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Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood): Treatment & Medication

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

Treatment

Medical Care

Education and reassurance are usually sufficient for concerned parents. Some children may require general supportive and symptomatic care for the associated viral or streptococcal infection.

  • Application of soothing, anti-itch topical preparations with menthol, colloidal oatmeal, or pramoxine in conjunction with oral antihistamines may be useful for relief of pruritus.
  • Avoidance of topical steroid use is advised.
  • If an associated streptoccocal infection is identified, a course of an appropriate systemic antibiotic should be initiated.

Consultations

In rare instances of persistent liver dysfunction in the setting of acute hepatitis B infection, consultation with a pediatric gastroenterologist should be considered.

Activity

Isolation is not necessary.

Medication

The goals of pharmacotherapy are to reduce associated symptoms, in particular pruritus. These agents do not shorten the course of the disease or prevent complications.

Antihistamines

These agents prevent histamine response in sensory nerve endings and blood vessels. They are more effective in preventing histamine response than in reversing it.


Diphenhydramine (Benadryl, Benylin, Diphen, AllerMax)

For symptomatic relief of allergic symptoms caused by release of histamine. Competes with histamine for H1-receptor sites on effector cells.

Adult

25-50 mg PO q6-8h prn; not to exceed 400 mg/d
10-50 mg IV/IM q6-8h prn; not to exceed 400 mg/d

Pediatric

12.5-25 mg PO tid/qid, or 5 mg/kg/d, or 150 mg/m2/d PO divided tid/qid; not to exceed 300 mg/d
5 mg/kg/d IV/IM or 150 mg/m2/d IV/IM divided qid; not to exceed 300 mg/d

Potentiates effect of CNS depressants; because of alcohol content, do not give syrup dosage form to patient taking medications that can cause disulfiramlike reactions

Documented hypersensitivity; concomitant use of MAOIs

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

Causes sedation; may exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction; use caution in patients with increased intraocular pressure or cardiovascular disease (including hypertension and tachycardia); may cause paradoxical excitation pediatric patients


Hydroxyzine hydrochloride (Atarax, Vistaril)

Offers a mild degree of relief from pruritus. Antagonizes H1 receptors in periphery. May suppress histamine activity in the subcortical region of CNS.

Adult

25-50 mg PO q6h prn

Pediatric

0.6 mg/kg/dose PO q6h prn

CNS depression may increase with alcohol or other CNS depressants

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 clinical exacerbations of porphyria (may not be safe for porphyric patients); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness; use caution in patients with narrow-angle glaucoma, prostatic hyperplasia, bladder neck obstruction, asthma, or COPD

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

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References
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References

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  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].

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  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].

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Further Reading

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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

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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; 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.

 
 
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