| Idiopathic necrotizing dermatitis: current management. | |
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MedLine Citation:
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PMID: 15670220 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. METHODS: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. RESULT: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. CONCLUSION: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites. |
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Authors:
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P C Lui; D Petersen; R M Kimble; R J Raven; J H Pearn |
Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of paediatrics and child health Volume: 41 ISSN: 1034-4810 ISO Abbreviation: J Paediatr Child Health Publication Date: 2005 Jan-Feb |
Date Detail:
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Created Date: 2005-01-26 Completed Date: 2005-05-04 Revised Date: 2007-09-24 |
Medline Journal Info:
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Nlm Unique ID: 9005421 Medline TA: J Paediatr Child Health Country: Australia |
Other Details:
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Languages: eng Pagination: 27-30 Citation Subset: IM |
Affiliation:
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Department of Paediatric Surgery, Royal Children's Hospital, Brisbane, Queensland, Australia. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Animals Anti-Infective Agents, Local / therapeutic use* Arachnidism / drug therapy, pathology*, surgery Bites and Stings / drug therapy, pathology*, surgery Child, Preschool Dermatitis / drug therapy, microbiology, pathology* Female Humans Infant Male Necrosis Silver Sulfadiazine / therapeutic use* Skin Ulcer / drug therapy, microbiology, pathology* Spiders |
| Chemical | |
Reg. No./Substance:
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0/Anti-Infective Agents, Local; 22199-08-2/Silver Sulfadiazine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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