Acropustulosis of Infancy Clinical Presentation

Updated: Mar 05, 2020
  • Author: Cassondra A Ellison, MD; Chief Editor: Dirk M Elston, MD  more...
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The classic history of infantile acropustulosis is an infant aged 2-12 months developing recurrent crops of pruritic erythematous macules or papules that progress into vesicles and then pustules. Lesions typically follow this progression over the course of 24 hours. Onset is usually in the first 3 months of life but lesions may sometimes be present at birth. [15] Children are fretful, irritable, and obviously uncomfortable, but otherwise healthy. Lesion are intensely pruritic and individual bouts of infantile acropustulosis last 3-14 days and recur in 2- to 4-week intervals. The attacks occur with progressively diminishing numbers of lesions, and with decreasing frequency, until they cease altogether. This typically occurs within 2 years of onset. [10, 15]

Often, children have been empirically treated with antiscabies medicines prior to presentation, [5] and some have been treated with topical or oral antibiotics as well. The intensity and the duration of infantile acropustulosis attacks diminish with each recurrence. Children with acropustulosis may be misdiagnosed with bacterial infections, hand-foot-and-mouth disease (Coxsackievirus or Enterovirus infection), or dyshidrotic eczema. [7]


Physical Examination

Acropustulosis of infancy is characterized by recurrent outbreaks. Lesions begin as crops of small macules or papules that eventually form distinct, noncoalescing vesicles and pustules. Lesions occur in an acral distribution, usually involving the palms, soles, and lateral surfaces of the digits. [15] Less frequently, lesions may occur on the dorsal hands, feet, trunk, scalp, and face.

They resolve with desquamation followed by postinflammatory macular hyperpigmentation. No other organ systems are involved.

See the images below.

Lateral and plantar aspects of the foot with a com Lateral and plantar aspects of the foot with a combination of intact acute vesicles and brownish hyperpigmentation of old vesicles.
Pustules on the dorsal hands of a 1-year-old child Pustules on the dorsal hands of a 1-year-old child.
Scattered new and resolving pustules on the dorsal Scattered new and resolving pustules on the dorsal feet.


Secondary bacterial infection of excoriated lesions may occur.