eMedicine Specialties > Dermatology > Pediatric Diseases

Acropustulosis of Infancy: Treatment & Medication

Author: Howard Pride, MD, Associate Professor, Departments of Pediatrics and Dermatology, Geisinger Medical Center
Contributor Information and Disclosures

Updated: Sep 22, 2009

Treatment

Medical Care

Treatment is often unnecessary because of the self-limited nature of infantile acropustulosis.

  • Topical steroids4 and oral dapsone7 have been used successfully, if justified in more difficult cases.
  • Topical pramoxine preparations are available without prescription for the treatment of pruritus.
  • Oral antihistamines may be useful in infantile acropustulosis.

Consultations

In infantile acropustulosis, consult a dermatologist or a pediatric dermatologist.

Activity

Isolation is not warranted.

Medication

High-potency topical steroids (classes 1 and 2) have been used successfully for control of pruritus. Children who are extremely symptomatic may be treated with dapsone.

Topical steroids

These agents provide symptomatic relief of pruritus.


Betamethasone (Diprolene, Betatrex)

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Use fluorinated topical steroids with caution in children.

Adult

Pediatric

Apply thin film to affected areas bid; occlusion increases effectiveness; avoid wraps that may present choking hazard

Documented hypersensitivity; paronychia; cellulitis; impetigo; angular cheilitis; erythrasma; erysipelas; rosacea; perioral dermatitis; acne

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Application over large surface areas may cause systemic absorption and adrenal suppression; do not use on skin with decreased circulation; can cause atrophy of groin, face, and axillae; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control

Antibiotics

Diaminodiphenylsulfone antibiotics have been used as anti-inflammatory agents.


Dapsone (Avlosulfon)

Bactericidal and bacteriostatic against mycobacteria; mechanism of action is similar to that of sulfonamides where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth. Used mainly to treat leprosy and dermatitis herpetiformis. Has antineutrophil and anti-inflammatory properties.

Adult

Pediatric

1-2 mg/kg/d PO; not to exceed 100 mg

May inhibit anti-inflammatory effects of clofazimine; hematologic reactions may increase with folic acid antagonists, eg, pyrimethamine (monitor for agranulocytosis during second and third months of therapy); probenecid increases toxicity; trimethoprim with dapsone may increase toxicity of both drugs; because of increased renal clearance, levels may significantly decrease when administered concurrently with rifampin
Concomitant administration of zidovudine may increase risk of hematologic toxicity; amprenavir and saquinavir may inhibit cytochrome P4503A (CYP3A), the hepatic isoenzyme group with major activity related to dapsone metabolism, thereby leading to increased dapsone serum concentrations and potential toxicity

Documented hypersensitivity; known G-6-PD deficiency (assay for G-6-PD activity prior to initiation of therapy)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Associated with a variety of systemic toxicities, including agranulocytosis, anemia, methemoglobinemia, hepatitis, and neuropathy; patients may experience headache and/or GI distress on initiation of therapy; perform weekly blood counts (first mo), then monthly WBC counts (6 mo), then semiannual WBC counts; discontinue if a significant reduction in platelets, leukocytes, or hematopoiesis occurs; caution in methemoglobin reductase deficiency, G-6-PD deficiency, or hemoglobin M because of high risk for hemolysis and Heinz body formation; caution in patients exposed to other agents or conditions (eg, infection, diabetic ketosis) capable of producing hemolysis; peripheral neuropathy can occur (rare); phototoxicity may occur when exposed to UV light; pancreatitis may occur; various forms of renal complications including acute renal failure, acute tubular necrosis, and oliguria have occurred with dapsone use

Antipruritics

These agents may relieve associated itching.


Pramoxine (Tronothane, Prax)

Blocks nerve conduction and impulses by inhibiting depolarization of neurons. Use 1% lotion or cream.

Adult

Pediatric

Apply to affected area prn; not to exceed 200 mg

Documented hypersensitivity; do not apply over large areas; avoid contact with eyes and nose

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in patients with trauma in area to be treated

More on Acropustulosis of Infancy

Overview: Acropustulosis of Infancy
Differential Diagnoses & Workup: Acropustulosis of Infancy
Treatment & Medication: Acropustulosis of Infancy
Follow-up: Acropustulosis of Infancy
Multimedia: Acropustulosis of Infancy
References
[ CLOSE WINDOW ]

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

  6. 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].

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

  8. Wagner A. Distinguishing vesicular and pustular disorders in the neonate. Curr Opin Pediatr. Aug 1997;9(4):396-405. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

acropustulosis of infancy, infantile acropustulosis, infant acropustulosis

[ CLOSE WINDOW ]

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.

Medical Editor

Daniel Mark Siegel, MD, MS, Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate
Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.