eMedicine Specialties > Dermatology > Pediatric Diseases

Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood): Differential Diagnoses & Workup

Author: Kara N Shah, MD, PhD, Assistant Professor, Department of Pediatrics and Dermatology, University of Pennsylvania School of Medicine; Attending Physician, Section of Dermatology, Division of General Pediatrics, Children's Hospital of Philadelphia
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; 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; Paul J Honig, MD, Director of Dermatology, Professor, Department of Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, University of Pennsylvania
Contributor Information and Disclosures

Updated: Oct 1, 2009

Differential Diagnoses

Contact Dermatitis, Irritant
Molluscum Contagiosum
Drug Eruptions
Papular Urticaria
Granuloma Annulare
Pityriasis Lichenoides
Henoch-Schönlein Purpura (Anaphylactoid Purpura)
Pityriasis Rosea
Insect Bites
Polymorphous Light Eruption
Langerhans Cell Histiocytosis
Sarcoidosis
Lichen Nitidus
Scabies
Lichen Planus
Xanthomas

Other Problems to Be Considered

Unilateral laterothoracic or asymmetric periflexural exanthem of childhood - Initially manifests as a unilateral papular exanthem in the axilla, the flank, and/or the antecubital fossa, characterized by minute, 1- to 2-mm papules, that become bilateral and more generalized over the course of several days

Workup

Laboratory Studies

  • Laboratory studies are not generally indicated.
  • Blood counts may reveal a lymphocytosis and a relative monocytosis or a lymphopenia secondary to the underlying viral infection.
  • In cases associated with acute infection with the hepatitis B virus, EBV, or CMV, anicteric hepatitis is evident by elevations in the levels of hepatic transaminases and antiviral antibodies.
  • A viral agent can be identified in approximately one third of cases. If a specific infectious etiology is suspected, testing can be directed at potential etiologies.
    • EBV - Monospot, immunoglobulin M (IgM) and immunoglobulin G (IgG) titers, or serum polymerase chain reaction (PCR)
    • CMV - IgM and IgG titers, serum CMV antigen levels, or serum PCR
    • RSV, parainfluenza virus, other respiratory viral pathogens - Nasal washing for fluorescent antibody testing
    • Enterovirus - Culture or polymerase chain reaction from serum
    • Parvovirus B19 - IgM and IgG titers or serum PCR
    • HHV-6 - Serum PCR
    • Group A beta-hemolytic streptococci - Serum PCR or throat culture

Histologic Findings

The histology of skin biopsy specimens is nonspecific. Mild epidermal acanthosis and spongiosis with focal parakeratosis can be seen. A lymphocytic exocytosis may also be seen. Edema of the papillary dermis and a superficial lymphohistiocytic infiltrate, sometimes with a perivascular localization or a lichenoid appearance, is common. Rarely, features of a lymphocytic vasculitis have been noted.

More on Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)

Overview: Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Differential Diagnoses & Workup: Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Treatment & Medication: Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Follow-up: Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
Multimedia: Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)
References
[ CLOSE WINDOW ]

References

  1. Taieb A, Plantin P, Du Pasquier P, Guillet G, Maleville J. Gianotti-Crosti syndrome: a study of 26 cases. Br J Dermatol. Jul 1986;115(1):49-59. [Medline].

  2. Manoharan S, Muir J, Williamson R. Gianotti-Crosti syndrome in an adult following recent Mycoplasma pneumoniae infection. Australas J Dermatol. May 2005;46(2):106-9. [Medline].

  3. Turhan V, Ardic N, Besirbellioglu B, Dogru T. Gianotti-Crosti syndrome associated with HBV infection in an adult. Ir J Med Sci. Jul-Sep 2005;174(3):92-4. [Medline].

  4. Gibbs S, Burrows N. Gianotti-Crosti syndrome in two unrelated adults. Clin Exp Dermatol. Nov 2000;25(8):594-6. [Medline].

  5. Mempel M, Abeck D, Bye-Hansen T, Ring J. Gianotti-Crosti syndrome in an adult patient following a recently acquired Epstein-Barr virus infection. Acta Derm Venereol. Nov 1996;76(6):502-3. [Medline].

  6. Cambiaghi S, Scarabelli G, Pistritto G, Gelmetti C. Gianotti-Crosti syndrome in an adult after influenza virus vaccination. Dermatology. 1995;191(4):340-1. [Medline].

  7. Ting PT, Barankin B, Dytoc MT. Gianotti-Crosti syndrome in two adult patients. J Cutan Med Surg. May-Jun 2008;12(3):121-5. [Medline].

  8. Ricci G, Patrizi A, Neri I, Specchia F, Tosti G, Masi M. Gianotti-Crosti syndrome and allergic background. Acta Derm Venereol. 2003;83(3):202-5. [Medline].

  9. Hofmann B, Schuppe HC, Adams O, et al. Gianotti-Crosti syndrome associated with Epstein-Barr virus infection. Pediatr Dermatol. Jul-Aug 1997;14(4):273-7. [Medline].

  10. Terasaki K, Koura S, Tachikura T, Kanzaki T. Gianotti-Crosti syndrome associated with endogenous reactivation of Epstein-Barr virus. Dermatology. 2003;207(1):68-71. [Medline].

  11. Draelos ZK, Hansen RC, James WD. Gianotti-Crosti syndrome associated with infections other than hepatitis B. JAMA. Nov 7 1986;256(17):2386-8. [Medline].

  12. James WD, Odom RB, Hatch MH. Gianotti-Crosti-like eruption associated with coxsackievirus A-16 infection. J Am Acad Dermatol. May 1982;6(5):862-6. [Medline].

  13. Carrascosa JM, Just M, Ribera M, Ferrandiz C. Papular acrodermatitis of childhood related to poxvirus and parvovirus B19 infection. Cutis. May 1998;61(5):265-7. [Medline].

  14. Chuh AA, Chan HH, Chiu SS, Ng HY, Peiris JS. A prospective case control study of the association of Gianotti-Crosti syndrome with human herpesvirus 6 and human herpesvirus 7 infections. Pediatr Dermatol. Nov-Dec 2002;19(6):492-7. [Medline].

  15. Di Lernia V. Gianotti-Crosti syndrome related to rotavirus infection. Pediatr Dermatol. Nov-Dec 1998;15(6):485-6. [Medline].

  16. Khan I, Gleeson J, McKenna D. Gianotti-Crosti syndrome following meningococcal septicaemia. Ir Med J. Feb 2007;100(2):373. [Medline].

  17. Monastirli A, Varvarigou A, Pasmatzi E, Badavanis G, Georgiou S, Mantagos S, et al. Gianotti-Crosti syndrome after hepatitis A vaccination. Acta Derm Venereol. 2007;87(2):174-5. [Medline].

  18. Kolivras A, André J. Gianotti-Crosti syndrome following hepatitis A vaccination. Pediatr Dermatol. Nov-Dec 2008;25(6):650. [Medline].

  19. Andiran N, Sentürk GB, Bükülmez G. Combined vaccination by measles and hepatitis B vaccines: a new cause of Gianotti-Crosti syndrome. Dermatology. 2002;204(1):75-6. [Medline].

  20. Karakas M, Durdu M, Tuncer I, Cevlik F. Gianotti-Crosti syndrome in a child following hepatitis B virus vaccination. J Dermatol. Feb 2007;34(2):117-20. [Medline].

  21. Tay YK. Gianotti-Crosti syndrome following immunization. Pediatr Dermatol. May-Jun 2001;18(3):262. [Medline].

  22. Velangi SS, Tidman MJ. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. Br J Dermatol. Dec 1998;139(6):1122-3. [Medline].

  23. Erkek E, Senturk GB, Ozkaya O, Bükülmez G. Gianotti-Crosti syndrome preceded by oral polio vaccine and followed by varicella infection. Pediatr Dermatol. Nov-Dec 2001;18(6):516-8. [Medline].

  24. Kang NG, Oh CW. Gianotti-Crosti syndrome following Japanese encephalitis vaccination. J Korean Med Sci. Jun 2003;18(3):459-61. [Medline].

  25. Boeck K, Mempel M, Schmidt T, Abeck D. Gianotti-Crosti syndrome: clinical, serologic, and therapeutic data from nine children. Cutis. Dec 1998;62(6):271-4; quiz 286. [Medline].

  26. Brandt O, Abeck D, Gianotti R, Burgdorf W. Gianotti-Crosti syndrome. J Am Acad Dermatol. 2006;Jan;54(1):136-45. [Medline].

  27. Caputo R, Gelmetti C, Ermacora E, Gianni E, Silvestri A. Gianotti-Crosti syndrome: a retrospective analysis of 308 cases. J Am Acad Dermatol. Feb 1992;26(2 Pt 1):207-10. [Medline].

  28. Chuh A, Lee A, Zawar V. The diagnostic criteria of Gianotti-Crosti syndrome: are they applicable to children in India?. Pediatr Dermatol. Sep-Oct 2004;21(5):542-7. [Medline].

  29. Chuh AA. Diagnostic criteria for Gianotti-Crosti syndrome: a prospective case-control study for validity assessment. Cutis. Sep 2001;68(3):207-13. [Medline].

  30. de la Torre C. Gianotti-Crosti syndrome following milkers' nodules. Cutis. Nov 2004;74(5):316-8. [Medline].

  31. Hurwitz S. Papular acrodermatitis of childhood. In: Clinical Pediatric Dermatology. Philadelphia, Pa: WB Saunders; 1993:128-30.

  32. Patrizi A, Di Lernia V, Ricci G, Masi M, Varotti C. Papular and papulovesicular acrolocated eruptions and viral infections. Pediatr Dermatol. Mar 1990;7(1):22-6. [Medline].

  33. Schacher LA, Hansen R C. Gianotti-Crosti Syndrome. In: Pediatric Dermatology. Amsterdam: Elsevier; 2003:667-70.

  34. Yoshida M, Tsuda N, Morihata T, Sugino H, Iizuka T. Five patients with localized facial eruptions associated with Gianotti-Crosti syndrome caused by primary Epstein-Barr virus infection. J Pediatr. Dec 2004;145(6):843-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

papulovesicular acrolocated syndrome, acropapulo-vesicular syndrome, infantile papular acrodermatitis, infantile lichenoid acrodermatitis, erythemato-papulous acrodermatitis, erythemato-vesiculo-papulous eruptive syndrome, acrodermatitis papulosa eruptiva infantilis, papular infantile acrodermatitis, acrodermatitis papulosa infantum, infantile eruptive papulous dermatitis, PAC, PAS

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Kara N Shah, MD, PhD, Assistant Professor, Department of Pediatrics and Dermatology, University of Pennsylvania School of Medicine; Attending Physician, Section of Dermatology, Division of General Pediatrics, 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; american college of physicians Honoraria 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.

Medical Editor

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.

Pharmacy Editor

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.

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.