Mid-face Toddler Excoriation Syndrome (MiTES): A new conundrum in the field?
an enigma in sensory neuropathy
Keywords:
Excoriation, neuropathy, midfaceAbstract
Genetically heterogeneous group of sensory neuropathies have variable clinical presentation with insensitivity to pain as a prime feature. Chronic scarring with midface erosions mostly found in infants and toddlers and may be the only primary manifestation of chronic insensitivity to pain. In these cases, parents report that lesions are self-induced but, doctors attribute fabricated illness by parents. Thorough clinical and laboratory workup has to be done to distinguish between sensory neuropathies, Factious illness and neurometabolic disease. Midface toddler excoriation syndrome is a recently described entity, clinically characterized by excoriations and sequelae of long-term scratching, over mid-face in toddlers. In this case we have proposed the recognition of this entity in young adult, would encourage further scientific reports, and help to elucidate the cause.References
Chen Y-C, Auer-Grumbach M, Matsukawa S, Zitzelsberger M, Themistocleous AC, Strom TM, et al. Transcriptional regulator PRDM12 is essential for human pain perception. Nat Genet. 2015;47(8):803-8.
Elhennawy K, Reda S, Finke C, Graul-Neumann L, Jost-Brinkmann PG, Bartzela T. Oral manifestations, dental management, and a rare homozygous mutation of the PRDM12 gene in a boy with hereditary sensory and autonomic neuropathy type VIII: a case report and review of the literature. J Med Case Rep. 2017;11(1):233.
Srinivas SM, Gowda VK, Owen CM, Moss C, Hiremagalore R. Midface toddler excoriation syndrome (MiTES): a new paediatric diagnosis. Clin Exp Dermatol. 2017;42(1):68-71.
Moss C, Srinivas SM, Sarveswaran N, Nahorski M, Gowda VK, Browne FM, et al. Midface toddler excoriation syndrome (MiTES) can be caused by autosomal recessive biallelic mutations in a gene for congenital insensitivity to pain, PRDM12. Br J Dermatol. 2018;179(5):1135-40.
Kumar P, Das A. Midface toddler excoriation syndrome. Indian J Dermatol Venereol Leprol 2021;87(4):528-9.
Moss C. Dermatitis artefacta in children and adolescents. Paediatric Child Health. 2015; 25(2):84-9.
T. Narang, S. Singh. Response to: Midface toddler excoriation syndrome (MiTES) can be caused by autosomal recessive biallelic mutations in a gene for congenital insensitivity to pain, PRDM12. Br J Dermatol. 2019;180(2):431.