Hydroa vacciniforme (HV) is a rare pediatric photosensitive dermatosis characterized by sun-induced recurrent lesions on exposed areas and subsequent atrophic scarring, with its pathogenesis remaining unclear. This report aims to improve clinicians' recognition of pediatric HV and provide practical references for its clinical diagnosis and management by detailing a typical case in a young child. We describe a 3-year-old male patient with recurrent erythema, blisters, erosion, crusts, and atrophic scars on the face, nasal dorsum, and auricles for over one year. His skin lesions worsened significantly after sun exposure, alleviated with strict photoprotection, and presented with obvious seasonal variations. A definitive diagnosis of HV was made based on the patient's typical clinical manifestations. The patient was treated with strict sun avoidance, oral vitamin B6, and topical fusidic acid, with notable clinical improvement during follow-up. This case highlights that the definitive diagnosis of pediatric HV relies on typical clinical manifestations combined with the exclusion of relevant differential diagnoses, which is crucial for the early identification and standardized management of this rare disease in young children.

Pustular rosacea is a rare chronic inflammatory disease whose prevalence increases with age. We report a case of an 8-year-old patient who presented with a 3-year history of recurrent papulopustular facial eruptions associated with severe burning sensation, primarily affecting the cheeks, nose, and chin, exacerbated by hot weather and swimming. His condition was misdiagnosed as psoriasis, eczema, food allergy, or acne with limited benefit from treatment other than temporary relief from glucocorticoids. Skin biopsy showed hyperkeratosis and vascular ectasia with neutrophilic microabscesses consistent with papulopustular rosacea. He was successfully managed with lifestyle modifications and medications including azelaic acid, metronidazole, and ambroxol hydrochloride resulting in significant improvement. Diagnosing rosacea can be challenging due to its overlap with other conditions. Early diagnosis and treatment are crucial to prevent complications like scarring, persistent erythema, and psychological distress while ensuring a better quality of life and sustained remission.

Mucormycosis ranks third among invasive mycoses after Candidiasis and Aspergillosis and is associated with high mortality. Its incidence has increased with the rising number of immunosuppressed patients. In developing countries, the most common predisposing factor is uncontrolled diabetes mellitus (DM), whereas in developed countries it is immunosuppressive conditions. To examine local epidemiological data, predisposing factors, diagnostic and therapeutic options and survival in our center eighty-six adult mucormycosis patients between 2000 and 2020 were retrospectively analyzed. Thirty-nine (45.35%) were male, 47 (54.65%) were female, and the median age was 52 years (IQR, 42.5-62). The most frequent clinical presentation was sinus involvement, observed in 77 cases (89.53%). Of these, 38 (44.18%) were sinonasal, 5 (5.81%) sinoorbital, 9 (10.47%) rhinocerebral, and 25 (29.07%) rhino-orbito-cerebral mucormycosis. The remaining 9 cases (10.47%) had pulmonary mucormycosis. Predisposing factors included hematologic diseases in 51 patients (59.30%), DM in 33 (38.37%), solid organ transplantation (SOT) in 7 (8.14%), and solid organ malignancy in 7 (8.14%). The most common symptoms were fever (70.93%), swelling around the eyes and face (51.16%), pain (40.7%), erythema (34.88%), nasal discharge (30.23%), and headache (25.58%). Most frequent physical examination findings were necrotic lesions in the oral cavity and sinuses (87.21%), ophthalmoplegia (29.07%), ptosis (26.74%), vision loss (25.58%), and proptosis (22.09%). In all cases, amphotericin B formulations were preferred as initial therapy. Patients who received combination therapy (n = 14), 13 used posaconazole (POS) + liposomal amphotericin B (L-AmB) and one patient used itraconazole (ITC) + L-AmB. POS was administered to 14 patients receiving sequential oral therapy. The median duration of amphotericin B therapy was 46.5 days (IQR, 14.7-84.5), and the median total duration of antifungal therapy was 46.5 days (IQR, 14.7-90.3). The most common adverse effect of amphotericin B formulations was hypokalemia [L-AmB 68.75%, amphotericin B deoxycholate (AmB-D) 54.84%, amphotericin B lipid complex (ABLC) 50%]. At least one surgical intervention was performed in 74.42% of cases. The 12-week mortality rate was 48.84%, overall mortality rate was 61.63%. In analysis advanced age [12-week: OR: 1.04 (95% CI: 1.01-1.07), p = 0.011; overall: OR: 1.04 (95% CI: 1.01-1.07), p = 0.026 respectively], coexistence of both hematologic disease and DM [12-week OR: 5.73 (95% CI: 1.16-28.33), p = 0.032] associated with mortality. No significant difference was observed in 12-week mortality between surgical and non-surgical patients (p = 0.107). In contrast, overall mortality was significantly higher in the non-surgical group (81.8% vs. 54.7%, p = 0.024). In univariable logistic regression analysis, surgical intervention was associated with a 73.2% reduction in the odds of overall mortality (OR: 0.268, 95% CI: 0.082-0.882, p = 0.030). In the multivariable logistic regression analysis, age was the only variable significantly associated with 12-week and overall mortality (respectively, p = 0.004 and p = 0.026). Each one-year increase in age was associated with an OR of 1.05 (95% CI: 1.02-1.09) for 12-week mortality and 1.04 (95% CI: 1.01-1.07) for overall mortality. In conclusion; our study showed that despite advanced diagnostic methods and antifungals, mortality remained high, sinus involvement was the most frequent involvement, surgical debridement increased survival, but increasing age was associated with poor prognosis.

Rosacea is a chronic skin condition with limited effective and well-tolerated treatment options. This study investigated the efficacy of 0.5% timolol maleate eye drops in treating facial rosacea lesions. A randomized, triple-blind, placebo-controlled clinical trial was conducted at Razi Hospital in Tehran, involving 42 participants diagnosed with erythematotelangiectatic rosacea (ETR). Participants were randomized to receive either 0.5% timolol maleate eye drops or a placebo (distilled water) administered once daily for 4 weeks. The participants were evaluated in three visits (at baseline, after 4 weeks of treatment, and 4 weeks after stopping treatment) using a Mexameter MX18 device (for lightness and erythema), Clinician Erythema Assessment Scale (CEA), Global Flushing Severity Score (GFSS), Patient Self-Assessment (PSA), and Visioface device (for ΔL and ΔE criteria). The primary outcome was the change in erythema severity, assessed by the Mexameter MX18 device. The timolol group significantly reduced Erythema Index (p < 0.001) and other secondary outcomes, including CEA, PSA, and GFSS. No significant adverse effects were reported. In addition, MANOVA revealed a significant time × group interaction across outcomes, indicating that the pattern of changes over time was significantly different between the intervention and placebo groups. This study provides preliminary evidence that 0.5% timolol eye drops could be an effective and well-tolerated treatment for facial rosacea. However, the small sample size and short follow-up duration limited our results.

A 55-year-old female patient exhibited erythematous nodular plaques on the right side of her face for more than 1 year. The dermatological examination identified mildly infiltrated erythematous patches, papules, and nodules varying in size from a wide bean to a coin on the right side of her face and nasal alae. Several nodules exhibited a yellow hue and coalesced, while the erythema presented a mildly annular configuration. The patient was diagnosed with sinus histiocytosis (Rosai-Dorfman disease) based on dermoscopy, reflectance confocal microscopy, and histopathological examination. The patient had previously had treatment at another hospital with thalidomide, methotrexate, hydroxychloroquine, and localized betamethasone injections, yielding disappointing outcomes. Subsequently, they pursued medical care at our hospital. Due to the inadequate response to the initial immunosuppressant treatment (thalidomide and methotrexate) over 2 weeks, fire needling was incorporated for an additional 2 weeks, leading to a modest improvement in the skin lesions. These treatments were then discontinued and replaced with oral tofacitinib monotherapy (5 mg twice daily), which resulted in marked regression of the skin lesions. Over a 4-month follow-up period, the skin lesions demonstrated significant flattening and fading, with no notable adverse effects observed. This case is the first report of the JAK inhibitor tofacitinib in the treatment of cutaneous Rosai-Dorfman disease, in conjunction with local fire needling intervention, providing a novel integrated therapeutic strategy combining traditional Chinese and Western medicine for refractory cases.

Horner's syndrome is a rare complication of thyroid surgery and is most commonly reported as a complication associated with lateral neck dissection. We present the case of a 46-year-old woman who developed a partial Horner's syndrome following hemithyroidectomy and central neck dissection, without lateral neck dissection. The patient underwent right hemithyroidectomy and central neck dissection for a TIRADS-5 nodule and developed right sided facial anhidrosis and absence of right-sided facial erythema on exertion 6 weeks post-operatively. No ocular involvement was detected. Neurologist review confirmed partial Horner's syndrome, which eventually resolved. The literature regarding development of Horner's syndrome as a complication of thyroid surgery without lateral neck dissection was reviewed via PubMed. All English language publications of adult patients developing features of Horner's syndrome after open thyroid surgery (hemithyroidectomy or thyroidectomy, +/- central neck dissection) were included. Twenty one cases of Horner's syndrome following thyroid surgery without lateral neck dissection were identified. Interestingly, only four of these cases featured anhidrosis, and no case reported asymmetrical facial erythema. Four possible mechanisms of cervical sympathetic chain dysfunction resulting in Horner's syndrome post-thyroidectomy have been proposed: neuropraxia from retraction; mass effect from post-operative haematoma; ischaemia-induced nerve damage; damage to communicating fibres during repeated inspection of the recurrent laryngeal nerve. To our knowledge, this is the only reported case of a post-thyroidectomy partial Horner's syndrome with associated asymmetrical flushing.

Rosacea is a chronic inflammatory dermatosis affecting the central face of adults, characterized by persistent erythema, flushing, papules, pustules, telangiectasias, and, in some cases, phymatous changes. Its pathogenesis involves a multifactorial interplay of immune dysregulation, neurovascular alterations, genetic predisposition, and disturbances of the skin and gut microbiota. Increasing interest in the gut-skin axis has prompted investigation into microbiota-targeted therapies, including probiotics, prebiotics, postbiotics, and synbiotics. This narrative review evaluates current evidence regarding the role of biotics in rosacea. A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science using combinations of the terms "rosacea," "gut-skin axis," "probiotics," "prebiotics," "postbiotics," and "synbiotics." Clinical trials, observational studies, and relevant mechanistic investigations published in English were considered. Available data suggest that certain probiotic strains, administered orally or topically, may improve inflammatory lesions, erythema, and skin barrier function, particularly as adjuncts to standard therapy. However, findings are characterized by significant heterogeneity in strains, dosages, study design, outcome measures, and treatment duration. Evidence supporting the use of prebiotics, postbiotics, and synbiotics in rosacea remains limited and, in many cases, extrapolated from related inflammatory conditions or preclinical models. Although microbiota modulation represents a promising therapeutic avenue, current evidence is insufficient to establish standardized clinical recommendations. Larger, well-designed randomized controlled trials with standardized endpoints and long-term follow-up are required to clarify their efficacy, optimal formulations, and safety.

Lupus erythematosus profundus, also known as lupus panniculitis, is a rare subtype of cutaneous lupus erythematosus characterized by inflammatory involvement of the deep dermis and subcutaneous adipose tissue. It is predominantly reported in adults, whereas pediatric presentations remain uncommon. A five-year-old Middle Eastern girl presented with a two-month history of progressive localized alopecia involving the left parietal scalp, associated with perioral swelling predominantly affecting the upper lip. Examination showed an alopecic patch measuring approximately 4 × 2 cm with reduced follicular openings, suggestive of early scarring alopecia, and diffuse upper lip swelling with surrounding mild erythema. Trichoscopy demonstrated decreased follicular density and areas of absent follicles. Laboratory evaluation revealed elevated inflammatory markers with negative antinuclear antibody testing and normal complement levels. Histopathological examination of scalp and nasolabial fold biopsies demonstrated predominant lobular lymphocytic and histiocytic panniculitis extending into the subcutaneous fat, consistent with lupus erythematosus profundus. Treatment with oral hydroxychloroquine led to significant improvement in lip swelling and stabilization of the scalp lesion, with subsequent hair regrowth on follow-up. Lupus erythematosus profundus is an uncommon but important cause of localized alopecia and facial swelling in children. Early clinicopathologic recognition and timely treatment are essential to reduce the risk of permanent scarring and disfigurement.