Asymmetric Periflexural Exanthem of Childhood Clinical Presentation
- Author: Patricia T Ting, MD, MSc, FRCPC, LMCC(Canada); Chief Editor: Dirk M Elston, MD more...
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.
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.
The exact cause of this eruption is unknown, and no specific viral pathogens have been identified.
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