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Lois La Grenade, FRCP; Angela Manns, MD, MPH; Valerie Fletcher, Dip Derm; Christine Carberry, DM; Barrie Hanchard, FRCPC; Elizabeth M. Maloney, MS; Beverley Cranston, BSc; Nadia P. Williams, DM; Rainford Wilks, DM, MRCP; Eric Choo Kang, FRCPC; William A. Blattner, MD

Arch Dermatol. 1998;134:439-444.

Objectives  To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I (HTLV-I).

Design  A case series of patients with ID were compared with patients with atopic dermatitis (AD), which is an important disease in the differential diagnosis of ID.

Setting  Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica.

Main Outcome Measures  Clinical and laboratory features of patients with AD were compared with those of patients with ID.

Patients  Consecutive patients older than 1 years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings.

Results  The mean ages of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both diseases were predominantly chronic dermatitis with propensity for skin colonization with Staphylococcus aureus and -hemolytic streptococci; however, the distribution of sites of skin involvement differed. Infection with HTLV-I was the most distinguishing feature among patients with ID, with seropositive results in 100%; only 5 (14%) of the 35 patients with AD had results seropositive for HTLV-I. Infective dermatitis was further characterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with palpable nodes. Anemia, lymphocytosis, and low albumin and elevated serum globulin levels were more prevalent among patients with ID. Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD. However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range. T-cell subsets among patients with ID revealed T-cell activation with a high percentage of HLA-DR antigen positivity, elevated CD4 (2.4 x 10⁹/L) and CD8 (1.4 x 10⁹/L) cell counts, with an increased CD4/CD8 ratio of 1:73.

Conclusion  Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.

From the Departments of Medicine (Drs La Grenade, Fletcher, and Carberry) and Pathology (Drs Hanchard, Williams, and Choo Kang and Ms Cranston) and the Tropical Medicine and Metabolism Unit (Dr Wilks), University of the West Indies, Kingston, Jamaica; and the Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (Drs Manns and Blattner and Ms Maloney).

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Infective Dermatitis: A Pabulum for Human T-Lymphotrophic Virus Type I Leukemogenesis?
Erwin Tschachler and Genoveffa Franchini
Arch Dermatol. 1998;134(4):487-488.
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