Pediatric Acropustulosis

Author: Howard Pride, MD; Chief Editor: Dirk M Elston, MD more...

Updated: Apr 20, 2009

What would you like to print?

Background
Pathophysiology
Epidemiology
Show All

Background

Infantile acropustulosis is a recurrent, self-limited, pruritic, vesiculopustular eruption of the palms and soles, occurring in infants aged 2-3 years. First described in 1979, the disorder is probably much more common than implied by the scarcity of reports.

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

Pathophysiology

The pathophysiology is unknown. Many incidents of acropustulosis are preceded by documented or suspected scabies infestation, and a scabies id reaction has been suggested. However, incidents of newborns affected with acropustulosis have been reported, making scabies reaction an unlikely source for the eruption in every case; scabies infestation has been thoroughly excluded in some well-documented cases of acropustulosis. Bacterial and viral cultures are consistently negative, and negative immunofluorescence on biopsy suggests that infantile acropustulosis is not an autoimmune process.

Frequency

United States

The incidence is unknown. Typically, acropustulosis affects children younger than 3 years.

International

The incidence is unknown. One report from Israel diagnosed 25 individuals with acropustulosis in a 9-year period, suggesting that this condition is not as uncommon as once believed.^[1]

Mortality/Morbidity

All incidents of acropustulosis spontaneously resolve in a few months to 3 years.

Race

Early reports suggested a predominance of incidence in black individuals; however, all races are now believed to be equally affected.^[1]

Sex

Early reports suggested a male predominance. Larger series have since demonstrated an equal distribution between males and females.^[1]

Age

Although acropustulosis has been reported in children as old as age 9 years, it typically begins within the first 2-12 months of life. Resolution by the time the individual is aged 3 years is usual.

Proceed to Clinical Presentation

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; 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; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

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 Lawson-Wilkins Pediatric Endocrine Society

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.

References

Dromy R, Raz A, Metzker A. Infantile acropustulosis. Pediatr Dermatol. Dec 1991;8(4):284-7. [Medline].
New York State Department of Health. Dermatologic manifestations. New York, NY: New York State Department of Health; 2004.
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].
Humeau S, Bureau B, Litoux P, Stalder JF. Infantile acropustulosis in six immigrant children. Pediatr Dermatol. Sep 1995;12(3):211-4. [Medline].
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].
Kahn G, Rywlin AM. Acropustulosis of infancy. Arch Dermatol. Jul 1979;115(7):831-3. [Medline].
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].
Mazereeuw-Hautier J. [Infantile acropustulosis]. Presse Med. Nov 6 2004;33(19 Pt 1):1352-4. [Medline].
Prendiville JS. Infantile acropustulosis--how often is it a sequela of scabies?. Pediatr Dermatol. Sep 1995;12(3):275-6. [Medline].
Truong AL, Esterly NB. Atypical acropustulosis in infancy. Int J Dermatol. Sep 1997;36(9):688-91. [Medline].
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].