Infantile papular acrodermatitis

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	Infantile papular acrodermatitis;
ICD-10	L44.4 (ILDS L44.400)
ICD-9	057.8
DiseasesDB	32236
MeSH	D000169

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Jesus Rosario Hernandez, M.D. [3]

Synonyms and keywords: Gianotti–Crosti syndrome; papular acrodermatitis of childhood; papulovesicular acrolocated syndrome; acrodermatitis papulosa infantum

Overview

Infantile papular acrodermatitis is a reaction of the skin to a viral infection.^[1] Hepatitis B^[2] and Epstein-Barr virus are the most frequently reported etiologies. Other incriminated viruses are hepatitis A, hepatitis non A-non B, strep, cytomegalovirus,^[3] coxsackie, adenovirus, enterovirus, rotavirus, rubella, HIV and parainfluenza.^[4]

Historical Perspective

It is named for Ferdinando Gianotti and Agostino Crosti.^[5]^[6]

Causes

Hepatitis B^[2] and Epstein-Barr virus are the most frequently reported etiologies of infantile papular acrodermatitis.

Other incriminated viruses are

Differentiating from other Diseases

Infantile papular acrodermatitis must be differentiated from:^[7]

Epidemiology and Demographics

Infantile papular acrodermatitis mainly affects infants and young children.

Natural History, Complications and Prognosis

Infantile papular acrodermatitis is a self limiting condition.
Spontaneous disappearance of the rash usually occurs after 15-60 days.
Complications occur as a result of associated conditions, rather than as a result of infantile papular acrodermatitis .

Diagnosis

The diagnosis of infantile papular acrodermatitis is clinical. A validated diagnostic criteria is as follows: ^[7]^[8]^[9] A patient is diagnosed as having infantile papular acrodermatitis if:

On at least one occasion or clinical encounter, he/she exhibits all the positive clinical features,
On all occasions or clinical encounters related to the rash, he/she does not exhibit any of the negative clinical features,
None of the differential diagnoses is considered to be more likely than infantile papular acrodermatitis on clinical judgment, and
If lesional biopsy is performed, the histopathological findings are consistent with infantile papular acrodermatitis.

The positive clinical features are:

Monomorphous, flat-topped, pink-brown papules or papulovesicles 1-10mm in diameter.
At least three of the following four sites involved – (1) cheeks, (2) buttocks, (3) extensor surfaces of forearms, and (4) extensor surfaces of legs.
Being symmetrical, and
Lasting for at least ten days.

The negative clinical features are:

Extensive truncal lesions, and
Scaly lesions.

Symptoms

Infantile papular acrodermatitis is generally recognized as a papular or papulovesicular skin rash occurring mainly on the face and distal aspects of the four limbs. The presence of less florid truncal lesions does not exclude the diagnosis.
Itching
Asthenia

Physical Examination

Skin

Papular or papulovesicular skin rash occurring mainly on the face and distal aspects of the four limbs.

Laboratory Findings

Raised liver transmainases with no rise in conjugated and unconjugated bilirubin are sometimes detectable, although the absence of such does not exclude the diagnosis.
Hepatitis virus serology or hepatitis B surface antigen
Screening for EBV antibodies
Serum zinc level may be tested in acrodermatitis enteropathica
Skin biopsy

Treatment

Infantile papular acrodermatitis is a harmless and self-limiting condition, so no treatment may be required. ^[11] Treatment is mainly focused on controlling itching, symptomatic relief and to avoid any further complications. For symptomatic relief from itching, oral antihistamines or any soothing lotions like calamine lotion or zinc oxide may be used. If there are any associated conditions like streptococcal infections, antibiotics may be required. ^[11]

References

↑ "Gianotti-crosti syndrome, papulovesicular acrodermatitis. DermNet NZ".
↑ ^2.0 ^2.1 Michitaka K, Horiike N, Chen Y; et al. (August 2004). "Gianotti-Crosti syndrome caused by acute hepatitis B virus genotype D infection". Internal Medicine (Tokyo, Japan). 43 (8): 696–9. doi:10.2169/internalmedicine.43.696. PMID 15468968.
↑ ^3.0 ^3.1 Haki M, Tsuchida M, Kotsuji M; et al. (October 1997). "Gianotti-Crosti syndrome associated with cytomegalovirus antigenemia after bone marrow transplantation". Bone Marrow Transplantation. 20 (8): 691–3. doi:10.1038/sj.bmt.1700945. PMID 9383234.
↑ ^4.0 ^4.1 Chandrasekaran M, Mukherjee S (September 2007). "Gianotti Crosti syndrome". Indian Pediatrics. 44 (9): 695. PMID 17921560.
↑ Template:WhoNamedIt
↑ CROSTI A, GIANOTTI F (1957). "[Eruptive dermatosis of probable viral origin situated on the acra.]". Dermatologica (in French). 115 (5): 671–7. PMID 13500859. Unknown parameter |month= ignored (help)
↑ ^7.0 ^7.1 Chuh A, Zawar V, Law M, Sciallis G. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep 2012: 4: e12
↑ Chuh A, Lee A, Zawar V. The diagnostic criteria of Gianotti-Crosti syndrome – are they applicable to children in India? Pediatr Dermatol 2004; 21: 542-7.
↑ Chuh AAT. Diagnostic criteria for Gianotti-Crosti syndrome – a prospective case control study for validity assessment. Cutis 2001; 68: 207-13.
↑ ^10.0 ^10.1 ^10.2 ^10.3 ^10.4 ^10.5 ^10.6 ^10.7 "Dermatology Atlas".
↑ ^11.0 ^11.1 "Gianotti-crosti syndrome. Dermatalk".

Template:WH Template:WS

[urlGianotti-crosti_syndrome,_papulovesicular_acrodermatitis._DermNet_NZ-1] "Gianotti-crosti syndrome, papulovesicular acrodermatitis. DermNet NZ".

[pmid15468968-2] 2.0 ^2.1 Michitaka K, Horiike N, Chen Y; et al. (August 2004). "Gianotti-Crosti syndrome caused by acute hepatitis B virus genotype D infection". Internal Medicine (Tokyo, Japan). 43 (8): 696–9. doi:10.2169/internalmedicine.43.696. PMID 15468968.

[pmid9383234-3] 3.0 ^3.1 Haki M, Tsuchida M, Kotsuji M; et al. (October 1997). "Gianotti-Crosti syndrome associated with cytomegalovirus antigenemia after bone marrow transplantation". Bone Marrow Transplantation. 20 (8): 691–3. doi:10.1038/sj.bmt.1700945. PMID 9383234.

[pmid17921560-4] 4.0 ^4.1 Chandrasekaran M, Mukherjee S (September 2007). "Gianotti Crosti syndrome". Indian Pediatrics. 44 (9): 695. PMID 17921560.

[5] Template:WhoNamedIt

[pmid13500859-6] CROSTI A, GIANOTTI F (1957). "[Eruptive dermatosis of probable viral origin situated on the acra.]". Dermatologica (in French). 115 (5): 671–7. PMID 13500859. Unknown parameter |month= ignored (help)

[idr-7] 7.0 ^7.1 Chuh A, Zawar V, Law M, Sciallis G. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep 2012: 4: e12

[pd-8] Chuh A, Lee A, Zawar V. The diagnostic criteria of Gianotti-Crosti syndrome – are they applicable to children in India? Pediatr Dermatol 2004; 21: 542-7.

[cutis-9] Chuh AAT. Diagnostic criteria for Gianotti-Crosti syndrome – a prospective case control study for validity assessment. Cutis 2001; 68: 207-13.

[www.atlasdermatologico.com.br-10] 10.0 ^10.1 ^10.2 ^10.3 ^10.4 ^10.5 ^10.6 ^10.7 "Dermatology Atlas".

[urlGianotti-crosti_syndrome._DermaTalk-11] 11.0 ^11.1 "Gianotti-crosti syndrome. Dermatalk".

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Infantile papular acrodermatitis
ICD-10	L44.4 (ILDS L44.400)
ICD-9	057.8
DiseasesDB	32236
MeSH	D000169