Treatment with itraconazol (400 mg once a week) was added for onycomicosis. Two weeks later, the patient was discharged from the hospital with substantial improvement of oedema and erythema, healing of the ulcers and pain relief. This patient represents a typical case of primary erytromelalgia. Diagnosis of this condition is important because proper counsel- ling can enable the patient to minimize the severity and frequency of the painful episodes. Davis et al. in a retrospective review of 168 patients with erythromelalgia showed increased mortality in patients with erythromelalgia compared with matched control subject. 5 Erythromelalgia decreases quality of life and makes nor- mal social function, work and family life impossible. There is no effective therapy for erythromelalgia. Most available clinical evi- dence regarding treatment of erythromelalgia comes from anecdo- tal studies. Treatment options include sodium channel blockers, intravenous lidocaine, prostaglandin analogs, serotonin reuptake inhibitors, venlafaxin, 6 opiods, mexiletine, gabapentin and beta- adrenergic drugs; however, further research is needed to develop more effective treatments. 7 D Galimberti,* A Ponto ´ n, L Rubio, A Torre, V Angles, E Soriano, R Galimberti Department of Dermatology and School of Medicine of the Hospital Italiano, Buenos Aires, Argentina *Correspondence: D Galimberti. E-mail: daniel.galimberti@hospitalitaliano.org.ar References 1 Van Genderen PJ, Michiels JJ. Erythromelalgia: a pathognomonic microvascular thrombotic complication in essential thrombocytemia and polycythemia vera. Sem Thromb Hemost 1997; 76: 322–333. 2 Choi JS, Dib-Hajj S, Waxman S. Inherited erythermalgia: Limb pain from an S4 charge-neutral Na channelopathy. Neurology 2006; 67: 1538–1539. 3 Nurowska-Wrozsek B, Tolodziecka L, Gaciong Z. Erythromelalgia: two case reports and literature review. Pol Arch Med Wewn 2007; 117: 322–326. 4 Davis MD, O’Fallon WM, Rogers RS et al. Natural history of erythromelalgia: presentation and outcome in 168 patients. Arch Dermatol 2000; 136: 330–336. 5 Kalgaard OM, Seem E, Kvernebo K. Erythromelalgia: a clinical study of 87 cases. J Intern Med 1997; 242: 191–197. 6 Firmin D, Roquedas AM, Greco M et al. Treatment of familial erythromelalgia with venlafaxina. J Eur Acad Dermatol Venereol 2007; 21: 836–837. 7 Novella SP, Hisama FM, Dib-Hajj SD et al. A case of inherited erythromelalgia. Nat Clin Pract Neurol 2007; 3: 229–234. DOI: 10.1111/j.1468-3083.2009.03212.x Annular lichenoid dermatosis of youth Editor Annular lichenoid dermatitis of youth (ALDY) is a rare dermatosis first described in 2003 by Anessi et al. 1 who reported 23 patients suffering from this condition. Since then, three additional cases were reported. 2–4 We present here a new case of ALDY and briefly review the main features of this condition. A 3.5-year-old Caucasian boy with an unremarkable personal and family history presented with a skin lesion that had been present on his proximal right thigh and the inguinal fold for about 1 year. It consisted of a round-oval annular plaque with a brown- ish, slightly raised border and a non-scaly surface. The centre of the plaque was hypopigmented and non-indurated. The lesion was asymptomatic and had appeared together with similar lesions on the trunk, which had regressed spontaneously. On 6-month fol- low-up, the initial lesion had enlarged (Fig. 1), and an erythema- tous patch had appeared on the left buttock. The child’s condition was good. Routine laboratory workup, including serology for Bor- relia burgdorferi, proved normal. Over the next months, the lesion progressively spread peripherally but became less conspicuous, and the lesion of the buttock regressed completely. Pathologic examination of a skin biopsy taken from the border of the lesion showed normal horny and granular layers. The rete ridges were occasionally elongated and anastomosing. The basal layer was vacuolated and at places inconspicuous. The papillary dermis con- tained focally oedema and a dense band-like cell infiltrate that invaded the lower epidermal layers and extended occasionally into the deeper dermis. It consisted predominantly of CD4+/ CD45RO + T cells, admixed with occasional histiocytes and rare multinucleate giant cells. Dermal papillae contained single or clus- tered colloid bodies (Fig. 2). ALDY is a recently described dermatosis of which 27 cases have been so far reported (including the present one). It affects young patients (mean age, 11 years; range, 2.5–22) with an equal sex ratio, and manifests with persistent, solitary or multiple annular Figure 1 Annular plaque over the right thigh. ª 2009 The Authors JEADV 2009, 23, 1327–1349 Journal compilation ª 2009 European Academy of Dermatology and Venereology LETTERS TO THE EDITOR 1339