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 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

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. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

FDA approves first generic iron sucrose injection for treating iron deficiency anemia in CKD patients aged 2 years and older.

FDA approves first generic iron sucrose injection for iron deficiency anemia in CKD

Brensocatib was granted FDA priority review in February 2025 for the small molecule, oral, reversible inhibitor.

FDA approves brensocatib to treat adolescents with non-cystic fibrosis bronchiectasis

FDA accepts priority review of gepotidacin, a first-in-class oral antibiotic, for treating uncomplicated urogenital gonorrhea in patients ≥12 years.

FDA accepts priority review for gepotidacin as oral treatment for gonorrhea

Explore essential resources and toolkits for managing the ongoing stimulant medication shortage affecting ADHD treatment and patient care.

A brief review of primary care resources and toolkits for the stimulant shortage

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

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A healthy 11-year-old boy is brought to the office for evaluation of asymptomatic reticulated rash that started on his ankles 3 weeks ago and since has spread to his shins and the tops of both feet. He is on no medications and has had no history of trauma or recent illness. What's the diagnosis?

Reticulated rash on boy’s lower extremities

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

 poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then, visit our website on July 9, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was provided by Drashti Patel, BS, BA, and Jyoti Budania, MD.

In November 2023, an otherwise healthy 11-year-old boy presented to the clinic with the chief complaint of testicular discomfort. He reported mild testicular pain that worsened with physical activity, and he denied the presence of dysuria, urinary urgency, or frequency. He was recently evaluated by ENT for an episode of epistaxis, which was benign and resolved without requiring cauterization. His medical history was otherwise unremarkable, notable only for molluscum contagiosum at5 years of age and a few episodes of streptococcal pharyngitis and otitis media.

His vital signs in clinic were within normal limits, and the only additional finding at this time was a nontender, nonpruritic, and nonpalpable petechial rash on the bilateral lower extremities. His mother observed that the rash appeared to fluctuate with his activity level, worsening during periods of increased stress or activity.

Given the presence of petechiae, an initial workup was initiated, including a complete blood count (CBC), comprehensive metabolic panel (CMP), prothrombin time (PT), and partial thromboplastin time (PTT). A point-of-care urinalysis performed in the clinic revealed traces of blood in the urine. The patient appeared well and did not show any other signs of illness. He was diagnosed with viral epididymitis while pending laboratory results. He was advised to remain hydrated and to return for follow-up if his symptoms persisted or worsened. His mother agreed with this plan and committed to closely monitoring his rash.

Over the following week, he returned to our clinic. His rash had progressed, spreading to his thighs, buttocks, and the distal shaft of his penis. All of his previous labs were within normal limits, and additional workup was initiated, including a platelet function assay and measurements of serum IgA, C3, and C4 levels, along with a repeat urinalysis.

Below, take your best guess at diagnosing this patient

Idiopathic thrombocytopenic purpura (ITP)

Now, click here for the full case presentation, differential diagnosis, and correct patient diagnosis. 

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies?

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

News

Case Studies

Can you diagnose this 11-year-old with a petechial rash?

Bite injuries are a significant problem in the United States. Discriminating between human and animal bites and identifying those associated with child maltreatment is essential. Approximately 250,000 human bites and several million animal bites occur annually.

 There was also a reported increase in animal bite injuries during the COVID-19 pandemic.

 Despite their frequency, it can be challenging to distinguish between types of bites. There are also few detailed images and descriptions of cutaneous findings of human and animal bites in the literature. 

Additionally, though such injuries occur in various ways, pediatric providers must consider the possibility of child maltreatment. In the COVID-19 pandemic, there was also a documented increase in child abuse–related injuries.

 Though bite wounds are a less common cutaneous finding in child abuse,

 both human and animal bites may result from nonaccidental trauma or neglect. 

In the poll below, try to identify what caused this bite mark on the palm of a 16-year-old boy

Thank you for taking this Contemporary Pediatrics puzzler poll

Visit ContemporaryPediatrics.com on Wednesday, August 6, 2025, at 12:00 PM ET or later for many more bite examples in the pediatric population and how to distinguish between common animal bites and human bites.

"This [case] was prompted by the increases in child abuse and animal bite injuries during the COVID-19 pandemic, with the need to add to the limited descriptions of cutaneous findings of bites in the literature," wrote the authors of this case.

Bula-Rudas FJ, Olcott JL. Human and animal bites. 

. 2018;39(10):490-500. doi:10.1542/pir.2017-0212

Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: a case for enhanced prevention. 

. 2020;225:231-232. doi:10.1016/j.jpeds.2020.06.071

Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. 

. 2021;116(Pt 2):104756. doi:10.1016/j.chiabu.2020.104756

Kos L, Shwayder T. Cutaneous manifestations of child abuse. 

. 2006;23(4):311-320. doi:10.1111/j.1525-1470.2006.00266.x

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

Puzzler poll: Can you identify this bite? 

A new drug application has been filed with the FDA by Johnson & Johnson (J&J) for its investigational targeted oral peptide icotrokinra to treat adults and pediatric patients 12 years or older with moderate to severe plaque psoriasis (PsO), according to a press release from the company.

If approved, this indication would be the first for the peptide that selectively blocks the IL-23 receptor, underpinning inflammatory response in plaque PsO and offering potential in other IL-23–mediated diseases, according to J&J. 

Application submission was based on data from 4 phase 3 studies conducted in the ICONIC clinical development program, including ICONIC-LEAD (NCT06095115), ICONIC-TOTAL (NCT06095102), ICONIC-ADVANCE 1 (NCT06143878), and ICONIC-ADVANCE 2 (NCT06220604). 

Data from the phase 3 ICONIC-LEAD study, presented at the 2025 American Academy of Dermatology Annual Meeting, demonstrated that once-daily icotrokinra significantly improved skin clearance in adolescents (≥ 12 years) and adults with moderate to severe plaque PsO. At week 16, 65% of patients receiving icotrokinra achieved an Investigator Global Assessment (IGA) score of 0/1 (clear or almost clear) and 50% achieved a 90% reduction in Psoriasis Area and Severity Index (PASI) score compared with 8% and 4% of placebo recipients, respectively (

Efficacy continued through week 24, with 74% of patients achieving IGA 0/1 and 65% reaching PASI score of 90 (PASI 90). Complete skin clearance was observed in 46% (IGA 0) and 40% (PASI 100) of treated patients. The overall rate of adverse events was comparable between the icotrokinra and placebo groups (49% each), and no new safety signals were reported. 

"People living with moderate to severe plaque psoriasis are seeking options that balance efficacy, safety, and ease of use,” said Robert Bissonnette, MD, chair of Innovaderm Research in Montreal, Quebec, Canada, and ICONIC-LEAD study investigator, at the time of data announcement. "These study results are promising and show the potential for treatment with icotrokinra to offer patients the unique combination of complete skin clearance and a favorable safety profile in a once-daily pill.”

In a study presented at the 2025 Society for Investigative Dermatology Annual Meeting, once-daily icotrokinra demonstrated significant skin clearance in adults and adolescents with moderate plaque PsO involving high-impact areas and as little as 1% body surface area. At week 16, 57% of patients treated with icotrokinra achieved the study’s primary end point—an IGA score of 0/1 with at least a 2-grade improvement from baseline—compared with 6% of those receiving placebo (

Icotrokinra also demonstrated clinical benefit across specific anatomical regions. At week 16, 66% of patients with scalp involvement achieved a scalp-specific IGA score of 0/1 vs 11% on placebo (

 < .001). Among patients with genital PsO, 77% achieved a static Physician’s Global Assessment (PGA) of Genitalia score of 0/1 compared with 21% receiving placebo (

In a smaller subgroup with hand and/or foot involvement, 42% of icotrokinra-treated patients reached a hand/foot PGA score of 0/1 compared with 26% on placebo.

Phase 3 ICONIC-ADVANCE 1 and ICONIC-ADVANCE 2 studies

Top-line results from the phase 3 ICONIC-ADVANCE 1 and 2 studies demonstrated that once-daily icotrokinra met its coprimary end points of achieving an IGA score of 0/1 and a 90% reduction in PASI at week 16 compared with placebo. The studies enrolled patients with moderate to severe plaque PsO and further reinforced the efficacy profile observed in earlier trials.

In addition to meeting the primary efficacy end points, icotrokinra achieved all key secondary end points at weeks 16 and 24, demonstrating superiority over deucravacitinib. These findings support the potential of icotrokinra as an effective treatment option for patients with moderate to severe plaque psoriasis.

“The rapid patient enrollment across our ICONIC clinical program underscores the unmet need for an advanced plaque psoriasis treatment that meaningfully addresses their needs and preferences,” said Liza O’Dowd, MD, vice president and immunodermatology and respiratory disease area lead at Johnson & Johnson Innovative Medicine. “Given the breadth and depth of our studies, along with the robust clinical results reported to date, we are confident that icotrokinra has the potential to transform how physicians and patients think about plaque psoriasis care, establishing a new standard in the treatment of this immune-mediated disease.”

Johnson & Johnson seeks first icotrokinra U.S. FDA approval aiming to revolutionize treatment paradigm for adults and adolescents with plaque psoriasis. Press release. Johnson & Johnson. July 21, 2025. Accessed July 21, 2025. https://www.jnj.com/media-center/press-releases/johnson-johnson-seeks-first-icotrokinra-u-s-fda-approval-aiming-to-revolutionize-treatment-paradigm-for-adults-and-adolescents-with-plaque-psoriasis

Icotrokinra results show potential to set a new standard of treatment in plaque psoriasis. Press release. Johnson & Johnson. March 8, 2025. Accessed July 21, 2025. https://www.jnj.com/media-center/press-releases/icotrokinra-results-show-potential-to-set-a-new-standard-of-treatment-in-plaque-psoriasis

Icotrokinra results show significant skin clearance in patients with difficult-to-treat scalp and genital psoriasis. Press release. Johnson & Johnson. May 9, 2025. Accessed July 21, 2025. https://www.jnj.com/media-center/press-releases/icotrokinra-results-show-significant-skin-clearance-in-patients-with-difficult-to-treat-scalp-and-genital-psoriasis

J&J is seeking the first approval for the investigational targeted oral peptide to treat patients 12 years or older with moderate to severe plaque psoriasis.

Chandan Lakhiani, MD, FAAP

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