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Pediatric Acropustulosis Clinical Presentation

  • Author: Christine Shanahan; Chief Editor: Dirk M Elston, MD  more...
Updated: Mar 29, 2016


Typically, an infant aged 2-12 months with acropustulosis exhibits pruritic erythematous macules or papules that progress into vesicles and then pustules. Children with acropustulosis are fretful, irritable, and obviously uncomfortable, but otherwise well. Individual bouts of the condition last 7-15 days and recur at 2- to 4-week intervals. The intensity and duration diminish with each recurrence.

Most children have been treated with antiscabies medications prior to presentation, and some have been treated with topical or oral antibiotics as well. Children with acropustulosis may be misdiagnosed with bacterial infections, hand-foot-and-mouth disease (Coxsackievirus or Enterovirus infection), or dyshidrotic eczema.[3]



The hands and feet always are involved, usually on the palms, soles, and lateral surfaces. Lesions may occur on the dorsal hands, feet, trunk, scalp, and face.

Lesions begin as small macules or papules that eventually form distinct, noncoalescing vesicles and pustules. They resolve with macular hyperpigmentation (see the image below). No other organ systems are involved.

Lateral and plantar foot exhibiting acropustulosisLateral and plantar foot exhibiting acropustulosis. A combination of intact acute vesicles and brownish hyperpigmentation of old vesicles is present.




The cause of acropustulosis is unknown.

Scabies (Sarcoptes scabiei infection)as a preceding or concomitant infestation is well documented. However, cases have been described in which a history of scabies was excluded. Many children are undoubtedly misdiagnosed as having scabies and are treated with lindane or permethrin prior to presentation.

Some studies suggest that acropustulosis and neonatal eosinophilic pustular folliculitis are associated and may be manifestations of the same underlying disease.[4, 5]

No other infectious agent has been documented.

Contributor Information and Disclosures

Christine Shanahan University of Virginia School of Medicine

Christine Shanahan is a member of the following medical societies: American Telemedicine Association, Medical Society of Virginia

Disclosure: Nothing to disclose.


Barbara B Wilson, MD Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, Medical Society of Virginia, Sigma Xi, American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.


Howard Pride, MD Associate Physician, Departments of Pediatrics and Dermatology, Geisinger Medical Center

Howard Pride is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

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Lateral and plantar foot exhibiting acropustulosis. A combination of intact acute vesicles and brownish hyperpigmentation of old vesicles is present.
Pustules on the dorsal hands of a 1 year old child.
Scattered new and resolving pustules on the dorsal feet.
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