eMedicine Specialties > Dermatology > Pediatric Diseases

Asymmetric Periflexural Exanthem of Childhood: Treatment & Medication

Author: Stewart P Adams, MD, FRCPC, Clinical Assistant Professor, Department of Medicine, University of Calgary Faculty of Medicine
Coauthor(s): Patricia T Ting, MSc, MD, Dermatology Resident, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta
Contributor Information and Disclosures

Updated: Sep 25, 2009

Treatment

Medical Care

No specific medical treatment is required for asymmetric periflexural exanthem of childhood (APEC).

  • Low-potency topical steroids may be used, though a minimal response is expected.
  • Hydroxyzine may be used to alleviate pruritus.
  • The use of moisturizers may be recommended to manage pruritus and fine scaling.

Surgical Care

None is required for asymmetric periflexural exanthem of childhood.

Consultations

No consultations are required for asymmetric periflexural exanthem of childhood.

Diet

Asymmetric periflexural exanthem of childhood is unrelated to diet.

Medication

The management of asymmetric periflexural exanthem of childhood typically does not require the use of prescription medications. Low-potency topical steroids such as hydrocortisone 0.5-1% may be used to control inflammation although it usually offers marginal benefit. Hydroxyzine may also be used if the lesions are pruritic and appear disruptive to daily functioning and interfere with normal sleep patterns.

H1-receptor antagonist antihistamines

These agents prevent the histamine response in sensory nerve endings and blood vessels but are not effective at reversing it. They competitively inhibit the binding of histamine at the H1 receptor. Histamine is responsible for mediating wheal and flare reactions, smooth muscle contraction, bronchial constriction, mucus secretion, edema, CNS depression, hypotension, and cardiac arrhythmias.


Hydroxyzine hydrochloride (Vistaril, Atarax, Vistazine)

Antagonizes H1 receptors in periphery. May also suppress histamine activity in subcortical region of CNS.

Adult

50-100 mg PO qd/qid

Pediatric

<6 years: 50 mg/d PO (2 mg/kg/d) in divided doses
>6 years: 50-100 mg/d PO in divided doses
All age groups: 1 h qhs

Potentiates effect of CNS depressants and alcohol. Syrup formulation contains alcohol; do not give to patients taking medications with disulfiramlike properties.

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 drowsiness; caution when operating heavy machinery or motor vehicles; may exacerbate porphyria, angle-closure glaucoma, hyperthyroidism, peptic ulcer, and anticholinergic effects (eg, dry mouth, urinary tract obstruction); ECG abnormalities (T-wave alterations) reported

Topical anti-inflammatory agents

These agents provide relief of inflammatory eczematous lesions.


Hydrocortisone - topical (LactiCare-HC, Cortaid, Cortate)

Low-potency topical corticosteroid with anti-inflammatory activity, as well as mineralocorticoid and glucocorticoid properties. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Use 1% cream.

Adult

Apply sparingly to affected areas bid/tid as needed

Pediatric

Apply as in adults

Documented hypersensitivity; do not use for bacterial, fungal, or viral infections

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

Avoid contact with eyes (risk of cataracts); prolonged or excessive use over large surface areas and with occlusive dressings may increase systemic absorption, leading to Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria

More on Asymmetric Periflexural Exanthem of Childhood

Overview: Asymmetric Periflexural Exanthem of Childhood
Differential Diagnoses & Workup: Asymmetric Periflexural Exanthem of Childhood
Treatment & Medication: Asymmetric Periflexural Exanthem of Childhood
Follow-up: Asymmetric Periflexural Exanthem of Childhood
Multimedia: Asymmetric Periflexural Exanthem of Childhood
References
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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. Bauza A, Redondo P, Fernandez J. Asymmetric periflexural exanthem in adults. Br J Dermatol. Jul 2000;143(1):224-6. [Medline].

  5. 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].

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

  7. 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].

  8. 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].

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

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. 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].

  15. 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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Further Reading

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Keywords

asymmetric periflexural exanthem of childhood, unilateral laterothoracic exanthem of childhood, ULE, APEC, papular erythema

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

Patricia T Ting, MSc, MD, Dermatology Resident, Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta
Patricia T Ting, MSc, MD is a member of the following medical societies: Alberta Medical Association, Canadian Dermatology Association, and Canadian Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Timothy McCalmont, MD, Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco
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

Pharmacy Editor

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.

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-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.

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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