Topical agents that are well tolerated by adults may cause quite severe reactions in infancy because of the lack of maturity of the skin barrier. The ability to scratch does not seem to fully develop until around the age of 6 months, and when it does, a rash may alter substantially because of the secondary lesions and the physical effects of persistent scratching on the skin as well as the presence of infective lesions. Widespread rashes may rapidly lead to dehydration in infancy because of the greatly increased rate of water loss through the abnormal skin. Hypothermia can develop very rapidly in young infants who have a widespread inflammatory skin disorder. When the disorder develops after infancy and is severe, the possibility of virilization due to an endocrine tumor or adrenocortical hyperplasia has to be considered. The exact cause of this odd skin disorder is obscure but is been suspected to be due to the occlusive footwear.