Background
Infantile acropustulosis is a recurrent, self-limited, intensely pruritic, vesiculopustular eruption of the palms and soles, occurring in infants aged 2-3 years. This disorder was first described in 1979 and was noted to be uncommon, yet not rare. Pediatric acropustulosis is probably much more common than implied by the scarcity of reports.
See the image below.
Lateral and plantar foot exhibiting acropustulosis. A combination of intact acute vesicles and brownish hyperpigmentation of old vesicles is present.
Pathophysiology
The pathophysiology is suspected scabies infestation. Many incidents of acropustulosis are preceded by documented or suspected infestation, which may suggest a scabies id reaction. However, incidents of newborns affected with acropustulosis have been reported, making a 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. [1]
Epidemiology
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 this condition is not as uncommon as once believed. [2] Another report noted that acropustulosis was not uncommon among internationally adopted children, especially with prior exposure to overcrowded living conditions and potential scabies infestations. [3]
Race
Early reports suggested a predominance of incidence in black individuals; however, all races are now believed to be equally affected. [2]
Sex
Early reports suggested a male predominance. Larger series have since demonstrated an equal distribution between males and females. [2]
Age
Although acropustulosis has been reported in children as old as 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.
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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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Pustules on the dorsal hands of a 1 year old child.
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Scattered new and resolving pustules on the dorsal feet.
