Bald Patch in two-year-old

[carole]

My Daughter has a blad patch in back of her head.

It happened like this.  On June 14, 1999 she was taken tothe ER in a state of DKA with BG in excess of 980 and a PH of 6.9.  While she was in the ER it was noted that she had a lump on the back of her head.  It was noted and not addressed because at that tie she had to be intubated and an A-;one for IV done.  After a few days in the PICU  she was finally weened from the respirator, allowing a better look.  It was blister like in appearence.  A few days later, the blister had broken open.  The doctors were not oncerned about it.  The area became infected and requied two courses of cephlaxin to get rid of the infection.  The area that had blistered up, fell off taking the hair with it.  There area has healed with shiny skin and no hair regrowth.  No difinitiive answer as to wat it was that had occured.  The dermatologists that she has been taken to have conflicting answers and conflicting treatments.  One gave steriods the other said that that was the worst thing for her.  The problem is that the diabetician is not concerned with the bald patch and the dermatologist is not comfortable with the diabets.  It was sugested that a biopsy be taken to help further the answer but that a head X-Ray would need to be done first.  Is there any reference to diabetes-related skin disorders of this nature that I could get information on?

[Alan Rockoff, MD]

Carole:

I appreciate your consternation, but there is little I can add.

To my knowledge, there is no scalp condition in children with a particular association with diabetes.  The most common cause of bald patches in children is alopeci areata, but that does not start as a "blister."  It sounds as though some inflammatory or infective process inflamed the scalp to the point of scarring the follicles.  If so, a biopsy is unlikely to point to a treatable diagnosis.

On the positive side, I can't think of any conditions which would require special attention on your part, diabetes-related or otherwise.

In dermatology -- and elsewhere --  may conditions have no specific explanations . . .

Best.

Dr. Rockoff

[carole]

Something in what you said struck a chord.  I had forgotten to search the original manifetation of the problem.  My serach yeilded something called Dermatitis herpatiformis.  This disease starts out as blisters , but usuallly on the buttocks.  It is associated with diabetes and gluten intolerance, which is also and autoimmune disease.   I will be taking the information that I have found in regards to this to her endocrinologist.  She recently had an antibody test done along with her HgbA1C and had a slightly raised level.  While this is indicative of some sort of celiac disease, the search is far from complete.  If there is any information you can direct me towards for dermatitis herpatiformis that is in layman's terms, I would really like that.  My current information contains a lot of tests, procedures and technical information that has me reading the medical dictionary almost as much as the articles themselves.  Sincerest thanks,

Carole

[akikoe]

A related discussion, My little girl has a bald spot and sore head was started.