Baboon Syndrome in Childhood: Easy to Avoid, Easy to Diagnose, but the Problem Continues

Abstract

Baboon syndrome was first described as a particular type of systemic contact dermatitis, characterized by an exanthem with involvement of the buttocks and flexures. In children, it is an important entity to take into account for the differential diagnosis of viral exanthem. A large number of allergens have been implicated, although inhalation of mercury vapor is a common trigger. We present the findings in 14 patients younger than 14 years with baboon syndrome. We also look at the frequency in children and the most common causes and triggers in our area.

Collate the literature on toxicity data on mercury in experimental animals and humans (Part I – Data on organic mercury)

“…Also exposure to organic mercury compounds like mercurial antiseptics (e.g. mercurochrome) or thiomersal in vaccines may cause this mercury exanthema (Moreno- Ramirez et al, 2004). But there are no reports on the induction of Baboon syndrome after oral ingestion of inorganic mercury.…”

Current understanding of Baboon syndrome

“…The youngest reported patient was an 18-month-old baby with erythromycin-induced BS [18]. In Spain, mercury-induced BS seems to be more common in childhood, probably because children use and break more thermometers than adults and also like to play with mercury drops from a broken thermometer [19,20]. Application of mercurial antiseptics to the umbilical cord of the newborn is an important source of mercury sensitization in some countries [12].…”

“…Itching and burning are usually the accompanying symptoms [2,18,22]. Sometimes, the lesional skin may show tiny papules [2, [23][24][25], vesicles [2,24], bullae [19,22,[26][27][28][29][30], erosions [31,32], petechiae [2,17,22,25,27,[32][33][34] or pustules [2,14,23,24,28,35], the latter raising the question as to whether or not acute generalized exanthematous pustulosis (AGEP) and BS should be regarded as variants of a continuous spectrum of possible clinical manifestations [16]. Concomitant use of iodine and mercury was reported to cause severe vesiculobullous lesions in one case due to the interaction between mercury and iodine to form iodide of mercury, which is harmful to the skin and can lead to cutaneous necrosis [30].…”

“…Plantar bullae [19], erosive intertriginous lesions mimicking toxic epidermal necrolysis (TEN) [31], spread of the eruption resulting in erythroderma [32] and cheilitis [18] have been reported in single cases.…”

“…Blood chemistry and hematology are normal. Mild eosinophilia [19,30] or leukocytosis with positive C-reactive protein [2], fever, headache, nausea, vomiting, abdominal pain and diarrhea, malaise, arthralgia and hypotension have been reported rarely [2,5,11,34,41,42]. In some cases of mercury-induced BS, elevated nontoxic levels of mercury can be detected in blood and urine, indicating exposure and absorption [10,11,16,30].…”