eMedicine Specialties > Dermatology > Pediatric Diseases

Acropustulosis of Infancy

Author: Howard Pride, MD, Associate Professor, Departments of Pediatrics and Dermatology, Geisinger Medical Center
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Updated: Sep 22, 2009

Introduction

Background

Infantile acropustulosis is a recurrent, self-limited, pruritic, vesicopustular eruption of the palms and the soles occurring in young children during the first 2-3 years of life. Newly described in 1979, infantile acropustulosis is probably much more common than the scarcity of reports would imply.¹

Pathophysiology

The pathophysiology of infantile acropustulosis is unknown. Many cases of infantile acropustulosis are preceded by well-documented or suspected scabies infestation, and a scabies id reaction has been suggested.^2,3,4 More often, cases of infantile acropustulosis occur despite scabies having been thoroughly ruled out. Bacterial and viral culture results are consistently negative, and negative immunofluorescence results suggest that infantile acropustulosis is not an antibody-mediated autoimmune process.

Frequency

United States

The exact incidence of infantile acropustulosis is unknown.

International

The exact incidence of infantile acropustulosis is unknown. One study from Israel reported 25 cases of infantile acropustulosis in a 9-year period, suggesting that this is not as uncommon as once thought.⁵

Mortality/Morbidity

All cases of infantile acropustulosis spontaneously resolve in a few months to 3 years.

Race

Early reports suggested a predominance of African Americans for infantile acropustulosis. Now, acropustulosis of infancy is believed to affect all races equally.

Sex

Early reports suggested a male predominance for infantile acropustulosis. Larger series have since shown an equal distribution between males and females.^4,5

Age

Although children as old as 9 years have been reported to have infantile acropustulosis, acropustulosis of infancy typically begins between the first 2-12 months of life⁵ . Resolution by age 3 years is the norm.

Clinical

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 presentation⁴ .
• The intensity and the duration of infantile acropustulosis attacks diminish with each recurrence.

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 Media file 1).
• They heal with macular hyperpigmentation.
• No other organ systems are involved in infantile acropustulosis,

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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