eMedicine Specialties > Pediatrics: General Medicine > Dermatology
Acropustulosis
Updated: Apr 20, 2009
Introduction
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.
Clinical
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.
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 Media file 1).
Lateral 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
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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| References |
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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].
Further Reading
Keywords
acropustulosis, infantile acropustulosis, skin disorder, skin disease, palmoplantar pustulosis, psoriasis, pustular psoriasis, pustular eruptions of the hands and feet, scabies, skin rash, skin irritation, treatment, diagnosis
