Prevalence and prevention of severe complications of hypohidrotic ectodermal dysplasia in infancy

Objective: To re-evaluate the mortality of hypohidrotic ectodermal dysplasia (HED) and the prevalence of hyperpyrexia and possible neurological sequelae in affected infants. Study design: A cross-sectional postal survey was conducted among parents of 100 children with ectodermal dysplasia who had been registered with the German-Swiss-Austrian patient support group within the past 10 years. Detailed questionnaires referring to the first year of life were evaluated statistically. Results: 63% of parents returned completed surveys, identifying 57% of children as patients with X-linked HED and 20% as patients with autosomal HED. Of those two groups, 17 infants had been placed in an incubator after birth, where body temperature recording proved to be of utmost importance. In 94% of all HED patients, episodes of unexplained fever were observed during the first year of life. X-linked HED was associated with frequent airway infections. Febrile seizures occurred in 5.9% of infants with X-linked HED, but in 17% of patients with autosomal HED. Developmental retardation was reported for 15% and 25%, respectively. Prognosis depended on the type of genetic defect and the time point of diagnosis. Except for one all patients survived infancy. Early recognition of the disease was aided by vigilant neonatal care and consulting a pediatric dermatologist. Interdisciplinary management, adequate instruction of the parents and networking with patient support groups served as effective measures to avoid complications of HED. Conclusions: Today, mortality of HED and the risk for hyperthermic brain damage are lower than reported previously. Both can be reduced by relatively simple measures.