Acropustulosis of Infancy Clinical Presentation

  • Author: Howard Pride, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 30, 2012
 

History

The classic history of infantile acropustulosis is an infant aged 2-12 months developing pruritic erythematous macules or papules that progress into vesicles and then pustules. Children are fretful, irritable, and obviously uncomfortable, but otherwise healthy. Individual bouts of infantile acropustulosis last 7-15 days and recur in 2- to 4-week intervals.

Often, children have been empirically treated with antiscabies medicines prior to presentation[4] . The intensity and the duration of infantile acropustulosis attacks diminish with each recurrence.

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Physical

The hands and the feet are always involved in infantile acropustulosis, usually on the palms, the soles, and the lateral surfaces. Lesions may occur on the dorsal aspects of the hands and the feet as well as the trunk, the scalp, and the face.

Infantile acropustulosis lesions begin as small macules or papules that then form distinct, noncoalescing vesicles and pustules (see the image below). They heal with macular hyperpigmentation. No other organ systems are involved in infantile acropustulosis,

Lateral and plantar aspects of the foot with a comLateral and plantar aspects of the foot with a combination of intact acute vesicles and brownish hyperpigmentation of old vesicles.
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Causes

The cause of infantile acropustulosis is unknown. Scabies as a preceding or concomitant infestation is well documented in some cases. Many children are undoubtedly misdiagnosed as having scabies and treated with lindane or permethrin without any confirmatory scrapings. No other infectious agent has been documented.

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Contributor Information and Disclosures
Author

Howard Pride, MD  Associate Professor, Departments of Pediatrics and Dermatology, Geisinger Medical Center

Howard Pride, MD is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. Jul 1979;115(7):831-3. [Medline].

  2. Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. Sep 1995;12(3):211-4. [Medline].

  3. Prendiville JS. Infantile acropustulosis--how often is it a sequela of scabies?. Pediatr Dermatol. Sep 1995;12(3):275-6. [Medline].

  4. Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response totopical corticosteroids. Pediatr Dermatol. Sep-Oct 1998;15(5):337-41. [Medline].

  5. Good LM, Good TJ, High WA. Infantile acropustulosis in internationally adopted children. J Am Acad Dermatol. Oct 2011;65(4):763-71. [Medline].

  6. Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. Dec 1991;8(4):284-7. [Medline].

  7. Vicente J, Espana A, Idoate M, et al. Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity?. Br J Dermatol. Nov 1996;135(5):807-9. [Medline].

  8. Truong AL, Esterly NB. Atypical acropustulosis in infancy. Int J Dermatol. Sep 1997;36(9):688-91. [Medline].

  9. Kimura M, Higuchi T, Yoshida M. Infantile acropustulosis treated successfully with topical maxacalcitol. Acta Derm Venereol. May 2011;91(3):363-4. [Medline].

 
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Lateral and plantar aspects of the foot with a combination of intact acute vesicles and brownish hyperpigmentation of old vesicles.
 
 
 
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