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Aust. J. Derm.

(1975), 16, 109

ACUTE INFANTILE PRURIGO : CLINICO-PATHOLOGICAL


CORRELATION IN ONE HUNDRED CASES*
FRANCISCO ARELLANO OcAMPOf A N D C L E M E N T E M O R E N O CoLLADoff
Puebla, Mexico

INTRODUCTION RESULTS
There is a group of several dermatological Clinical Aspects Out of J.OO cases 57 were
entities, under the name of prurigo and classified males and 43 females ; 50 of them were infants
among the cutaneous reactive syndromes, whose and the rest were in school or of pre-school age.
common denominator is pruritus as a constant The age groups are shown in Table 1.
subjective manifestation and papules as the
fundamental dermatological lesion'. Therefore, TABLE 1
prurigo ~ does not correspond to a nosological Age No. of Cases
entity, but to several conditions whose grouping
under this title is due to morphological and First year 13
symptomatic similarities, the aetiology being so Second year 36
Preschool year 29
varied that in fact we cannot speak of prurigo School year 22
but of the prurigos^. Besides, within general
statistics of the most common dennatosis in our Total 100
environment, the prurigos amount to 30-4%-
10-69%^'^. This is the reason why they become Aetiology: Clinical study and allergy tests,
very important. In regard to acute infantile such as intradermal exclusion or re-exposure
prurigo they cover 8-9%^ of the dermatoses. tests to the allergen, as well as clinical correlation
This high percentage led us to study 100 gave the following data. In 30 cases, tlie only
children afflicted with acute infantile prurigo. cause of the disturbance was insect bites, as
The purpose was firstly to know its clinical shown in Table 2.
features and secondly to find clinical and
TABLE 2
pathological correlates in order to reach definite
conclusions. Insect Bites No. oi Cases
Fleas 12
MATERIALS AND METHOD Bedbugs 8
One hundred cases of acute infantile prurigo, Mosquitoes 2
Lice
including both sexes, were studied and their Picahuye o
4 : , '

complete clinical history prepared. The Others . . 2


following factors, which would allow us a
ranking of the patients, were emphasized : age, Total 30
sex, aetiology, home and environmental hygiene,
season of the year when the disease started, In 32 cases the cause was insect bites combined
developmental period, family and personal with other factors, as indicated in Table 3.
history of allergy, sinusitis, badly decayed
teeth, intestinal parasitosis, skin mycoses and TABLE 3
finallj', type of diet and immunizations. Mixed Aetiology No. of Cases
* Presented at the Pacific Congress of Dermatology Insect bites and foods 24
Sydney, 22-27 June, 1975. Insect bites, intestinal parasites 5
t Chief, Department of Dermatology, Hospital and foods
Regional de Puebla del Instituto Mexicano del Seguro Insect bites, dentition and
Social ; Profr. of the School of Medicine, Universidad foods
Autonoma de Puebla. Insect bites, drugs and foods
t t Chief, Dermatology Service, Hospital Central Total 32
Militar.
no FRANCISCO ARELLANO OCAMPO AND CLEMENTE MORENO COLLADO

In 29 cases the only outstandingly apparent The results are stated in Tables 6 and 7, showing
cause was foods, in particular the commercially that proper home and environmental hygiene
prepared ones such as Gerber's, Nestle's, and lessen the percentage incidence of prurigo.
other trade mark milks (Table 4).
TABLE 7
TABLE 4
Environment Sanitary N o . of Cases
Foods No. of Cases Condition

Gerber foods Good 19


Nestle foods Fair 28
Canned milk Bad 53
Milk
Banana Total 100
Strawberry
Canned food
Flour
Others . . In respect of the time of onset of the disorder
(Table 8), the higher frequency during the first
Total 29 year of life is noticeable, followed by, in
decreasing order, the second and third years.
Other factors taken into account are listed in TABLE 8
Table 5, and among them only digestive dis-
turbances by overfeeding, intestinal parasites, Evolution Time No. of Cases
tooth eruption, drugs and. exposure to sunlight
or cold seemed to be involved in the pathogenesis 4 to 29 days 9
of prurigo. 1 to 11 months 33
1 Year . . 26
2 years . . 13
TABLE 6 3 years . . g
4 years . . a
Other Factors No. of Cases 5 years . . 1
6 years . . 1
Digestive disorders due to 7 years . . 2
overfeeding . . Unknown 1
Intestinal parasitosis . .
Bacterial infections Total 100
Dentition
Caries ...
Superficial mycoses
Other infeetions Allergic history was thoroughly and carefully
Drugs . . investigated. A family history was found in
Sun exposure . . 33% of the cases and the clinical pictures are
Cold exposure . . summarized in Table 9.
Pregnancy of the mother
TABLE 9
Total 9
Antecedents Antecedent Type No. of Cases

TABLE 13
Positive 33
Asthma 12
Allergic rhinitis 9
Home Sanitary Condition N o . of Cases (Rash) Urticaria 6
Quincke's oedema . . 3
Good 21 Actinodermatitis . . 2
Fair 44 Atopic dermatitis 1
Bad 35 Negative 66
Unknown 1
Total 100
Total 100

Hygiene at home was evaluated and also the


environment in which the patient was being Personal allergic background was found in
raised, since it undoubtedly bears a close 23 patients. Only the relevant clinical pictures
relationship to the presence of insects and mites. are shown in Table 10.
ACUTE INFANTILE PRURIGO 111

TABLE 10 already existing prurigo. Polio and DPT triple


vaccines trigger this action most often.
Antecedents Antecedent Type No. ot Cases From a clinical point of view acute infantile
Positive 23 prurigo involves mainly the superior and inferior
Urticaria 7 limbs and less frequently the face, neck, palms
Allergic rhinitis 5 and soles (Figure 1). It is characterized by the
Atopic dermatitis . . 4
Asthma 3
Actinodermatitis . . 1
Penicillin allergy . . 1
(hypersensitivity)
Quincke's oedema . . 1
Fixed pigmented 1
erythema
Negative 76
Unlcnown 1
Total 100

Certainly both are very important as pre-


disposing factors especially if prurigo is to be
regarded as an atopic disease. Diet, as
mentioned above, is important. Indeed, the
commercially prepared foodstuffs are the most
common apparent cause of prurigo. The
seasons of the year, as shown in Table 11, do
not seem to be definitely involved in the aetiology
of this disorder. Something similar is shown
by infectious foci whether they are bacterial,
parasitic or mycotic (Table 12).
TABLE 11

Season No. of Cases


Spring . . 30 FIGURE 1.Acute infantile prurigo, involving
Summer 20 mainly the superior and inferior limbs.
Autumn 16
Winter 28
Unknown 6 onset of sudden, eruptive, extremely pruritic
patches. It starts with an urticarial macule in
Total 100
the centre of which appears a little round papule
of 1 or 2 mm in diameter. This papule is pink,
TABLE 12 hot and hard, consistently having a tense little
vesicle on its vertex. After 4-12 hours, the
Infection Positive Negative Unknown No. of urticarial macule disappears, but the papule
Cases remains for a period of 815 days. The vesicle
remains until the end if it is not destroyed by
Rank's scratching. Otherwise it is replaced b}' a blood
complex . . 3 89 8 100
crust (Figure 2). When the outbreak declines
Sinusitis 1 99 0 100
Caries 2nd it leaves residual hj'perpigmented or hypo-
degree 20 74 0 100 chromic lesions behind it which later on disappear
Intestinal spontaneously (Figure 3). Histological examin-
parasitosis 27 73 0 100 ation showed loss of epidermal substance,
Superficial sometimes superficial and at other times deep,
mycoses . . 3 97 0 100
correlated to erosions and excoriations (Figure 4).
Protein and serous effusions were mixed with
It should be taken as important and remark- parakeratotic elements and occasionally^ with
able that in 48% of the cases immunizations poly-morphonuclear leucocytes at the level of
caused new outbreaks or exacerbations of the corneal layer, a fact clinically correlated to
FRANCISCO ARELLANO OCAMPO AND CLEMENTE MORENO COLLADO

FIGURE 2.Characteristic lesions of acute FIGURE 3.Hyperpiginented residual lesions


infantile prurigo. and some small papules.
crusts (Figure 5). These alterations at times could only be detected in ]%-2%amounting
coincide witli spongiosis and exocytosis. In to a total of only 9% in our patients.
the dermis tliere appeared a dense and nodular The importance of hygienic conditions was
inflammatory infiltrate consisting of monocytes, demonstrated but not so the importance
lymphocytes and histiocytes, and charac- attributed to tlie season of the year in which the
teristically polymorphs, eosinophils and illness appears. The highest level of incidence
neutrophils, surrounding in particular the is during the first year of life and decreases
neighbourhood of the eccrine sweat glands and in steadily in the second and third years.
lesser degree the blood vessels (Figure 6). The
degree of oedema of the dermal papillae and
capillary distention were related to the length
of the disorder.
DISCUSSION AND CONCLUSIONS
Prurigo is usually more frequent in males,
older infants and pre-school children. It was
confirmed that insect bites are the main cause.
It is remarkable that foodstuffs, particularly the
marketed pre-elaborated ones, are involved in a
considerable percentage of cases, though patients
in this category often had an atopic history.
Other causes referred to by different authors,
such as digestive disturbances through over-
feeding, intestinal parasites, cold and heat, FIGURE 4
ACUTE INFANTILE PRURIGO 113

Infectious foci, bacterial, parasitic or mycotic


do not seem to be definitely involved in the
aetiology ; 48% of the cases presented new
relapses or exacerbation of the already existing
lesions when they were immunized, especially
with polio and DPT triple vaccines. The arms
and legs are the most affected zones. The
papule upon an urticarial lesion, crowned by a
vesicle, was the common lesion. In 82% of the
patients the vesicle was replaced by a blood
crust or by a simple erosion.
The histological studj' presented variations
according to the stage of the lesions from which
the biopsies were taken. Sixty-tliree per cent
of the cases showed typical prurigo lesions
without the vesicle and the data obtained
corresponded to those mentioned above. There
occurred epidermal blisters in 18 cases on the
site of the mentioned vesicle ; the rest of the
findings matched tliose already described.
From the histological point of view the skin
presented normal features in 19 cases, wliich
suggested rapidity in the evolution of the lesions
and the early resolution of the residual maculae.
From the above the following conclusions are
drawn :
1. Prurigo has an histological picture of its
own ;
2. It helps in diagnosis definitely in 80% of
FIGURE O the cases ;
3. Findings vary according to the stage of
Although a family and personal history of the lesion from which the biopsy is made ;
allergy was obtained only from 1/3 and 1/4 of 4. The skin develops normal features in spite
the cases respectively, it was interesting to of it showing a clinical appearance of
observe that when the food was part of the injury. .
disorder's aetiology, the patients were atopic.
REFERENCES
' Arellano Ocampo, F. (1974) : Dermaiosis Frecuentes
en Medicina Familiar. Pag. 29, IMSSPuebla,

^^^^^iM^^
Mexico.
- Rosales Perez, S. (1973) : Vermatosis RcaccionaUs.
L>nd Ed.Pag. 60. IMSS-Puebla. Mexico.
' Arellano Ocampo, F., and Rosales Perez, S. (1972) ;
" Fstudio Estadistico del Seryicio de Derma-
tologi'a del-Hospital Regional del IMSS. Puebla,
Pue.1968-70 " , Bol. med. Ttist. mex. Seg. Soc.
14, 3.
* Arellano Ocampo, F., Rosales Perez, S., and Corichi,
R. (1974) : " Estadi'stica Dermatologica.
Hospital Regional del IMMS. Pnebla, Pue.
1971-72 ", Bol. med. Inst. mex. Seg. soc, 16, 16.
5 Rosales Perez, S., and Arellano Ocampo, F. (1975) :
FIGURE 6 Apuntes de Dennatologia. 2nd Ed. UAP.
Mexico.