Background: Vitiligo is a depigmenting and psychologically devastating disorder. Childhood-onset vitiligo has different epidemiological and clinical characteristics as compared to adults. Aim: To study the clinical and epidemiological characteristics of childhood vitiligo. Materials and Methods: First 100 pediatric patients younger than 18 years, with vitiligo who attended the Pediatric Dermatology Clinic of Victoria Hospital, Bangalore Medical College, Bangalore, India, between April 2013 and December 2013 were included in the study. A detailed history and examination along with autoimmune diseases, laboratory parameters, and vitiligo disease activity score (VIDA) score were recorded. Results: In the 100 patients who attended pediatric dermatology OPD in 9 months duration of the study, we had 55 female patients (55%) and 45 male patients (45%). The mean age at onset was 8.92 years (ranging day 1-16 years), with duration of disease varying from 2 months to 8 years with mean duration of 1.36 years. According to standard classification most common pattern of vitiligo was vulgaris (46%), followed by focal (36%), mucosal (8%), acro-facial (7%), segmental (3%). The most common site for vitiligo was lower limb (62%), followed by face (46%), upper limbs (30%), scalp (25%), and mucosal (18%). Segmental vitiligo was seen in 3% and nonsegmental vitiligo in 97%. VIDA score +4 was most common and was seen in 81%. Conclusion: Vitiligo is a common depigmenting disorder with vulgaris being the most common pattern and lower limbs being the most common site seen in pediatric patients. Autoimmune associations were more frequent in nonsegmental vitiligo. Among the cutaneous associations, atopic dermatitis was most frequently encountered. Patients with family history of autoimmune disorders tend to present at an early age.

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Acne can be classified into neonatal acne, infantile acne, mid-childhood acne and prepubertal acne depending on the age of onset. There is limited literature available on acne in pediatric age group. This article provides an overview of clinical presentation and pathogenesis of acne in children and proposes therapeutic guidelines.

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Pigmentary mosaicism is a spectrum of disorders characterized by dyspigmentation along the lines of blaschko and other patterns such as phylloid, checkerboard and patchy pigmentation without midline separation. This group of disorders may be associated with or without systemic abnormalities. Pigmentary mosaicism includes hypomelanoses of Ito, linear and whorled nevoid hypermelanosis, phylloid hypo- and hypermelanosis and pigmentary mosaicism of both hypopigmented and hyperpigmented type. We describe a case of pigmentary mosaicism with constellation of multiple extracutaneous abnormalities.

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Background: Bullous disorders are a complex group of disorders which continue to be an enigma and a challenge to the medical profession in general and the dermatologists and pediatricians in particular. Due to the delicacy of child's skin, factors of immunobiological response and many other extrinsic and intrinsic factors, the clinical manifestations of cutaneous disorders in children often differs from those in adults. Aim: The present study aims to know the clinical pattern and to assess the observations as a diagnostic means to detect different vesiculobullous disorders and to find out their prevalence in that age group. Materials and Methods: The study group comprises children in age group between 0 and 14 years, presenting with intact blisters attending the Skin and VD outpatient Department, SCB Medical College and Hospital, Cuttack and the cases referred from the Department of Medicine and Surgery. All cases were evaluated by means of standard proforma which included a detailed history, thorough clinical examination with appropriate investigations where ever required. Results: Overall male:female incidence was 3:2. Children in the age group of 1-6 years showed maximum incidence (48/100) of the vesiculobullous diseases, Impetigo being the most common vesiculobullous disease with the highest incidence of 42%. Chronic bullous disease of childhood (CBDC) came out to be the most common immunobullous disease with the incidence of 7% closely followed by dermatitis herpetiformis (DH) (6%). Mucosal involvement was predominantly seen in pemphigus vulgaris, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), while other diseases presented with either skin or both skin and mucous membrane involvement. Lesions in herpes simplex were seen confined to the face. Varicella, herpes simplex, CBDC and DH presented with tense blisters whereas pemphigus group, SJS, and TEN presented with flaccid lesions, with raw areas and crusting seen in all the diseases. Toxic features were encountered in varicella, pemphigus, TEN.

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Blepharitis is a chronic inflammatory process of the eyelid margin that fluctuates in severity with periods of exacerbations and remissions. Burning sensation, irritation, tearing, photophobia, blurred vision and red eyes are the common symptoms associated. Blepharitis has been categorized into anterior and posterior blepharitis. Blepharitis can coexist with various dermatological conditions, and the patients may present with a wide array of signs and symptoms. Various types of blepharitis can often be differentiated on the basis of the appearance of the eyelid margins. Blepharitis is difficult to manage due to uncertain etiology and considerable overlap of symptoms that adds to its misdiagnosis. We present a typical case of ulcerative blepharitis in a child with atopic dermatitis, to highlight the association of candidiasis as the cause of ulcerative type of blepharitis in atopics.

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Background: Management of vitiligo in children is difficult as therapeutic options are restricted when compared to that in adult patients. Selection of treatment should be careful in these patients with the aim to achieve best results with minimal side effects. Only few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in children with vitiligo. Aims: The purpose of this study was to know the efficacy and safety of NBUVB in children with vitiligo of age group ranging from 3 to 16 years. Methods: Twenty-eight patients (12 males, 16 females), aged 3-16 years with vitiligo were included in the study between years 2011 and 2013 and were treated twice weekly with NBUVB. The starting dose was 150 mJ/cm ² in children, with 20% dose increments at each subsequent visit given for a maximum period of 1-year and were followed-up for another 12 months for stability of repigmentation. Results: Analysis of our study showed that a majority of our cases, 22 (78.6%) had > 75% to complete repigmentation, about 4 (14.2%) achieved 26-75% moderate repigmentation and 2 (7.2%) had < 25% mild repigmentation. Adverse effects were transient and minimal. Only one child developed depigmentation of repigmented sites during 1-year follow-up. Conclusion: Our study proves that NBUVB therapy is safe and effective tool in the management of childhood vitiligo, with good stability of repigmentation.

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The antiphospholipid (APL) antibody syndrome is an autoimmune conditions characterized by recurrent thromboembolic events. The exact incidence of its occurrence in the pediatric age group in Indian population is not known. Due to the higher incidence of infections in this age group there is a higher incidence of APL antibodies (APLAs) while the patients are asymptomatic, thereby making the establishment of diagnosis challenging. Secondary APL antibody syndrome is associated with underlying systemic lupus erythematosus. Due to the higher incidence of positivity of APLAs in children it is advised to conduct the diagnostic tests twice. Varying cutaneous features and lack of adequate awareness regarding the presenting signs and symptoms in pediatric population makes the diagnosis difficult. There are no guidelines for the management of this condition in children and it is extrapolated from the guidelines used in the adults. Early detection of this condition helps in reducing morbidity and improving the care and management of the patient.

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Furuncular myiasis (FM) is a type of cutaneous myiasis, a human infestation by maggots of Diptera flies. Our patient presented with scalp lesions closely mimicking pyoderma of the scalp, only to reveal crawling larvae of Lucilia sericata. Though the patient was promptly managed, cicatricial alopecia as a tell-tale sign of FM remained.

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Ichthyosis follicularis alopecia photophobia (IFAP) syndrome (OMIM 308205) is a rare genetic disorder characterized by a triad of follicular ichthyosis, congenital atrichia of scalp and photophobia. Until date, only 40 patients have been mentioned in the worldwide literature. The management of this syndrome remains a daunting task because very few case reports have described interventions for treating various clinical features of this entity. We describe IFAP syndrome in an 18-month-old male child, who showed transient improvement in his cutaneous features with oral isotretinoin therapy.

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We present a case of 8 h old newborn girl with symmetrical, stellate type of truncal aplasia cutis congenita. She was the survivor twin as the other fetus died at gestational age of 13 weeks and 5 days.

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Loose anagen hair syndrome (LAHS) is due to a defective anchorage of the hair shaft to the follicle, resulting in retarded hair growth and diffuse or patchy alopecia. LAHS usually presents as diffuse alopecia in blonde girls, occurring as isolated cases but rarely in association with hereditary or developmental disorders. We report this case because of the unique presentation of LAHS in a dark-skinned male toddler as patchy alopecia in association with developmental delay.

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Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by tender polymorphous skin lesions, accompanied by fever and peripheral neutrophilia. Although it may be seen at any age, it most commonly occurs in women in the fourth and fifth decade. It is a relatively rare diagnosis in children. We report a 1-year-old boy with Sweet's syndrome following an upper respiratory tract infection.

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Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of low-grade malignant potential. Although rare, DFSP is especially challenging to recognize and diagnose in children. In children, the clinical appearance may be heterogeneous, and a high index of suspicion is necessary to avoid delays in diagnosis that can lead to further morbidity. Prompt and definitive treatment is essential based on the tumor's high rate of recurrence. Histologic examination, often with the use of appropriate immunostains, is necessary for diagnosis. Surgery with wide local excision or Mohs micrographic surgery is the mainstay of treatment.

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