Pediatric Acropustulosis Clinical Presentation
- Author: Christine Shanahan; Chief Editor: Dirk M Elston, MD more...
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.
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.
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.
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