A six-month-old girl who presented with dermatitis was found to have multiple, …

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Biology Articles » Medicine » Dermatology » Circumferential skin folds in a child: A case of Michelin tire baby syndrome » Case report

Case report

- Circumferential skin folds in a child: A case of Michelin tire baby syndrome

A six-month-old female child with a clinical suspicion of Cushing's syndrome was referred from the Department of pediatrics for the management of itchy skin lesions. The child had an intensely pruritic, oozy dermatitis involving the face and extensor extremities. In addition, there were multiple, symmetric, deep, gyrate skin folds involving her trunk and similar circumferential lesions on her extremities [Figure - 1],[Figure - 2]. She had a characteristic round face with hypertelorism, depressed nasal bridge, thin, down-turned vermillion border of upper lip and short neck [Figure - 3]. The folds were present since birth and were asymptomatic without causing any physical discomfort to the child. The parents did not have any complaint regarding these as it was perceived by them as a sign of good health.

She did not have any major illness in the past necessitating prolonged treatment. Though there was a resemblance to Cushing's syndrome, detailed examination did not reveal any features suggestive of this condition. Her body weight was 8.5 kg. Other anthropometric measurements were within normal limits and developmental milestones were normal. Several of her family members had history of atopy but none had similar skin folds.

A diagnosis of MTBS was made. A skin biopsy was done from a deep fold on the right arm. Histopathology (H and E) showed normal epidermis and papillary dermis. There were scattered bundles of smooth muscle fiber in the reticular dermis. Masson trichrome stain revealed presence of increased smooth muscle fibers.

The child's dermatitis improved with a short course of systemic steroids, antihistamines and emollients. The cause and nature of the skin folds were discussed with the parents and they were counseled about the self-limiting course of this disorder.