Impfgranulome sind eine häufige (0,3–1

BACKGROUND:Vaccine granulomas are a common (0.3-1%) adverse event (AE) of (accidentally) subcutaneously administered vaccines and specific immunotherapies containing aluminum conjugates. The clinical symptoms with persistent itching subcutaneous nodules, predominantly affect infants and young children on the lateral thigh. AIM:To sensitize dermatologists to recognize this common and harmless vaccination AE, in order to prevent invasive diagnostics and confusion among parents and physicians. MATERIALS AND METHODS:Retrospective analysis of 13 children consulting pediatric dermatology between 2019 and 2023. Identification of diagnostic criteria and guidelines for action, based on the literature. RESULTS AND CONCLUSION:In all, 13 children (9 boys, 4 girls) with subcutaneous indolent but itching nodules at the vaccination sites (11 on the thighs, 2 on the upper arms) with a latency of weeks to months were retrospectively evaluated. The children were vaccinated according to German STIKO ("Ständige Impfkommission") recommendations. Only inactivated vaccines contain aluminum. The documented occurrence of the first vaccination granulomas was between the 12th and 36th month of life. Regarding the STIKO vaccination calendar, the third immunization with the hexavalent inactivated vaccine coincides with the first administration of the live measles, mumps and rubella (MMR) vaccine (varicella (V)). This may incorrectly lead to the assumption that the live vaccine was the cause of granuloma development. Aluminum conjugation appears to be a central trigger of the granulomas; further susceptibility factors are largely unknown. Diagnosis of sensitization to aluminum through epicutaneous testing has no practical impact and is, therefore, not routinely recommended. After weeks to years, granulomas spontaneously regress.

Atopic dermatitis (AD) is the most common skin disease in infants and children with a prevalence of 10% in the first two years of life. In this age group up to 15% are severely affected. "Children are not little adults" - this applies in particular to infants with severe atopic dermatitis. Age-specific clinical aspects (psychosocial, neurocognitive, morphological) of the disease require an adjusted disease management. Considering recent approval of systemic treatment options, early identification of infants and children with severe and early persistent disease is of particular importance also in view of possible prevention of atopic comorbidity. As several inborn errors of immunity (IEI) share features of the atopic phenotype, it is essential for clinicians to distinguish signs of immunodeficiency from severe AD. Here, we describe a practical approach on the basis of clinical history and key dermatological and laboratory findings. Furthermore, this paper is aimed at providing an update on general management of severe AD in early infancy, including recommendations for systemic treatment.

ZusammenfassungDie atopische Dermatitis ist die häufigste chronische Hauterkrankung im Kindesalter mit einer Prävalenz von 10% bei Kleinkindern unter 2 Jahren, wovon etwa 15% einen hohen Schweregrad aufweisen. „Kinder sind keine kleinen Erwachsenen“, dies trifft für die schwere frühkindliche atopische Dermatitis in besonderem Maße zu. Innerhalb dieser sensiblen Lebensphase zeigen sich alterstypische Facetten der Erkrankung (psychosozial, neurokognitiv, klinisch‐morphologisch), die Unterschiede im Management mit sich bringen.Besondere Bedeutung hat die Identifikation von Säuglingen und Kleinkindern mit früh‐persistierendem, schwerem Verlauf mit Blick auf eine erstmals für diese Altersgruppe zugelassene Systemtherapie: sowohl für die unmittelbare Versorgung der Hauterkrankung als auch unter dem Aspekt einer möglichen Prävention von Begleiterkrankungen. Da der „atopische Phänotyp“ klinische Überlappungen zum Spektrum der Immundefekte aufweist, ist die korrekte Einordnung des Hautbefundes bei therapierefraktärem Ekzem essenziell. In dieser Arbeit beschreiben wir eine alltagstaugliche Strategie, um anhand anamnestischer Warnhinweise, dermatologischer Leitbefunde und Labordiagnostik eine Abgrenzung von ekzematösen Hauterscheinungen bei primären Immundefekten vorzunehmen. Dazu geben wir aktuelle Empfehlungen zum Management des schweren frühkindlichen atopischen Ekzems, auch in Bezug auf die Indikation zur Systemtherapie.

tosum and Rothmund-Thomson syndrome. Only a few reports discuss the presence of lichenoid changes in DC; these early findings were attributed to “simultaneously occurring OLP.” White patches have been mislabeled as “leukoplakia” and are considered the main oral finding in DC. “Leukoplakia” is a descriptive clinical term which bears no diagnostic meaning and has interchangeable use in clinical medicine. It does not inform the nature of the lesion in study. The white keratoses seen in DC are scars, and their histopathology in our cases revealed only hyperkeratotic cicatricial mucosa. Patient 1 never developed leukokeratosis during a 5-year follow-up before dying of complications of bone marrow transplantation; his lichenoid lesions were followed by mucosal atrophy, and he showed in situ SCC on histopathology. The term “Marjolin ulcer” designates SCCs occurring at the site of scars and wounds such as in the sequelae of discoid lupus erythematosus, lupus vulgaris, epidermolysis bullosa, hidradenitis, and OLP. Oral SCC in DC should be added to this list, since this SCC clearly arises in the areas of chronic mucosal scarring, a factor that seems not directly related to the DC gene mutations. We postulate that persistent interface inflammation in DC promotes scarring of oral tissues. Atrophic or hyperkeratotic scars ultimately develop. These might lead to SCC. The genetically altered epithelium due to the underlying disease possibly contributes to earlier development of SCC compared to other scarring diseases such as OLP, as in patient 4 (16-year-old).

Papillomatosis confluens et reticularis (Morbus Gougerot-Carteaud; MGC) is a poorly understood skin disorder predominantly affecting adolescents and young adults [1]. Patients typically show brownish, reticular coalescing papules and plaques with predilection of the neck, upper trunk and axillae (Figure 1) [1–3]. Given its nonspecific histopathoClinical Letter logical findings, diagnosis of MGC is largely made on clinical grounds [1, 3]. Davis et al. have recently proposed a set of diagnostic criteria for MGC that have become accepted in clinical practice [1]:

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 18, Issue 8 p. 908-910 Clinical Letter Successful targeted cytokine blockade in a case of aseptic abscess syndrome Andreas Benedikt Weins, Corresponding Author andreas.weins@uk-augsburg.de Department of Dermatology and Allergology, University of Augsburg, Augsburg, Germany Department of Dermatology and Allergology, University of Ulm, Ulm, Germany Correspondence to Andreas Weins, MD Department of Dermatology and Allergy University of Augsburg Sauerbruchstrasse 6 86179 Augsburg, Germany E-mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorKarin Scharffetter-Kochanek, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorTina Weiss, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorDiana Crisan, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorNicola Hehl, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorJohannes Weiss, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorAnca Sindrilaru, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this author Andreas Benedikt Weins, Corresponding Author andreas.weins@uk-augsburg.de Department of Dermatology and Allergology, University of Augsburg, Augsburg, Germany Department of Dermatology and Allergology, University of Ulm, Ulm, Germany Correspondence to Andreas Weins, MD Department of Dermatology and Allergy University of Augsburg Sauerbruchstrasse 6 86179 Augsburg, Germany E-mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorKarin Scharffetter-Kochanek, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorTina Weiss, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorDiana Crisan, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorNicola Hehl, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorJohannes Weiss, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this authorAnca Sindrilaru, Department of Dermatology and Allergology, University of Ulm, Ulm, GermanySearch for more papers by this author First published: 12 July 2020 https://doi.org/10.1111/ddg.14147Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue8August 2020Pages 908-910 RelatedInformation

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 18, Issue 2 p. 140-142 Clinical Letter Morbus Mucha-Habermann unter dem Bild eines Kawasaki-Syndroms Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München (TUM), München, Deutschland Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Korrespondenzanschrift Dr. Andreas B. Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorMartin Theiler, Martin Theiler Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this authorBettina Bogatu, Bettina Bogatu Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Allergologie, Zürich, SchweizSearch for more papers by this authorKarin Kerl, Karin Kerl Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this authorMarc Pleimes, Marc Pleimes Praxis für Kinder- und Jugendhaut, Dr. med. Pleimes, Heidelberg, DeutschlandSearch for more papers by this authorJana Pachlopnik-Schmid, Jana Pachlopnik-Schmid Universitäts-Kinderspital Zürich, Fachbereich Immunologie, Zürich, SchweizSearch for more papers by this authorLisa Weibel, Lisa Weibel Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this author Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München (TUM), München, Deutschland Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Korrespondenzanschrift Dr. Andreas B. Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorMartin Theiler, Martin Theiler Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this authorBettina Bogatu, Bettina Bogatu Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Allergologie, Zürich, SchweizSearch for more papers by this authorKarin Kerl, Karin Kerl Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this authorMarc Pleimes, Marc Pleimes Praxis für Kinder- und Jugendhaut, Dr. med. Pleimes, Heidelberg, DeutschlandSearch for more papers by this authorJana Pachlopnik-Schmid, Jana Pachlopnik-Schmid Universitäts-Kinderspital Zürich, Fachbereich Immunologie, Zürich, SchweizSearch for more papers by this authorLisa Weibel, Lisa Weibel Universitäts-Kinderspital Zürich, Fachbereich pädiatrische Dermatologie, Zürich, Schweiz Universitätsspital Zürich, Klinik für Dermatologie, Zürich, SchweizSearch for more papers by this author First published: 06 February 2020 https://doi.org/10.1111/ddg.13989_gCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue2February 2020Pages 140-142 RelatedInformation

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 18, Issue 8 p. 908-911 Clinical Letter Erfolgreiche zielgerichtete Therapie eines aseptischen Abszesssyndroms Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm Korrespondenzanschrift Dr. med. Andreas Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorKarin Scharffetter-Kochanek, Karin Scharffetter-Kochanek Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorTina Weiss, Tina Weiss Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorDiana Crisan, Diana Crisan Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorNicola Hehl, Nicola Hehl Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorJohannes Weiss, Johannes Weiss Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorAnca Sindrilaru, Anca Sindrilaru Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this author Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm Korrespondenzanschrift Dr. med. Andreas Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorKarin Scharffetter-Kochanek, Karin Scharffetter-Kochanek Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorTina Weiss, Tina Weiss Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorDiana Crisan, Diana Crisan Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorNicola Hehl, Nicola Hehl Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorJohannes Weiss, Johannes Weiss Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this authorAnca Sindrilaru, Anca Sindrilaru Klinik für Dermatologie und Allergologie, Universitätsklinikum UlmSearch for more papers by this author First published: 21 August 2020 https://doi.org/10.1111/ddg.14147_gAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume18, Issue8August 2020Pages 908-911 RelatedInformation

Das α-Gal-Syndrom basiert auf einer Sensibilisierung auf das Kohlenhydratepitop Galactose-α-1,3-Galactose (α-Gal). Das Allergen findet sich in Säugetierfleisch und Innereien, aber auch weiteren Lebensmitteln und Medizinprodukten tierischen Ursprungs. Allergische Reaktionen treten bei Betroffenen, abhängig von der individuellen Toleranzschwelle und dem Einfluss von Kofaktoren, in der Regel mit einer zeitlichen Latenz zum Allergenkontakt auf. Für die Verdachtsdiagnose eines α-Gal-Syndroms können bereits anamnestische Hinweise im Patientengespräch richtungsweisend sein. Zur weiteren Objektivierung bedarf es besonderer Kenntnisse für die Durchführung und Interpretation der weiteren In-vitro- und In-vivo-Diagnostik: Während Prick-Tests mit kommerziellen Fleisch-Gesamtextraten häufig diagnostisch unzuverlässig sind, lässt sich bei Betroffenen regelhaft allergenspezifisches IgE (α-Gal) nachweisen. Zellbasierte Tests, wie z.B. der Basophilenaktivierungstest, finden bislang dagegen nur für experimentelle Fragestellungen Anwendung. Zur Beurteilung der klinischen Relevanz einer bestehenden Sensibilisierung sollte eine stationäre Provokationstestung, z.B. mit gekochtem Schweinefleisch oder Schweineniere und Berücksichtigung von Kofaktoren, angestrebt werden.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 17, Issue 11 p. 1165-1167 Clinical Letter Erfolgreiche Behandlung eines schweren dyshidrosiformen Ekzems mit Dupilumab bei einem Kind Andreas B. Weins, Corresponding Author Andreas B. Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), München Korrespondenzanschrift Dr. med. Andreas Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorTilo Biedermann, Tilo Biedermann Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorKilian Eyerich, Kilian Eyerich Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorSigrid Moeckel, Sigrid Moeckel Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorChristina Schnopp, Christina Schnopp Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this author Andreas B. Weins, Corresponding Author Andreas B. Weins andreas.weins@uk-augsburg.de Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), München Korrespondenzanschrift Dr. med. Andreas Weins Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg Sauerbruchstraße 6 86179 Augsburg E-Mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorTilo Biedermann, Tilo Biedermann Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorKilian Eyerich, Kilian Eyerich Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorSigrid Moeckel, Sigrid Moeckel Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this authorChristina Schnopp, Christina Schnopp Klinik und Poliklinik für Dermatologie und Allergie am Biederstein, Klinikum rechts der Isar der Technischen Universität München (TUM), MünchenSearch for more papers by this author First published: 25 November 2019 https://doi.org/10.1111/ddg.13929_gAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume17, Issue11November 2019Pages 1165-1167 RelatedInformation

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 18, Issue 2 p. 140-142 Clinical Letter Febrile ulceronecrotic Mucha-Habermann disease mimicking Kawasaki disease Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Department of Dermatology, University Hospital Augsburg, Augsburg, Germany Klinikum rechts der Isar, Technical University of Munich (TUM), Department of Dermatology and Allergy Biederstein, Munich, Germany University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland Correspondence to Andreas Benedikt Weins, MD Department of Dermatology University Hospital Augsburg Sauerbruchstrasse 6 86179 Augsburg, Germany E-mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorMartin Theiler, Martin Theiler University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this authorBettina Bogatu, Bettina Bogatu University Children's Hospital Zurich, Division of Pediatric Allergy, Zurich, SwitzerlandSearch for more papers by this authorKarin Kerl, Karin Kerl University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this authorMarc Pleimes, Marc Pleimes Praxis Pleimes for pediatric dermatology, Heidelberg, GermanySearch for more papers by this authorJana Pachlopnik-Schmid, Jana Pachlopnik-Schmid University Children's Hospital Zurich, Division of Immunology, Zurich, SwitzerlandSearch for more papers by this authorLisa Weibel, Lisa Weibel University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this author Andreas Benedikt Weins, Corresponding Author Andreas Benedikt Weins andreas.weins@uk-augsburg.de Department of Dermatology, University Hospital Augsburg, Augsburg, Germany Klinikum rechts der Isar, Technical University of Munich (TUM), Department of Dermatology and Allergy Biederstein, Munich, Germany University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland Correspondence to Andreas Benedikt Weins, MD Department of Dermatology University Hospital Augsburg Sauerbruchstrasse 6 86179 Augsburg, Germany E-mail: andreas.weins@uk-augsburg.deSearch for more papers by this authorMartin Theiler, Martin Theiler University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this authorBettina Bogatu, Bettina Bogatu University Children's Hospital Zurich, Division of Pediatric Allergy, Zurich, SwitzerlandSearch for more papers by this authorKarin Kerl, Karin Kerl University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this authorMarc Pleimes, Marc Pleimes Praxis Pleimes for pediatric dermatology, Heidelberg, GermanySearch for more papers by this authorJana Pachlopnik-Schmid, Jana Pachlopnik-Schmid University Children's Hospital Zurich, Division of Immunology, Zurich, SwitzerlandSearch for more papers by this authorLisa Weibel, Lisa Weibel University Children's Hospital Zurich, Division of Pediatric Dermatology, Zurich, Switzerland University Hospital Zurich, Department of Dermatology, Zurich, SwitzerlandSearch for more papers by this author First published: 09 December 2019 https://doi.org/10.1111/ddg.13989Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue2February 2020Pages 140-142 RelatedInformation

endogenous (haematogenous) dissemination, with development of primary extrapulmonary infection or postprimary reactivation, or as a result of direct inoculation of the bacillus through skin abrasion. The perianal region may be affected by both forms; nevertheless, its involvement is extremely rare, with few cases described in the literature (58 cases between 1970 and 2014). Cutaneous TB often affects immunocompromised patients. Patients with perianal TB usually harbour the disease for a long time before diagnosis and onset of treatment, as perianal TB is frequently mistaken for other more common perianal conditions, such as Crohn’s disease. For that reason, most patients have chronic and recurrent lesions that have failed to respond to multiple drug and surgical treatments. Proper clinical suspicion is crucial in cases of perianal TB for various reasons. The disease may manifest itself in different forms with symptoms that range from a single perianal ulcer to extensive scrofuloderma with bone involvement and high morbidity. The diagnosis of M. tuberculosis infection requires specific complementary tests, such as direct test (Ziehl–Neelsen staining method), PCR-based assay for M. tuberculosis and mycobacterial culture, and the lesion will only heal after the onset of the antituberculosis treatment. Moreover, some cases of perianal TB are associated with abdominal TB, and all clinical and diagnostic efforts should be expended to find the primary focus. We reported a case of perianal TB in an immunocompetent patient without previous or current history of abdominal TB, which posed a diagnostic challenge. In this case, exogenous inoculation probably occurred after local trauma, and cutaneous perianal disease was the only TB symptom. Proper diagnosis and follow-up of the patient were paramount, given the epidemiological importance of the disease, as well as its potential effect on quality of life and high morbidity and mortality rates.