IntroductionPatient eczema severity time (PEST) is a new atopic dermatitis (AD) scoring system based on patients’ own perception of their disease. Conventional scales such as SCORing of atopic dermatitis (SCORAD) reflect the clinician’s observations during the clinic visit. Instead, the PEST score captures eczema severity, relapse and recovery as experienced by the patient or caregiver on a daily basis, promoting patient engagement, compliance with treatment and improved outcomes. This study aims to determine the correlation between carer-assessed PEST and clinician-assessed SCORAD in paediatric AD patients after 12 weeks of treatment using a ceramide-dominant therapeutic moisturizer.MethodsProspective, open-label, observational, multi-centre study in which children with AD aged 6 months to 6 years were treated with a ceramide dominant therapeutic moisturizer twice daily for 12 weeks; 58 children with mild-to-moderate AD were included. Correlation between the 7-day averaged PEST and SCORAD scores for assessment of AD severity was measured within a general linear model. PEST and SCORAD were compared in week 4 and week 12.ResultsAt week 12, a moderate correlation was found between the SCORAD and PEST scores (r = 0.51). The mean change in SCORAD and PEST scores from baseline to week 12 was −11.46 [95% confidence interval (CI) −14.99 to −7.92, p < 0.0001] and −1.33 (95% CI −0.71 to −0.10, p < 0.0001) respectively. PEST demonstrated greater responsiveness to change (33.3% of scale) compared to SCORAD (13.8% of scale).ConclusionThe PEST score correlates well with the SCORAD score and may have improved sensitivity when detecting changes in the severity of AD. The ceramide-dominant therapeutic moisturizer used was safe and effective in the management of AD in young children.FundingHyphens Pharma Pte Ltd.Trial Registrationclinicaltrials.gov identifier, NCT02073591.

This study reveals discordance between caregiver-reported and physician-rated severity of childhood atopic dermatitis (AD). Physicians and parents value different aspect in assessing severity of AD. This study examined the measures from a real-life perspective. The results also show that caregivers may have a better understanding of severity, given that they see the child on a daily basis. Physicians should therefore work in partnership with caregivers to encourage adherence to treatments. This information sheds light on when parental understanding of severity is differently understood, which is an important step in improving adherence to treatment recommendations.This study examined concordance between caregiverreported and physician-rated estimates of severity of atopic dermatitis (AD) in paediatric patients and explored potential explanatory factors. Physician-reported severity of AD was retrieved from medical records, while caregiver-reported disease severity and sociodemographic data were obtained through a survey that also collected information on out-of-pocket expenses due to AD. There was 38.5% (95% confidence interval (95% CI) 30.1, 43.5) disagreement between physician and caregivers with regards to both underestimating and overestimating the condition. A duration since AD diagnosis shorter than 6 months showed higher concordance (kappa: 44.4%; 95% CI 30.6, 58.2) between caregiver and physician estimates of AD severity compared with a duration of 6 months or longer. Care givers underestimating their child's AD accounted for 27.7% among all participants, while 10.8% overestimated the severity of AD compared with physicians. Factors significantly associated with caregiver's under estimation of disease severity were age of the child and time since disease diagnosis. Comparison of concordance between caregiver-reported and physicianrated estimates of severity of AD in paediatric patients revealed a tendency amongst caregivers to underestimate severity of AD. This information may have clinical implications for treatment outcomes if caregivers fail to adhere to medical advice.

Introduction: The development of cutaneous neoplasms at immunization sites following vaccination is uncommon, and only few have been reported in the literature worldwide. We report an unusual case of an ulcerated giant dermatofibroma that developed as a chronic nonhealing plaque in the immunization scar of a young boy after vaccination. Case Report: A 13-month-old Chinese boy presented with an unusual skin reaction on the vaccination site at the right anterolateral thigh following a routine intramuscular injection of ‘5-in-1’ (diphtheria, tetanus, pertussis, polio and Haemophilus influenzae B) vaccine at 4 months of age. The immunization site developed a slightly raised papule with a central punctum that progressively grew in size, ulcerated and showed occasional bleeding over a span of 9 months. On follow-up, the lesion showed a chronic granulomatous reaction with surrounding induration and a central scarring. The right inguinal lymph node was palpable. Ultrasound of the lesion showed only nonspecific focal skin thickening. An incisional skin biopsy with careful histopathological evaluation revealed microscopic features consistent with an ulcerated giant dermatofibroma. Conclusion: Neoplastic development in immunization scars following vaccination is a rare occurrence and, hence, makes this case a diagnostic challenge. A high index of suspicion is crucial in atypical presentations of a common skin lesion, as typified by this case. Careful history taking and clinicopathological correlation of clinical findings with gross and microscopic findings along with targeted immunohistological staining is often essential to aid early diagnosis.

Unfortunately, the given name and family name of the co-author Dr. Jin Ho Chong was incorrectly published in the original publication. The correct given name and family name should read as 'Jin Ho' and 'Chong', respectively. The original article has been updated.

A 9-year-old boy presented with 2 weeks of fever; oligoarthritis involving the right elbow, left knee and elbow; and bilateral conjunctivitis. He had a history of typhoid fever 1 year ago, which was treated and resolved. Investigations showed sterile pyuria, with a white blood cell count of 25 cells per high-power field with negative urine culture, suggestive of urethritis. During the admission, he developed painless, psoriasiform plaques with surrounding erythematous borders and scaling on the glans penis ( Figure 1). There was no associated urethral discharge or other mucocutaneous lesions, and the palms and soles were uninvolved. Chlamydia and gonorrhea PCR were negative, and syphilis and human immunodeficiency virus serologies were negative. Penile swab bacterial culture and fungal scraping were unremarkable. HLA-B27 was positive. Autoimmune markers, such as rheumatoid factor and antinuclear antibodies, were negative.