HTLV-I-associated infective dermatitis: past, present, and future.

Infective dermatitis (ID) of Jamaican children, a distinctive pattern of dermatitis first described in Jamaican children in 1966 was found to be associated with human T-cell lymphotropic virus type I (HTLV-I) infection in 1990. Since then, ID has been reported from other HTLV-I endemic areas. Further studies have confirmed the HTLV-I association and have demonstrated immunologic abnormalities in cellular and humoral immune systems as well as at the subcellular level. Viral genome has been detected in cultured skin biopsy material, and genetic factors may predispose people to the development of ID. Transmission of HTLV-I infection in ID appears to be from mother to infant via breast milk. Present therapy is with long-term antibiotics to control bacterial infection and hence the dermatitis. Complications are frequent and include crusted scabies, corneal opacities, chronic bronchiectasis, parasitic worm infestation, early death, and progression to more severe HTLV-I-associated disorders such as adult T-cell leukemia/lymphoma and HTLV-I-associated myelopathy/tropical spastic paraparesis. Future studies are planned to determine the precise immunologic defect, the role of socioeconomic and nutritional factors, and the natural history. Intervention studies to limit breast feeding and hence HTLV-I transmission are also planned.