Open Access Research article

Human T cell lymphotropic virus type 1- associated infective dermatitis in KwaZulu Natal, South Africa

Carol Hlela12*, Natalie Graham3, Ahmed I Bhigjee4, Graham P Taylor5, Nonhlanhla P Khumalo6 and Anisa Mosam2

Author Affiliations

1 Division of Dermatology; Red Cross Children’s Hospital, University of Cape Town, Cape Town, South Africa

2 Department of Dermatology; Nelson Mandela School of Medicine, University of KwaZulu Natal, Congella, Durban, South Africa

3 Virology Laboratory, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa

4 Neurology Department, Nelson Mandela School of Medicine, University of KwaZulu Natal, Congella, Durban, South Africa

5 Department of GU Medicine and Communicable Diseases, Imperial College, Faculty of Medicine, Norfolk Place, London, UK

6 Division of Dermatology, Groote Schuur Hospital, Observatory, Cape Town, South Africa

For all author emails, please log on.

BMC Dermatology 2013, 13:11  doi:10.1186/1471-5945-13-11

Published: 23 October 2013



The Human T cell lymphotropic virus type 1 (HTLV-1)-associated infective dermatitis (IDH), is a chronic relapsing dermatitis which usually presents in children older than 2 years. A total of 300 cases have been reported worldwide (Latin America, the Caribbean and only 5 from Senegal). Neither IDH, nor its complications have been reported from the rest of Africa. We aimed to examine the clinical and aetiological characteristics of IDH in a cohort of South African children.


Attendees at the dermatology clinic at King Edward VIII Hospital, Durban underwent clinical examination. After obtaining consent those suspected of IDH had specimens taken for blood counts, immunoglobulins, serum protein electrophoresis, viral studies (including genotyping), skin swabs and stool examinations.


Nineteen of 60 suspected cases recruited over 3 years met the diagnostic criteria for IDH. The male-to-female ratio was 1:2; mean age 8 years (range 0.7 to 15). Dermatitis mostly affected the scalp (78.9%) and axilla (73.7%); fewer children had nasal crusting (47.4%). Mean Ig A, IgG and IgM were raised, at 3.52 g/l, 22.6 g/l and 1.38 g/l, respectively. The median CD4 cell count was 1958 cells/mm3. Viral genotyping of all tested samples were positive for the Cosmopolitan, Subtype A (HTLV-1a).


IDH is a distinct entity which also affects South Africans. Our patients were older at presentation and the majority did not present with nasal crusting as has been described in other countries.