Infective dermatitis: A purely cutaneous manifestation of HTLV-1 infection

Infectious dermatitis is a cutaneous manifestation of HTLV-1 infection. Although initially described in children in Jamaica, it is well documented that the disease can also present in adults. The clinical picture is of an oozing dermatitis affecting the scalp, face, retroauricular areas, the neck, and intertrigious areas, such as the axilla and groin. Histologically it has two patterns: a superficial perivascular dermatitis or a lichenoid dermatitis. The epidermal hyperplasia may mimic psoriasis. An important differential diagnosis is with mycosis fungoides, with epidermotropism, alignment of lymphocytes along the epidermal junction, lymphocytes in halo and wiry bundles of collagen in the papillary dermis. An important difference is the lack of marked lymphocytic atypia. The infiltrate is composed of a predominance of CD8-positive lymphocytes, analogous to what is seen in tropical spastic paraparesis. Infectious dermatitis patients may be confused with many common dermatological conditions, such a atopic dermatitis and contact dermatitis. Its diagnosis represent a challenge both to clinicians and dermatopathologists working in endemic areas.