Lui P C, Petersen D, Kimble R M, Raven R J, Pearn J H
Department of Paediatric Surgery, Royal Children's Hospital, Brisbane, Queensland, Australia.
J Paediatr Child Health. 2005 Jan-Feb;41(1-2):27-30. doi: 10.1111/j.1440-1754.2005.00531.x.
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.
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.
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.
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.
识别并阐述婴儿坏死性皮炎，这是一种罕见且令人困惑的综合征，据传闻报道及个人经验显示，三分之一的病例可能需要皮肤移植。关于这种令人痛苦的综合征的发病机制，诸多专业讨论聚焦于蜘蛛毒液的作用，尤其是澳大利亚白尾蜘蛛（Lampona cylindrata）的推测作用。
我们在此呈现1991年至1999年期间在布里斯班皇家儿童医院和玛特儿童医院接受手术治疗的6例坏死性皮炎病例。对每个病例的临床病史、手术细节及病理检查进行了回顾。对坏死性溃疡进行微生物学调查，包括标准需氧和厌氧培养。
两例培养出诺卡菌和葡萄球菌，但未目睹明确的叮咬，儿童及其父母也未识别出蜘蛛。所有病例均用磺胺嘧啶银乳膏治疗。两名婴儿需要全身麻醉、切除清创及分层皮肤移植。白尾蜘蛛（Lampona cylindrata）在昆士兰并不存在，但Lampona murina存在；这两种蜘蛛的毒液中均无坏死成分。间接证据表明该综合征可能是由于无脊椎动物毒液所致，可能是蜘蛛叮咬后引起。
根据我们的经验，在现阶段的科学认知中，尚无足够证据归咎于某一特定种类为病因。如果致病生物是蜘蛛，据我们计算，坏死性皮炎综合征在蜘蛛叮咬中发生率低于五千分之一。
