Human T-cell lymphotropic virus-Associated Infective Dermatitis

  • Endemic areas:
    • Africa
    • Northeastern South America
    • Caribbean
    • Southern Japan
    • Iran
  • 90% of carriers are asymptomatic
  • 2% risk of infective dermatitis in infected children
  • Rarely persists into adulthood

  • Transmission of Human T-cell lymphotropic virus type 1:
    • Breastfeeding
    • Sexual intercourse
    • Blood transfusions
    • Needle sharing
  • Human T-cell lymphotropic virus type1
    • Spontaneous T cell proliferation leading to interleukin-2 receptor expression and increased interleukin-2 secretion 
    • Induction of interferon-γ, interleukin-5 and interleukin-10
    • Dysregulation of immune system leading to immunosuppression:
      • More prone to infections (Staphylococcus aureus, ß-hemolytic streptococcus)

  • Criteria for diagnosis:
    • 4 major criteria and
    • Seropositivity for Human T-cell lymphotropic virus type 1 (HTLV-1)

Major criteria:

  • Eczema involving at least 2 body regions of the head and neck (scalp, ears, eyelid margins, paranasal skin), axillae and groin 
  • Chronic water nasal discharge ± crusting anterior nares
  • Chronic relapsing dermatitis
  • Onset during early childhood
  • Seropositivity for Human T-cell lymphotropic virus type 1

Minor criteria:

  • Positive skin or anterior nares culture (Staphylococcus aureus ± ß-hemolytic streptococcus) 
  • Generalized fine popular rash
  • Anemia, elevated erythrocyte sedimentation rate (ESR)
  • Hyperimmunoglobulinemia
  • High CD4+ and CD8+
  • High CD4/CD8 ratio

Complications: 

  • Secondary infection (Staphylococcus aureus, ß-hemolytic streptococcus)
  • Parasitic infestations
  • Corneal opacities
  • Progression of Human T-cell lymphotropic virus type 1

  • Findings of acute/subacute / chronic dermatitis

  • Oral antibiotics (improve lesions but do not prevent relapses)
  • Topical antibiotics (intranasal)
  • Topical corticosteroids
  • Bleach baths