Exfoliative Dermatitis in Thai Children: 10 Years Review
Keywords:
Exfoliative dermatitis, children, neonateAbstract
Background: Exfoliative dermatitis is an uncommon, potentially serious skin condition. Thus it might poses a significant challenge to find the underlying etiologies.
Objective: To determine the etiologies, clinical presentations, laboratory findings and outcomes of exfoliative dermatitis in Thai children.
Material and methods: A retrospective study of patients diagnosed of exfoliative dermatitis at the Dermatology Unit, Queen Sirikit National Institute of Child Health during January 2009 to December 2019 was reviewed.
Results: Forty-one patients were identified. Age ranged from birth to12 years, with median age was 5 months (IQR 0-33 months), female to male ratio of 1:1. Clinical findings were pruritus (80.5%), fever (51.2%), failure to thrive (14.6%) and alopecia (12.2%). The most common causative diseases were inflammatory dermatoses in 26 cases (63.4%), including atopic dermatitis in 15 cases (36.6%), psoriasis in 8 cases (19.5%), pityriasis rubra pilaris in 2 cases (4.9%) and pityriasis lichenoides et varioliformis acuta in
1 case (2.4%). Other causes were genodermatoses in 9 cases (22.0%), primary immunodeficiency syndrome in 2 cases (4.9%), drug allergy in 1 case (2.4%) and unknown causes in 3 cases (7.3%). In neonatal exfoliative dermatitis (N=11), the underlying causes included congenital ichthyosis in 9 cases (81.8%) and Netherton syndrome in 2 cases (18.2%). Skin biopsies were done in 30 cases (73.2%). The follow up of 37 cases (90.2%) revealed good complete recovery in 8 patients (19.5%), chronic dermatoses in 19 patients (46.3%) and persistent exfoliative dermatitis in 10 patients (24.4%). Mortality rate was 2.4% due to severe sepsis.
Conclusion: The clinical features of exfoliative dermatitis are unspecified with few cause-orienting clues. Etiologies of exfoliative dermatitis depend on the patient’s age group. In neonatal exfoliative dermatitis are most commonly due to congenital ichthyosis or immunodeficiency syndrome. Likewise, exfoliative dermatitis with infants and childhood onset are most attributed to inflammatory dermatoses.
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