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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.

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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.

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place.

New case study, HHS adopts influenza recommendation, and back-to-school vaccination

Study links early childhood eczema timing to risk of allergies like food allergy, asthma, and rhinitis, with five distinct disease phenotypes identified.

Atopic dermatitis phenotypes and allergic disease development in children

Lori Handy, MD, MSCE, is an attending physician in the Division of Infectious Diseases, Children’s Hospital of Philadelphia; and associate director, CHOP Vaccine Education Center. 

Lori Handy, MD, MSCE, highlights how pediatricians can better prepare families and systems for missed vaccines during the back-to-school rush.

Lori Handy, MD: Vaccine-only visits can help ease back-to-school gaps

Tyra Bryant-Stephens, MD, is a board-certified pediatrician; medical director, Asthma Prevention Program; chief health equity officer, Center for Health Equity, at Children’s Hospital of Philadelphia.

Tyra Bryant-Stephens, MD, encourages families to revisit asthma triggers, refill medications, and manage allergies to prevent avoidable complications.

Tyra Bryant-Stephens, MD, talks asthma reminders ahead of school year

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

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A boy with a history of skin eruption, intermittent fever, and generalized weakness now has red bumps on the bony prominences of his hands, elbows, and knees. What's the diagnosis?

Weeks of weakness, then reddish bumps on prominences

**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 23 at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was presented by Umer Muhammad, MD; Neil Copeland, MD; and John Bishara, DO

A 23-month-old girl presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax, with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes. 

Below, take your best guess at diagnosing this patient

Congenital pulmonary adenomatoid malformation (CPAM) 

website on Wednesday, July 23, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

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

Puzzler poll: Diagnose this 23-month-old with cough and rhinorrhea

Pediatric pulmonologist Richard Wong, DO, outlines how school environments can complicate asthma management for children across all age groups.

Richard Wong, DO, explains challenges children with asthma face in school

Before long, students will be walking the hallways of schools across the nation, and children with asthma often face heightened risks and management challenges that differ significantly from their home environment, according to Richard Wong, DO, pediatric pulmonologist at Phoenix Children’s Hospital.

“At home, families can better control exposures and reduce triggers, but school presents a much more complex environment,” Wong said. “Respiratory viruses, allergens, exercise, and environmental exposures like air pollution all contribute to increased risk.” 

Wong noted that the start of the school year frequently correlates with a dramatic increase in asthma-related emergency department (ED) visits. “In one large metropolitan area, ED visits jumped by almost 46% after school resumed,” he said. “That pattern highlights how common and serious school-related asthma challenges can be.”

Beyond increased exposure, students may struggle with adherence to maintenance therapy due to more rigorous and unpredictable schedules that could lead to missed doses and decreased control of asthma symptoms. 

As school season approaches, now is a good time to remind parents to have inhalers stocked so children can have the resources they need to help control asthma. This time of year also serves as a good reminder to create an asthma action plan, as going without one can bring challenges for the child once school is back in session. 

In some cases, children do not have timely access to rescue inhalers while at school. “Whether due to restrictive school policies, lack of an asthma action plan, or even bullying and stigma, some kids can’t or won’t get the help they need when they’re symptomatic,” Wong said. “This leads to increased flares and worsening control.”

Age is also a critical factor in how children manage asthma and how providers should tailor education and interventions. 

“Younger children, such as those in preschool or elementary school, may not have the ability to describe their symptoms,” Wong said. “They rely on adults—teachers and school nurses—to recognize what’s happening and intervene appropriately.”

Middle schoolers, on the other hand, begin to take more responsibility but may avoid treatment out of embarrassment. “They may hesitate to use their inhalers in front of friends, leading to untreated symptoms and avoidable complications,” he said. 

In high school, many teens are given full independence in managing their condition, which can create another set of issues. “Adolescents often feel like if they’re not having symptoms, their daily controller medication isn’t necessary,” Wong said. “That mindset can result in skipped doses and overuse of rescue inhalers, which sets the stage for serious asthma flares.”

Wong emphasized the importance of consistent education, communication, and support across all age groups to help children manage asthma safely—both at home and in the classroom. 

Silverman RA, Ito K, Stevenson L, Hastings HM. The relationship of fall school opening and emergency department asthma visits in a large metropolitan area. 

 2005;159(9):818-823. doi:10.1001/archpedi.159.9.818 

Pediatric pulmonologist Richard Wong, DO, outlines how school environments can complicate asthma management for children across all age groups. 

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 at 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.

J&J submits icotrokinra NDA for plaque psoriasis in patients 12 years or older

Discover the latest in pediatric infectious diseases with Infectious Insights, a new podcast series hosted by expert Tina Tan, MD, FIDSA, FPIDS, FAAP.

Introducing Infectious Insights, a new pediatric infectious disease podcast

Discover the latest in pediatric infectious diseases with Infectious Insights, a new podcast series hosted by expert Tina Tan, MD, FIDSA, FPIDS, FAAP. 

Maya B. Lodish, MD

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