Infliximab, in our experience, has proved to be effective in reducing nail lesions and, in some cases, even clearing them. Our data demonstrate long-term efficacy of this biological agent in nail psoriasis.

Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of environmental mycobacteria are often misdiagnosed, and their treatment is difficult because these agents can show in vivo and in vitro multidrug resistance. The most common environmental mycobacteria that can cause cutaneous infections are Mycobacterium fortuitum and Mycobacterium marinum. All mycobacteria are characterized by low pathogenicity and they can contaminate affected or traumatized skin only in immunocompetent subjects (mainly in fishermen, swimming-pool attendants, and aquarium owners) whereas medical and esthetic procedures are at risk for the infections because of the quick-growing mycobacteria. Immunocompromised subjects can instead easily develop environmental mycobacterial infections of differing degrees of severity.

Objectives: The aim of this study was to evaluate the clinical and epidemiological profile of hair and scalp disorders in children referred to the Pediatric Dermatology Outpatient Clinic. Materials and Methods: We performed a retrospective study of children with hair loss problems or scalp diseases who turned to the Pediatric Dermatology Service, Anna Meyer Pediatric Hospital, Florence, Italy, from January 1, 2009, to December 31, 2009. Demographics, personal and familial medical history, laboratory tests, clinical examination, final diagnosis and therapeutic interventions were obtained from the manual chart review. Results: Of the 2,640 children who had access to the Pediatric Dermatology Service, 190 (7.19%) had a hair or scalp disorder. Among the 190 children, 60 (31.57%) presented with nonscarring alopecia, 56 (29.47%) had benign neoplasias, hamartomas or vascular malformations of the scalp, 51 (26.84%) had scalp inflammatory diseases, 14 (7.36%) had scarring alopecia, 5 (2.63%) had infections and 2 (1.05%) had infestation of the scalp. A case of constitutional hypertrichosis (0.52%) and also a case (0.52%) of lamellar ichthyosis were diagnosed. Conclusions: Our results underline that hair and scalp diseases represent an important percentage of admittances to a dermatological pediatric outpatient clinic. The variety and complexity of the diseases observed in this study included diseases commonly found also in adulthood.

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A 2‐month‐old white male infant presented with a slightly infiltrated, brownish‐erythematous plaque on the left arm a few days after birth (following normal physiologic pregnancy and parturition). His parents noted the development of a flaccid bulla on the site of the lesion after a fever and sought the aid of a specialist. The child presented no other general symptoms. At presentation, there was a blood serum‐filled flaccid bulla surrounded by seemingly healthy skin (Fig. 1). Rubbing of the skin surrounding the bulla produced a hive‐like reaction (Darier's sign). With the suspicion of a cutaneous mastocytoma, an incisional cutaneous punch biopsy was obtained (4 mm in diameter). 1 A blood serum‐filled flaccid bulla surrounded by seemingly healthy skin on the left arm of a 2‐month‐old white male infant Histopathologic examination showed a monomorphous and dense proliferation of mast cells within the superficial and deep dermis. Neoplastic cells displayed moderately abundant, oval‐ or polygonal‐shaped cytoplasm and round to oval nuclei (Fig. 2). The nuclei were characterized by clumped chromatin and indistinct or inapparent nucleoli. The cytoplasm was filled with small, faintly visible, eosinophilic or amphiphilic granules which stained metachromatically with Giemsa stain (Fig. 3). Scattered eosinophils were observed throughout the lesion. A final diagnosis of nodular mastocytoma was made. 2 Hematoxylin and eosin stain showing a dermal monomorphous proliferation of cells characterized by moderately abundant, oval‐ or polygonal‐shaped cytoplasm and round to oval nuclei (original magnification, ×20) 3 Giemsa stain showing metachromatic small granules within the cell cytoplasm (original magnification, ×20) Having followed the lesion's evolution for 3 years, we have observed that it has been affected periodically by blistering, together with sudden episodes of flushing lasting 15–20 min, in the presence of triggering factors such as fevers or vaccinations. The most recent episodes occurred between the age of 15 and 24 months, and were associated with the eruption of deciduous teeth. Over the past few months, with the patient now approximately 3 years of age, the lesion has grown progressively lighter and is beginning to disappear (Fig. 4). 4 After the age of 2 years, the mastocytoma became progressively lighter and smaller