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eczematous eruptions, predominantly on the patient's trunk (Fig. 1a,b).Laboratory assessment of a peripheral blood sample showed a normal leucocyte count of 6.7 9 10 9 /L (normal range 3.3-8.8 9 10 9 /L) with raised eosinophils (10%, 0.70 9 10 9 /L; normal ranges 0-8%, 0.07-0.45 9 10 9 /L, respectively). The serum level of thymus and activation-regulated chemokine (TARC) was elevated at 2818 pg/mL (normal level 450 pg/mL) and soluble interleukin-2 receptor levels were within normal limits.Histological examination of a skin biopsy specimen revealed epidermal spongiosis, basal vacuolar change, and infiltration of lymphocytes and eosinophils in the papillary dermis (Fig. 1c). In addition, there were no atypical lymphocytes exhibiting cerebriform or convoluted nuclei, no haloed lymphocytes or true epidermotropism in the epidermis, and no papillary dermal fibrosis.These findings did not favour a diagnosis of mycosis fungoides (MF), thus, based on the results, eczematous drug eruption due to clonazepam or azilsartan was most strongly suspected.Consequently, 3 weeks after the eruptions appeared, clonazepam and azilsartan were discontinued, and the patient was treated with prednisolone 40 mg (0.74 mg/ kg) daily and prednisolone 10 mg every 4 days, tapered over time. The eruptions disappeared within 3 weeks from initiation of prednisolone.Nine days later, to confirm the causative agent, clonazepam was restarted after obtaining the patient's informed consent. Two weeks after restarting clonazepam administration, infiltrative erythema appeared on the head, trunk and bilateral thighs (Fig. 1d,e). The serum TARC level was increased at 11 300 pg/mL. A biopsy specimen demonstrated histopathological features similar to those of the previous biopsy specimen, consisting of vacuolar changes, spongiosis, oedema, and infiltration of lymphocytes and eosinophils in the superficial perivascular region (Fig. 1f). The drug-induced lymphocyte stimulation test was positive for clonazepam.Consequently, we made a final diagnosis of eczematous drug eruption due to clonazepam, and clonazepam was discontinued. Ten weeks after discontinuing clonazepam, the eruptions disappeared and azilsartan was restarted. At follow-up 4 months after restarting azilsaltan administration, there was no recurrence of eruptions, serum TARC level had decreased to 729 pg/mL, and blood eosinophil level was within the normal range at 306/lL.Clonazepam, one of the drugs in the benzodiazepine class, is used as an antianxiety medication. To our knowledge, this is the first case of an eczematous drug eruption due to clonazepam that was correlated with serum TARC levels. TARC is a T-helper 2-type

Background To describe the cutaneous acral findings in a pediatric population noticed during this pandemic. Methods A retrospective descriptive study was performed collecting data on 36 patients under 14 years old, presenting suspicious acral skin manifestations for coronavirus disease 2019 (COVID-19). Results Patients were mostly male (63.8%). The mean age was 11.11 years. 66.67% of patients showed erythematous papules, and 44.44% purpuric macules. Feet were affected in 97.22% of patients and hands in 5.55%. Lesions were asymptomatic in 50% of patients. 30.55% of patients showed extracutaneous findings, preceding skin lesions in 12.62 days. Seven patients underwent specific severe acute coronavirus 2 (SARS-CoV-2) testing; all of these patients tested negative. Conclusions The association between these symptoms and SARS-CoV-2 remains unclear. We recommend using these manifestations as a sign of SARS-CoV-2 infection in children. This could lead to the examination of asymptomatic and mildly symptomatic children so that contagions may be avoided.

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Dimethyl fumarate (DMF) is an oral formulation approved for the treatment of moderate-to-severe psoriasis in adult patients requiring systemic therapy. Here, we describe our clinical experience with DMF for moderate-to-severe psoriasis in Spain. Patients and Methods: This is a retrospective study including 30 adult patients with moderate-to-severe psoriasis under treatment with DMF between September 2018 and January 2020. Patients were treated with DMF as per its Summary of Product Characteristics and the median duration of treatment was 15 weeks (4-55 weeks). Psoriasis Area and Severity Index (PASI) and body surface area (BSA) severity scales were evaluated from baseline to week 36 and adverse events (AEs) developed during treatment were described. Results: The efficacy of DMF was assessed at week 8 and at week 36 (n = 5), both PASI and BSA were 0. At week 24, median PASI showed a decrease in both the last observation carried forward (LOCF; n = 23) and the observed cases (OC) (n = 10): from 10 to 6 and from 10 to 1.5, respectively. Median BSA also showed a decrease from 19 to 10 in LOCF and from 17 to 3 in OC. The most frequent AEs were diarrhoea (40.0%), flushing (13.3%) and lymphopenia (3.3%). In 47.1% patients, AEs have been solved by adjusting the DMF dose. Treatment discontinuation rate due to AEs was 43.3%. Conclusion: Our clinical experience indicates that DMF could be an effective and safe treatment for moderate-to-severe psoriasis in adult patients.