Asymmetric Periflexural Exanthem of Childhood Clinical Presentation

  • Author: Patricia T Ting, MD, MSc; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

History

  • Most affected children are healthy and asymptomatic at presentation, with an unremarkable medical history.
  • Occasionally, patients may report a current and/or recent episode of upper respiratory tract infection, adenopathy/lymphadenopathy, fever, otitis media, or diarrhea.
  • In rare instances, other children in the family may also have asymmetric periflexural exanthem of childhood.
  • Mild pruritus is reported in approximately 50% of patients.
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Physical

  • The primary (pathognomonic) lesion is a small erythematous papule with a surrounding pale halo. The general appearance of lesions includes a morbilliform, eczematous, and occasionally reticulated group of macules, papules, or coalescent plaques. These are occasionally accompanied with fine scaling.
  • At the initial onset, lesions are unilateral and usually begin near the axillae, lateral trunk, and upper inner arm or groin. During the course of the condition, lesions often progress bilaterally with an asymmetric predominance.
  • The 4 sequential stages of the lesions are as follows:
    • Eczematous, when initial lesions occur on the axillae and lateral chest wall
    • Coalescence, when lesions extend to the trunk and proximal extremities and are separated by areas of normal skin
    • Regression, when older lesions may develop a central dusky-gray center
    • Desquamation, when residual branlike scale appears and resolves with time
  • Asymmetric periflexural exanthem of childhood lesions spare the face, palms, soles, and mucous membranes.
  • Lichenification is not usually observed.
  • See the images below.Morbilliformlike eruption in a child with involvemMorbilliformlike eruption in a child with involvement of the axilla, lateral thorax, and abdomen. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology. Eczematouslike eruption with a predominantly hemicEczematouslike eruption with a predominantly hemicorporeal distribution photographed on the eighth day after initial appearance of lesions. Used with permission from Bodemer and de Prost (1992) from the Journal of the American Academy of Dermatology. Pattern of reticulated plaques on the posterior loPattern of reticulated plaques on the posterior lower limb of a child. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
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Causes

The exact cause of this eruption is unknown, and no specific viral pathogens have been identified.

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Contributor Information and Disclosures
Author

Patricia T Ting, MD, MSc  Resident Physician, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Canada

Patricia T Ting, MD, MSc is a member of the following medical societies: Alberta Medical Association, Canadian Dermatology Association, and Canadian Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stewart P Adams, MD, FRCPC  Clinical Assistant Professor, Department of Medicine, University of Calgary Faculty of Medicine

Stewart P Adams, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Canadian Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Timothy McCalmont, MD  Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Apsara Consulting fee Independent contractor

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Brunner MJ, Rubin L, Dunlap F. A new papular erythema of childhood. Arch Dermatol. Apr 1962;85:539-40. [Medline].

  2. Bodemer C, de Prost Y. Unilateral laterothoracic exanthem in children: a new disease?. J Am Acad Dermatol. Nov 1992;27(5 Pt 1):693-6. [Medline].

  3. Taieb A, Megraud F, Legrain V, Mortureux P, Maleville J. Asymmetric periflexural exanthem of childhood. J Am Acad Dermatol. Sep 1993;29(3):391-3. [Medline].

  4. Arun B, Salim A. Transient linear eruption: asymmetric periflexural exanthem or blaschkitis. Pediatr Dermatol. May-Jun 2010;27(3):301-2. [Medline].

  5. Bauza A, Redondo P, Fernandez J. Asymmetric periflexural exanthem in adults. Br J Dermatol. Jul 2000;143(1):224-6. [Medline].

  6. Chan PK, To KF, Zawar V, Lee A, Chuh AA. Asymmetric periflexural exanthem in an adult. Clin Exp Dermatol. May 2004;29(3):320-1. [Medline].

  7. Corazza M, Virgili A. Asymmetric periflexural exanthem in an adult. Acta Derm Venereol. Jan 1997;77(1):79-80. [Medline].

  8. Auvin S, Imiela A, Cuvellier JC, Catteau B, Vallee L, Martinot A. Asymmetric periflexural exanthem of childhood in a child with axonal Guillain-Barre syndrome. Br J Dermatol. Feb 2004;150(2):396-7. [Medline].

  9. Guimera-Martin-Neda F, Fagundo E, Rodriguez F, et al. Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B19. J Eur Acad Dermatol Venereol. Apr 2006;20(4):461-2. [Medline].

  10. Harangi F, Varszegi D, Szucs G. Asymmetric periflexural exanthem of childhood and viral examinations. Pediatr Dermatol. Jun 1995;12(2):112-5. [Medline].

  11. Pauluzzi P, Festini G, Gelmetti C. Asymmetric periflexural exanthem of childhood in an adult patient with parvovirus B19. J Eur Acad Dermatol Venereol. Jul 2001;15(4):372-4. [Medline].

  12. Coustou D, Leaute-Labreze C, Bioulac-Sage P, Labbe L, Taieb A. Asymmetric periflexural exanthem of childhood: a clinical, pathologic, and epidemiologic prospective study. Arch Dermatol. Jul 1999;135(7):799-803. [Medline].

  13. Coustou D, Masquelier B, Lafon ME, et al. Asymmetric periflexural exanthem of childhood: microbiologic case-control study. Pediatr Dermatol. May-Jun 2000;17(3):169-73. [Medline].

  14. Gutzmer R, Herbst RA, Kiehl P, Kapp A, Weiss J. Unilateral laterothoracic exanthem (asymmetrical periflexural exanthem of childhood): report of an adult patient. J Am Acad Dermatol. Sep 1997;37(3 Pt 1):484-5. [Medline].

  15. McCuaig CC, Russo P, Powell J, Pedneault L, Lebel P, Marcoux D. Unilateral laterothoracic exanthem. A clinicopathologic study of forty-eight patients. J Am Acad Dermatol. Jun 1996;34(6):979-84. [Medline].

  16. Nahm WK, Paiva C, Golomb C, Badiavas E, Laws R. Asymmetric periflexural exanthem of childhood: a case involving a 4-month-old infant. Pediatr Dermatol. Sep-Oct 2002;19(5):461-2. [Medline].

 
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Morbilliformlike eruption in a child with involvement of the axilla, lateral thorax, and abdomen. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
Eczematouslike eruption with a predominantly hemicorporeal distribution photographed on the eighth day after initial appearance of lesions. Used with permission from Bodemer and de Prost (1992) from the Journal of the American Academy of Dermatology.
Pattern of reticulated plaques on the posterior lower limb of a child. Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
Histopathologic slide demonstrates perivascular, interstitial, and periadnexal infiltrate of lymphocytes and histiocytes in the deep dermis (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
Histopathologic slide demonstrates epidermal spongiosis and lymphocytic infiltration of the intraepidermal portion of an eccrine duct (hematoxylin-phloxine-saffron stain). Used with permission from McCuaig et al (1996) from the Journal of the American Academy of Dermatology.
 
 
 
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