A 28-year-old man presented at our clinic with 1-month history of an ulcer covered with crust on his left anterior tibia. Based on the morphological features and molecular identification, the patient was diagnosed as cutaneous alternariosis caused by Alternaria arborescens. He was successfully cured by oral itraconazole and topical use of 0.25% liposomal amphotericin B. A review of published studies revealed 29 cases of cutaneous alternariosis. Most cases (90%) occurred in immunosuppressed patients; itraconazole (59%) and voriconazole (24%) are the most effective treatments of choices.

Infantile hemangiomas can present a therapeutic challenge to clinicians, especially when associated with severe pain and feeding difficulties. The standard therapeutic management includes corticosteroids and propranolol. However, the clinical response is not always satisfactory. We present six cases of infantile hemangiomas successfully treated with oral itraconazole approximately 5 mg/kg per day. In the first month, the red color of the lesions became a little lighter and the growth of the lesions was controlled in all cases. An obvious clinical improvement was noted in all cases during the 3-month period, with 80-100% improvement in each patient at the end of the treatment, which was judged by both their parents and the dermatologists. Compliance with treatment instructions of oral itraconazole in infants was judged to be very good. Side-effects were mild and limited. Although itraconazole can inhibit angiogenesis and tumor growth in vitro and in vivo associated with some cancers, further research is required to understand the pathogenesis of infantile hemangiomas and the mechanism of itraconazole.

Infantile hemangioma is the most common benign vascular tumor of infancy. We have previously reported that itraconazole, a common antifungal agent, can clinically improve or cure infantile hemangioma; however, the underlying molecular mechanisms are still unclear. Here, we show that itraconazole treatment significantly inhibits proliferation and promotes apoptosis of the endothelial cells of mouse hemangioma cell line and infantile primary hemangioma endothelial cell. Itraconazole also remarkably reduced angiogenesis of hemangioma endothelial cell in vitro. We further performed transcriptome profiling via mRNA microarrays in hemangioma endothelial cell upon itraconazole treatment, and identified cytokineecytokine receptor interaction as the top significantly enriched pathway. Importantly, itraconazole significantly reduced plateletderived growth factoreD level, resulting in suppression of platelet-derived growth factoreb activation and inhibition of its downstream effectors, such as PI3K, Akt, 4E-BP1, and p70S6K, which are important for cellular growth and survival of infantile hemangioma. In conclusion, our results suggest that platelet-derived growth factoreD is a target of itraconazole in infantile hemangioma.

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Genital molluscum contagiosum is rare in children. We report a molluscum contagiosum around the vulva and anus of 9-year-old girl, which has atypical presentations and was finally confirmed by histopathological and electron microscopy findings.