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Clinical Cases in Adolescent Dermatology Springer

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Clinical Cases in Adolescent Dermatology

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Adelphi University

Chapter 1 A 13 Years Old Female with Refractory Purpura Kenan Barut, Defne Özkoca, and Zekayi Kutlubay A 13-year-old female applied to the outpatient clinic complaining of bruising on the upper extremities for 2 months. Her medical history and family history were unremarkable. She has no hist...

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clinical cases in adolescent dermatology
a 13 years old female with refractory purpura

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Clinical Cases in Dermatology
Series Editor: Robert A. Norman

Torello M. Lotti
Fabio Arcangeli Editors

Clinical Cases
in Adolescent
Dermatology

,Clinical Cases in Dermatology
Series Editor
Robert A. Norman, Tampa, FL, USA

,This series of concise practical guides is designed to facilitate the clinical decision-
making process by reviewing a number of cases and defining the various diagnostic
and management decisions open to clinicians.
Each title is illustrated and diverse in scope, enabling the reader to obtain relevant
clinical information regarding both standard and unusual cases in a rapid, easy to
digest format. Each focuses on one disease or patient group, and includes common
cases to allow readers to know they are doing things right if they follow the case
guidelines.

More information about this series at http://link.springer.com/series/10473

,Torello M. Lotti • Fabio Arcangeli
Editors

Clinical Cases in Adolescent
Dermatology

,Editors
Torello M. Lotti Fabio Arcangeli
Dermatology University of Rome “G.Marconi”
University of Rome “G.Marconi” Rome, Italy
Rome, Roma, Italy

ISSN 2730-6178 ISSN 2730-6186 (electronic)
Clinical Cases in Dermatology
ISBN 978-3-030-91525-4 ISBN 978-3-030-91526-1 (eBook)
https://doi.org/10.1007/978-3-030-91526-1

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

,Contents

1 A 13 Years Old Female with Refractory Purpura�� 1
Kenan Barut, Defne Özkoca, and Zekayi Kutlubay
2 A 16-Year-Old Boy Developing Lesions on His Tattoo �� 5
Indrashis Podder, Debatri Datta, and George Kroumpouzos
3 A Boy with Reticular Lesions on His Waist and Back�� 9
Bei-xue Jiang and Lin Dang
4 A Disseminated Papulonodular Eruption in a
15-Year-Old Male with Aplastic Anemia�� 13
Ana Sofia Pereira, Rebeca Calado, Joana Azevedo,
and Leonor Ramos
5 A Red Plaque on the Cheek in a 12-Year-Old Girl �� 17
Hong-Mei Zhou, Li-Hong Zhao, and Songmei Geng
6 A Teenager with Refractory Erythroderma�� 21
Tong Zhou and Song-Mei Geng
7 A Young Boy with Hyperpigmented
and Hypopigmented Macules�� 27
Jingang An and Songmei Geng
8 Adolescent Female with Brown Papules and Peculiar Nails�� 33
Adelina-Maria Sendrea, Mariana Diana Tatomir,
Sabina Andrada Zurac, Razvan Andrei,
and Carmen Maria Salavastru
9 An Adolescent with Recurrent Eczematous Lesions�� 41
Raffaele Brancaccio, Giuseppe Ruggiero, Stefano Belletti,
and Vincenzo Patella

v

,vi Contents

10 An Unusual Coincidence of Alopecia Areata with
Trichotillomania in a Child with Osteogenesis Imperfecta�� 45
Cinthia C. D. Thamrin, Lili Legiawati, Larisa Paramitha Wibawa,
Lis Surachmiati, and Irma Bernadette S. Sitohang
11 Deep Red Macules in a Blaschkoid Distribution
in an Adolescent Male�� 49
Sabha Mushtaq, Erdinc Terzi, and George Kroumpouzos
12 Ecchymotic Lesions on the Left Foot in a 14-Year-Old Child�� 53
Cristina Malvasio, Giuseppe Ruggiero, and Fabio Arcangeli
13 Erythema Annulare Centrifugum Mimicking Tinea
Cruris on Child with Acute Myeloid Leukemia�� 57
Irmadita Citrashanty, Yuri Widia, Sawitri, Iskandar Zulkarnain,
and Made Putri Hendaria
14 Erythematous Plaques with Central Atrophy on Lower
Limbs in Young Woman�� 61
Valeria Evangelista, Annalucia Virdi, Giulia Veronesi,
Miriam Leuzzi, and Iria Neri
15 Erythrodermic Psoriasis in Pediatric Age �� 65
Sarah Diba, Nopriyati Husan, and Tiar Marina Octyvani
16 Generalized Hypopigmented Macules and Verrucous
Papules in Three Siblings�� 69
Shashank Bhargava and George Kroumpouzos
17 Generalized Molluscum Contagiosum in a Young Girl�� 73
Luh Made Mas Rusyati, Ketut Kwartantaya Winaya,
and Marrietta Sugiarti Sadeli
18 Leprosy in Pediatric Age �� 77
Luh Made Mas Rusyati, Ni Luh Putu Ratih Vibriyanti Karna,
Prima Sanjiwani Saraswati Sudarsa, and Marrietta Sugiarti Sadeli
19 Localized Acquired Alopecia over the Mental Area of Chin�� 81
Hassan M. Abdel Aziz and Mohamed L. Elsaie
20 Low-Birthweight Dwarfism with Features Include
Cranio-Facial Disproportion, Facial Dysmorphia,
Lateral Asymmetry and Clinodactyly�� 85
Piotr Brzezinski and Katarzyna Borowska
21 Multifocal Erythematous Plaques Complicated
by Ulceration on the Face and Upper Extremities in a Child�� 89
Shashank Bhargava and George Kroumpouzos

,Contents vii

22 Multiple Papular and Nodular Facial Lesions�� 93
Mohamed Saeed Mohamed, Shady M. Ibrahim,
and Mohamed L. Elsaie
23 Nail Dystrophy in a Teenager�� 97
Sabha Mushtaq
24 Necrotic and Vesicular Lesions after Sun Exposure �� 101
Annalisa Franch and Fabio Arcangeli
25 Non-Pseudomonal Ecthyma Gangrenosum Resembling
Pyoderma Gangrenosum on Malnourished Child
with End Stage Renal Disease�� 107
Made Putri Hendaria, Yuri Widia, Sawitri, Iskandar Zulkarnain,
and Irmadita Citrashanty
26 Norwegian Scabies in Patient with Down Syndrome�� 111
Satya Wydya Yenny, Tutty Ariani, and Dwi Sabtika Julia
27 Painful Herpetiform Aphthous Ulcers in the Oral Mucosa
in a 15-Year-Old Man�� 115
Virginia Botta Tommei, Francesco Bartoli, and Torello M. Lotti
28 Painful, Violaceous, Woody Mandibular Nodule
in a Healthy Teenager�� 119
Carmen Maria Salavastru, Adelina-Maria Sendrea,
Claudiu Socoliuc, and Alexandra Bastian
29 Skin Pigmentation at Angle of the Mouth�� 125
Mohamed L. Elsaie, Mohamed Saeed Mohamed,
and Shady M. Ibrahim
30 Subcutaneous Nodular Lesion of the Lumbar Area �� 129
Amalia Licordari and Fabio Arcangeli
31 Tuberous Sclerosis Complex with Clinodactyly�� 135
Srie Prihianti Gondokaryono, Argani Gracias Pospos,
R. M. Rendy Ariezal Effendi, Reiva Farah Dwiyana,
and Inne Arline Diana
32 Vascular Lesion on the Hand�� 143
Erdinc Terzi, Aliye Ceyla Ozbayoglu, Umit Türsen,
and Sedat Altın
33 Vulvar Ulcers in a Young Girl �� 147
Maurizio Parisi and Fabio Arcangeli

Index�� 153

,Chapter 1
A 13 Years Old Female with Refractory
Purpura

Kenan Barut, Defne Özkoca, and Zekayi Kutlubay

A 13-year-old female applied to the outpatient clinic complaining of bruising on the
upper extremities for 2 months. Her medical history and family history were unre-
markable. She has no history of trauma or allergies. Her childhood vaccinations
were performed on time. The dermatological examination revealed multiple ecchy-
motic red-brown macules with irregular and indistinct borders located especially on
upper extremities, shown in Fig. 1.1. She had no other cutaneous pathology and her
other system physical examinations were completely normal. She was consulted
with pediatric rheumatology as well. According to the consultation note, her weight
and height were in accordance with her age; and there were no signs of physical or
sexual abuse. Her usual biochemistry was completely normal; she had no laboratory
results suggestive of anemia, infection or inflammation. Keeping the pandemia in
mind, her Anti SARS-Cov-2 serology tests were requested: Anti SARS Cov-2 IgM
was negative but Anti SARS Cov-2 IgG was positive (3.6) (N < 1). Furthermore,
D-dimer was 0.28 mg/L, C3 was 1.06 g/L (N), C4 was 0.19 g/L (N), antinuclear-
antibody was negative, Anti Ds DNA was negative, Anti MPO was negative and
Anti PR3 was negative.
Based on the case description and the photograph, what is your diagnosis?

K. Barut
Department of Pediatric Rheumatology, Cerrahpaşa Medical Faculty, İstanbul University-
Cerrahpaşa, Dalı İstanbul, Turkey
e-mail:
D. Özkoca · Z. Kutlubay (*)
Department of Dermatology and Venerology, Cerrahpaşa Medical Faculty, İstanbul
University-Cerrahpaşa, Dalı İstanbul, Turkey

© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2022
T. M. Lotti, F. Arcangeli (eds.), Clinical Cases in Adolescent Dermatology,
Clinical Cases in Dermatology, https://doi.org/10.1007/978-3-030-91526-1_1

, 2 K. Barut et al.

Fig. 1.1 Multiple
ecchymotic red-brown
macules with irregular and
indistinct borders located
on the left upper extremity

• Urticarial vasculitis
• Child abuse
• Microvascular Angiopathy of SARS-Cov-2
• Henoch Schönlein Purpura
• Erythema multiforme
Diagnosis Microvascular Angiopathy of SARS-Cov-2.

Discussion

The SARS-Cov-2 pandemia started in Wuhan, China in December 2019. The initial
cases had pneumonia with respiratory distress, and thus the disease was named as
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. Soon, the dis-
ease spread worldwide and cutaneous manifestations started to be reported. Initially,
non-dermatologist physicians reported the rate of cutaneous manifestations as 0.2%
[2], yet, with the involvement of dermatologist in the care of SARS-CoV-2 patients,
the reported rate of cutaneous manifestations has risen up to 20.4% [1]. The

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