Dermatologic Manifestations of Gianotti-Crosti Syndrome Clinical Presentation

  • Author: Kara N Shah, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 3, 2010
 

History

Children with Gianotti-Crosti syndrome (papular acrodermatitis of childhood) usually present with an acute, symmetric, exanthematous, asymptomatic cutaneous eruption that develops over several days. The eruption typically lasts at least 10 days but can last longer than 6 weeks in more than 50% of patients. Complete resolution typically takes more than 2 months. Recurrences are rare. Pruritus accompanies the eruption in 23% of patients.

Other symptoms related to the primary viral syndrome or underlying bacterial infection may include mild constitutional symptoms such as low-grade fever and malaise, pharyngitis and/or mucosal lesions, or symptoms of an upper respiratory tract infection. When associated with a hepatitis B virus, EBV, or CMV infection, an anicteric acute hepatitis may be present.

A case control study of 29 children with Gianotti-Crosti syndrome from Bologna, Italy demonstrated a higher prevalence of atopic dermatitis in patients versus controls (24.1% vs 6.8%). They also found that patients were more likely than controls to have elevated levels of total and specific immunoglobulin E and a family history of atopy.[8]

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Physical

The cutaneous eruption of Gianotti-Crosti syndrome (papular acrodermatitis of childhood) is characterized by monomorphous pale, pink-to-flesh–colored or erythematous 1- to 10-mm papules or papulovesicles localized symmetrically and acrally over the extensor surfaces of the extremities, the buttocks, and the face. The number of lesions ranges from few to many. The trunk, knees, elbows, palms, and soles are rarely involved, and, in general, extensive involvement of the trunk is not consistent with a diagnosis of Gianotti-Crosti syndrome. Individual papules may coalesce to form larger plaques. Uncommonly, the eruption may develop a petechial or purpuric appearance. Partial involvement of only the face or the extremities is not uncommon, especially in older children. Over days to weeks, the papules may acquire a smooth-topped, polished, or lichenoid appearance. Other findings upon physical examination include the following:

  • Fever (27%)
  • Lymphadenopathy (31%)
  • Hepatosplenomegaly (4%)
  • Pharyngeal erythema, oropharyngeal ulcers or vesicles, or tonsillar swelling in cases secondary to infections of the upper respiratory tract
  • Note the images below.Characteristic erythematous papules of Gianotti-CrCharacteristic erythematous papules of Gianotti-Crosti syndrome appear on the face of this child. The child does not have a toxic appearance. Characteristic erythematous papules of Gianotti-CrCharacteristic erythematous papules of Gianotti-Crosti syndrome can be seen on the extremities, as is the case in this young child. A 9-year-old girl who recently returned from a triA 9-year-old girl who recently returned from a trip to Europe with her family. She developed a low-grade fever, malaise, and some lymphadenopathy. An eruption limited to her face, arms, legs, and buttocks was noted. A mildly pruritic eruption characterized by erytheA mildly pruritic eruption characterized by erythematous papules localized to the face, arms, legs, and buttocks.
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Causes

Gianotti-Crosti syndrome has been associated with the following infectious agents:

Gianotti-Crosti syndrome has also been reported to occur after vaccination for the following:

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Contributor Information and Disclosures
Author

Kara N Shah, MD, PhD  Assistant Professor, Department of Pediatrics and Dermatology, University of Pennsylvania School of Medicine; Clinic Director, Pediatric Dermatology, Children's Hospital of Philadelphia

Kara N Shah, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Albert C Yan, MD  Section Chief, Associate Professor, Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania

Albert C Yan, MD is a member of the following medical societies: American Academy of Dermatology, American Academy of Pediatrics, Society for Investigative Dermatology, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: elsevier Royalty Other

Paul J Honig, MD  Director of Dermatology, Professor, Department of Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, University of Pennsylvania

Paul J Honig, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Dermatology, and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernice R Krafchik, MBChB, FRCPC  Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto

Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

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.

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, 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.

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Characteristic erythematous papules of Gianotti-Crosti syndrome appear on the face of this child. The child does not have a toxic appearance.
Characteristic erythematous papules of Gianotti-Crosti syndrome can be seen on the extremities, as is the case in this young child.
A 9-year-old girl who recently returned from a trip to Europe with her family. She developed a low-grade fever, malaise, and some lymphadenopathy. An eruption limited to her face, arms, legs, and buttocks was noted.
A mildly pruritic eruption characterized by erythematous papules localized to the face, arms, legs, and buttocks.
 
 
 
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