True about Infantile Tremor Syndrome

There is hyperpigmentation, especially over dorsum of hands ,feet ,knees,ankles ,wrists and terminal phalanges Clinical Features- A classical picture of ITS is a plump looking infant between 6 months to 18 months with presence of malnutrition. These children are listless, apathetic and disinterested in surroundings. Scalp hair is sparse and light colored. Dark pigmentation is present over dorsal aspects of hands, nail folds, feet, knees, ankles, buttocks and axillae. There is regression of milestones in the recent past. Tremors have an acute onset following an acute infection or stress. Initially they are intermittent but become continuous in a few days. They are more prominent in distal pas of limbs, head, face and tongue. These tremors disappear during sleep. Hypotonia with flabbiness of muscles is common. There is presence of anemia, which may be macrocytic, microcytic or even normocytic. Ref : Ghai pediatrics eighth edition pg no 581