Dermatologic Manifestations of Gianotti-Crosti Syndrome Clinical Presentation

Updated: Aug 13, 2019
  • Author: Kara N Shah, MD, PhD; Chief Editor: William D James, MD  more...
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Presentation

History

Children with Gianotti-Crosti syndrome (papular acrodermatitis of childhood) usually present with an acute, symmetric, exanthematous, asymptomatic cutaneous eruption that develops over several days. The eruption typically lasts at least 10 days but can last longer than 6 weeks in more than 50% of patients. Complete resolution typically takes more than 2 months. Recurrences are rare, although a recurrent case associated with influenza virus vaccination has been reported. [37] Pruritus accompanies the eruption in 23% of patients.

Other symptoms related to the primary viral syndrome or underlying bacterial infection may include mild constitutional symptoms such as low-grade fever and malaise, pharyngitis and/or mucosal lesions, or symptoms of an upper respiratory tract infection. When associated with a hepatitis B virus, EBV, or CMV infection, an anicteric acute hepatitis may be present.

A case control study of 29 children with Gianotti-Crosti syndrome from Bologna, Italy demonstrated a higher prevalence of atopic dermatitis in patients versus controls (24.1% vs 6.8%). They also found that patients were more likely than controls to have elevated levels of total and specific immunoglobulin E and a family history of atopy. [38]

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Physical Examination

The cutaneous eruption of Gianotti-Crosti syndrome (papular acrodermatitis of childhood) is characterized by monomorphous pale, pink-to-flesh–colored or erythematous 1- to 10-mm papules or papulovesicles localized symmetrically and acrally over the extensor surfaces of the extremities, the buttocks, and the face. The number of lesions ranges from few to many. The trunk, knees, elbows, palms, and soles are rarely involved, and, in general, extensive involvement of the trunk is not consistent with a diagnosis of Gianotti-Crosti syndrome. Individual papules may coalesce to form larger plaques. Uncommonly, the eruption may develop a petechial or purpuric appearance. Partial involvement of only the face or the extremities is not uncommon, especially in older children. Over days to weeks, the papules may acquire a smooth-topped, polished, or lichenoid appearance. Other findings upon physical examination include the following:

  • Fever (27%)

  • Lymphadenopathy (31%)

  • Hepatosplenomegaly (4%)

  • Pharyngeal erythema, oropharyngeal ulcers or vesicles, or tonsillar swelling in cases secondary to infections of the upper respiratory tract

Note the images below.

Characteristic erythematous papules of Gianotti-Cr Characteristic erythematous papules of Gianotti-Crosti syndrome appear on the face of this child. The child does not have a toxic appearance.
Characteristic erythematous papules of Gianotti-Cr Characteristic erythematous papules of Gianotti-Crosti syndrome can be seen on the extremities, as is the case in this young child.
A 9-year-old girl who recently returned from a tri A 9-year-old girl who recently returned from a trip to Europe with her family. She developed a low-grade fever, malaise, and some lymphadenopathy. An eruption limited to her face, arms, legs, and buttocks was noted.
A mildly pruritic eruption characterized by erythe A mildly pruritic eruption characterized by erythematous papules localized to the face, arms, legs, and buttocks.
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Complications

There are no expected complications of Gianotti-Crosti syndrome. Complications may arise from the inciting infection, if present.

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