Pediatric Acropustulosis Clinical Presentation

  • Author: Howard Pride, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 26, 2012
 

History

  • 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-week to 4-week intervals. Intensity and duration diminish with each recurrence.
  • Most children have been treated with antiscabies medications prior to presentation.
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Physical

  • The hands and feet always are involved, usually on the palms, soles, and lateral surfaces. Lesions may occur on the dorsal hands and 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).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.
  • No other organ systems are involved.
  • The New York State Health Department released guidelines detailing dermatologic manifestations.[2]
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Causes

  • The cause of acropustulosis is unknown.
  • Scabies as a preceding or concomitant infestation is well documented.
    • However, cases have been described in which a present or past history of scabies was excluded.
    • Many children are undoubtedly misdiagnosed as having scabies and are treated with lindane or permethrin prior to presentation.
  • No other infectious agent has been documented.
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Contributor Information and Disclosures
Author

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, 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.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

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. Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. Dec 1991;8(4):284-7. [Medline].

  2. New York State Department of Health. Dermatologic manifestations. New York, NY: New York State Department of Health; 2004.

  3. Braun-Falco M, Stachowitz S, Schnopp C, et al. Infantile acropustulosis successfully controlled with topical corticosteroids under damp tubular retention bandages. Acta Derm Venereol. May 2001;81(2):140-1. [Medline].

  4. Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. Sep 1995;12(3):211-4. [Medline].

  5. Ergin S, Ersoy-Evans S, Sahin S, Ozkaya O. Acitretin is a safe treatment option for infantile pustular psoriasis. J Dermatolog Treat. 2008;19(6):341-3. [Medline].

  6. Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. Jul 1979;115(7):831-3. [Medline].

  7. Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatr Dermatol. Sep-Oct 1998;15(5):337-41. [Medline].

  8. Mazereeuw-Hautier J. [Infantile acropustulosis]. Presse Med. Nov 6 2004;33(19 Pt 1):1352-4. [Medline].

  9. Prendiville JS. Infantile acropustulosis--how often is it a sequela of scabies?. Pediatr Dermatol. Sep 1995;12(3):275-6. [Medline].

  10. Truong AL, Esterly NB. Atypical acropustulosis in infancy. Int J Dermatol. Sep 1997;36(9):688-91. [Medline].

  11. Vicente J, Espana A, Idoate M, et al. Are eosinophilic pustular folliculitis of infancy and infantile acropustulosis the same entity?. Br J Dermatol. Nov 1996;135(5):807-9. [Medline].

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