mothers were in the age group of 21–25 years, 318 (25.23%) below 20 years, 162 between 26 and 30 years (12.86%), and 16 (1.26) were more than 30 years. Mongolian spot, milia, sebaceous hyperplasia, erythema toxicum, and physiological scaling were the common physiological and transient dermatoses seen. A few pathological conditions such as Waardenburg syndrome and bathing trunk nevus were seen. Conclusion: The hospital-based incidence of neonatal dermatoses was 98.5% with no sexual predilection. Although common, most of the skin lesions in newborn are self-limiting requiring no treatment. Correct diagnosis and counseling the parents may relieve the anxiety and mental trauma.

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Condyloma acuminata (also known as anogenital warts or venereal warts) a sexually transmitted disease (STD) is usually seen in younger adults. However, genital warts have been reported in all age groups of children including infants. The possibility of sexual abuse is a major concern in the evaluation of children with genital warts. We hereby report a case of genital warts in a three year old female child.

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Mastocytosis is a group of a disorder characterized by infiltration of mast cell in various organs, e.g. skin, bone marrow, liver, spleen, gastrointestinal tract, lymph node, etc., The term bullous mastocytosis is generally used to describe the varieties of mastocytosis manifested with predominantly cutaneous vesico-bullous lesions and the more commonly represents the diffuse cutaneous form. We report a case of diffuse cutaneous mastocytosis (bullous mastocytosis) in a 6-month-old child.

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Background: Vitiligo is a systemic autoimmune disease due to the loss of melanocytes from the epidermis. Very few reports in the literature are available about the ocular findings and associated cutaneous abnormalities in childhood vitiligo. Aims: Objective of this study was to evaluate the ocular findings, various clinical characteristics and associated cutaneous abnormalities of childhood vitiligo. Materials and Methods: We retrospectively analyzed the clinical data of children with vitiligo who presented to the Dermatology Outpatient Department from August 2011 to August 2014. All patients were assessed for the natural history, clinical characteristics, family history, and associated ocular and cutaneous abnormalities. Results: Of the total 180 children with vitiligo studied, 64 (35.6%) were boys and 116 (64.4%) were girls. The mean current age of the children visiting our hospital was 8 years. History of trauma prior to the onset of vitiligo was present in 13 patients (7.2%). The family history of vitiligo was present in 37 patients (20.6%). Most common clinical type of vitiligo seen in our patients was vitiligo vulgaris (n = 68, 37.8%), followed by segmental (n = 41, 22.8%). The most common site of initial lesion was head and neck followed by lower limbs. Leukotrichia was seen in 65 patients (36.1%), while Koebner phenomenon was observed in 48 children (26.7%). Vitiligo disease activity (VIDA) score of +4 was most commonly seen in 108 patients (60%), followed by +3 seen in 20 patients (11.1%). VIDA score 0 and −1 were seen in 15 (8.3%) and 22 (12.2%) patients, respectively. Cutaneous associations with vitiligo were found in 24 patients (13.3%). These were halo nevi in nine patients (5%), atopic dermatitis in six patients (3.3%), alopecia areata in four patients (2.2%), premature canities in three patients (1.7%), and nevus depigmentosus and lichen nitidus in one patient each (0.6%). Thirty-eight patients (21.1%) were found to have periocular depigmentation. Depigmented spots in the iris were seen in two patients (1.1%). Other findings were lamellar cataract and persistent papillary membrane in one patient each (0.6%). Conclusion: Childhood vitiligo in our study showed preponderance in females. Majority of patients (77.9%) had <5% body surface area involvement. Limited number of patients with ocular findings in comparison with adult population might suggest that childhood vitiligo patients do not have ocular pigmentary abnormalities in the beginning, but as they age or as the disease progresses they may develop ocular pigmentary changes. Anatomical localization of vitiligo to periorbital area may alert us to look for ocular findings.

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Porokeratosis is a heterogeneous disorder of keratinization usually inherited in an autosomal dominant pattern. It usually affects the trunk and extremities. Lesions exclusively present over face are rare and not well-documented. We present a case of linear porokeratosis along the blaschkoid lines over the face in a 9-year-old girl.

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Introduction: Cutaneous lesions are very common in pediatric HIV infection, and many of the dermatoses are linked to the underlying levels of CD4 counts. Aims: The primary aim was to study the clinico-epidemiological patterns of dermatoses in pediatric HIV infection, and the secondary aim was to ascertain if any dermatoses is a marker of HIV infection. Materials and Methods: This is a retrospective descriptive, 1-year study. All data regarding the clinico-epidemiological features of pediatric HIV patients in the study period were analyzed. Results: There were 65 patients in this study, comprising 44 males (67.69%) and 21 females (32.31%). The age group 7–12 constituted the maximum number of cases, 35 (53.84%). Parental to child transmission was the most common mode of transmission seen in 54 patients, (83.07%). Cutaneous manifestations were seen in 43 patients (66.15%). Exaggerated insect bite reaction (IBR) was the most common cutaneous manifestation seen in this study accounting for 19 patients (29.23%), with a mean CD4 count in patients in the age group 1–5 being 425 cells/mm³ and 212 cells/mm³ in the age group 6–12. Conclusions: IBR in pediatric HIV infection indicates very low CD4 counts and in the absence of other caused for immunosuppression can be a marker of HIV infection.

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Macrocephaly with cutis marmorata telangiectatica congenita (M-CMTC) is a cutaneous disorder often accompanied by additional anomalies, most commonly segmental overgrowth. Recently, a clinically discrete condition has been described comprising CMTC and congenital macrocephaly together with pre- and post-natal macrosomia, segmental overgrowth, central nervous system malformations, connective tissue abnormalities, and intellectual handicap. We describe the natural history of M-CMTC syndrome of an 11-month-old female child first born of nonconsanguinous marraige brought to us with complaints of delayed development, asymmetric swelling over the body, and progressively increasing head size. On examination, we found macrocephaly, frontal bossing, segmental hypertrophy of right side of face, left side of upper limb and right side of lower limb, multiple hemangiomas over philtrum and nape of neck, cutis marmorata over bilateral upper limbs, hypotonia, laryngomalacia, bilateral syndactyly, hyperextensibility of joints, and magnetic resonance imaging showing arrested hydrocephalus; all these features fitting into a rare disorder known as M-CMTC. M-CMTC is a multisystem disorder and a team of specialist pediatrics, dermatology, neurology and radiology is needed to diagnose and treat such patients.

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Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare and idiopathic disorder of blood vessels which is common in head and neck area of middle-aged women. We report a case of angiolymphoid hyperplasia of lower lip in a 7-year-old child, confirmed by histopathological findings of hyperplastic lymphoid follicles, eosinophilia, and proliferation of vessels and positive staining with CD3 and CD20 in immunohistochemistry. Lesion was treated with imiquimod for 16 weeks following which it resolved completely. We present this case for the rarity of the case in this age group on an atypical rare site. To the best of our knowledge, this is the first reported case of ALHE on oral mucosa of a male child.

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Histoid leprosy is a clinical variant of nodular form of lepromatous leprosy. De novo histoid leprosy in children is a rare clinical presentation. We hereby report a case of a 12-year-old child presenting with lesions of histoid leprosy.

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Becker's nevus is an epidermal nevus presenting as hyperpigmented macules. Onset in infancy, bilateral distribution, location on forearms, and associated neurological manifestations makes this case of Becker's nevus worth reporting.

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Down syndrome (DS), or trisomy 21, is the most common chromosomal disorder. DS has been associated with autoimmune diseases including autoimmune thyroiditis, Type 1 diabetes mellitus, celiac disease, autoimmune chronic active hepatitis, alopecia, vitiligo, hypoparathyroidism, psoriasis, and psoriatic arthritis. To our knowledge, we herein report the first concurrence of psoriasis and Hashimoto's thyroiditis in an individual with DS, emphasizing the predisposition of DS individuals to autoimmune diseases.

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Keratosis follicularis spinulosa decalvans (KFSD) is a rare disease with unknown etiology. It clinically presents with diffuse follicular hyperkeratosis of scalp which progress to atrophy, cicatricial alopecia, and photophobia. The lesions start in chilhood and an aggrevasion occurs after puberty by the development of scalp pustules with bacterial infection and causes both functional and cosmetic discomfort. Here, we report a Cypriot girl that diagnosed KFSD that do not have any family history.

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Kaposiform hemangioendothelioma is a rare, potentially life-threatening vascular tumor often associated with a coagulopathy known as Kasabach–Merritt phenomenon (KMP). We report the case of an infant with satellite lesions around a large vascular tumor and associated KMP.

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Kindler syndrome is a rare autosomal recessive disorder associated with skin fragility. It is characterized by blistering in infancy, photosensitivity, and progressive poikiloderma. The syndrome can also involve mucous membrane, eyes, bones, and rarely nails. We report the case of an adolescent female patient with characteristic features of Kindler syndrome and striking presence of long and thick cuticle of nails, which has been rarely reported.

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