A second case of rosacea-like demodicosis in an HIV-positive child was seen at our center. No such cases have previously been published. The present case is a 2-year-old boy, the son of an HIV-positive mother, who responded well to oral erythromycin and topical metronidazole. The frequency of rosacea-like eruptions in HIV-negative children is very low. However, the incidence of these eruptions in HIV-positive children may have been underestimated. The pathogenic role of Demodex mites is discussed as well as the possible mechanisms for an exaggerated reaction.

The authors have indicated no significant interest with commercial supporters.M erkel cell carcinoma (MCC) is a malignant neuroendocrine tumor that typically affects elderly patients. 1 It is aggressive, with frequent recurrences after excision. Regional and distant metastases develop in approximately 40% of cases. Patients without lymph node involvement have been reported to have a survival rate of 75% at 5 years, whereas patients with distant metastases have a survival rate of 25% at 5 years. 2 The etiology of MCC remains unknown, although a polyomavirus has recently been linked to this tumor. 3 The incidence reported is higher in men than in women. 2,4 Surgery is the primary approach for clinically localized disease, although there is great variability regarding the use of further treatments. 5 Some studies have suggested that the use of sentinel lymph node biopsy improves survival and decreases nodal recurrence. 6 Recent studies have also demonstrated that the use of local adjuvant radiation after surgery lowers the risk of local and regional recurrences. 7,8 Despite the highly malignant course of this tumor, there have been reports of spontaneous regression. 9-27 We report two cases of MCC with complete spontaneous regression after skin biopsy and describe the clinical, histologic, and dermoscopic features. Case Report Patient 1A healthy 86-year-old woman presented with a nodular lesion on her right cheek that had appeared 5 weeks previously. Clinical examination revealed a pinkish-red, firm, non-ulcerated nodule measuring 22 Â 12 mm (Figure 1). Dermoscopy revealed a polymorphous vascular pattern over a cherry-colored homogeneous base. This pattern was composed of linear and comma vessels and vessels that were longer and more curved than comma vessels. We describe these as horseshoe-like structures (Figure 2). In addition, white streaks were present in the central part of the tumor.An incisional biopsy revealed a tumor in the deep dermis and a normal epidermis. The tumor cells were small and arranged in layers and solid networks ( Figure 3A and B). They had a uniform appearance, with round and hyperchromatic nuclei and scanty cytoplasm. Immunohistochemical staining was positive for neurone-specific enolase, chromogranin, synaptophysin, p-53, bcl-2, and cytokeratin 20 (CK20). Ki-67 expression was strongly positive (480%). Immunological studies showed a moderate infiltrate of CD3 1 cells around the tumor nests ( Figure 4). Routine laboratory test results (erythro-

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Erythema elevatum diutinum (EED) is a rare chronic disease of unknown origin, part of the spectrum of cutaneous leucocytoclastic vasculitis. A case of EED in a 32-year-old HIV-infected male patient, with no previous opportunistic infections and a CD4+ cell count of less than 200/mm3, is reported. Therapy with oral dapsone (100 mg/day for 15 days) resulted in clinical cure with no relapse after 6 months of follow-up. To our knowledge, only six cases of EED in HIV-positive patients have been reported to date. A brief review of these seven cases is described.