Overview
Infective dermatitis is a rare and severe chronic dermatitis which relapses. It promptly responds to therapy (antibiotics) and recurs on discontinuation.
Incidence
The incidence of infective dermatitis for people with HTLV-1 infection varies across geographical locations. Its incidence in Central Australia is unknown. It is a condition of childhood with incidence and severity decreasing into adolescence and adulthood.
Morbidity
Infective dermatitis responds well to antibiotics aimed at common pathogens Staphylococcus and B haemolytic Streptococcus.
Symptoms
Severe erythematous and exudative dermatitis with scaling and crusting primarily affecting the scalp, forehead, eyelids, paranasal area, neck, retroauricular areas, and to a lesser extent axilla and groin.
Diagnosis
Diagnostic criteria include:
- dermatitis of the scalp, axillae and groin, external ear and retroauricular areas, eyelid margins, paranasal skin, and/or neck;
- chronic watery nasal discharge without other signs of rhinitis and/or crusting of the anterior nares;
- early childhood-onset or chronic relapsing dermatitis with prompt response to appropriate therapy but prompt recurrence on withdrawal of use of antibiotics; and
- HTLV-1 antibody seropositivity.
Differentiating infective dermatitis from other skin conditions in a person living with HTLV-1 infection can be difficult and relies on clinical features, including the relapsing nature, and exclusion of alternative diagnoses such as atopic and seborrheic dermatitis.
Treatment
Infective dermatitis responds well to antibiotics aimed at common pathogens Staphylococcus and B haemolytic Streptococcus.
Management and Care
Treatment with continuous antibiotics until adolescence is recommended due to risk of relapse, and the risk of conditions associated with Streptococcal infection, i.e. post streptococcal glomerulonephritis (PSGN) and acute rheumatic fever.
Infective dermatitis may serve as an indicator of increased risk of developing other HTLV-1 associated diseases, in particular HAM/TSP and ATTL. Clinical surveillance of patients after a diagnosis of infectious dermatitis is recommended.
