Gianotti-Crosti syndrome
| Gianotti–Crosti syndrome | |
| ICD-10 | L44.4 (ILDS L44.400) |
|---|---|
| ICD-9 | 057.8 |
| DiseasesDB | 32236 |
| eMedicine | derm/165 |
| MeSH | D000169 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Infantile papular acrodermatitis, Papulovesicular acrolocated syndrome, Papular acrodermatitis of childhood.
Overview
Gianotti–Crosti syndrome 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, cytomegalovirus,[3] coxsackie, adenovirus, enterovirus, rotavirus, rubella, HIV and parainfluenza.[4] It is named for Ferdinando Gianotti and Agostino Crosti.[5][6]
Clinical features and diagnosis
Gianotti–Crosti syndrome mainly affects infants and young children. Children of age as low as 1.5 months is reported to be affected.[7] It is generally recognized as a papular or papulovesicular skin rash occurring mainly on the face and distal aspects of the four limbs. Purpura is generally not seen but may develop following application of tourniquet. However extensive purpura without any hemorrhagic disorder has been reported.[7] The presence of less florid truncal lesions does not exclude the diagnosis. Lymphadenopathy and hepatomegaly are sometimes noted. Raised liver transaminases with no rise in conjugated and unconjugated bilirubin are sometimes detectable, although the absence of such does not exclude the diagnosis. Spontaneous disappearance of the rash usually occurs after 15–60 days.
The diagnosis of Gianotti–Crosti syndrome is clinical. A validated diagnostic criteria[8][9][10] is as follows:
A patient is diagnosed as having Gianotti–Crosti syndrome if:
1. On at least one occasion or clinical encounter, he/she exhibits all the positive clinical features,
2. On all occasions or clinical encounters related to the rash, he/she does not exhibit any of the negative clinical features,
3. None of the differential diagnoses is considered to be more likely than Gianotti–Crosti syndrome on clinical judgment, and
4. If lesional biopsy is performed, the histopathological findings are consistent with Gianotti–Crosti syndrome.
The positive clinical features are:
1. Monomorphous, flat-topped, pink-brown papules or papulovesicles 1-10mm in diameter.
2. At least three of the following four sites involved – (1) cheeks, (2) buttocks, (3) extensor surfaces of forearms, and (4) extensor surfaces of legs.
3. Being symmetrical, and
4. Lasting for at least ten days.
The negative clinical features are:
1. Extensive truncal lesions, and
2. Scaly lesions.
The differential diagnoses are: acrodermatitis enteropathica, erythema infectiosum, erythema multiforme, hand-foot-and-mouth disease, Henoch-Schönlein purpura, Kawasaki disease, lichen planus, papular urticaria, papular purpuric gloves and socks syndrome, and scabies.
Treatment
Gianotti-Crosti disease 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.[8] [9] [10] [11]
References
- ↑ "Gianotti-crosti syndrome, papulovesicular acrodermatitis. DermNet NZ".
- ↑ Michitaka K, Horiike N, Chen Y; et al. (2004). "Gianotti-Crosti syndrome caused by acute hepatitis B virus genotype D infection". Internal Medicine (Tokyo, Japan). 43 (8): 696–9. PMID 15468968. Unknown parameter
|month=ignored (help) - ↑ Haki M, Tsuchida M, Kotsuji M; et al. (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. Unknown parameter
|month=ignored (help) - ↑ Chandrasekaran M, Mukherjee S (2007). "Gianotti Crosti syndrome". Indian Pediatrics. 44 (9): 695. PMID 17921560. Unknown parameter
|month=ignored (help) - ↑ 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 Sarma, N (2013). "Hemorrhagic Gianotti-Crosti Syndrome in a One and Half Month old Infant: An Extremely Unusual Presentation". Ind J Dermatol. 58 (1): 65–67. doi:10.4103/0019-5154.105313. Unknown parameter
|month=ignored (help); Unknown parameter|coauthors=ignored (help) - ↑ 8.0 8.1 Chuh AAT. Diagnostic criteria for Gianotti-Crosti syndrome – a prospective case control study for validity assessment. Cutis 2001; 68: 207-13.
- ↑ 9.0 9.1 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.
- ↑ 10.0 10.1 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
- ↑ 11.0 11.1 "Gianotti-crosti syndrome. Dermatalk".