title: Mid-face toddler excoriation syndrome (MiTES): a new paediatric diagnosis.
abstract: Chronic ulcerating lesions on the face are rarely seen in toddlers. Blistering disease, vasculitis, infections and self-mutilation due to neurometabolic disease can usually be excluded on clinical and histological grounds. In the absence of identifiable disease, such lesions are sometimes attributed to child abuse or fabricated illness. We describe three toddlers with chronic mid-face erosions, two from India and one from the UK. One had moderate developmental delay and one had had seizures. The lesions appeared to be self-inflicted, no underlying disease was identified and there was no suspicion of child abuse. Recognition of the same disease pattern in different continents implies a distinct pathological entity. The pattern closely resembles that seen in some patients with mutations in the pain-insensitivity genes PRDM12 and SCN11A. We suggest the term 'mid-face toddler excoriation syndrome' (MiTES) to acknowledge the existence of this condition, encourage further reports and help clarify the pathogenesis.
authors.affiliation: Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: S M
authors.initials: SM
authors.lastname: Srinivas
authors.affiliation: Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Gowda
authors.affiliation: Department of Dermatology, East Lancashire Hospitals NHS Trust, Lancashire, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Owen
authors.affiliation: Department of Dermatology, Birmingham Children's Hospital and University of Birmingham, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Moss
authors.affiliation: Centre for Human Genetics and Manipal Hospitals, Bangalore, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Hiremagalore
mesh_terms: D002675:Child, Preschool; D003937:Diagnosis, Differential; D005148:Facial Dermatoses / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012867:Skin / Q000473:pathology*; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis*; D013577:Syndrome